Clinical impact of open versus laparoscopic approach on the outcome in cases of congenital duodenal obstruction: A comparative study

Introduction Congenital duodenal atresia/partial duodenal obstruction/duodenal stenosis is one of the most common variants of intestinal atresia, occurring 1 in 2500–5000 live births. The aim of this study was to compare between both the laparoscopic and open approaches for repair of congenital duodenal obstruction regarding their effects on outcome.Patients and methods A total of 20 cases diagnosed with congenital duodenal obstruction (atresia, web, and stenosis) in the neonatal and pediatric surgical units of Cairo University Specialized Pediatric Hospital were studied. All cases underwent either laparoscopic or open repair. Cases associated with malrotation or multiple atresias were excluded. Patients’ characteristics, including age, sex, presenting symptoms, associated anomalies, preoperative investigations, intraoperative details, and postoperative outcomes, were documented.Results A total of 20 cases of duodenal obstruction were included in this study over 1 year, from January 2017 to January 2018. We did duodenoduodenostomy in 15 cases (web in the second part of duodenum, types II and III) and excision of the web in the first part of duodenum in five cases. Laparoscopic repair was done in 11 (55%) cases (diamond-shaped duodenoduodenostomy in nine cases and web excision in two cases) whereas open technique was performed in nine (45%) cases (diamond duodenoduodenostomy in six cases, and excision of the web in three cases). The average operative time in cases of laparoscopic duodenoduodenostomy was 120 min whereas in the cases of open technique was 90 min. The average time needed until full feeding to be achieved was 6–7 days in cases done  laparoscopically, whereas other group was 10–20 days. In this cohort, no stricture or leakage or wound dehiscence was found in both groups. Laparoscopic group afforded a better cosmesis and more parent satisfaction.Conclusion Use of the laparoscope in duodenal obstruction in either neonates or children is a safe and easy technique, and despite being a lengthier operation, feeding could be established earlier. Keywords: duodenal atresia, laparoscopic, TPN

Usefulness of laparoscopy for determining the location of transitional zone in patients with inconclusive barium enema for Hirschsprung’s disease: a prospective clinical trial

Objective: The present study aims to evaluate the efficacy of laparoscopy to localize the transitional zone in cases of Hirschsprung’s disease (HD) with nondiagnostic contrast enema.Summary background data: In the treatment of HD, preoperative ascertainment of the extent of aganglionosis by contrast enema is crucial, as this affects the planning for transanal endorectal pull-through. Patients with aganglionic rectal biopsy with inconclusive barium enema present difficulty in determining the extent for transanal resection asthe colon is not directly visualized as compared with transabdominal approach.Patients and methods: A study was conducted in our institution on 30 patients fulfilling such criteria with a median age at the time of surgery of 50 months. The location of the transitional zone by intraoperative laparoscopy view was used to plan further management.Results: The junction between normal dilated bowel with peristalsis and aganglionic collapsed bowel without peristalsis was marked by diathermy followed by transanal endorectal pull-through in the same setting in 14 (46.7%) cases. Subsequent histopathological examination of the excised specimens showed adequately ganglionated surgical margin in all 14 cases. In three (10%) patients, the transitional zone was seen in the most distal part of the rectum and the patients were diagnosed as suffering from very shortsegment HD; therefore, anorectal myectomy was performed. In the remaining 13 patients no definite funnel was seen and leveling biopsy was done to exclude total colonic HD. Since frozen section biopsy was not available in our facility at the time of this study, all biopsies were sent for fixed paraffin sections. Further management for biopsied patients at later stage was in the form of either anorectal myectomy in five (16.7%) patients or Botox injection in eight (26.7%) patients.Conclusion: Laparoscopy was found to be a useful diagnostic and therapeutic tool for such patients.Keywords: Hirschsprung’s disease, laparoscopic biopsy, transanal endorectal pull-through, transition zone, ultra-short segmen

Modified Bianchi pyloromyotomy versus laparoscopic pyloromyotomy for patients with infantile hypertrophic pyloric stenosis: Intraoperative considerations and parents’ satisfaction

Introduction Infantile hypertrophic pyloric stenosis is a common cause of persistent nonbilious vomiting during infancy. Ramstedt pyloromyotomy through right upper quadrant transverse incision is the conventional treatment. The laparoscopic and Tan-Bianchi approaches were introduced to improve the cosmesis and decrease postoperative morbidity. In this study, we compared between laparoscopic and modified Bianchi approaches regarding intraoperative technical considerations and postoperative outcomes.Patients and methods The study included 40 patients with infantile hypertrophic pyloric stenosis. Overall, 20 patients underwent laparoscopic pyloromyotomy (LP) and the other 20 patients underwent modified Bianchi pyloromyotomy (MBP). Patients’ characteristics, including age, sex, gestational age, and associated  comorbidities, were documented. Intraoperative details and complications and postoperative outcomes were recorded.Results The operative time and intraoperative complications including mucosal perforation and bleeding did not significantly differ between both the groups. From the laparoscopic group, one (5%) case was complicated by mucosal perforation and converted to open and another case (5%) developed hypercapnia. There was no statistically significant difference between the two groups regarding time till full feed (P=0.648) and postoperative hospital stay (P=0.082). In addition, there was no statistically significant difference between the two groups regarding postoperative complications, with one (5%) case from the laparoscopic group underwent incomplete myotomy and required redo-operation and another case (5%) developed wound infection. MBP had a significantly more parent satisfaction regarding cosmesis than LP (P=0.016).Conclusion MBP is comparable to LP regarding intraoperative complications and postoperative outcomes; however, the modified Bianchi approach offered more parent satisfaction than laparoscopic approach.  Keywords: laparoscopic, modified Bianchi, pyloric stenosis, pyloromyotom

Outcome of primary posterior tracheopexy in thoracoscopically repaired esophageal atresia neonates with tracheomalacia; single center's experience

Background: Tracheomalacia frequently develops in esophageal atresia patients (EA) especially in those with tracheoesophageal fistula (TEF). Conservative management has been the standard treatment; however, it was reported that delay in management could result in chronic lung conditions. Thus, early surgical interventions have been recently recommended. Patients and Methods: We enrolled patients presented with type-C esophageal atresia, with concomitant moderate to severe tracheomalacia, who had their thoracoscopic intervention done during the study period 2019–2022. Early and intermediate- term outcomes were studied and compared to another cohort with mild or no tracheomalacia. Results: During the allocated study period, 24 patients met the inclusion criteria for tracheopexy, but only 17 were followed up due to early demise of the other seven. During the follow-up period, 7/17 patients developed respiratory symptoms, which were attributed to esophageal stricture in 5 patients, recurrent TEF in 2 patients and one of them had residual tracheomalacia in addition to the developed recurrent TEF. The outcomes of the enrolled patients for tracheopexy were similar to those with no or mild tracheomalacia. Conclusions: Primary posterior tracheopexy during the primary repair might be considered a safe and feasible option not only to alleviate respiratory symptoms secondary to tracheomalacia in EA patients, but also to decline the need of further surgical interventions. However, more comprehensive studies with long-term follow-ups are mandatory