We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Pediatric surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Thoracoscopic repair of pure esophageal atresia
A full-term baby weighing 2.8 kg was diagnosed with pure esophageal atresia. No other associated anomalies were found by abdominal sonography and echocardiography. The primary anastomosis was completed thoracoscopically after mobilization of both esophageal pouches. The patient was placed in a prone position at the edge of the operating table. A 5mm, 30-degree angled scope was introduced one fingerbreadth below the lower angle of the scapula. Two 3mm working ports were also inserted; the first in the same costal space as the camera port 3cm from the middle line and the second as high as possible in the axilla. A thin fibrous strand was found connecting both ends of the esophagus. The azygos vein was left intact. Blunt dissection was used throughout the whole procedure to preserve the aortic branches to the lower pouch, dissecting in between them. Without traction, the distance between both pouches was approximately 4cm or 4 vertebral bodies. No tracheoesophageal fistula (TEF) was identified. Nine polyglactin 5/0 sliding tumble square knots were used to complete the anastomosis. The operative time was 85 minutes. The postoperative period was uneventful. Nasogatric tube feeding started on postoperative day 2, and the patient was discharged on postoperative day 6 after performing a contrast swallow test ensuring that there is no leakage.
MM Elbarbary, KHK Bahaaeldin, AE Fares, H Seleim, A Shalaby, M Elseoudi, MM Ragab
Surgical intervention
1 year ago
1911 views
231 likes
0 comments
18:13
Thoracoscopic repair of pure esophageal atresia
A full-term baby weighing 2.8 kg was diagnosed with pure esophageal atresia. No other associated anomalies were found by abdominal sonography and echocardiography. The primary anastomosis was completed thoracoscopically after mobilization of both esophageal pouches. The patient was placed in a prone position at the edge of the operating table. A 5mm, 30-degree angled scope was introduced one fingerbreadth below the lower angle of the scapula. Two 3mm working ports were also inserted; the first in the same costal space as the camera port 3cm from the middle line and the second as high as possible in the axilla. A thin fibrous strand was found connecting both ends of the esophagus. The azygos vein was left intact. Blunt dissection was used throughout the whole procedure to preserve the aortic branches to the lower pouch, dissecting in between them. Without traction, the distance between both pouches was approximately 4cm or 4 vertebral bodies. No tracheoesophageal fistula (TEF) was identified. Nine polyglactin 5/0 sliding tumble square knots were used to complete the anastomosis. The operative time was 85 minutes. The postoperative period was uneventful. Nasogatric tube feeding started on postoperative day 2, and the patient was discharged on postoperative day 6 after performing a contrast swallow test ensuring that there is no leakage.
Laparoscopic gastric pull-up in long-gap esophageal atresia
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.
A Parilli, W Garcia, I Galdon, G Contreras
Surgical intervention
6 years ago
2199 views
24 likes
0 comments
10:54
Laparoscopic gastric pull-up in long-gap esophageal atresia
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.