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The value of 2-step laparoscopic Fowler-Stephens orchiopexy for intrabdominal testes
No full textPurpose: We report our experience in the treatment of high intra-abdominal testis with a
complete laparoscopic 2-stage Fowler-Stephens procedure with associated transperitoneal closure
of the internal ring in pediatric patients.
Materials and Methods: Between 1990 and 1997, 100 boys with 105 nonpalpable testes
underwent laparoscopy. Laparoscopy showed intra-abdominal testis in 40 cases. In 5 cases when
the testis was just proximal to the internal ring, we performed standard orchiopexy. In 35 cases
with the testis in the high intra-abdominal position, we performed the Fowler-Stephens procedure
with the first stage performed laparoscopically. To date, all 35 testis have undergone the
second phase after 6 to 12 months (2 by open technique, 33 by laparoscopy). The last 33 patients
underwent the second phase of the 2-stage Fowler-Stephens procedure by laparoscopy with
associated video surgical transperitoneal closure of internal ring.
Results: All testes were successfully placed in the scrotum. At a mean 30 months of followup,
with clinical examination, ultrasonography and comparative colorimetric echo Doppler study, all
testes were viable in the scrotum, except for 1 that became atrophic 2 months after the second
open phase of 2-stage Fowler-Stephens technique.
Conclusions: Our early results suggest that the 2-stage Fowler-Stephens procedure, performed
completely using laparoscopy, is a feasible technique for treating high intra-abdominal testis
Laparoscopic management of ovarian cysts in the newborns
No full textBackground: Cysts are the most common ovarian masses
found in newborn girls. Spontaneous regression, which occurs
in ~25–50% of cases, is more frequent with smaller
cysts. Pre- or postnatal complications are common; these
complications may consist of intracystic bleeding, torsion of
the cyst or corresponding annex, or self-amputation of the
cyst. When the cyst is <4 cm it is possible to perform a
simple echographic monitoring to check for the possibility
of spontaneous involution; all other cases require surgery.
Methods: Between February 1985 and June 1997, we
treated 22 neonatal ovarian cysts laparoscopically. In 14
cases, the right side was involved; in eight cases, it was the
left. The patients’ ages ranged between 7 days and 5 months
(median, 45 days). In all cases, we used three trocars. An
intraperitoneal cystectomy was done in eight cases, a
transparietal cystectomy in four cases, an ovariectomy in
seven cases, and the simple removal of the cyst in one case
where self-amputation had occurred. In two cases of bilateral
pathology, the cysts, which were <1 cm, were left untreated.
Results: Average operating time was 40 min (range, 25–60
min). Intraabdominal pressure never exceeded 6–8 mmHg
during the intervention. The postoperative course was always
under 3 days. No intra- or postsurgical complications
were recorded, and long-term ultrasonographic follow-ups
were all normal.
Conclusion: Our experience indicates that the laparoscopic
approach is a reliable and safe technique in the treatment of
neonatal ovarian cysts
Pediatric laparoscopic splenectomy: are there real advantages in comparison with traditional open approach?
No full textThe hospital records of patients who underwent splenectomy during the last 2 years were reviewed to compare the advantages of the laparoscopic approach with traditional open splenectomy (OS). Between March 1994 and March 1996, 16 children underwent splenectomy, in 8 using an open approach and 8 by a laparoscopic procedure. Of the patients who underwent laparoscopic splenectomy (LS), 2 had a concomitant cholecystectomy. Ages ranged between 4 and 11 years (mean 6.4 years); there were 9 girls and 7 boys. The indications for splenectomy were: hereditary spherocytosis (7 cases); idiopathic thrombocytopenic purpura (4); sickle-cell disease (3); and beta-thalassemia (2). The average operating time for OS was 100 min (range, 50-155), for LS 170 min (range 125-240). The hospital stay for patients who had OS ranged from 3 to 9 days (mean 4.7), for those who had LS from 2 to 5 days (mean 3). One OS patient developed a wound infection. In 3 of the LS patients, the spleen was removed via a 7-cm Pfannenstiel minilaparotomy in the suprapubic region; in 5 cases the spleen was captured into an extraction bag, crushed, and removed through the umbilical orifice. The authors believe that LS must be performed only when it is possible to use the extraction bag to remove the spleen from the umbilical orifice (spleens weighing less than 700 g) and when a concomitant procedure such as cholecystectomy is indicated; in other cases OS is preferable
Traditional versus laparoscopic fundoplication in children for treatment of refractory gastroesophageal reflux.
No full textBACKGROUND/AIMS:
A retrospective study has been carried out on the last 20 consecutive patients operated for gastro-oesophageal reflux to compare the results of the traditional operation with those using the laparoscopic approach.
METHODS:
In ten cases, the operation was performed with an open traditional approach and in the other 10 cases using laparoscopy. The mean age of the patients was 7 years and their mean weight was 20 kg. There were 11 girls and 9 boys. We used a 360 degrees Nissen fundoplication in the patients operated on via laparotomy and a Nissen-Rossetti fundoplication in patients operated on via laparoscopy.
