Comparison of a novel technique of the microlaparoscopic pyloromyotomy to circumbilical and Weber-Ramstedt approaches.

INTRODUCTION: The aim of this retrospective comparative study was to compare the surgical results and outcomes of the newly inaugurated approach of microlaparoscopic pyloromyotomy with open techniques. METHODS: The surgical charts of 110 infants (85 boys and 25 girls, ages ranging from 10 to 98 (average 28) days) undergoing pyloromyotomy microlaparoscopically (28), through the circumbilical approach (56), or via the right upper quadrant access (26) were reviewed. The variables were compared between the three surgical approach groups, and the statistical analysis was performed. RESULTS: There was a significant difference between Bianchi and microlaparoscopy in terms of operation time (average 38.5 vs. 20.5 min, p < 0.0001) and time to full enteral feed (average 48 vs. 32 h, p = 0.001). There was no significant difference in postoperative length of stay (75 vs. 82 h, p = 0.12). The operative time for the surgeons experienced in microlaparoscopy was in average of 14 min (range, from 9 to 18 min). When comparing the Weber-Ramstedt procedure and microlaparoscopy, microlaparoscopy required significantly less operative time (50 vs. 20 min, p < 0.0001), a shorter time to full enteral feed (70 vs. 32 h, p < 0.001), and a shorter postoperative length of stay (90 vs. 82 h, p = 0.04). There were no cases of mucosal perforation or incomplete pyloromyotomy. CONCLUSION: Despite the small sample size included in the present study, it seems that microlaparoscopic pyloromyotomy is safe and feasible with the lowest rate of complications and the shortest operative time. The Bianchi approach is a good alternative to achieve a small scar without laparoscopy.

A microlaparoscopically assisted pull-through procedure for Hirschsprung's disease: initial experiences.

PURPOSE: The purpose of this prospective study was to evaluate the efficiency, feasibility, and surgical outcomes of microlaparoscopy-assisted pull-through (MAPT) for Hirschsprung's disease. METHODS: Starting in 2005, pull-through procedures for Hirschsprung's disease were performed exclusively using 2-mm instruments and miniscopes (microlaparoscopy). Three miniports were inserted laterally in the right abdominal wall in one line, with the miniscope at the level of the umbilicus and the working trocars cranially/caudally of the scope. The left colon was dissected, and transanal pull-through was performed. RESULTS: MAPT was performed in 16 children (10 boys and 6 girls; average age: 5.7 months). Six patients had previous abdominal surgeries. A 1.9-mm cystoscope or a 2.4-mm arthroscope was used in the first 5 cases. In the remainder, a recently developed 2.4-mm miniscope was used for visualization. The length of the resected colon segment was up to the left colonic flexur in 5 children, up to the middle of the descending colon in 4 cases and up to the sigmoid-descending segment in 7 children. The average operation time was 185 minutes (range: 120-330 minutes). The only intraoperative complication that occurred was an injury of the right iliac vein by inadvertent slippage of an electrocautery hook requiring laparotomy. At follow-up, 80% of the parents were unable to identify the scars after microlaparoscopy. CONCLUSION: MAPT is a safe and practical procedure regardless of age or previous surgery.

Laparoscopic inguinal herniorrhaphy in babies weighing 5 kg or less.

BACKGROUND: This retrospective study aimed to evaluate the feasibility, safety, and complication rate of laparoscopic inguinal hernia repair for small babies weighing 5 kg or less compared with the traditional open herniotomy. METHODS: A retrospective analysis was performed on the surgical charts of 147 infants weighing 5 kg or less who underwent laparoscopic hernia repair. Either a regular 5-mm scope or a microlaparoscope was used for visualization, and 2-mm instruments were used for closure of the inner inguinal ring. RESULTS: Of the 147 infants (100 boys and 47 girls; 41 bilateral, 77 right-sided, 29 left-sided hernias) 39 (26.5%) presented with an irreducible hernia. The median weight at surgery was 3.9 kg (range, 1.45-5 kg). Of the infants, 11 (7.5%) weighed less than 2.5 kg, and 58 (39.4%) were premature. The median operative time for the bilateral hernia was 20 min. No serious intraoperative surgical complications occurred. Anesthesiologic complications were noted in eight cases. After a median follow-up period of 26 months (range, 6-52 months), 124 children were clinically examined. In the boys, testicular volume and echogenic texture were studied ultrasonographically, and testicular perfusion was measured using the O2C device. Hernia recurrence was observed in four patients (2%). According to a linear regression analysis, the risk of recurrence was increased by 14.16% for children classified as American Society of Anesthesiology (ASA) 3 or more. No cases of testicular atrophy occurred. In five boys, we observed seven cases of high testes requiring subsequent orchiopexy (4% of 172 hernia repairs among the boys). The regression analysis showed that for every 1 kg less body weight, the risk of an undescended testis increased by 65.5%. CONCLUSION: Laparoscopic inguinal hernia repair for babies weighing 5 kg or less is feasible, safe, and perhaps even less technically demanding than open herniotomy.

Microlaparoscopic pyloromyotomy in children: initial experiences with a new technique.

INTRODUCTION: We conducted a prospective feasibility study to evaluate the value of microlaparoscopic pyloromyotomy for hypertrophic pyloric stenosis in infants. METHODS: All data were prospectively collected, and the procedures were documented by video recording. Patients were selected based on the availability of the equipment and consultant surgeons experienced in microlaparoscopy. Microlaparoscopic (exclusive use of 2-mm instruments and small-diameter scopes, 1.7-1.9 mm in diameter) pyloromyotomy was performed. All procedures were done under general anesthesia with endotracheal intubation. RESULTS: This study includes 21 infants, 14 boys and 7 girls (aged 3-12 weeks, average 4.8 weeks). Weight at admission averaged 4,100 g (range 3,200-5,500 g). Mean wall thickness of pyloric muscle measured by ultrasound was 4.5 mm (range 3.8-7.8 mm). Average operative time was 13 min for the consultant surgeon. Full feeding was attained on the first postoperative day in 16 infants. Postoperative length of stay averaged 87 h. Eighteen infants were re-examined to assess cosmesis. CONCLUSION: Despite the limited patient population included in this study, we conclude that use of microlaparoscopic pyloromyotomy for hypertrophic pyloric stenosis is safe and feasible, and the technique provides minimal access trauma and superior cosmesis.

Morphine-related apnoea in CPAP-treated preterm neonates.

BACKGROUND: Morphine can be used to treat pain in preterm neonates with CPAP because of its analgetic potency; however, it is known to induce apnoea. AIM: To evaluate this risk of apnoea. METHODS: We retrospectively analysed 91 preterm neonates with CPAP who received morphine intravenously. The incidence of apnoea 4 h before and after morphine administration was compared. The data were analysed for three dosage groups (<0.01, 0.01-0.03 and 0.03 mg/kg) and according to the incidence of apnoea before morphine application. RESULTS: In the whole group (gestational age 29.1+/-2.9 wk, morphine dosage 0.017+/-0.01 mg/kg) we did not find differences in apnoea before and after morphine (0.9+/-1.8 vs 1.1+/-1.8 apnoea). The only significant increase in apnoea was seen in the subgroup of patients receiving > 0.03 mg/kg (0.3+/-0.67 vs 1.5+/-2.5 apnoea). Interestingly, we found a significantly delayed increase in apnoea in the fourth hour. CONCLUSION: Morphine in preterm infants with CPAP is not widely accepted practice until further randomized studies evaluate efficacy and safety. Morphine in a low dosage (