Abstract
Background/Purpose. Kimura's diamond-shaped-duodenoduodenostomy (DSD) is a known technique for the correction of congenital intrinsic duodenal obstruction. We present a modification of the technique and review the advantages of this new technique. Methods. From 1992 to 2006, 14 newborns were treated for duodenal atresia. We inverted the direction of the duodenal incisions: a longitudinal incision was made in the proximal duodenum while the distal was opened by transverse incision. Results. Our “inverted-diamond-shaped-duodenoduodenostomy” (i-DSD) allowed postoperative oral feeding to start on days 2 to 3, peripheral intravenous fluids discontinuity on days 3 to 8 (median values 3.6); time to achieve full oral feeds on days 8 to 12 (median values 9.4); the length of hospitalisation ranged from 10 and 14 days (median value 11.2). No complications related to the anastomosis, by Viz leakage, dehiscence, biliary stasis, or stenosis were observed. Conclusions. The i-DSD provides a safe procedure to protect the ampulla of Vater from injury and avoids any formation of a blind loop. The results show that patients who have i-DSD achieve full oral feeds in a very short time period and, consequently, the length of hospitalisation is also significantly reduced.
Highlights
For the surgical treatment of congenital intrinsic duodenal obstruction KIMURA, in 1977, introduced an anastomotic technique of side-to-side duodenoduodenostomy in two layers, arranging the bowel incisions to form a “diamondshaped” (DSD) and created a larger stoma
All of the nine patients with inverted diamond-shaped duodenoduodenostomy (iDSD) started oral feeding on days 2 to 3
The patients did not show complications related to the duodenal anastomosis as leakage, dehiscence, spillage or stenosis, blind loop, and biliary stasis
Summary
For the surgical treatment of congenital intrinsic duodenal obstruction KIMURA, in 1977, introduced an anastomotic technique of side-to-side duodenoduodenostomy in two layers, arranging the bowel incisions to form a “diamondshaped” (DSD) and created a larger stoma. In 1990, he refined his technique based on a transverse incision in the distal end of the proximal duodenum and a longitudinal incision in the distal duodenum. No gastrostomy or transanastomotic tube was used. By this technique the anastomosis recovered its function in a significantly shorter time period and early postoperative feeding could be started. We adopted this new technique in 2 cases (in which we observed a start of alimentation after 3 and 4 days and postoperative duodenal-gastric reflux)
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