YU Zen gwen,YANG Yang,LI Suo lin,et al. The experimental studies and clinical applications of laparoscopic duodenal singlelayer sutured anastomosis in children.[J].Journal of Clinical Pediatric Surgery,,10():90-93.
The experimental studies and clinical applications of laparoscopic duodenal singlelayer sutured anastomosis in children.
- Keywords:
- ; Laparoscopes; Dudenum; Anastomosis; Surgical; Animals; Laboratory
- Document code:
- A
- Abstract:
- 【Abstract】ObjectiveTo explore the reliable method of a laparoscopic singlelayer duodenal sutured anastomosis in the animal experiments and clinical application. MethodsThe ten rabbits were pretended to simulate the abdominal environment of newborn and infant. They were randomly divided into the continuous suture group and the interrupted suture group to carry out the singlelayer diamondshaped anastomosis in the duodenum. A singlelayer fullthickness sutured anastomosis was applied in 12 children with congenital duodenal obstruction(CDO). Under the laparoscopic visualization, the cause of duodenal obstruction was explored and a singlelayer sutured anastomosis was performed.ResultsThe anastomotic time was 38.8±5.07min in the interrupted suture group and 27.0±7.25min in the continuous suture group, the continuous suture time took shorter than the interrupted suture time(t=2.984,P=0.017). The laparotomy after laparoscopic procedure in two groups showed good patency of the anastomosis and no leakage. The tolerant pressure of the anastomosis wasn’t found the significant difference between the two groups. The etiology of 12 cases was laparoscopically identified and all procedures were successfully performed. Six cases with duodenal diaphragmatic stenosis were encountered a partial excision of the diaphragm after vertical incision of the anterior part in the duodenum followed by a transverse suture. A diamondshaped fullthickness duodenoduodenal anastomosis was completed in 4 cases with duodenal atresia and 2 annular pancreas. The operative time was 60~150min. There was no intraoperative complications and blood transfusion. Except 1 neonate with transient anastomotic leak was cured by draining for 3 days (from day 2 to 4 postoperatively) without another intervention. All children were cured and the postoperative period of hospital stay was 7 to 12 days.ConclusionThe handsewn singlelayer anastomosis is carried out that it avoids mucosal eversion. If the mucosal eversion occured, the anastomotic tolerant pressure would decrease significantly and prone to anastomotic leakage. The singlelayer interrupted and continuous suture anastomosis could achieve satisfactory effect, but the continuous suture is more convenient and timesaving comparing with the interrupted suture under the laparoscope.
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