117,304 research outputs found
Laparoscopic Palomo varicocelectomy
No full textSir,
We have been called into question on the proper use
of term laparoscopic Palomo varicocelectomy by Letter
to the Editor: Nitinkumar Borkar, Nitin K. Kashyap,
Debajyoti Mohanty: Is it a Palomo’s operation? Afr
J Paed Surg. October-December 2014/Vol 11/Issue 4
371-372 who refer to: Marte A, Pintozzi L, Cavaiuolo
S, Parmeggiani P. Single-incision laparoscopic surgery
and conventional laparoscopic treatment of varicocele
in adolescents: Comparison between two techniques.
Afr J Paediatr Surg 2014;11:201-5.
It’s unquestionable that the original report of
Dr. Alejandro Palomo of J Urol 1949[1] (in prelaparoscopic
era) refers to an open retroperitoneal
approach with an en bloc section of testicular vascular
bundle, and according to the Author, this can be
implemented without compromising the testicular
vitality. From the original drawings: “Veins and artery
have been freed and are removed after clamps have
been applied. Proximal and distal stumps of the vessels
are ligated by transfixations sutures”.[1
Use of LigaSure on bile duct in rats. An experimental study.
No full textAims.The closure of a cystic duct during cholecystectomy by means of radiofrequency is still controversial. We report our preliminary experimental results with the use of LigaSure on common bile duct in rats.
MATERIALS AND METHODS:
Thirty Wistar rats weighing 70 to 120gr were employed for this study. The animals were all anaesthetized with intraperitoneal Ketamine and then divided into three groups. The first group (10 rats, Group C) underwent only laparotomy and isolation of the common bile duct. The second (10 rats, Group M) underwent laparotomy and closure of the common bile duct (CBD) with monopolar coagulation. The third group (10 rats, Group L) underwent laparotomy and sealing of the common bile duct with two application of LigaSure. Thereafter, all rats were kept in comfortable cages and were administered Dibenzamine for five days. They were all sacrificed on day 20. Through a laparotomy, the liver and bile duct were removed for histological examination. Blood samples were obtained to dose bilirubin, amylase and transaminase levels.
RESULTS:
Mortality rate was 0 in the control group (C), 3/10 rats in group M and 0 in group L. In group L, the macroscopic examination showed a large choledochocele (3 - 3.5 cm x 1.5 cm) with few adhesions. At the histological examination there was optimal sealing of the common bile duct in 9/10 rats. In group M, 2/10 rats had liver abscesses, 3/10 rats had choledochocele and 5/10 rats, biliary peritonitis. There was intense tissue inflammation and the dissection was difficult. Analyses of blood samples showed an increase in total bilirubin, aspartate aminotransferase (AST) and alanine amitransferase (ALT) in groups M and L.
CONCLUSIONS:
The preliminary results of our study confirm that radiofrequency can be safely used for the closure of the common bile duct. The choledochocele obtained with this technique could represent a good experimental model. These results could be a further step for using the LigaSure in clipless cholecistectomy
Tubularized proximally-incised plate in distal/midshaft hypospadias repair
No full textThe aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique
Laparoscopic treatment of symptomatic simple renal cysts in children: single-center experience
No full textSimple renal cysts, although common in adults, are rare in children. They are usually discovered incidentally in the course of the study of other urinary tract symptoms, although they are not always asymptomatic. Renal cysts can be classified as being either simple or complex. The purpose of this review is to present our case series of simple symptomatic renal cysts treated with laparoscopy. Nineteen patients with symptomatic renal cysts (6 to 13.5 cm) were referred to our institution between January 2006 and January 2017. They comprised 12 (40.5%) females and seven (59.5%) males, aged 8 to 15, with a mean age of 12.2 years. Of these patients, nine had previously been treated unsuccessfully by ultrasound-guided aspiration/alcoholization with 95%-ethanol, between 9 and 13 months prior to the laparoscopy. Five patients had undergone one treatment and four had undergone two treatments. All of the patients were treated by laparoscopic threetrocar deroofing. The cysts were opened and the wall excised using scissors and a monopolar hook. In most cases, to better handle the edges of the cyst and obtain a better grip, a needle was used to aspirate a small amount of fluid (used for cytological examination). The wall of the cyst was excised, the cyst edges were sealed, and the perirenal fat was placed on the bottom of the cyst (wadding technique). The mean operating time was 95 minutes (range 50- 150). The postoperative course was uneventful for all of the patients. The hospital stay ranged from one to three days. All of the patients were asymptomatic following the treatment. At a mean follow-up time of 3.6 years, none of the patients had experienced a recurrence. Renal function, as assessed by a MAG3 renal scintigraphy scan, was well-preserved in all of the patients, and all of them undergo an annual ultrasound scan
FINE SCALE ANALYSIS OF LEAF PACK COLONIZATION IN A SALT MARSH MEDITERRANEAN LAGOON: LAKE ALIMINI GRANDE (OTRANTO, LE, ITALY).
