monthly focus

surgical intervention video

Enteric duplication cysts (EDCs) are rare congenital malformations due to embryonic development alterations of the digestive tract (1). They are usually prenatally diagnosed. Postnatal clinical presentation depends on size, location, type, mucosal pattern, and presence of complications (1). Usually, ultrasound is sufficient to confirm the suspected diagnosis. However, in case of doubt, second-level imaging such as magnetic resonance and computed tomography may be useful (2). Surgery must be always performed due to the high risk of intestinal obstruction, perforation, and neoplastic evolution. There are different surgical options, namely conservative surgery, including cyst excision without intestinal resection, which is now considered the treatment of choice, and intestinal resection with end-to-end anastomosis (1). Even if there are no significant differences in terms of complications, growth, and stool frequency between patients undergoing different surgical procedures. Resumption of oral intake and hospital stay after surgery are significantly shorter in patients undergoing cyst excision without ileocecal resection (3). This video shows the case of a 2-month-old boy presenting with an ileocecal duplication cyst.



References:

1. Sangüesa Nebot C, Llorens Salvador R, Carazo Palacios E, Picó Aliaga S, Ibañez Pradas V. Enteric duplication cysts in children: varied presentations, varied imaging findings. Insights Imaging. 2018 Dec;9(6):1097-1106. doi: 10.1007/s13244-018-0660-z. Epub 2018 Oct 11. PMID: 30311079; PMCID: PMC6269332.



2. Yan J, Yan J, Ding C, Guo J, Peng Y, Chen Y. Clinical features of colorectal duplication in children: A study of 25 cases. J Pediatr Surg. 2022 Sep;57(9):97-101. doi: 10.1016/j.jpedsurg.2021.09.042. Epub 2021 Oct 2. PMID: 34706815.



3. Yan J, Lei W, Yan J, Ding C, Liu T, Chen Y. Ileocecal duplication in children: a single-center experience of 115 cases. Eur J Pediatr. 2022 Nov;181(11):3937-3944. doi: 10.1007/s00431-022-04611-8. Epub 2022 Sep 12. PMID: 36094665.



Laparoscopic cyst excision without intestinal resection for an ileocecal duplication cyst in a 2-month-old boy

Excision kystique par laparoscopie sans résection intestinale pour kyste de duplication iléo-cæcal chez un garçon de 2 ans

Vertebral body tethering (VBT) is an innovative surgical technique used to treat idiopathic scoliosis in pediatric patients. Unlike conventional methods that involve posterior arthrodesis, VBT focuses on early intervention before skeletal maturity. This procedure involves a thoracoscopic anterior approach, in which a flexible Tether™ is attached to the vertebral bodies, allowing for a controlled growth modulation. VBT aims to correct spinal deformities while preserving spinal flexibility, hence reducing the need for a definitive fusion. It offers a less invasive option in young patients with scoliosis, potentially leading to improved outcomes and quality of life. 



Bibliography: 

1. Roser, Megan J., et al. « Vertebral Body Tethering for Idiopathic Scoliosis: A Systematic Review and Meta-Analysis ». Spine Deformity, juillet 2023. Springer Link, https://doi.org/10.1007/s43390-023-00723-9. 

2. Raitio, Arimatias, et al. « Vertebral Body Tethering: Indications, Surgical Technique, and a Systematic Review of Published Results ». Journal of Clinical Medicine, vol. 11, no 9, janvier 2022, p. 2576. www.mdpi.com, https://doi.org/10.3390/jcm11092576. 

3. Vatkar, Arvind, et al. « Vertebral Body Tethering in Adolescent Idiopathic Scoliosis with More than 2 Years of Follow-up- Systematic Review and Meta-Analysis ». European Spine Journal, vol. 32, no 9, septembre 2023, p. 3047 57. Springer Link, https://doi.org/10.1007/s00586-023-07724-2. 

Vertebral body tethering in adolescent idiopathic scoliosis, a fusionless anterior correction 

Modulation de croissance par ligament antérieur dans la scoliose idiopathique de l'adolescent : une correction sans fusion

Conventional treatment options for high abdominal testis included the laparoscopic Fowler-Stephens orchiopexy (FSO) and the microvascular autotransplantation of the testis, both of which had suboptimal outcomes. In 2008, the Shehata technique was proposed as a staged laparoscopic assisted technique to lengthen testicular vessels, facilitating scrotal orchiopexy with promising results and minimal complications. In this video, the procedure was demonstrated in a stepwise fashion highlighting key anatomical landmarks and fundamental technical aspects. In this approach, the intra-abdominal testis was evaluated for the feasibility of one-stage orchiopexy. If the vessel is short, the testis is mobilized medially to be sutured to the abdominal wall on the contralateral side near the anterior superior iliac spine. This allows the vessels to gain length within a two-month period. This lengthening occurs thanks to the gentle continuous pressure exerted by the weight of the gut on the horizontally oriented testicular pedicle. In the second stage, the testis can be brought to the scrotum without tension through a neo-ring medially to the inferior epigastric vessels. The novel technique of two-stage laparoscopic traction orchiopexy is useful in intra-abdominal testis but not amenable to one-stage laparoscopic assisted orchiopexy as it resulted in a significant elongation of testicular vessels without atrophy. It is a safe and good alternative for the two-stage laparoscopic Fowler-Stephens technique, which entails the division of the main testicular vessels. 



