Outcome of alimentary tract duplications operated on by minimally invasive surgery: a retrospective multicenter study by the GECI (Groupe d'Etude en Coeliochirurgie Infantile).

BACKGROUND: Alimentary tract duplications (ATD) are a rare cause of intestinal obstruction in childhood. There are many case reports but few series about laparoscopy or thoracoscopy for ATD. The aim of our study was to report the outcome of minimally invasive surgery (MIS) for ATD. METHODS: This was a retrospective multicenter study from the GECI (Groupe d\u27Etude en Coeliochirurgie Infantile). We reviewed the charts of 114 patients operated on by MIS for ATD from 1994 to 2009. RESULTS: Sixty-two patients (54 %) had a prenatal diagnosis. Forty-nine patients (43 %) were symptomatic before surgery: 33 of those patients (63 %) with postnatal diagnosis compared to 16 (25 %) with prenatal diagnosis (P < 0.01). In this last group, the median age at onset of symptoms was 16 days (range = 0-972). One hundred and two patients had laparoscopy (esophageal to rectal duplications) and 12 patients had thoracoscopy for esophageal duplications. The mean operative time was 90 min (range = 82-98). There were 32 (28 %) resection anastomoses, 55 (48 %) enucleations, and 27 (24 %) unroofings. The conversion rate was 32 %, and in a multivariate analysis, it was significantly higher, up to 41 % for patients weighing <10 kg (P < 0.01). Ten patients (8 %) had unintentional perioperative opening of the digestive tract during the dissection. Eight patients had nine postoperative complications, including six small bowel obstructions. The median length of hospital stay was 4 days (range = 1-21) without conversion and 6 days (range = 1-27) with conversion (P = 0.01). The median follow-up was 3 months (range = 1-120). Eighteen of the 27 patients who underwent partial surgery had an ultrasound examination during follow-up. Five (18 %) of them had macroscopic residue. CONCLUSION: This study showed that MIS for ATD is feasible with a low rate of complications. Patients with prenatal diagnosis should have prompt surgery to prevent symptoms, despite a high rate of conversion in small infants

Fifteen years experience in laparoscopic inguinal hernia repair in pediatric patients. Results and considerations on a debated procedure.

Background Laparoscopic inguinal hernia repair is rarely reported in pediatric patients. We report our 15-year experience on this topic to show the long-term results of this technique. Methods During a 15-year period, we operated 596 boys for unilateral inguinal hernia using laparoscopy. The age range was variable from 6 months to 15 years (median, 54 months), with a median body weight of 18.5 (range, 8– 54) kg. Preoperatively, 352 boys had a right hernia and 172 had a left hernia. We always used three trocars. We used the laparoscopic herniorrhaphy described by our group 15 years ago; it consists of sectioning the sac distally to the inguinal ring and performing a pursestring suture around the periorificial peritoneum using a 4/0 nonresorbable suture. Results The median operating time was 19 min. All procedures were performed in a day-hospital setting. As for laparoscopic findings in 95 of 596 patients (15.9%), we found a contralateral patency of the processus vaginalis. In these 95 cases, we performed bilateral herniorrhaphy. In 7 of 596 patients (1.2%), we discovered a direct hernia. With follow-up between 1 and 15 years, we have only 11 recurrences (1.5%)—all reoperated by laparoscopy. Conclusions We believe that laparoscopic repair of inguinal hernia performed by expert hands is a safe and effective procedure to perform with long-term follow-up. Its ability to repair simultaneously all forms of inguinal hernias together with contralateral patencies has cemented its role as a viable alternative to conventional repair

Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs

Background/Purpose: Laparoscopic inguinal herniorrhaphy has been introduced recently as an alternative to conventional open repair in children. This study was undertaken to evaluate the safety, efficacy, and reproducibility of this minimally invasive approach. Methods: A total of 933 laparoscopic inguinal herniorrhaphies were performed on 666 children (597 boys and 69 girls), ranging in age from 3 weeks to 14 years (median, 3.2 years). A 5-mm laparoscope was placed through an umbilical incision, and two 2-mm or 3-mm needle drivers were inserted through the lateral abdominal wall. The neck of the sac was closed with a 4-0 monofilament suture. The needle was inserted directly through the abdominal wall, and removed together with the trocar. Only the umbilical fascia was closed with an absorbable suture. No skin sutures were applied. Results: A total of 911 indirect inguinal hernia sacs were closed (337 right, 172 left, 402 bilateral) and 22 direct inguinal hernias were repaired (14 boys, 3 girls; 11 right, 3 left, 4 bilateral). The median operating time was 22 minutes (range, unilateral, 7 to 45 min; bilateral, 9 to 51 min). With experience, this time gradually decreased. There were no intraoperative complications. The contralateral asymptomatic processus was unexpectedly open on the left side in 137 of the boys (23%) and 10 of the girls (15%), and on the right side in 131 of the boys (22%) and 21 of the girls (32%). In 16% of the children, the final procedure was modified on the basis of the anatomic findings. No hernia was found in 13 children (1.9%). The recurrence rate was 3.4% (follow-up time ranged from 2 months to 7 years). Hydroceles were observed in 4 children, and a subtle change in testicular position and size was noted in one boy. Conclusions: Laparoscopic inguinal repair in children proved safe and reproducible, although the recurrence rate was slightly higher than with the open approach. However, laparoscopy allows easy and precise identification of the type of defect and its correction. In this series, the incidence of direct inguinal hernias was higher, and the incidence of a patent contralateral processus vaginalis was lower than previously reported

Laparoscopic treatment of recurrent inguinal hernia in children

The authors report their experience with the laparoscopic treatment of recurrent inguinal hernia in children. Between April 1993 and January 1998, 225 boys aged 8 months to 14 years (mean 4.4 years) were treated laparoscopically for a hydrocele, spermatic-cord cyst, or hernia. Ten boys had recurrent inguinal hernias after conventional surgery, in one case bilateral. The technique requires 3 trocars: a 0 degrees, 5-mm telescope inserted through the umbilicus and two 3-mm trocars placed 3-4 cm below the umbilicus on either side. Simple patency of the peritoneal vaginal duct (dpv) was found in eight cases and a direct inguinal hernia in three. In cases with an open dpv, we opened the external hemicircumference of the neck in order to bring the conjoined tendon closer to the crural arch with a non-resorbable 4/0 suture, and then placed a 3/0 resorbable pursestring suture around the peritoneum of the internal orifice of the inguinal canal. In direct inguinal hernias the orifice was closed by placing 2-3 nonabsorbable 3/0 sutures between the two muscular sides of the hernial defect. There were no intra- or postsurgical complications. All patients, at a maximum follow-up of 3 years showed total recovery from the hernia. Our early results suggest that laparoscopic surgery is a feasible and safe technique for the treatment of recurrent inguinal hernia in childre

Laparoscopic surgery for gastroesophageal reflux disease during the first year of life

BACKGROUND: Very few children need gastroesophageal antireflux surgery during their first year of life; hence, no series has been published so far. The authors report their experience in 3 centers. METHODS: From January 1993 to December 1998, 36 infants between 23 days and 13 months of age, suffering from gastroesophageal reflux disease (GERD), underwent surgery by a laparoscopic approach. The patients' weights ranged from 2.4 to 8.5 kg. Preoperative diagnostic studies included esophagograms, manometries, endoscopies, and pH-metries. Fifteen babies (41.6%) had associated anomalies, and 10 (27.7%) were neurologically impaired. Thirty-six laparoscopic fundoplications were performed according to either Toupet's procedure (17 of 36), Rossetti's (10 of 36), Nissen's (8 of 36) or Lortat-Jacob's (1 of 36). Four infants previously had undergone a gastrostomy, whereas 6 needed one during the antireflux procedure. RESULTS: There was no mortality in our series. Three infants (8.3%) had an intraoperative complication: 1 lesion of a diaphragmatic vessel, 1 pneumothorax, and 1 case of severe hiatal hernia requiring conversion to open surgery. During the median follow-up of 22 months, 4 redo procedures were performed (11.1%). CONCLUSIONS: This experience shows the feasibility of laparoscopic fundoplication even in children below 1 year of age. An accurate preoperative diagnostic study is mandatory, because 50% of these patients presented associated anomalies. A long and accurate follow-up is necessary to evaluate long-term results and detect possible complications, which can occur as late as 1 year after surgery. In addition, we believe that redo antireflux surgery is possible by the laparoscopic approach without major difficulties, based on our larger experience with older children