Laparoscopic cholecystectomy versus open cholecystectomy in children.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is well accepted as the standard cholecystectomy only in adult patients. However, the advantages of LC over open cholecystectomy have never been proved in pediatric patients because the number of pediatric cholecystectomies is limited as well as the faster ability of pediatric patients to resume their normal activity. MATERIAL AND METHOD: Retrospective study of 42 pediatric cholecystectomies (laparoscopic cholecystectomy (n = 8) (LCs), open cholecystectomy alone (n = 8) (OCs) and open cholecystectomy concomitant with splenectomy (n = 26)(OCs + S)) done in Siriraj University Hospital, Bangkok, Thailand between 1992 and 2000 was conducted. RESULTS: Statistical comparison revealed that LC was superior to OC in regard to diet resumption. LCs resumed soft diet on 1.38 days, whereas OCs and OCs + S could resume soft diet on 3.38 and 3.35 days respectively. The average length of hospitalization following LCs was significantly shorter than OCs' and OCs + S' ones (3.00 vs 8.38 and 4.85 days respectively). There was no morbidity and mortality in LCs, whereas two OCs and three OCs + S had complications. CONCLUSION: In this preliminary study, laparoscopic cholecystectomy is a preferred method of cholecystectomy in children because it has a shorter post-operative interval of diet resumption and shortens hospitalization with minimal morbidity. However, this study has a limited number of patients and further study is still required to conclude the benefits of LC.

All-in-one parenteral nutrition in surgical neonates.

During 1982-1990, we gave peripheral parenteral nutrition (PPN) using “single bottle technique” to 130 neonates with very satisfactory results. After following some experimental works from literature on lipid emulsion stability, we have developed total nutritional admixtures (all-in-one) that incorporate fat, aminoacids, dextrose, minerals, trace elements and vitamins in one container. Since 1993, all-in-one PN has been given to 27 neonates. The majority of cases suffered gastroschisis, omphalocele, tracheo-esophageal fistula, intestinal atresia and necrotizing enterocolitis. Duration of all-in=one feeding ranged from 5 to 46 days (60% were within 8-15 days). Complications ere minimal, phlebitis occurred only in 2 cases and cholestasis in one case. No precipitation or bacterial growth was detected. Five babies died from the severity of their conditions not from PPN. Compared with 51 neonates who received the old conventional method in the same period f time, there were no difference in the result. The all-in-one admixture ad administration of nutrition is simpler for the nurses, allowing more time for other activities and only one infusion pump is used. The cost of the conventional parenteral nutrition in the neonate is well tolerated, effective and safe.

Treatment of anal fissure in children.

Anal fissure is a very common condition in small children. Constipation, painful defecation and bleeding during defecation are usually main complaints. The conventional therapy using laxatives, enema, stool softener, local treatment and dietetic measures are generally accepted but still it is not clear that how long it will take for treating anal fissure adequately. This paper presents a conventional therapy for anal fissure in 124 children, aged 1 month to 6 years. Parents were advised to pay attention to the children strictly according to the schedule of treatments. Follow up was done regularly after 2, 4, 8 and 12 weeks in every case. The result revealed that treatment is time consuming. At least eight weeks were required before most of the symptoms disappeared. The cooperation of parents is also an important factor involving results of treatment and preventing recurrence.