No full textSpectrum of Ectopic Pelvic Kidney in Children: A Ten-year Experience.
No full textIntroduction: Many patients with ectopic kidneys remain often undiagnosed
or asymptomatic throughout life. Ectopic pelvic kidneys present a large spectrum
of presentation and symptoms from renal dysplasia to a severe obstruction. One
of the most common problem is the UPJ obstruction with stones formation. We
present here our experience of pelvic kidney in children, the clinical presentation
and the surgical procedures performed
Material and Methods: A total of 17 children, aged from 6 months to 17
years, (14m;3f) were referred to our Institution between January 2004 to June
2014 for pelvic kidney. There were 5 (29.41%) left and 12 (70.5%) right Kidneys.
1. 9 patients presented with moderate to severe UPJ obstruction (three
cases with 10 to 20mm pelvic stones) with normal/moderately-reduced
≥25% relative function at MAG3 radionuclide scan of these patients,
5 with clear symptoms of UPJ obstruction underwent a laparoscopic
dismembered Anderson –Hynes pyeloplasty. The remaining 4,
presented symptomatic intermittent hydronephrosis with colic abdominal
pain. These patients underwent pelvis derotation through a minimally
invasive transposition of the UPJ.
2. 5 patients presented non-functioning kidneys, in 2 cases associated to
hypertension, and underwent laparoscopic nephrectomy.
3. 2 patients presented asymptomatic pelvic kidney.
4. 1 patient presented 3rd G. VUR on the ipsilateral pelvic kidney.
The associate pathology was 1 midshaft hypospadias, 2 criptorchidism , 1
mild mitral insufficiency.
The evaluation of each patient involved their personal and family medical
history, ultrasound examination, VCUG, MAG3 renal scan and MRI in selected
cases.
Results: After a mean follow-up of 6.9 yrs the majority of the patients are
well and none present hypertension. Symptoms resolved in 13 out of 15 surgical
patients. 2 patients needed the positioning of a double J stent from 3 to 8 months
after pyeloplasty that was removed from 6 to 12 weeks after the procedure
Conclusion: Pelvic kidneys present a large spectrum of symptoms.
UPJ obstruction with/without stones, intermittent hydronephrosis, recurrent
abdominal pain, UTI is the most frequent symptoms. The majority of our patients
needed surgical procedures. In four cases there were associated pathologies
as hypospadias, cryptorchidism, and mild mitral insufficiency. Laparoscopic
approach seems a useful tool for the treatment of these kidneys. Pelvis
derotation can be an easy and effective procedure in moderate, intermittent
obstruction
Efficacy and safety of Botulinum-A Toxin for treating bladder hyperactivity in children and adolescents with neuropathic bladder secondary to myelomeningocele.
