7 research outputs found
Laparoscopic treatment of congenital inguinal hernia in children
PURPOSE:
The authors report their experience in the laparoscopic treatment of congenital inguinal hernia in children.
METHODS:
Between September 1994 and September 1995, 45 boys between 8 months and 13 years of age (mean, 4 years) were treated laparoscopically for hydroceles, spermatic cord cysts, or hernias. Twenty-six (57.8%) boys showed a right inguinal hernia, 17 (37.8%) a left hernia, and two cases (4.4%) presented the clinical data of a bilateral pathology. The approach used for small hernias was the placement of purse-string suture around the internal orifice of the inguinal canal (28 cases). As to hernias exceeding 4 to 5 mm in diameter, the external hemicircumference of the neck was opened to bring the conjoined tendon closer to the crural arch with a nonresorbable suture (17 cases). There was never need to use a prosthesis.
RESULTS:
Surgery lasted from 15 to 45 minutes with the duration decreasing with experience. There were no intra- or postsurgical complications. Two patients (4.4%) experienced a recurrent inguinal hernia, which was successfully operated on again with laparoscopy.
CONCLUSION:
The early results of these authors suggest that laparoscopic surgery is a feasible and safe technique for the treatment of patent peritoneal vaginal canal (PVC) and inguinal hernia in children
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
Complications of laparoscopic antireflux surgery in childhood.
Background: The aim of this study was to assess the complications
associated with the laparoscopic treatment of gastroesophageal
reflux disease (GERD) in children.
Methods: From March 1992 to March 1998, we used the
laparoscopic approach to treat 289 children affected by gastroesophageal
reflux disease. The patients’ ages ranged between
4 months and 17 years (median, 4.3 years), and their
body weight ranged between 5 and 52 kg. In 148 children
(51.3%), we adopted a Nissen-Rossetti procedure and in
141 (48.7%) a Toupet technique.
Results: The duration of surgery ranged between 40 and 180
min (median, 70). There were no deaths and no anesthesiological
complications in our series. We recorded 15 (5.1%)
intraoperative complications: six pleural perforations, four
lesions of the posterior vagus nerve, two esophageal perforations,
two gastric perforations, and one pericardiac perforation.
Conversion to open surgery was necessary in only
four cases (1.3%). We recorded 10 (3.4%) postoperative
complications: one peritonitis due to an esophageal perforation
not detected during the intervention that required a
reoperation, five cases of herniation of the epiploon through
a trocar orifice, three cases of dysphagia that disappeared
spontaneously after a few months, and one case of delayed
gastric emptying that subsequently required a pyloroplasty.
We had six recurrences of GERD (2.1%). In two cases, a
new fundoplication was performed using the laparoscopic
approach; in the other four, the GERD was controlled with
medical therapy.
Conclusion: Our results show that laparoscopic fundoplication
is an adequate treatment for children with GERD that
has a low rate of complications. When severe complications
do occur, they can be treated effectively via the laparoscopic
approach
Laparoscopic esophagomyotomy for the treatment of achalasia in children: a preliminary report of eight cases
Background: Albeit rare in children, achalasia is a disorder
with severe symptoms that causes growth impairment. The
treatment of choice in children is the esophagomyotomy,
although there are variations in the surgical approaches
available and differences of opinion regarding the inclusion
of an adjunctive antireflux procedure. The recent advent of
the laparoscopic approach has had a profound impact on the
treatment of achalasia in both adults and children.
Methods: In this report, we describe eight patients with
severe achalasia who were treated by laparoscopic Heller’s
operation associated with a fundoplication according to either
Dor’s or Toupet’s technique. The patients’ ages ranged
between 2 and 13 years. A five-port technique was used: a
10-mm port placed infraumbilically for the optics and four
5-mm ports. One was placed in the right abdominal quadrant
for retraction of the left hepatic lobe, one in the left
abdominal quadrant for the first operative instrument, one
below the xyphoid appendix for the second operative instrument,
and the last one to introduce a 5-mm cannula
laterally to the umbilicus to retract the stomach below. A
7–8-cm laparoscopic Heller esophagomyotomy was completed,
followed by an anterior Dor fundoplication in six
cases and a Toupet in two. The longitudinal division of the
anterior esophageal musculature was performed with a scalpel
or scissors. The myotomy was made along the stomach,
extending for $2–3 cm.
Results: Mean operating time was 120 mins. Three complications
were recorded. There were two perforations of the
gastroesophageal mucosa; the first was sutured in laparoscopy
and the second required a second operation. The third
complication was a case of dysphagia resolved by dismounting
a fundoplication that was too tight. At follow-up,
which lasted from 6 months to 5 years, the children were all
free of symptoms.
Conclusions: Laparoscopic Heller esophagomyotomy appears
to be a complex and difficult operation, but it is as safe
and effective as laparotomy in children with achalasia.
However, complications can be numerous and severe at the
beginning of a surgeon’s experience