RESULTS:
Mean operating time was 65 minutes for traditional surgery and 100 minutes for laparoscopy. There were two complications: 1 case of oesophageal perforation in a child affected by endo-brachyoesophagus with peri-oesophagitis, operated using the laparoscopic technique, and one case of wound infection in a child operated with the open technique. The hospital stay was remarkably shorter and less painful for the children operated on laparoscopically. At 13-month mean follow-up, all 20 patients are alive and present no reflux symptoms.
CONCLUSIONS:
Our results demonstrate that laparoscopic surgery is a valid alternative to the traditional surgical approach for the treatment of gastro-oesophageal reflux
Splenectomy in childhood: The laparoscopic approach
No full textBackground: We set out to analyze the results of the first 19
laparoscopic splenectomies performed by our team in order
to show the advantages and limitations of the laparoscopic
approach to this kind of procedure in children.
Methods: Between March 1994 and June 1997, 19 children
underwent laparoscopic splenectomy; two of them also had
a concomitant cholecystectomy. Their ages ranged between
4 and 14 years (median, 7.2 years). There were 14 girls and
5 boys. All the patients underwent elective laparoscopic
splenectomy: seven children had hereditary spherocytosis,
six were affected by a b thalassemia, five had an idiopathic
thrombocytopenia purpura, and one presented with sickle
cell disease.
Results: Mean operating time was 145 min (range, 110–240
min). Hospital stay ranged from 2 to 5 days (median, 3
days). In three patients, the spleen was removed with a 7-cm
mini-laparotomy, according to the technique of Pfannenstiell,
in the suprapubic region. In the other 16 cases, the
spleen was captured into a extraction bag, fingerfragmented,
and removed from the umbilical orifice.
Conclusions: Laparoscopic splenectomy can be performed
only when the spleen can be removed through the umbilical
orifice with an extraction bag. For this reason, preoperative
ultrasonography is necessary to measure the exact spleen
volume. When the spleen is very large, an open splenectomy
is preferable
Traditional versus laparoscopic fundoplication in children for treatment of refractory gastroesophageal reflux.
No full textBACKGROUND/AIMS:
A retrospective study has been carried out on the last 20 consecutive patients operated for gastro-oesophageal reflux to compare the results of the traditional operation with those using the laparoscopic approach.
METHODS:
In ten cases, the operation was performed with an open traditional approach and in the other 10 cases using laparoscopy. The mean age of the patients was 7 years and their mean weight was 20 kg. There were 11 girls and 9 boys. We used a 360 degrees Nissen fundoplication in the patients operated on via laparotomy and a Nissen-Rossetti fundoplication in patients operated on via laparoscopy.
RESULTS:
Mean operating time was 65 minutes for traditional surgery and 100 minutes for laparoscopy. There were two complications: 1 case of oesophageal perforation in a child affected by endo-brachyoesophagus with peri-oesophagitis, operated using the laparoscopic technique, and one case of wound infection in a child operated with the open technique. The hospital stay was remarkably shorter and less painful for the children operated on laparoscopically. At 13-month mean follow-up, all 20 patients are alive and present no reflux symptoms.
CONCLUSIONS:
Our results demonstrate that laparoscopic surgery is a valid alternative to the traditional surgical approach for the treatment of gastro-oesophageal reflux
Complications of pediatric laparoscopic surgery
No full textBackground: Surgical complications of laparoscopy most
often occur during Veress needle or primary trocar placement.
Veress needle punctures are insignificant and require
no further treatment, whereas trocar-induced vascular injuries
can be catastrophic. The frequency of vascular and
viscus injuries is difficult to calculate because several complications
are not reported in the literature.
Methods: During a 10-year-period (1984–1995), at the Division
of Pediatric Surgery at ‘‘Federico II’’ University of
Naples, 430 laparoscopic procedures were performed in 395
children with a mean age of 5 years. The incidence of complications
related to laparoscopy was 1.8% with eight complications,
one of which was rather severe. The complications
included one abdominal wall hematoma, two perforations
of abdominal viscus (stomach, ovary), one umbilical
scar complication, one postoperative hydrocele, one subcutaneous
emphysema, and one pneumothorax during a Nissen
procedure. The only severe complication occurred in a
young girl with neurologic problems and a kyphoscoliosis
operated on via laparoscopy for a gastroesophageal reflux.
She suffered injuries of both right common iliac vessels and
several intestinal perforations due to blind introduction of
the first umbilical trocar.
Results: In this case rapid conversion, complex vascular
reconstruction, and multiple intestinal sutures were performed.
The Nissen fundoplication with pyloroplasty was
performed traditionally and the patient left the hospital free
of symptoms after 20 days. The other seven complications
were resolved without any problem intra- or postoperatively.
Conclusions: The authors believe that the open approach
with a blunt trocar is most important in helping to avoid
complications in pediatric laparoscopy
Surface staining on the villus of lactase protein and lactase activity in adult-type hypolactasia
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