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#June 2019
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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
842 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
359 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
844 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.