Pérez-Lorenzana H, López-Cruz RE

Language: Spanish
References: 7
Page: 27-32
PDF size: 208.43 Kb.

ABSTRACT

Introduction. The duodenum is the most frequent site of neonatal obstruction, with an incidence of 1 in 5000 to 10 000 live births. Currently, the laparoscopic approach is considered the less invasive with improved outcomes compared to traditional surgery. The aim of this study is to show the adequacy for the management of duodenal obstruction by needlescopic surgery performed at our hospital.
Materials and Methods. We performed a retrospective, descriptive study, in the period March 2009 to March 2012. Registration for age, weight, sex, complications, onset of postoperative feeding. The technique used was: laparoscopic duodeno-plasty and percutaneous sutures placement. In supine position, 5mm transumbilical optic and two 3mm working ports are placed, identifying the atresic or occluded segment, placing the percutaneous sutures at the left flank, which is used to bring both ends of the duodenum. Apply another percutaneous sutures from the right hypochondrium with an anchor on the same side of the plasty, joining both ends, which allowed a better vision of the edges to be sutured by the surgeon.
Results. We included 9 patients that underwent laparoscopic surgery and the application of percutaneous sutures, the diagnosis was 3 incomplete membranes and 5 complete membranes, 1 mesenteric clamp; 4 patients were female and 5 male, the average weight was 3110 g, enteral feeding occurred within an average of 10 days. Some required the use of procinetics for approximately a month due to oral intolerance. One neonate presented pulmonary sepsis and died, the rest had a favorable outcome.
Discussion. We propose a modification to the use of percutaneous sutures, which offer the advantage of rectifying the sides to be anastomosed, avoiding the use of a 3rd or 4th working port in reduced operating areas (as in neonates), it means less trauma and the use simple tools that allow for the reproduction of this technique by pediatric surgeons.

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