Laparoscopic cholecystectomy: the treatment of choice for cholelithiasis in infancy and childhood

Twelve consecutive laparoscopic cholecystectomies [LC] were performed between January 1994 and October 1996 at King Khalid University Hospital. In all patients the indication for cholecystectomy was symptomatic gallstones. Among the 12 children, six had sickle cell disease. The operating time ranged between 65 and 135 minutes [mean=89 +/- 21.06]. There was no major morbidity or mortality. The average duration of postoperative parenteral analgesia [pethidine hydrochloride] required was 0.47 +/- 0.19 day [ranged between 0.3 and one day]. The average postoperative stay was 1.67 +/- 0.44 days [ranged between 1 and 2.5 days]. In conclusion, LC is safe, effective and the preferred approach for cholelithiasis in children, with the advantages of short postoperative analgesia requirement, shorter hospitalization, and therefore, an early return to normal daily activities

management of esophageal strictures in children

During a 10-year period from 1982 to 1992, 36 children and infants were treated for esophageal stricture. The severity of the stricture was indicated by the degree of feeding intolerance manifested by delays in growth and development and confirmed by fluoroscopy and endoscopy. Their ages ranged from one month to seven years. During the first eight years, the initial treatment was the conventional use of Savory dilators. Balloon dilatation was applied in all patients with esophageal stricture during the last two years. According to the etiology of the stricture, patients were divided into three groups. Group A: [seven patients] due to peptic esophagitis following persistent gastroesophageal reflux [GER]. Group B : [15 patients] following ingestion of corrosive material. All had severe strictures; two had stomach outlet obstruction in addition. Group C : [14 patients] following repair of esophageal atresia. There was no mortality; however, overall morbidity was 5.5%, as one patient had esophageal perforation during the initial esophageal dilatation and one patient developed anastomotic leak

Midline cervical cleft

Three patients with midline cervical cleft are reported. To our knowledge, this rare condition has not been described previously in Arab children. A description of the lesion, its management and a review of the literature are given

experience of modified soave procedure in King Khalid University Hospital

A modification of the original Soave procedure is described in this paper. Eight patients within the age range 6 months to 14 years at the time of presentation were operated upon. Three of those were referred after trial of conservative treatment for constipation to exclude or confirm Hirschsprung's disease; in five, transverse colostomy had already been performed. There was no operative mortality but three patients had postoperative complications; namely anal stenosis and subacute intestinal obstruction

Gastric transposition for oesophageal replacement in childhood

Two infants who presented with long-gap oesophageal atresia and tracheo-oesophageal fistula were initially treated in King Khalid University Hospital by division of the fistula, gastrostomy and cervical oesophagostomy. A year later the whole stomach was used to replace the oesophagus. One patient had herniation of the small bowel into the chest months after surgery, through the old oesophageal hiatus. This required surgical intervention. Both patients showed a normal growth and developmental pattern over the 2 years following surgery. Gastro-oesophageal reflux has not been a problem in either patient

Volvulus of the sigmoid colon in a child

Volvulus of the sigmoid colon, which is common in certain groups of adults and in certain ethnic groups, is extremely rare in infancy and childhood. The clinical features and the radiological appearances may not distinguish the condition from other causes of an acute abdomen. We report this condition in a Saudi child in whom laparotomy and simple reduction of the volvulus proved satisfactory