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Minimally invasive surgery for esophagectomy and tubularized gastric pull-up
The accidental ingestion of caustic agents is a common problem in pediatric emergency units. These agents can cause a series of damage to the upper gastrointestinal tract and can lead to an esophageal stricture. We present the case of a 4-year-old girl who was referred to our hospital for vomiting and hematemesis after ingesting a caustic solution. Physical examination revealed tongue edema and denuded buccal mucosa. Friable mucosa and esophageal ulceration were observed in the endoscopy. The patient was administered omeprazole and a nasogastric tube was placed for a week. Two esophageal strictures were observed after 3 weeks of the ingestion. The patient underwent esophageal dilatation once or twice a month during 21 months depending on the symptoms. Due to the refractory stricture, we decided to perform an esophagectomy and tubularized gastric pull-up by combining thoracoscopy, laparoscopy, and cervicotomy. In addition, we performed a jejunostomy to provide sufficient nutritional support. The patient started feeding on postoperative day 7 and she is currently asymptomatic.
I Cano Novillo, A García Vázquez, F de la Cruz Vigo, B Aneiros Castro
Surgical intervention
3 months ago
845 views
4 likes
1 comment
12:40
Minimally invasive surgery for esophagectomy and tubularized gastric pull-up
The accidental ingestion of caustic agents is a common problem in pediatric emergency units. These agents can cause a series of damage to the upper gastrointestinal tract and can lead to an esophageal stricture. We present the case of a 4-year-old girl who was referred to our hospital for vomiting and hematemesis after ingesting a caustic solution. Physical examination revealed tongue edema and denuded buccal mucosa. Friable mucosa and esophageal ulceration were observed in the endoscopy. The patient was administered omeprazole and a nasogastric tube was placed for a week. Two esophageal strictures were observed after 3 weeks of the ingestion. The patient underwent esophageal dilatation once or twice a month during 21 months depending on the symptoms. Due to the refractory stricture, we decided to perform an esophagectomy and tubularized gastric pull-up by combining thoracoscopy, laparoscopy, and cervicotomy. In addition, we performed a jejunostomy to provide sufficient nutritional support. The patient started feeding on postoperative day 7 and she is currently asymptomatic.
Thoracoscopy for voluminous left thoracic neuroblastoma in a 2-year-old girl
Video-assisted oncological surgery should be performed in strict compliance with surgical oncology requisites: complete excision, no risk of cancer cell dissemination, and no additional operative risks. Radical surgery requirements must be respected and adjacent organs must be preserved. Our team contributed to research articles on neurogenic tumor surgery, published in international medical journals in 2007 (J Pediatr Surg, 2007; 42 (10): 1725-8 and J Laparoendosc Adv Surg Tech A 2007; 17 (6): 825-9).
Our case study further demonstrates that the thoracoscopic resection of neurogenic tumors perfectly meets oncological surgery requirements, offering the parietal benefits of minimally invasive surgery. A magnified operative field is a major asset because it allows performing surgery safely. It is now possible to gain a perfect knowledge of the patient and tumor anatomy preoperatively by using a 3D modeling tool and preoperative CT-scan images of the patient.
C Klipfel, A Lachkar, F Becmeur
Surgical intervention
3 months ago
360 views
1 like
0 comments
04:32
Thoracoscopy for voluminous left thoracic neuroblastoma in a 2-year-old girl
Video-assisted oncological surgery should be performed in strict compliance with surgical oncology requisites: complete excision, no risk of cancer cell dissemination, and no additional operative risks. Radical surgery requirements must be respected and adjacent organs must be preserved. Our team contributed to research articles on neurogenic tumor surgery, published in international medical journals in 2007 (J Pediatr Surg, 2007; 42 (10): 1725-8 and J Laparoendosc Adv Surg Tech A 2007; 17 (6): 825-9).
Our case study further demonstrates that the thoracoscopic resection of neurogenic tumors perfectly meets oncological surgery requirements, offering the parietal benefits of minimally invasive surgery. A magnified operative field is a major asset because it allows performing surgery safely. It is now possible to gain a perfect knowledge of the patient and tumor anatomy preoperatively by using a 3D modeling tool and preoperative CT-scan images of the patient.
Subtotal laparoscopic splenectomy for hemolytic disorders in a 5-year-old girl
In case of hemolytic disease, subtotal splenectomy is an alternative to total splenectomy, the efficacy of which has been evidenced in the literature (Inter J Surg 2010;8:48-51). This procedure is particularly relevant in young children as it precludes risks of infection related to total splenectomy. Subtotal splenectomy should reduce the size of the splenic parenchyma by 80% in order to prevent recurrence and completion surgery in the short term. In 2008, we had already reported a first multicentric study on subtotal splenectomy (Surg Endosc 2008;22:45-9).