Bibliography:

1. Shehata S, Shalaby R, Ismail M, Abouheba M, Elrouby A. Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique) Stretching the limits for preservation of testicular vasculature. J Pediatr Surg 2016. doi:10.1016/j.jpedsurg.2015.10.063.

2. Shehata SM, Shehata SMK, A. Baky Fahmy M. The intra-abdominal testis: Lessons from the past, and ideas for the future. Pediatr Surg Int 2013;29. doi:10.1007/s00383-013-3406-5.

3. Shehata SM. Laparoscopically assisted gradual controlled traction on the testicular vessels: A new concept in the management of abdominal testis. A preliminary report. Eur J Pediatr Surg 2008;18. doi:10.1055/s-2008-1039028.

Staged laparoscopic orchiopexy for intra-abdominal testis (Shehata technique)

Orchidopexie laparoscopique par étapes selon Shehata pour cryptorchidie

This video describes the rare case of a laparoscopic central hepatectomy in a pediatric patient. A pure laparoscopic anatomical resection of Couinaud’s liver segment IVb and segment V resection in a 5-year-old boy suffering from a hepatoblastoma was performed. This video may be useful to pediatric oncologists and surgeons.



Bibliography:

1.	Wang J, Jin S, Zhang Y. A Report of 21 Cases of Laparoscopic Liver Resection in Children. J Laparoendosc Adv Surg Tech A. 2020 May;30(5):581-585. doi: 10.1089/lap.2019.0376. Epub 2020 Mar 26. PMID: 32213130.

2.	Veenstra MA, Koffron AJ. Minimally-invasive liver resection in pediatric patients: initial experience and outcomes. HPB (Oxford). 2016 Jun;18(6):518-22. doi: 10.1016/j.hpb.2015.11.004. Epub 2016 Apr 23. PMID: 27317956; PMCID: PMC4913138.

3.	Wakabayashi G, Cherqui D, Geller DA, Abu Hilal M, Berardi G, et al. The Tokyo 2020 terminology of liver anatomy and resections: Updates of the Brisbane 2000 system. J Hepatobiliary Pancreat Sci. 2022 Jan;29(1):6-15. doi: 10.1002/jhbp.1091. Epub 2021 Dec 20. PMID: 34866349.

4.	Torzilli G, McCormack L, Pawlik T. Parenchyma-sparing liver resections. Int J Surg. 2020 Oct;82S:192-197. doi: 10.1016/j.ijsu.2020.04.047. Epub 2020 Apr 23. PMID: 32335245.





Laparoscopic liver segmentectomy IVb with segment V resection for hepatoblastoma in a 5-year-old child

Segmentectomie laparoscopique du segment hépatique IVb avec résection du segment V pour hépatoblastome chez un enfant de 5 ans

video lecture

In this authoritative lecture, Dr. Steven Rothenberg considers the evolution of a technique, providing an update on thoracoscopic repair of esophageal atresia and tracheoesophageal fistula (TEF), 24 years after the first thoracoscopic approach.

Update on thoracoscopic repair of esophageal atresia and tracheoesophageal fistula (TEF), 24 years after the first thoracoscopic approach: evolution of a technique

Prise en charge thoracoscopique de l'atrésie de l'œsophage et de la fistule trachéo-œsophagienne, 24 ans après la première approche thoracoscopique : évolution d'une technique

In this authoritative lecture, Dr. Chiarenza outlines the laparoscopic repair of duodenal atresia.

Duodenal atresia: laparoscopic repair

Atrésie duodénale : prise en charge laparoscopique

Chirurgie laparoscopique pour neuroblastome rétropéritonéal localement avancé

This video presents the case of a laparoscopic resection of a locally advanced retroperitoneal neuroblastoma in a pediatric patient. Although neurogenic tumors are a quite common pediatric tumor, this procedure has limited indications, especially in patients with a large number of risk factors. Since there is a risk of injury to the main vessels, it is not often performed. This video may be useful to pediatric oncologists and surgeons. 



Bibliography:

1. Huang G, Yang G, Huang W, Liu M, Su Y, Li S. Laparoscopic surgery for stage III neuroblastoma: A case report. Exp Ther Med. 2022 Jun 17;24(2):524. doi: 10.3892/etm.2022.11451. PMID: 35837030; PMCID: PMC9257955.

2. Shaffiey SA, Le HD, Christison-Lagay E, et al. Critical elements of pediatric neuroblastoma surgery. Semin Pediatr Surg. 2023;32(5):151338. doi:10.1016/j.sempedsurg.2023.151338

3. Kawano T, Souzaki R, Sumida W, Ishimaru T, Fujishiro J, Hishiki T, Kinoshita Y, Kawashima H, Uchida H, Tajiri T, Yoneda A, Oue T, Kuroda T, Koshinaga T, Hiyama E, Nio M, Inomata Y, Taguchi T, Ieiri S. Laparoscopic approach for abdominal neuroblastoma in Japan: results from nationwide multicenter survey. Surg Endosc. 2022 May;36(5):3028-3038. doi: 10.1007/s00464-021-08599-4. Epub 2021 Jun 18. PMID: 34143289.

Focus on pediatric surgery