Wilfredo GARCIA

This is the case of a 2-year-old male preschooler, diagnosed with type III esophageal atresia. During the neonatal period, the patient had a right thoracotomy. Ligation of a tracheo-esophageal fistula and an esophago-esophagostomy were carried out, but failed because there was a long gap atresia. The measured gap of four vertebrae confirmed the diagnosis of long gap esophageal atresia; upon its evaluation by a multidisciplinary team, a laparoscopic gastric pull-up was carried out using 4 trocars: one 12mm, two 5mm and one 3mm trocar. The 6-hour duration of surgery was due to a firm adhesion of the esophagus to the posterior mediastinum. The patient had a favorable outcome without major complications. He remained in PICU for 72 hours and was extubated 48 hours after surgery. This is the sixth case of this particular pediatric surgeon and although our follow-up is still underway, we believe that laparoscopic pediatric surgeons with a certain degree of experience would be able to reproduce this technique, which is an excellent therapeutic option for the management of long gap esophageal atresia with good postoperative results.

This is the case of a 22-month-old female infant. The pathology started two weeks before with a gradual increase of abdominal circumference and intermittent hypo-colic stools. A CT-scan of the abdomen showed a large cystic tumor with interior partitions measuring 16.5 in width by 10.6 in length by 12.1cm in depth, originating in segments V and VI of the liver, displacing the remaining liver to the left and compressing the right kidney, bowel, celiac artery, gallbladder, and pancreas. A laparoscopic approach for tumor resection was decided on due to the scarce tumor vascularization and entirely cystic consistency. The procedure required 4 ports, three of 5mm and one of 3mm, emptying the cystic content of approximately 2 liters of citrine fluid. Dissection was performed using the Ligasure™ vessel-sealing device and monopolar cautery, preserving adjacent vital structures and preventing bleeding. The surgical specimen was removed through the umbilical scar. No transfusion was required and surgery lasted four hours. There were no postoperative complications. As a result, laparoscopic surgery is considered a safe procedure for the excision of large tumors in children provided they are cystic and benign, as emptying the cyst gives broader visualization of the area and permits better tissue handling.