Diamond-shaped versus side-to-side anastomotic duodenoduodenostomy in laparoscopic management of annular pancreas in children: a single-center retrospective comparative study

Background

Annular pancreas is a rare congenital disorder that requires surgical management once diagnosed. Diamond-shaped and side-to-side duodenoduodenostomy are both popular worldwide nowadays in the surgical management of annular pancreas. Here we present our experience with laparoscopic management of annular pancreas in the last 5 years and compare the clinical results of the diamond-shaped versus side-to-side anastomotic techniques.

Methods

Fifty-two patients diagnosed with annular pancreas who underwent duodenoduodenostomy at our medical center between January 2016 and April 2021 were included in the study. Forty-four patients underwent laparoscopic diamond-shaped duodenoduodenostomy (DS group) and eight underwent laparoscopic side-to-side duodenoduodenostomy (STS group). Clinical data, including surgical indices and early outcomes after surgery, with at least 19 months of follow-up, were collected and analyzed.

Results

Of the 52 patients, 61.5% were prenatally diagnosed, and vomiting was the most common clinical manifestation after birth. The operative time and bleeding volume were 187.5 [interquartile range (IQR), 150-228)] min and 2 (IQR, 2-5) mL in the DS group, compared to 175 (IQR, 155-270) min and 2 (IQR, 2-4.25) mL in the STS group (P=0.89 and 0.32 respectively). The mean time from surgery to initial oral feeding and full oral feeding was 6 (IQR, 4-10) and 12 (IQR, 10-15) days in the DS group, compared to 8 (IQR, 4.75-11.25) and 14.5 (IQR, 13-16.75) days in the STS group (P=0.61 and 0.46 respectively). The mean hospital stay was 16 (IQR, 14-19) and 20 (IQR, 17.75-26) days in the DS and STS groups respectively (P=0.13). No severe complications such as anastomotic leakage, anastomotic stenosis, reoperation or unsuspected rehospitalization were noted in either group. Feeding intolerance was revealed in six cases in the DS group and two cases in the STS group, and there was no significant difference between the two groups (P=0.50).

Conclusions

Both laparoscopic diamond-shaped and side-to-side techniques showed good clinical results in treating annular pancreas. The surgical technique, trans-anastomotic tube and early feeding are not likely to increase the risk of postoperative feeding intolerance.

Recurrent non-bilious vomiting in a child: A case report of an uncommon diagnosis

Annular pancreas (AP) is a congenital anomaly and a recognised cause of duodenal obstruction which can affect all age groups. It may manifest early in the neonatal period, but it may also have varied and often delayed symptoms. We report the case of AP in an 18-month-old girl with a long history of recurrent post-prandial non-bilious vomiting treated for a long time with the clinical diagnosis of gastroesophageal reflux. Upper gastrointestinal study was suggestive of partial duodenal obstruction and computed tomography revealed a complete ring of pancreatic parenchyma surrounding the second part of the duodenum. Diamond-shaped duodenoduodenostomy was achieved successfully and the post-operative period was uneventful. Although rare, AP must be kept in mind of any paediatric surgeon while confronted to symptoms of partial duodenal obstruction.

[Surgical aspects of pancreas transplantation: exocrine drainage. Part 3]

Exocrine drainage is an Achilles heel of pancreas transplantation. The author analyzed the outcomes of pancreas transplantations with different types of exocrine drainage in various centers (n=93). The article will ensure insight into evolution of techniques of exocrine drainage within the historical context and current state of this issue.

[Surgical aspects of pancreas transplantation: exocrine drainage. Part 2]

Exocrine drainage is an Achilles heel of pancreas transplantation. The author analyzed the outcomes of pancreas transplantations with different types of exocrine drainage in various centers (n=93). The article will ensure insight into evolution of techniques of exocrine drainage within the historical context and current state of this issue.

Tapering duodenoplasty: a beneficial adjunct in the treatment of congenital duodenal obstruction

Objective

Congenital duodenal obstruction is typically treated by duodenoduodenostomy. Tapering of the dilated segment has been indicated to reduce duodenal dysmotility. The purpose of this study was to review the outcomes between these two approaches.

Methods

We retrospectively reviewed cases of duodenal obstruction repair performed at a quaternary care referral pediatric hospital from 2007 to 2017. The length of stay, time to full enteral feeding, and complications were compared between patients who underwent duodenoduodenostomy with and without tapering duodenoplasty (n=4 and n=35, respectively).

Results

Both groups had similar times to initial enteral feeding (7 days) and full enteral feeding (14 vs. 15 days). Among the 35 patients who underwent duodenoduodenostomy alone, 6 (17%) required a return to the operating room; in contrast, no patients who underwent tapering required a return to the operating room. Of those who returned to the operating room, two underwent tapering at that time because of duodenal dilation and feeding intolerance.

Conclusions

Although limited by the small sample size, this study suggests that patients undergoing tapering duodenoplasty may have a slightly shorter time to full enteral feeding and a lower rate of complications than patients undergoing duodenoduodenostomy alone.

A Single Surgeon Laparoscopic Duodenoduodenostomy Case Series for Congenital Duodenal Obstruction in an Academic Setting

Introduction: Laparoscopic duodenoduodenostomy can be performed to repair congenital duodenal obstructions from atresia or duodenal web. There are only a few published case series in the literature. We are reporting on a single surgeon's experience with the operation and discuss the technical aspects of the operation. Material and Methods: A retrospective chart review was performed using the electronic medical record identifying all patients who underwent laparoscopic duodenoduodenostomy or duodenojejunostomy at two institutions by a singular surgeon. Results: Fifteen patients were identified as having undergone laparoscopic duodenoduodenostomy from 2010 until 2017. The weight at the time of the operation ranged from 1.5 to 8.7 kg (median 2.5 kg). The age ranged from 0 days to 15 months (median 3 days). Operative time (including other procedures) ranged from 2 hours 10 minutes to 3 hours 45 minutes with a median of 2 hours 55 minutes. One case was converted to open due to poor visualization. One patient developed a stricture that required open anastomotic revision 4 weeks after the initial surgery. In 1 patient, an enterotomy in the first portion of the duodenum was created from a retraction stitch-this was immediately recognized and repaired by primary laparoscopic closure. One patient had a small anastomotic leak that was treated with antibiotics. There were no mortalities and no intraoperative blood loss requiring transfusion. Conclusion: Laparoscopic duodenoduodenostomy is an operation that can be performed with excellent outcomes following simple steps that are easily taught in a teaching setting.

Surgical Decision Making in Preduodenal Portal Vein: Report of Two Cases in Neonates

Preduodenal portal vein (PDPV) is a rare anomaly that can cause duodenal obstruction. PDPV is associated with other congenital anomalies, mainly cardiac and gastrointestinal. Treatment usually consists of bypassing the obstruction by duodenoduodenostomy. We report two cases of PDPV in association with atrial isomerism and malrotation with different surgical management.

Annular pancreas in an 11-year-old girl: a case report

Annular pancreas (AP) is a rare cause of congenital duodenal obstruction that is usually discovered at the neonatal period, but clinical severities can vary over a wide range and definite diagnosis could be delayed until late childhood or adulthood. We report here a case of AP detected in an 11-year-old girl who had a long history of symptoms of partial duodenal obstruction. Upper gastrointestinal (UGI) study revealed narrowed second portion of duodenum by extrinsic compression, and computed tomography demonstrated complete ring of pancreatic tissue surrounding the second portion of the duodenum. Diamond-shaped duodenoduodenostomy successfully cured the patient, and the postoperative UGI study showed smooth passage through the bypass segment. Although rare, AP should be differentiated in children with unresolved symptoms of partial duodenal obstruction.

Transition from Laparotomy to Laparoscopic Repair of Congenital Duodenal Obstruction in Neonates: Our Early Experience

BACKGROUND

The aim of this report was to review our early experience of the last 7 years with repairs of congenital duodenal obstruction (CDO) to determine the efficacy and outcomes of laparoscopic repairs compared to laparotomy.

METHODS

A retrospective review was conducted on all neonate (<30 days) with CDO between 2009 and 2015. Patients with duodenal atresia, stenosis, web, and annular pancreas were included. Patients with only malrotation or delayed presentation were excluded.

RESULTS

Twenty-six neonates underwent laparoscopy and 30 underwent traditional laparotomy. The operative time was longer in the laparoscopic group (P = 0.001), but time to initiation of feeds and time to full feeds were similar for the laparoscopic and open groups. There was no mortality, anastomosis leakage, or stenosis in the laparoscopic group. Six laparoscopic cases required conversion to an open procedure (23%). In the earlier cases, the open conversion rate was high, but it decreased over time (P = 0.003).

CONCLUSION

Laparoscopic repair is safe and effective for repair of CDO in neonates. Despite operative time was slightly longer in the laparoscopic group, clinical outcomes remained similar to the open group. For pediatric surgeon with experience in laparoscopic techniques, laparoscopic duodenoduodenostomy is a sufficient available procedure.

125 Cases of duodenoduodenostomy in pancreas transplantation: a single-centre experience of an alternative enteric drainage

Several exocrine drainage procedures have been successfully developed to perform pancreas transplantation (PT). Retroperitoneal graft placement allows exocrine drainage via direct duodenoduodenostomy (DD). This technique provides easy access for endoscopic surveillance and biopsy. A total of 241 PT procedures were performed in our centre between 2002 and 2012. DD was performed in 125 patients, and duodenojejunostomy (DJ) in 116 patients. We retrospectively compared our experience with these two types of enteric drainage, focusing on graft and patient survivals, as well as postoperative complications. With a mean follow-up of 59 months, both groups demonstrated comparable patient and graft survivals. 14 (11%) of 125 cases in the DD group and 21 (18%) of 116 cases in the DJ group had pancreatic graft loss (P = 0.142). Graft thrombosis [5 (4%) vs. 18 (16%) P = 0.002], anastomotic insufficiency [2 (1.6%) vs. 8 (7%) P = 0.052] and relaparotomy [52 (41%) vs. 56 (48%) P = 0.29] occurred more frequently in the DJ group, whereas gastrointestinal bleeding [14 (11%) vs. 4 (3%) P = 0.026] occurred more often in the DD group. DD is a feasible and safe technique in PT, with no increase in enteric complications. It is equivalent to other established techniques and extends the feasibility of anastomotic sites, especially in recipients who have undergone a second transplantation.