A simple technique for thoracoscopic treatment of diaphragmatic eventration.

True diaphragmatic eventration is a rare congenital defect that is most commonly asymptomatic, but can result in dyspnea and recurrent respiratory infections. Advancements in endoscopic technology and technique have resulted in minimally invasive methods for repair of this defect with pronounced benefit when compared to the open thoracotomy. We report a case in which a two year old male who suffered from recurrent respiratory infections was found to have unilateral right diaphragmatic eventration that underwent plication utilizing thoracoscopy and cutting endostaplers with Peri-strips. This procedure was followed by a remarkably fast recovery and discharge, improved radiological findings, and a reprieve from respiratory infection.

Choledochoduodenostomy: is it really so bad?

BACKGROUND: Choledochoduodenostomy (CDD) has been shunned by some surgeons for the management of the benign distal common bile duct stricture due to the potential complication of "sump syndrome." The feared sump syndrome is theorized to occur from bile stasis and reflux of duodenal contents into the terminal common bile duct with bacterial overgrowth, resulting in cholangitis or hepatic abscess. The true incidence and resultant morbidity of sump syndrome, however, are not well defined. METHODS: With the approval of the Institutional Review Board, a retrospective chart review of all patients undergoing choledochoduodenostomy for benign disease at a single institution between 1994 and 2008 was undertaken. Data were collected with particular attention to operative indications, perioperative course, and long-term results. Long-term outcomes were assessed through clinical reports at outpatient follow-up, emergency room visits, and hospital readmissions. RESULTS: Seventy-nine patients underwent side-to-side CDD for benign diseases over the 15-year period [51 (65%) men; mean age, 52 years (standard deviation (SD), 12)]. Indications for surgery included chronic pancreatitis (80%), choledocholithiasis (11%), and cholangitis (4%). Patients presented with abdominal pain (80%), nausea/vomiting (30%), and jaundice 13%. Sixty-one patients (77%) underwent an additional procedure at the time of their CDD, including lateral pancreaticojejunostomy (26%). There was no perioperative mortality. Postoperative complications occurred in 15 (19%) patients, including intraabdominal abscess (26%), wound infection (20%), and biliary leakage (13%). The mean hospital stay was 9.7 days (SD, 6.9). The mean follow-up was 6.2 years (SD, 4.2). There was no occurrence of cholangitis. Two patients (2.5%) developed hepatic abscess, which was managed by antibiotics and image-guided percutaneous drainage. CONCLUSIONS: CDD is a safe and effective method of decompressing the distal common bile duct in benign pancreatobiliary disease. Long-term results are acceptable, with sump syndrome being a rare occurrence.