[Laparoscopic cholecystectomy in children and adolescents]. / Laparoskopická cholecystektomie u detí a adolescentu

INTRODUCTION: In the treatment of cholelithiasis in adults, laparoscopic cholecystectomy is the method of first choice. There is plentiful literary evidence of the low complication incidence in this age group, but similar assessment is lacking in the paediatric population. In this work, the authors focus on cholelithiasis in children and the possible use of laparoscopy in the diagnostic - therapeutic scheme. MATERIAL AND METHODS: The study group consisted of 148 patients operated on by laparoscopic cholecystectomy between 2002 and 2011 at the Department of Paediatric Surgery, Orthopaedics and Traumatology of University Hospital Brno. The first objective of the study was to evaluate the length of surgery; the second one was the occurrence of complications which were divided into intraoperative and postoperative. Intraoperative complications were subdivided into severe and moderate, postoperative complications into early and late. The last objective was to evaluate the benefit (number of complications, treatment outputs) of intraoperative cholangiography for obstructive jaundice before the surgery. RESULTS: In the above mentioned period, 143 laparoscopic cholecystectomies and five laparoscopic cholecystectomies including splenectomy were performed. The average age of the patients was 13.9 years; the average length of laparoscopic surgery was 52 minutes. One major, serious intraoperative complication (0.7%) was recorded - injury to the ductus hepaticus communis. Moderate intraoperative complications occurred in 4.5%. Furthermore, one serious early postoperative complication (0.7%) - bleeding from the cystic artery --and one minor (0.7%) - in a patient with acute pancreatitis after endoscopic retrograde cholangiopancreatography - was recorded. Late postoperative complications occurred in 4% of the patients. Conversion of laparoscopic operation with a definitive resolution of the serious condition was performed in one patient because of the aforementioned serious intraoperative complications. Eleven patients underwent intraoperative cholangiography; extraction of stones from the bile duct was performed in six cases. CONCLUSION: Intraoperative cholangiography in children and adolescents can be recommended as a safe and effective imaging modality for patients with preoperative evidence of biliary obstruction. Laparoscopic cholecystectomy in children and adolescents can be clearly recommended as an effective and safe surgical technique convenient for paediatric patients.

[Laparoscopic surgery varicocele in the childhood and adolescent--our experience with 202 patients]. / Laparoskopické operace varikokély v detském a adolescentním veku--nase zkusenosti s 202 pacienty.

UNLABELLED: The aim of this work was to assess benefits and complications of laparoscopic procedures of varicocoelas in children and adolescents, conducted in our clinic. MATERIAL AND METHODOLOGY: From 2000 to 2004, 202 patients (198 with leftsided, 2 with rightsided and 2 with bilateral varicocoelas) underwent laparoscopic procedures in our clinic. Patients with stage II and III varicocoelas were operated. The median age of the operated patients was 15 years (range 11-18 years). The procedures saved arteries and lymphatics maximally. RESULTS: During a two-year follow up period, 8 patients (3.96%) relapsed, 21 patients (10.39 %) presented with hydroceolas. No testical hypotrophy was recorded in our patient group. Also, no peroperative complications were recorded during the laparoscopic procedures. The procedures lasted 20.4 min, on average, hospitalization lasted 4.2 days, on average (range 4-6 days). CONCLUSION: Laparoscopic varicocolectomy, maximally saving arteries and lymphatics, proved a safe method. The rate of complications is similar to that of other treatment procedures of childhood varicocoelas. Rather long term effects considering a quality of hormonal production of testes and seminal counts, than postoperative complications rates, are the main parametres for choice of a treatment method.

[Laparoscopic surgical procedures in children with the Hirschprung's disease--initial experience]. / Laparoskopické operace u detí s Hirschprungovou nemocí--první zkusenosti.

Laparoscopically assisted resection of the large intestine in the Hirschprung's disease patients was introduced into practice worldwide in mid 90-ies of the last century. In the Czech Republic this procedure had not been conducted. The aim of this work was to introduce the method in the Czech Republic. In this study the authors present their initial experience with this new method. They have successfully operated three patients with this disorder.

[Comparison of laparoscopic and open nephrectomy in children]. / Srovnání laparoskopických a otevrených nefrektomií u detí.

