Surgical treatment of idiopathic megarectum in constipated children.

BACKGROUND: Chronic constipation in children is associated with primary megarectum. This study investigated outcomes of surgical treatment of idiopathic megarectum in children. METHODS: This retrospective comparative study included 52 children with idiopathic megarectum (mean age, 9.4 ±â€¯1.7 years) treated from 2007 to 2016. Patients were divided into 2 groups. Group 1 included 23 patients who underwent a Soave pull-through operation. Group 2 included 29 children who underwent laparoscopic low anterior resection with endorectal stapled anastomosis using laparoscopic ultrasound guidance. All patients had clinical and laboratory evaluations with anorectal manometry, colonoscopy and contrast enema studies. RESULTS: Six patients (26.1%) in Group 1 and one (3.5%) in Group 2 experienced anastomosis leakage requiring colostomy (χ2 = 3.867, P = 0.049). In long-term follow-up, 3 children (13.1%) in Group 1 and 2 (6.9%) in Group 2 had ongoing constipation; this difference was not significant. Frequent loose stools with soiling were significantly more common in Group 1 (14 patients; 60.9%) than in Group 2 (4 patients; 13.8%) (χ2 = 10.566, P = 0.001). CONCLUSIONS: Our experience shows that laparoscopic video-assisted low anterior resection of the colon with endorectal stapled anastomosis under laparoscopic ultrasound guidance to determine the level of colon resection is the better operation then Soave for children with idiopathic megarectum and chronic constipation. This approach provides good functional results and reduces complications. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Laparoscopic Treatment in Children with Hydatid Cyst of the Liver.

BACKGROUND: There is no consensus on the surgical treatment of children with hydatid cyst of the liver (HCL). We evaluated the outcomes of laparoscopic and open surgery for childhood HCL. METHODS: We performed 81 open surgery and laparoscopic procedures in 37 (45.7%) boys and 44 (54.3%) girls with HCL (mean age 9.3 ± 2.1 years) who were assigned to a main group (laparoscopy, n = 21) and a control group (open surgery, n = 60). Clinical assessments, surgical durations, complications, and postoperative outcomes were investigated. Cyst types in the two groups were I (Gharbi)/CE 1 (WHO-IWGE), 71.4 and 58.3%, respectively; II/CE 2, 19.1 and 25.0%, respectively; and III/CE 3, 9.5 and 16.7%, respectively. The parasitic hydatid cysts were located mostly in the right liver lobe in both the main and control groups (90.4 and 80.0%, respectively). RESULTS: Hospital stays were significantly (p < 0.05) longer in patients in the control group (12.1 ± 1.5 vs. 5.6 ± 2.2 days). Operation time was significantly (p < 0.01) shorter for the main group (90.1 ± 7.8 vs. 120.6 ± 5.3 min). Local complications (residual cavity infection, biliary fistula) occurred in 21.6% of patients in the control group and 14.3% in the main group. Each was treated, and none recurred. There were no apparent systemic complications. CONCLUSIONS: Laparoscopic surgical treatment for children with HCL is safe in compliance with all classic open surgery principles. The laparoscopic technique offered a shorter duration of the surgical effects and markedly fewer postoperative complications.

Outcome of Laparoscopic Treatment of Anorectal Malformations in Children.

BACKGROUND: Operative correction of anorectal malformations (ARMs) remains a challenge in pediatric surgery. The study aimed to evaluate the outcomes of laparoscopic treatment of ARM in children. METHODS: From 2007 to 2014, we performed 104 laparoscopic-assisted anorectal pull-through procedures in children with a mean age of 11.3 ± 0.4 months and ARMs. Clinical assessment, surgical durations, complications, and postoperative outcome were investigated. RESULTS: The mean duration of the operation was 126.5 ± 17.2 min. Mean intraoperative bleeding was 20 ± 5.7 g. Three (2.9 %) children required conversion to laparotomy. One (0.9 %) child developed a pelvic abscess, requiring an additional intervention. Three to six months after laparoscopic-assisted anorectal pull-through, 72 patients were hospitalized for stoma closure. Good functional results were achieved in 39 (54.2 %) patients. On examination of the perineum, 11 (15.3 %) patients were found to have mucosal prolapse. The circular symmetric anal reflex to tactile stimulation was confirmed in 53 (73.6 %) patients and a tactile weakened anal reflex in 5 (6.9 %) children. At the 1-year follow-up, constipation was present in nine (12.5 %) patients and soling in two (2.8 %) patients. A barium enema study performed after the operation showed good outcomes in 67 (93.1 %) patients and fair outcomes in 5 (6.9 %) patients. None had a poor outcome. CONCLUSIONS: Our experience confirms that laparoscopic-assisted anorectal pull-through enabled complete correction of ARM in the meanwhile avoiding damage to the rectum and anus. Also, the technique of double bipolar myostimulation of muscle complex in laparoscopic ARM might lead to these better results.