Comparison of the Laparoscopic and Open Methods of Gastrostomy at Neonates and Infants Up To Three Months of Age.

Background: An open surgical intervention is a common approach for gastrostomy tube placement in neonates and infants. Also available, however less often used, is a laparoscopic technique for low-profile gastrostomy tube (button) placement. In this study we compare the pre-, intra-, and post-procedural outcomes of each technique. Methods: We retrospectively evaluated all open and laparoscopically inserted gastrostomies at our department from January 2002 to December 2016 and compared them in terms of operative parameters and outcomes. Results: In the study interval, 44 open and 90 laparoscopically placed low-profile (button) gastrostomies were performed. There were no significant differences in gender distribution, mean age (42.54 versus 34.16 days), and mean weight (3311 versus 3476 g). The frequency of concomitant Nissen fundoplication was higher in the laparoscopy group (18% versus 47%; P < .05). The duration of G-tube placement by laparotomy was significantly longer (mean difference 16 minutes), than by laparoscopy, as were time periods between G-tube insertion and the onset of first feeding (mean differences 8.4 and 19.6 hours, respectively). Children in the laparoscopy group spent nearly 15 fewer days in the hospital than those who received a G-tube by laparotomy (29.0 versus 13.9; P < .05). Major complications were observed in 3 (6.82%) patients in the laparotomy group in the form of gastric content leak into the abdominal cavity and resulting peritonitis; complications were lower in the laparoscopy group (68.18% versus 13.33%; P = .03). Conclusions: Compared with open gastrostomy, the laparoscopic approach appears to be advantageous with respect to procedural duration, initiation of feedings, hospitalization duration, and rate of complications. Another difference was the frequency of concomitant Nissen fundoplication. Further prospective studies may determine the role of these patient-specific factors regarding who benefits most from the laparoscopic technique.

Comparison of Two Laparoscopic Techniques for Gastropexy in Children.

BACKGROUND: Laparoscopic gastrostomy is a widely used interventional procedure in pediatric surgery. We report comparative data for two endosurgical methods for the fixation of the stomach against the abdominal wall, using the U-stitches technique and the Saf-T-Pexy® (Halyard Health Inc., Alpharetta, GA) system. MATERIALS AND METHODS: Within the period from January 2012 to June 2014 we performed 24 operations involving laparoscopic placement of a gastrostomy tube using U-stitches (Group I) and 24 operations using the Saf-T-Pexy system (Group II). The two groups of patients were compared in terms of demographics and intraoperative and postoperative results. RESULTS: No statistical difference (P > .05) was found while comparing the patients' demographics and intra- and postoperative results. The mean duration of the surgical procedure in Group I was 23.75 minutes; in contrast, the mean duration of surgery in Group II was 22.71 minutes (P > .05). The time to first feeding (9.96 hours versus 10.63 hours) and time to full enteral feeding (23.13 hours versus 24.5 hours) were consistent for patients from both groups (P > .05). A similar postoperative duration of stay was recorded for the patients from the comparison groups (7.25 days versus 7.21 days; P > .05). Statistical analysis of the two groups demonstrated a significant difference in the parameters of minor postoperative complications (41.67% versus 8.33%; P < .05). CONCLUSIONS: Use of the Saf-T-Pexy system is a simple and efficient method for gastropexy involving placement of gastrostomy tubes that significantly reduces the number of postoperative complications.

Single-incision pediatric endosurgery in newborns and infants.

This study focuses on the successful application of single-incision pediatric endosurgery in the treatment of congenital anomalies and acquired diseases in neonates and infants. The purpose of this scientific review consists in highlighting the spectrum, indications, applicability, and effectiveness of single-port endosurgery in children during the first 3 postnatal months.

Technology of Single-Incision Laparoscopic Surgery in Treatment of Inguinal Hernia in Small Babies.

PURPOSE: The aim of this study was the comparison of single-port and multiport laparoscopic methods for the treatment of inguinal hernia in children during the first 3 months of life. SUBJECTS AND METHODS: Between January 2002 and December 2012, we performed 260 laparoscopic operations in neonates and infants with the diagnosis of inguinal hernia. Surgical procedures were single-port endoscopic herniorraphy (Group I; 180 patients) and multiport laparoscopic herniorraphy (Group II; 80 patients). The two groups were compared for demographics of patients, operative report, and early and late postoperative outcomes. RESULTS: We applied the single-port laparoscopic method for correction of inguinal hernia in small babies. The mean operative time (duration of one-sided and bilateral repair) in Group I was 16 minutes, whereas the mean duration of the operation in Group II was 15.73 minutes. The number of doses of postoperative analgesia was 1.19 and 1.22, respectively. The length of hospital stay was 8.12 hours in Group I and 8.27 hours in Group II. No differences between the two groups were recorded in the follow-up period: no recurrence in either group and hydrocele formation in only 1 patient in Group II. CONCLUSIONS: There are similar functional results in treatment of inguinal hernia in babies during the first 3 months of the life using single- and multiport laparoscopy. Scarless cosmetic results are seen in the single-incision laparoscopic surgery group.

Thoracoscopic plication of the diaphragm in infants in the first 3 months of life.

PURPOSE: Thoracoscopic plication of the diaphragm is an alternative to conventional surgical treatment of diaphragmatic evisceration via thoracotomy in neonates and infants. The aim of this study is to compare results of treatment by these two methods in the past 11 years. MATERIALS AND METHODS: We studied the data of 35 neonates who underwent standard posterolateral thoracotomy (18 patients; Group I) or video-assisted thoracoscopic surgery (17 patients; Group II) for diaphragmatic plication. The two groups were compared for patient demographics, operative reports, and postoperative parameters. RESULTS: The groups were similar in terms of demographics and preoperative parameters. There was a significant difference in mean operative time between the open and thoracoscopic procedure (71.67 minutes versus 51.76 minutes; P<.05). Duration of care in the neonatal intensive unit and length of hospital stay were significantly shorter in Group II (5.89 days versus 3.23 days [P<.05] and 13.06 days versus 9.88 days [P<.05]). Early postoperative complications (hemothorax, pneumothorax) were frequent in the thoracotomy group (Group I) (16.67% versus 0%; P>.05). Recurrence of diaphragmatic evisceration was observed only in the thoracotomy group (11.11% versus 0%; P=.486). CONCLUSIONS: Thoracoscopic plication of the diaphragm in infants in the first 3 months of life demonstrates better results than open surgery.

Laparoscopic nephrectomy: advantages of technique in infants and newborns.

UNLABELLED: In spite of the appearance of new instruments, equipment, and new surgical techniques, the amount of laparoscopic procedures in newborns and infants remains limited. Nevertheless, some advantages of the laparoscopic nephrectomy technique in infants, which we present in this article allow us to recommend this approach as the method of choice in some renal pathologies in infants and newborns. MATERIALS AND METHODS: During the last 2 years of using laparoscopy, we removed 9 multicystic dysplastic kidneys. All babies were full term. The mean age was 5 weeks (range, 3-9) at the time of the procedures, and mean body weight was 4.130 g (range, 3.750-5.230 g). RESULTS: Five of the 9 removed kidneys were located at the left side. The average size of removed kidneys was: length from 30 to 70 mm, width from 25 to 40 mm. During the procedures, we noted the following technical advantages in infants, in comparison with older children: Troacarless approaches for instruments are easy to do and for the exchange of instruments, if necessary We did not need more than three approaches at the same time Wide mobilization and back fixation of colon are not necessary Kidney mobilization is easy enough We did not need clip application, just coagulation of vessels Easy mobilization of the ureter without any additional peritoneum cutting Possibility of extraction of nonfragmented kidney The mean duration of the procedure was 47 + or - 8 minutes, including changing the babies' position. All babies needed postoperative analgesia just once, and all of them were discharged on the day after procedures. In all cases, we observed good aesthetic results. CONCLUSIONS: We believe that the laparoscopic approach should be considered if nephrectomy is indicated in newborns and infants less than 3 month of life. There are the advantages that simplify the surgical technique, reduce quantity of the necessary endoscopic instruments, and minimize surgical trauma and morbidity, thereby improving cosmetic results and reducing hospital stay in this age group.