Between August 1997 and October 2000 16 children aged 13 months to 15 years (mean 5.9 years) were subjected to laparoscopic nephrectomy on account of benign kidney disease, 10 by a transperitoneal approach, 6 by the retroperitoneal route. Retrospectively this group was compared with a group of 16 children aged 1 month to 15 years (mean 4.6 years) where in 1995-1998 nephrectomy was performed for the same reasons by the open route. The mean duration of the operation was 106.5 min. for the laparoscopic approach and 54.3 min. for open surgery (p = 0.00004), the postoperative drainage of the wound was 1.18 days in laparoscopic operations and 2.12 days in open operations (p = 0.025). The mean period of hospitalization was 5.12 and 6.68 days resp. (p = 0.003), analgetics were administered for 21.3 and 31.25 hours resp. after operation (p = 0.03). As to the beginning of oral food intake there was no significant difference, a blood transfusion was administered to one patient after the open operation. One patient developed a postoperative complication after open nephrectomy. The authors consider laparoscopic nephrectomy in children a safe and useful method.

[Use of central venous catheters in children with hematologic neoplasms from the viewpoint of the pediatric surgeon]. / Pohled detského chirurga na pouzití centrálního zilního katétru u hematologicko-onkologicky nemocných detí.

Venous access by cannulation of the central vein is a necessary prerequisite of the oncological treatment. Within the period 1998-2001 there 395 CVCs (Central Venous Catheters) were introduced using a subcutaneous tunnel in 335 hospitalised patients at the Clinic of the Child Surgery, Orthopaedics and Traumatology FN Brno. In 310 patients Hickman CVC was used and in 25 Groshong CVC. Using the vena subclavia 1. dx., 131 CVCs were introduced, via the vena subclavia 1. sin. 264 CVCs. The average period of CVCs introduction was 3 months. In 78 introduced CVCs infectious complication developed. A local infection was noticed only 8 times, general infection at 70 cases. In 13 patients CVCs had to be removed. The authors present their experience with the introduction of tunneled CVCs in oncological patients and the options for solving the infectious complications when using CVCs.

[The importance of laparoscopy in children]. / Význam laparoskopie u detí.

The authors submit the evaluation of 720 laparoscopic operations performed at the Clinic of Child Surgery and Traumatology in Brno between the end of 1994 and May 1999. The group is formed by children aged 3 weeks to 18 years. The mean age was 8.4 years. The authors recorded once an early and 4 times a late complication. None of the complications were serious and did not threaten the child's health or life. With regard to ever more frequently performed acute laparoscopy the percentage of conversions (2.5%) is higher. The authors emphasize there is practically no age limit for performing this operation (32 infants and toddlers). On the other hand, perfect technical equipment and adequate training of the whole team is necessary.

[Effectiveness of dilatation of distal urethral stenosis in girls]. / Efektivita dilatací distální stenózy dívcí uretry.

Dilatation of distal urethral stenoses is one of the relatively frequent minor operations in child urology. The authors present a group of 830 female patients age 2-16 years treated by dilatation of the urethra in 1988-1994. According to the predominating finding they divide the cases into three groups--vesicoureteral reflux (VUR), infection of the urinary pathways (IUP), enuresis--and in these they evaluate the effectiveness of the operation, which was greatest in the group of patients with IUP (37%). Finally they discuss both possibilities of treatment of stenoses--dilatation and urethrotomy.

[Moth fragments as intraocular foreign bodies]. / Falterfragmente als intraokulare Fremdkörper.

The authors describe an accident leading to penetration of the eye of an 11-year-old boy by an unusual foreign body, and the subsequent diagnosis and treatment. Persistent ocular irritation following a corneal perforation wound, in spite of appropriate treatment, led to the presence of an intraocular foreign body being suspected. The results of radiologic examination, including CT (Siemens Somatom 2), were negative. Only A-scan sonography (Kretztechnik 7002) called attention to the possibility of a foreign body in the vitreous behind the traumatic cataract. Extracapsular extraction was immediately followed by careful removal of very small foreign-body particles from the vitreous. Once the corneal sutures had been removed the irritation decreased. The scanning electron microscope (Cambridge) images of the largest particle showed the foreign bodies to be fragments of a moth (order Noctuideae).