Excision duodenoplasty: a new technique for congenital duodenal obstruction |
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Authors: | S J Singh R Dickson S Baskaranathan J Peat K Spence R Kimble D Cass |
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Institution: | (1) Department of Paediatric Surgery, University Hospital, Queen's Medical Centre, Nottingham NG72UH, UK, GB;(2) Department of Paediatrics and Child Health Medical Research, The Children's Hospital at Westmead, Westmead, Sydney NSW 2124, Australia, AU;(3) Department of Neonatal Medicine, The Children's Hospital at Westmead, Westmead, Sydney NSW 2124, Australia, AU;(4) University of Queensland, Department of Paediatrics and Child Health, Royal Royal Children's Hospital, Brisbane QLD 4029, Australia, AU |
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Abstract: | Slow anastomotic function is a common problem in the management of congenital duodenal obstruction. We describe a simple
technique of excision duodenoplasty (ED) that results in a fixed open anastomosis, which facilitates early commencement of
feeds and discharge from hospital. A retrospective case-note review (1981–2000) was undertaken to compare the results of ED
with side-to-side duodenoplasty (SSD) and diamond-shaped anastomosis (DD). The outcome measures were days to commencement
of feeds, duration of total parenteral nutrition (TPN), and length of hospital stay. In ED a 1.0 to 1.5-cm elleptical segment
of dilated duodenum is excised. A longitudinal incision is made in the smaller distal duodenum. A side-to-side one-layer anastomosis
is performed. The wall of the proximal duodenal stump is thick, and excision of the ellipse keeps the anastomosis open by
preventing apposition of the opposing walls. This facilitates good drainage across the anastomosis. The time to onset of feeding
was longer after SSD (median 7 days) compared to ED (5 days) and DD (5 days). The total duration of TPN was also longer for
SSD (9 days) in comparison to ED (7 days) and DD (7 days). Although the duration of hospital stay was more for SSD (18 days)
than ED (13 days) and DD (16 days), this difference was not statistically significant. The ED technique thus gives an equally
good result as DD and a better result than SSD. It is simple to perform and to teach.
Accepted: 26 February 2001 |
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Keywords: | Duodenal atresia Duodenal obstruction Duodenal stenosis Duodeno-duodenostomy Duodenoplasty |
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