Laparoscopic treatment of duodenal obstruction: report on first experiences in Latin America.
BACKGROUND
There are few reports in the literature on the use of a laparoscopic approach for duodenal obstruction, particularly for duodenal atresia. We report here the results of 4 cases treated laparoscopically, and discuss the safety, feasibility and long-term results of this approach.


METHODS
Four pediatric patients presented with duodenal obstruction, one with duodenal atresia, one with annular pancreas, and two with duodenal obstruction due to Ladd's bands but without malrotation. Diagnosis was made by clinical evaluation, simple X-ray film in the Ladd's patients, and contrast gastroduodenal X-ray series for the annular pancreas. All procedures were performed using 3-mm instruments and 3 trocars. Two duodeno-duodenal anastomoses were performed and two lyses of Ladd's bands; all procedures were carried out laparoscopically.


RESULTS
An upper GI contrast excluded obstruction or leakage in all patients 5 - 7 days after surgery and feedings were started. The patient with annular pancreas died of cardiovascular complications after one months. The other 3 patients are asymptomatic and tolerating feedings after a follow-up of 36 months.


CONCLUSIONS
We conclude that a laparoscopic approach for duodenal obstruction can be performed safely and effectively and achieves a short hospital stay. Laparoscopic lysis of Ladd's bands is easy to perform, but duodenoduodenostomy requires advanced laparoscopic skills.
Department of Pediatric Surgery, Christus Muguerza Hospital Alta Especialidad, Monterrey, Mexico. cima_riquelme@hotmail.com
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M
Riquelme
A
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Aranda
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Riquelme-Q
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C
Rodriquez
D000714:Anastomosis, Surgical / Q000379:methods; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007843:Latin America / Q000453:epidemiology; D008297:Male; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D016896:Treatment Outcome