Totally laparoscopic combined freehand ileocystoplasty and malone procedures

Background and Purpose: Cecostomy performed together with open enterocystoplasty can allow continent bowel evacuation in children with neurogenic dysfunction. We present the first report on a combined approach to fecal and urinary incontinence in children with myelomeningocele that was performed exclusively by freehand laparoscopy. Patients and Method: We treated six dysrhaphic patients for total urinary and fecal incontinence by laparoscopy. Through five ports, a selected segment of ileum was isolated with cautery. A single-layer intestinal anastomosis, fashioning of the U-shaped patch, and anastomosis to the opened bladder dome were all done by endocorporeal freehand suturing. The tip of the appendix was simply brought to the skin via a trocar site. Results: The procedures took 5 to 8.5 hours. Patients remained hospitalized for 5 to 16 days (median 5 days). At 13 to 16 months' follow-up, all patients remain continent of urine, and nearly perfect fecal continence has resulted on antegrade enema. Leak from the ileal anastomosis in one patient resolved rapidly with conservative management. One short retrocecal appendix later developed stenosis and was replaced by a tubed cecal flap. Conclusion: Apart from its cosmetic advantage, this procedure is notable for addressing all evacuation problems at one session. Our suturing time seems reasonable compared with open sutured precedents. Use of a gastrointestinal stapling device for anastomosis would have significantly increased the cost while not necessarily guaranteeing against complications. We present this laparoscopic combination as an effective alternative to its open counterpart. © Mary Ann Liebert, Inc

Laparoscopic v open donor nephrectomy for pediatric kidney recipients: Preliminary report of a randomized controlled trial

Background and Purpose: Laparoscopic surgery is widely accepted for nephrectomy in adult renal transplantation. The success of this technique has not been compared with open donor nephrectomy (ODN) in children. Patients and Methods: In this randomized clinical trial, 40 adult kidney donors were randomly divided into two groups: 20 cases of laparoscopic donor nephrectomy (LDN) and 20 of ODN. Recipients had an age of <15 years. Our exclusion criteria were previous renal transplantation, hemolytic uremic syndrome, focal segmental glomerulosclerosis, oxalosis in the recipients, and multiple renal arteries bilaterally in donors. Results: All donor nephrectomies were completed as scheduled, and no patients undergoing LDN required conversion to open nephrectomy. No patients in either the ODN or the LDN group required reoperation. Acute rejection was diagnosed in six patients receiving kidneys procured by ODN (30) and 4 patients (20) receiving kidneys obtained by LDN (P = 0.3). No recipients or donors died. At 1 year, the graft survival times in the ODN and LDN groups were 310.8 ± 28.8 and 302.7 ± 28.2 days, respectively (P = 0.8). Conclusion: At our medical center, pediatric LDN recipients had graft outcomes similar to those of ODN recipients. We recommend LDN for harvest of kidneys for pediatric recipients at experienced centers. © 2007 Mary Ann Liebert, Inc

Feasibility and safety of clipless and sutureless laparoscopic adrenalectomy: A 7-year single center experience

Purpose: Laparoscopic adrenalectomy (LAD) is considered the gold standard surgical method for resecting adrenal tumors. To date, only few small studies have investigated the safety of clipless laparoscopic adrenalectomy in which the adrenal vessels were controlled by the LigaSure system or bipolar coagulation. The aim of the present study was to evaluate the safety and feasibility of sutureless and clipless laparoscopic adrenalectomy operations performed in our center. Materials and Methods: All patients with functional adrenal tumors, nonfunctional adrenal tumors larger than 5 cm and secondary adrenal metastases from the kidneys, lungs or breasts who had underwent an LAD procedure between 2012 to 2019 were included in our study. In all of the cases, complete coagulation of adrenal veins was achieved through bipolar cautery and no vascular staplers, clips or other energy sources were used for controlling the adrenal vessels whatsoever. Outcomes of interest included operation time, length of hospital stay, changes of serum hemoglobin level, and occurrence of major complications. Results: Of a total 251 patients, unilateral right and left-side adrenalectomy was performed in 168 and 67 cases, respectively, and 16 cases had underwent bilateral adrenal resection. The mean age (SD) of patients was 40.7 (13.6) years old at the time of operation and the mean size (SD) of the adrenal lesions was 5.2 (3.1) cm as measured by the greatest diameter. Histological examination showed that the most common pathology of the resected adrenal glands was pheochromocytoma (n=78). None of the laparoscopic operations required a conversion to open surgery. Also, major bleeding or other serious complications did not occur in any of the cases either intraoperatively or postoperatively. Conclusion: Clipless and sutureless laparoscopic adrenalectomy seems to be feasible and safe for removing adrenal tumors. Moreover, bipolar cautery is associated with an acceptable outcome for vessel closure. © 2019 Urology and Nephrology Research Centre

Preliminary report of a nationwide case-control study for identifying risk factors of tuberculosis following renal transplantation

Background. Tuberculosis (TB) is an important infection encountered posttransplantation, especially among patients in developing countries, where there are high incidences of morbidity and mortality. Materials and Methods. One hundred and twenty subjects (1) from 15 major kidney transplantation centers in Iran from 1984 to 2003 were compared with 440 controls who were matched for operative time, treatment center, and surgical team. Results. Mean ages of research subjects and controls were 38.6 and 36.6 years (P = .04), respectively. The mean duration of pretransplantation hemodialysis was 29 months (range, 2 to 192 months) in research subjects and 20 months (range, 1 to 180 months) in controls (P = .003). Positive past history of tuberculosis was detected in 4 (3.3) research subjects and in 7 (1.5) controls (P = .2). Fifty-two research subjects (43.3) and 241 controls (54.8) had pretransplantation purified protein derivative of tuberculin less than 5 mm (P = .02). Mean dosages of initial and maintenance immunosuppressive drugs in research subjects and in controls were not significantly different. Sixty research subjects (50) and 152 controls (34.5) had rejection prior to diagnosis of TB (P = .03). Conclusion. To our knowledge, this is the first study that demonstrates an increased risk of posttransplant TB by prolonged duration of pretransplant hemodialysis and number of posttransplant rejection episodes. Further study is needed to clarify these findings specifically with respect to various immunosuppressive regimens. © 2005 by Elsevier Inc. All rights reserved