title: Laparoscopic pancreas-preserving distal duodenectomy for duodenal stricture related to nonsteroidal antiinflammatory drugs (NSAIDs).
abstract: BACKGROUND
  Chronic ingestion of nonsteroidal antiinflammatory drugs (NSAIDs) has rarely been associated with the development of intestinal diaphragm-like strictures. We have explored the role of laparoscopic surgery for the management of NSAID-related long distal duodenal strictures.
  
  
  METHODS
  A 49-year-old woman had been on NSAID therapy (ibuprofen) for backache more than 2 years. She showed symptoms of gastric outlet obstruction and gastrointestinal blood loss, and investigations showed a long stricture in the third and fourth parts of the duodenum. She underwent a laparoscopic pancreas-preserving distal duodenectomy with duodenojejunal anastomosis.
  
  
  RESULTS
  Relaparoscopy on postoperative day 1 for bleeding showed no active source of bleeding. The patient's subsequent recovery was uneventful, and she was discharged on postoperative day 4. Further symptomatic strictures developed 2 months later at the previously ulcerated pylorus and distal duodenal bulb and were managed by a laparoscopic Roux-en-Y gastrojejunostomy. The patient was discharged on postoperative day 3, but represented 2 months later with symptomatic stenosis at the gastrojejunostomy which was managed by a laparoscopic revision gastrojejunostomy. Discharged on the postoperative day 2, she had regained weight and remained symptom free at follow-up assessment 3 months later.
  
  
  CONCLUSIONS
  Laparoscopic pancreas-preserving distal duodenectomy for the management of benign duodenal strictures is feasible and safe. Moreover, we have demonstrated the beneficial role of relaparoscopy for the management of postoperative complications and for revision surgical procedures.
authors.affiliation: Royal Gwent Hospital, Newport, Gwent, United Kingdom NP20 2UB. Bammori@aol.com
authors.forename: B J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D004380:Duodenal Obstruction / Q000139:chemically induced* / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000379:methods*; D005260:Female; D005763:Gastroenterostomy / Q000379:methods; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D014839:Vomiting / Q000209:etiology / Q000601:surgery; D015431:Weight Loss / Q000502:physiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal