Comparative study of respiratory and hemodynamic effects of thoracoscopy versus laparoscopy for repair of congenital diaphragmatic hernias in neonates and infants

The use of minimally invasive surgery has been expanding steadily in pediatric surgical practice. Thoracoscopy and laparoscopy have been used for correction of congenital diaphragmatic defects in neonates and in young children. This study aimed at comparing cardiorespiratory effects of both techniques when used for the repair of congenital diaphragmatic hernias. From January 2007 to December 2007, 20 neonates and young infants were enrolled in the study. Children were all ASA II and III their age ranged from 0-6 months and their mean weight was 4485g. ETCO2, O2 saturation, HR and MAP were recorded at basleine [before insufflation], at 30, 60 minutes after insufflation and 10 minutes after desufflation, also minute volume and peak inspiratory pressure were recorded before and after insufflation. The operative time was also recorded and compared in both groups. The mean operative time was 116 +/- 9.3 minutes for thoracoscopy and 152 +/- 12.5 minutes for laparoscopy p<0.05. O2 saturation decreased from 99.4% +/- 1.3 to 96.1 +/- 4.8 p<0.05 and from 99.2 +/- 1.6 to 95.8 +/- 4.8 p<0.05 in the laparoscopic and thoracoscopic groups respectively. ETCO2 increased from 28.2 +/- 5.4 to 36.1 +/- 6.9 mmHg p<0.05 and from 27.4 +/- 6.5 to 39.8 +/- 4.2 mmHg p<0.05 in the laparoscopic and thoracoscopic groups respectively. The duration of insufflation influenced the increase in ETCO2, as values of ETCO2 recorded after one hour showed the greatest values [39.2 +/- 5.3 and 40.3 +/- 3.9 in the laparoscopic and thoracoscopic groups respectively all patients showed increase in HR from 119 +/- 12.7 to 134 +/- 17.2 heats/minute p<0.05 and from 121 +/- 11.9 to 138 +/- 14.7 heats/minute p<0.05 in the laparoscopic and thoracoscopic groups respectively after CO2 insufflation, in 90% of cases the MAP was stable during CO2 insufflation. In conclusion, this study demonstrated comparable cardiorespiratory effects of thoracoscopy and laparoscopy-within the mentioned insufflation pressure in the study- for repair of CDH in neonates and young infants nevertheless thoracoscopy could be performed in a significantly shorter time

Role of splenic autotransplantation in management of thalassemia major in children

The aim of this study was to assess the outcome of pediatric patients with beta thalassemia undergoing splenectomy with splenic autotransplantation. It was conducted on 20 children suffering from beta thalassemia major over a period of two years. The rate of blood transfusion decreased considerably in both groups. One patient developed severe pneumonia in the NST group. The postoperative laparoscopic biopsy confirmed the reticular pattern of the implants with perivascular lymphocytic aggregations. All the transplanted splenic tissues showed a good uptake on scintigraphy with a gradual increase in C3, IgM and IgG levels at one and three months postoperatively with 1.5-2 fold increase of IgM and IgG levels after vaccination. Splenectomized only patients showed no significant increase in these levels

Anterior versus posterior sagittal anorectoplasty without colostomy for repair of vestibular anus

In this study, rectovestibular and anovestibular fistulae were repaired in 30 girls using the sagittal anorectoplasty technique without colostomy over a period of three years. A preoperative preparation of the bowels was performed using low residue diet, oral mannitol 10% as laxative, intestinal antiseptics and broad spectrum antibiotics with a gradual restoration of oral feeding after surgery. The anterior approach was adopted in 15 consecutive patients and their results were compared with those of other 15 ones to whom the posterior approach was performed. The incidence of wound infection was slightly higher in the PSARP group than in the ASARP, but in both groups, it was mild with no complete disruption of the wound. Generally, excellent results with normal bowel function were obtained in 19 cases with nearly equal results in both ASARP and PSARP groups. Good results having mild constipation that responded to diet or simple laxative with occasional soiling occurred in eight cases. Fair outcome was more frequent in PSART group. Complete incontinence with a poor outcome was not encountered in any of the two groups