Department of Pediatric Surgery, Hospital Regional de Alta Especialidad Materno Infantil, Monterrey, Mexico.
Pediatric Surgery Residency Program Universidad de Monterrey (UDEM), Hospital Regional Materno Infantil de Alta Especialidad de Nuevo Leon, Monterrey, Mexico.
J Pediatr Surg. 2024 Dec;59(12):161700. doi: 10.1016/j.jpedsurg.2024.161700. Epub 2024 Aug 23.
Duodenal obstructions are one of the most common causes of upper intestinal obstruction during the neonatal period. Minimally invasive surgical treatment is considered highly complex. We report our experience with 43 patients treated using this method.
We conducted a retrospective study at our institution from January 2013 to May 2023, including patients classified as having upper intestinal obstructions. All patients received preoperative diagnoses based on clinical findings, radiography, and abdominal ultrasound. Laparoscopic surgery was performed on all patients.
We included 43 patients diagnosed with duodenal obstruction (DO) in our study after reviewing the medical records at our hospital for cases meeting this diagnosis. The laparoscopic Kimura procedure was performed on 31 patients (72%), while duodenotomy and anastomosis following the Heineke-Mikulicz principle were performed on 9 patients (21%). In the remaining 3 patients (7%), a side-to-side duodeno-duodeno anastomosis was conducted. Annular pancreas was the most common cause of duodenal obstruction in our series, affecting 21 patients (49%). Type I duodenal atresia was observed in 17 patients (40%), while type III atresia was present in 3 patients (7%), and type II atresia in 2 patients (4%). One case required conversion to open surgery due to concomitant jejunoileal atresia. The only reported complication was partial anastomotic dehiscence, which occurred in two patients (4%).
Minimally invasive surgery (MIS) for managing duodenal obstruction (DO) has proven to be both feasible and safe, yielding comparable outcomes to the traditional open approach; its effectiveness can be significantly enhanced through appropriate training. Furthermore, the growing availability of duodenal atresia simulators offers valuable opportunities to refine laparoscopic skills and apply them effectively. Better outcomes and fewer complications are expected with further experience and an increased number of cases.
IV, Case series with no comparison group.
十二指肠梗阻是新生儿期上消化道梗阻的最常见原因之一。微创外科治疗被认为极具复杂性。我们报告了使用这种方法治疗的 43 例患者的经验。
我们在机构内进行了回顾性研究，时间为 2013 年 1 月至 2023 年 5 月，包括以上消化道梗阻为诊断的患者。所有患者均根据临床表现、影像学和腹部超声进行术前诊断。所有患者均接受腹腔镜手术。
我们在医院病历中回顾了符合该诊断的病例，共纳入 43 例诊断为十二指肠梗阻（DO）的患者。31 例患者（72%）行腹腔镜 Kimura 手术，9 例患者（21%）行经 Heineke-Mikulicz 原则的十二指肠切开吻合术。在其余 3 例患者（7%）中，行侧侧十二指肠-十二指肠吻合术。环状胰腺是本系列中十二指肠梗阻的最常见原因，影响 21 例患者（49%）。17 例患者（40%）存在Ⅰ型十二指肠闭锁，3 例患者（7%）存在Ⅲ型闭锁，2 例患者（4%）存在Ⅱ型闭锁。1 例因并发空肠回肠闭锁而需要转为开放手术。唯一报告的并发症是 2 例患者（4%）出现吻合口部分裂开。
微创外科（MIS）治疗十二指肠梗阻（DO）已被证明是可行且安全的，其结果与传统的开放方法相当；通过适当的培训，可以显著提高其有效性。此外，越来越多的十二指肠闭锁模拟器的出现为腹腔镜技能的提高和有效应用提供了宝贵的机会。随着经验的增加和病例数量的增加，预计会有更好的结果和更少的并发症。
IV，无对照的病例系列。
