ABSTRACT
Objective To evaluate the effectiveness of laparoscopic sutured anastomosis of the duodenum for children with congenital duodenal obstruction (CDO). Methods From February 2003 to July 2008,13 patients (aged 2 days to 12 years) with CDO underwent laparoscopic sutured anastomosis of the duodenum in our hospital. Among the cases,7 were newborns,3 were infants,and 3 were children. Laparoscopy showed duodenal atresia or stenosis in 7 cases,annular pancreas in 2 cases,superior mesenteric artery syndrome (SMAS) in 3 cases,and preduodenal portal vein in 1 case. Results Excepting the patient with preduodenal portal vein,who was converted to mini-laparotomy for duodenojejunostomy,all the cases were treated by laparoscopy. In 5 cases,the diaphragm was excised partially after a vertical incision was made at the anterior part of the duodenum,and then a transverse suture was completed; the 2 patients with duodenal atresia and the 2 with annular pancreas received diamond-shaped side-to-side duodenoduodenal anastomosis under a laparoscope; and the 3 cases of SMAS were treated by Roux-en-Y duodenojejunostomy. The mean operation time in this series was (97.0?18.2) min (range,75 to 180 min). No intraoperative complications occurred. The patients started oral intake in 2 to 5 days after the surgery,and resume a normal diet in 7 to 9 days. Before being discharged from the hospital,upper gastrointestinal tract imaging showed no evidence of obstruction in the patients.A follow-up up to 6 months to 4 years were available in 11 patients,among which 8 were followed for more than 1 year. During the period,the patient developed well. Conclusions The laparoscopic sutured anastomosis of the duodenum is feasible and effective for children. It can be performed in neonates securely as an excellent minimally invasive treatment for congenital duodenal obstruction.
ABSTRACT
Objective To explore the feasibility and efficacy of laparoscopic rectopexy with peritoneal strips for severe complete rectal prolapse (SCRP) in children. Methods From August 2004 to October 2008,6 patients (aged 2 to 6 years with a mean of 3.5) with SCRP were treated in our hospital. The clinical data of the patients were reviewed. Under the laparoscope,two L-shaped peritoneal strips with the pedicle were cut from the incrassated and slack peritoneum of the pelvic cavity on bilateral sites of the rectum,and then were folded and sutured with the lateral wall of the free rectum with the ends being stitched on the fascia in front of the sacral promontory to suspend the rectum. Afterwards,the incisal margin of the peritoneum was sutured together with the anterior wall of the rectum in order to embed the peritoneal strips and reconstruct the pelvic peritoneum. Results All of the 6 cases of laparoscopy were completed successfully with a mean operation time of (120?24) min (ranged from 95 to 210 min). The blood loss was less than 10 ml in all of the cases. The patients received a mean of 28-month follow-up (range,6 to 54 months),during the period,none of them had recurrence or abnormal bowel movement. Conclusions Laparoscopic rectopexy with peritoneal strips is an effective and satisfactory treatment for SCRP with minimal invasion,quick recovery and a low-recurrence rate.
ABSTRACT
Objective To explore the feasibility and value of laparoscopic cholecystectomy (LC) for acute cholecystitis complicated with incarcerated gallstones. Methods From January 2005 to December 2007,71 patients with acute cholecystitis complicated with incarcerated gallstones received laparoscopic cholecystectomy by using four trocars in our hospital. The Arteria cystica and ductus cysticus were operated successively. For widened ductus cysticus,we ligated the duct first and then cut it off. Afterwards,the wound on the liver bed and its margin were electrocoagulated. After the operation,a drainage tube was placed under the liver. Results Of the patients,the LC were successfully completed in 67 cases (94.4%),4 cases were converted to open surgery (2 of them had a disease course of less then 3 days,and one over 3 days). No biliary injury or death occurred in this series. The patients were discharged from hospital in 2-6 days (mean,3 days). No complication was found during a 6-month follow-up. Conclusions With the improvement of operator's proficiency and skills,LC becomes feasible and safe for acute cholecystitis complicated with incarcerated gallstones.