Using an optical trocar for laparoscopic access in overweight and obese children.

The open Hasson technique with a purse-string suture is generally favored among pediatric surgeons performing laparoscopy. This is a challenge in overweight and obese children and often leads to delays or conversion to laparotomy. In this article, we report our experience with an optical trocar for primary port access in overweight and obese children.

Surgical outcome in biliary atresia: etiology affects the influence of age at surgery.

Objective: The exact nature of the relationship between age at Kasai portoenterostomy (KP) for biliary atresia (BA) and outcome is controversial.

Methods: Single-center retrospective analysis of consecutive cases (January 1994-December 2005) undergoing KP, using 2 dichotomous measures of outcome (clearance of jaundice to <20 micromol/L and native liver survival at 2 years post-KP). Outcome was analyzed by age cohort (<30 days, 30-40 days, etc) and cumulatively.

Spontaneous perforation of the biliary tract and portal vein thrombosis in infancy.

Spontaneous biliary perforation (SBP) is an uncommon cause of surgical jaundice in the first few weeks of life and is characterised by the occurrence of a punched-out defect in the bile duct, typically where the cystic duct joins the common hepatic duct. In most cases the site occurs anteriorly and bile leaks into the general peritoneal cavity. We now describe two cases of SBP where the perforation occurred posteriorly, limiting the leak and resulting in delayed recognition.