ABSTRACT
Objective:To investigate the feasibility and effectiveness of surgical ligation in the treatment of congenital extra-hepatic portosystemic shunt (Abernethy malformation) in children.Methods:Among the 12 children with Abernethy malformation admitted at our hospital, 9 cases for blood stools, 2 cases for elevated transaminase level and jaundice, and 1 case for hypoxemia. Intraoperatively, if portal pressure was ≤ 26 cm H 2O(1 cmH 2O=0.098 kPa) after clamping the shunt, than the shunt was ligated, when>26 cm H 2O, the portosystemic shunt was partially ligated and the shunt was completely ligated in a two stage. All patients were followed up for 5-70 months (mean: 35.2 months). Results:Six cases underwent the one stage ligation of portosystemic shunt, five cases underwent the two stage ligation and one case with partial ligation of portosystemic shunt. The symptoms of hematochezia relieved in 9 cases. The levels of blood bilirubin and transaminase returned to normal after operation in 2 cases with increased transaminase. The oxygen saturation returned to normal in 1 case with hypoxemia.Conclusion:The surgical ligation of portosystemic shunt is an effective method to treat type Ⅱ Abernethy malformation.
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Objective To investigate the efficacy and safety of laparoscopic repair in children with congenital esophageal hiatal hernia. Methods From September 2001 to December 2008,seven children with congenital esophageal hiatal hernia,including 4 boys and 3 girls,were treated by laparoscopic repair and Nissen's fundoplication in our hospital. One of them received laparoscopic pyloroplasty in the meanwhile because of delayed gastric emptying (confirmed by preoperative gastrointestinal angiography); one child underwent laparoscopic high ligation due to right oblique inguinal hernia; spleneolus was found in one patient,no further treatment was carried out. Results The procedures were completed in all of the patients without conversion to open surgery. The mean operation time was 94.2 min (75-150 min) in this series,and the average blood loss was 5 ml (2-10 ml). No patient received blood transfusion after the surgery. The children began to intake milk or regular diet in 24-48 hours after the operation. They were discharged from hospital in a mean of 4.5 days (ranged from 3 to 7 days). Then,the children were followed up for 6 to 20 months (mean,12.6 months). One of the patients suffered from vomiting on the 10th day after the operation,1 patient showed recurrence in 1 year postoperation and then was cured by a second operation. The other five patients were healthy during the follow-up. Conclusions Laparoscopic repair of congenital esophageal hiatal hernia is a safe,effective,and minimally invasive procedure. It is feasible for patients complicated with other diseases. The indications for the surgery must be strictly selected.
ABSTRACT
Objective To explore the feasibility of laparoscopically assisted one-stage anorectoplasty for the treatment of intermediate imperforate anus. Methods Under laparoscopic visualization, the rectum was mobilized. Then the rectourethral (or rectovaginal) fistula was repaired laparoscopically (6 cases) or through perineal approach (4 cases). Afterwards a tunnel was made through the center of pelvic floor musculature by combined use of laparoscopic and perineal approach. The rectum was pull-through the perineum and anastomosed with skin. At Last the colostomy was closed. Results Laparoscopically assisted anorectal pull-through was successfully performed in all cases. The mean duration of laparoscopic dissection was 32.8 minutes (range, 25~78 minutes). The mean blood loss was 5.3 ml (range, 2~10 ml). No blood transfusion was needed. The intraurethral catheter or cystostomy tube was removed on the 11th postoperative day. No intraoperative complication was encountered and all infants had uneventful postoperative recovery without wound infection. During a follow-up for 3~66 months (mean, 45 months), the fecal continence evaluation showed excellent in 8 cases and good in 3 cases. Conclusions Laparoscopically assisted anorectoplasty is an effective and minimally invasive technique for the treatment of intermediate imperforate anus. This technique has advantages of simple performance, accurate identification of the center of the pelvic floor musculature, and low infection rate.