A novel technique for correction of intestinal XXXX at the ligament of Treitz.

@entity1146 @entity1 @entity254
PURPOSE: After reconstruction of jejunal @entity1146 at the ligament of Treitz, many @entity1 do not respond to simple tapering and @entity254 requiring repetitive operations because of dysfunction of dilated proximal bowel. A new operative approach using lateral duodenectomy and duodenojejunostomy (LDAD) is reported. METHODS: Three @entity1 with @entity1146 within 10 cm of the ligament of Treitz were treated with LDAD, and their records are reviewed retrospectively. The entire duodenum is visualized after creating a malrotation; this is followed by opening the dilated duodenum and resecting dilated proximal jejunum. The resection is extended proximally, incorporating the lateral duodenal incision, excising the lateral duodenal wall, and preserving the ampulla. The residual duodenum is fashioned into a tube and anastomosed to the spatulated distal jejunum. RESULTS: Three @entity1 underwent this procedure over a 4-year period. Two had undergone tapering enteroplasties previously but were unable to tolerate oral feedings; 1 @entity1 had LDAD primarily. All were ultimately successfully managed by LDAD and were feeding within 14 days. Follow-up is from 14 to 49 months. CONCLUSION: Although experience is limited to 3 @entity1 , the prompt return of intestinal function with LDAD may justify primary use of this more radical procedure in difficult-to-treat proximal @entity1146 .
