Treatment of pectus excavatum in patients over 20 years of age.

Background: The ideal time to operate on pectus excavatum (PE) using the Nuss procedure (NP) is between 12 and 18 years of age, because it is more difficult to bend the sternum of older patients and they have more pain and complications. The authors present a prospective study of adult patients with PE operated on by NP, analyzing technical improvements, new tricks, bar modifications, and preliminary outcomes.

Materials And Methods: From May 2003 to September 2009, 19 patients presenting PE (group 1), aged 20-27 years, underwent NP.

Laparoscopically assisted esophagectomy and colon interposition for esophageal replacement in children: preliminary results of a novel technique.

Background: Colonic interposition is one of the surgical options in children when esophageal replacement is necessary, especially when the stomach is not suitable as a conduit. Conventional open surgery and blind mediastinal dissections present reasonable morbidity, which can be reduced by videosurgery. The authors present novel techniques and the preliminary results of the first series of laparoscopically assisted esophagectomies and colonic interpositions (LECIN) in children.

Laparoscopic gastric pull-up for long gap esophageal atresia.

Background: Esophageal replacement (ER) is indicated for long gap esophageal atresia (LGEA) when anastomosisis not possible, especially in cases without fistula or when elongation techniques have failed. The authors show their techniques and analyze preliminary results of the laparoscopic gastric pull-up (LGPU) for ERin LGEA.

Methods: Four children with LGEA admitted for ER (three type A, one type C) underwent LGPU.

Experimental antegrade enema. Effects on water, electrolyte and acid-base balances with different solutions.

Purpose: To study the effects on the water, electrolyte, and acid-base balances in rabbits submitted to antegrade enema with different solutions through appendicostomy.

Methods: Forty male New Zealand rabbits were submitted to appendicostomy, and distributed in 4 groups, according to the antegrade enema solution: PEG group, polyethylene glycol electrolyte solution (n=10); ISS group, isotonic saline solution (n=10); GS group, glycerin solution (n=10); SPS group, sodium phosphate solution (n=10). After being weighed, arterial blood gas analysis, red blood count, creatinine and electrolytes were measured at 4 times: preoperatively (T1); day 6 postop, before enema (T2); 4h after enema (T3); and 24h after T3 (T4).

Laparoscopic treatment of biliary atresia and choledochal cyst.

Minimally invasive surgery (MIS) has overcome many technical limitations and has evolved into a safe alternative for the treatment of many complex pediatric surgical procedures. The introduction of this approach for the correction of congenital biliary tract anomalies had to wait until instrumentation and surgeons' skills improved enough. This happened not so long ago: less than 10 years have elapsed since the first reported case of a minimally invasive operation for choledochal cyst and less than 3 years since the first reported case of a laparoscopic Kasai.

Laparoscopic Kasai portoenterostomy for biliary atresia.

Conventional surgery for extrahepatic bile-duct atresia (EHBDA) usually requires a large, painful, muscle-cutting laparotomy, dislodgment of the liver, and wide manipulations, followed by adhesions and possible complications that may disturb the postoperative course and hamper liver transplantation (LT). The main role of laparoscopy in EHBDA has been for diagnostic purposes. Besides all the advantages of minimally-invasive access, it allows excellent visibility and dissection of tiny hilar structures.