Technically, it is interesting to have access to an inconstant artery draining the superior pole of the spleen, which is then left in place (Surg Endosc 2006;21:1678). When this artery is not present, the superior pole of the spleen will be preserved as it is vascularized by one or two short vessels of the gastrosplenic omentum.
F Becmeur, C Klipfel, A Lachkar
Surgical intervention
3 months ago
849 views
7 likes
0 comments
04:19
Subtotal laparoscopic splenectomy for hemolytic disorders in a 5-year-old girl
In case of hemolytic disease, subtotal splenectomy is an alternative to total splenectomy, the efficacy of which has been evidenced in the literature (Inter J Surg 2010;8:48-51). This procedure is particularly relevant in young children as it precludes risks of infection related to total splenectomy. Subtotal splenectomy should reduce the size of the splenic parenchyma by 80% in order to prevent recurrence and completion surgery in the short term. In 2008, we had already reported a first multicentric study on subtotal splenectomy (Surg Endosc 2008;22:45-9).
Technically, it is interesting to have access to an inconstant artery draining the superior pole of the spleen, which is then left in place (Surg Endosc 2006;21:1678). When this artery is not present, the superior pole of the spleen will be preserved as it is vascularized by one or two short vessels of the gastrosplenic omentum.
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
T Huy, H Osei, AS Munoz Abraham, R Damle, GA Villalona
Surgical intervention
8 months ago
674 views
5 likes
0 comments
05:33
Laparoscopic ligation of middle sacral artery and dissection of sacrococcygeal teratoma to decrease intraoperative hemorrhagic risk
Sacrococcygeal teratomas are the most common teratomas presenting at birth. Life-threatening bleeding is a major complication during tumor excision in children. In this video, we demonstrate our technique for the laparoscopic division of the middle sacral artery during dissection of sacrococcygeal teratomas in two pediatric patients.
Two female infants diagnosed with type IV and type III sacrococcygeal teratomas underwent preoperative evaluation in the postnatal period. The first patient was an 18-month-old female patient who presented with a metastatic type IV teratoma resected after neoadjuvant therapy. The second patient was a 6-day-old female infant with a prenatal diagnosis of cystic type III teratoma. Using laparoscopy in both patients, the presacral space was reached by opening the peritoneal reflection with blunt dissection and the middle sacral artery was identified. It was then carefully isolated and divided with a 5mm LigaSure™ vessel-sealing device. The pelvic components of the tumors were partially dissected using laparoscopy. The first patient’s tumor resection was completed using a posterior sagittal approach and the second patient required a standard Chevron incision.
Both patients underwent a successful laparoscopic division of the middle sacral artery and resection of the sacrococcygeal teratomas without complications. As a result, laparoscopic middle sacral artery division before sacrococcygeal teratoma excision offers a safe approach which can reduce the risk of hemorrhage during surgery.
Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.
R Adjerid, F Sebaa, N Otsmane, A Khelifaoui
Surgical intervention
8 months ago
1714 views
9 likes
1 comment
05:13
Laparoscopic treatment of a hydatid cyst of the liver in children
Introduction:
Hydatid cyst is a parasitic disease caused by the Echinococcus granulosus tapeworm. Laparoscopic treatment of a hydatid cyst of the liver remains controversial and few series have been published. The aim of this work is to present a case of liver hydatid cyst in an 8-year-old girl treated laparoscopically.
Case presentation:
An 8-year-old child was admitted to our department for the management of a voluminous liver hydatid cyst. The patient underwent a thoraco-abdominal CT-scan, which concluded to a left lobe liver hydatid cyst. The laparoscopic open access is achieved at the umbilicus using a 10mm port. Carbon dioxide pneumoperitoneum pressure is maintained at 10mmHg. Two other 5mm ports are introduced in the right and left hypochondrium. A 0-degree laparoscope is then used. The cyst is protected by means of pads filled with a 10% hypertonic saline solution. After we proceed to a puncture aspiration of the cyst, sterilization is achieved via injection of a hypertonic saline solution during 15 minutes, then reaspiration is performed with a Veress needle. The cyst is opened with a coagulating hook and the proligerous membrane is removed and put in a bag. The last step is the resection of the dome and the search for biliary fistula. We drained the residual cavity. The pads are removed. The Redon drain was removed on day 2 and the patient was discharged from hospital on postoperative day 3. Postoperatively, the patient was put on albendazole (10mg/kg) for one month.
Conclusion:
Laparoscopy stands for an excellent approach to the treatment of a hydatid cyst of the liver in children by respecting appropriate indications.