No full textAbstract
We verified the efficacy and safety of Botulinum-A toxin A (BT-A) in treating children with neuropathic bladder secondary to myelomeningocele. There were 47 patients out of 68 with neuropathic bladder, (22 females, 25 males, age range 5-17 years, mean age 10.7 years, with hypertonic/hyperactive neurogenic bladder detrusor hyperactivity, on clean intermittent catheterization, and resistant or non compliant to anticholinergics. 10 patients presented 2nd to 4thgrade concomitant monolateral/bilateral vesicoureteral reflux (VUR). All patients were incontinent despite catheterization. BT-A was administered by intradetrusoral injection of 200 IU of toxin in 20 sites. Follow-up including clinical, ultrasound, urodynamics was performed at 6, 12 and 24 weeks and annually thereafter.7 patients remained stable, 22 patients required a 2nd injection after 6-9 months and 18 a 3rd injection. VUR was corrected, when necessary, in the same session after Botox injection, by 1 to 3cc of subureteral dextranomer/hyaluronic acid copolymer (Deflux). Urodynamic parameters considered has been leak point pressure (LPP), leak point volume (LPV) and specific volume at 20 cmH2O pressure. The results were analyzed using the Wilcoxon test. All patients experienced a significant 66.45% average increase of LPV (Wilcoxon paired rank test=7,169 e-10) and a significant 118.57% average increase of SC 20 (Wilcoxon paired rank test=2.466 e-12). Difference between preoperative and postoperative LPP resulted not significant (Wilcoxon paired rank test=0.8858) The reflux was cured by one or two injection of Deflux. 38 out of 47 patients achieved dryness between CIC, 9 patients improved their incontinence but still need pads
Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: comparison between two techniques
No full textBackground: Single-incision laparoscopic surgery (SILS) has gained great popularity in paediatric surgery due to its minimally invasive approach and
improved cosmetic results. Notwithstanding, reports
describing its adoption in children are still fragmentary
and some perplexities have been raised by some
surgeons. We reviewed our experience with the SILS
Palomo varicocelectomy procedure (SIL-V) in children
and adolescents, comparing this group with a similar
series operated using conventional laparoscopic
varicocelectomy (CL-V). Patients and Methods: A
total of 69 Palomo laparoscopic varicocelectomies
were performed in patients aged 11-17 years from
January 2011 to January 2013. Indications for surgery
included grades II-III varicocele or ipsilateral testicular
hypotrophy. The SIL-V procedure was performed in
44 patients with roticulating and conventional 5 mm
instruments. Testicular vessels were isolated “en
bloc,” clipped and cut. Operating time, visual analogue
scale and post-operative results were compared to
a similar group of 25 patients operated with CL-V.
Results: No patient of the SIL-V group required
conversion to conventional laparoscopy, none to open
surgery. Mean operative time was 22 min (range:
19-28) in the SIL-V group, not signifi cantly different
compared with CL-V (mean 21 min, range: 18-25). All
patients experienced a smooth recovery from surgery
without any complications, and were discharged on
day 1. No diffi culties were found in the SIL-V group.
The post-operative pain score was signifi cantly better
in SIL-V. Conclusion: The SIL-V procedure is safe
and effective and allows a fast and effi cient isolation
of the vascular bundle. The use of conventional
instruments is technically feasible in SIL-V
Vesicoscopic Treatment of Symptomatic Congenital Bladder Diverticula in Children: A 7-Year Experience.
No full textThe objective of this study was to report on the use of vesicoscopy in the treatment of symptomatic congenital bladder diverticula (CBD) in children. Material and Methods In this study, 16 males, aged 4 to 12 years (median age, 6.25 years), were treated for symptomatic CBD; 3 patients presented double diverticulum and 13 presented single diverticulum. The presenting symptoms were recurrent urinary tract infection, hematuria, lower abdominal pain, and voiding dysfunctions as urgency, frequency alone, or in association. A first midline 5-mm trocar was introduced for a 0-degree telescope at the dome of the bladder, and two left and right 3- or 5-mm trocars were inserted through the anterolateral wall. The bladder was then insufflated with carbon dioxide to 10 to 12 mm Hg pressure. The diverticula were inverted into the bladder and the mucosa around the neck was circumcised by using scissors and hook. The defect was sutured and the bladder was drained. Vesicoureteral reflux (VUR) of third grade or higher was treated endoscopically. Results Mean operative time was 90 minutes for procedures. At 6-month follow-up, ultrasound and voiding cystourethrogram (VCUG) showed the disappearance of the diverticulum in 15 out of the 16 patients. The patient, with huge double diverticulum and fourth grade right VUR, presented recurrence of a small left diverticulum. Patients with voiding disorders presented a gradual improvement of their urgency. VUR disappeared at VCUG in all patients. Conclusion Vesicoscopic diverticulectomy resulted a safe and effective procedure and can be considered a valid alternative to the open or laparoscopic procedures. In our opinion, routine use of vesicoscopy could become the gold standard for the treatment of CBD in children
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