Laparoscopic partial external biliary diversion procedure in progressive familial intrahepatic cholestasis: a new approach.

Background: Progressive familial intrahepatic cholestasis results in fibrosis, cirrhosis, and liver insufficiency if untreated. Medical therapy often fails and partial external biliary diversion has been recommended to prevent early liver transplantation. We present a new technique of performing a laparoscopic partial external biliary diversion and report our experience in a first series of infants.

Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations.

Background: Anorectal malformations (ARM) are common congenital anomalies seen throughout the world. Comparison of outcome data has been hindered because of confusion related to classification and assessment systems.

Methods: The goals of the Krinkenbeck Conference on ARM was to develop standards for an International Classification of ARM based on a modification of fistula type and adding rare and regional variants, and design a system for comparable follow up studies.

Anuria during pneumoperitoneum in infants and children: a prospective study.

Introduction: Transient oliguria during laparoscopic surgery is a known phenomenon. Currently, no data on the impact of pneumoperitoneum on renal function in children are available.

Patients And Methods: Thirty children with normal kidney function, who underwent laparoscopic surgery, were included in a prospective study.

Thoracoscopic resection of intra- and extralobar pulmonary sequestration in the first 3 months of life.

Background: Thoracoscopic techniques have gained increasing acceptance in pediatric surgery, but experience with newborns and small children is limited. To our knowledge, a series of minimally invasive resection of pulmonary sequestration in newborns has not yet been reported in the literature. We report on 5 patients with pulmonary sequestration thoracoscopically.

Surgical repair of combined gastroschisis and sternal cleft.

We present a case of prenatally diagnosed gastroschisis combined with a sternal cleft, as well as the successful surgical management of this unusual condition. Successful management of gastroschisis combined with sternal cleft has not been reported before in the literature.

Laparoscopic resection of congenital choledochal cyst, choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis.

Background: The feasibility of laparoscopic resection of choledochal cyst and hepaticojejunostomy in children is still unclear. This report presents the author's experience with a first series of patients.

Methods: Data from 11 consecutive children (median age 17.

Mini-laparotomy and full laparotomy, but not laparoscopy, alter hepatic macrophage populations in a rat model.

Background: Immune function is better preserved by laparoscopic versus conventional surgery. Numerous mediators of the systemic trauma response are synthesized and/or regulated by the liver. However, it has been stated that the advantages of laparoscopic surgery are no more obvious when conventional operations are performed via mini-laparotomy.

Family cases of gastroschisis.

The etiology of gastroschisis is still unclear. To the authors' knowledge, there are only 14 cases of familial gastroschisis in the literature. The authors add the second case of mother-and-son occurrence and a case of siblings occurrence, thereby updating the current literature for family gastroschisis.

Laparoscopic resection of congenital choledochal cyst, hepaticojejunostomy, and externally made Roux-en-Y anastomosis.

The authors present a 3-month-old patient with a congenital choledochal cyst, which was asymptomatic until treatment. On laparoscopy, a type I choledochal cyst was confirmed and excised laparoscopically. A Roux-en-Y anastomosis was constructed after exteriorization of the small bowel via the infraumbilical trocar incision.

Stem-like cells in human hepatoblastoma.

Hepatoblastoma is a pediatric liver tumor with epithelial components resembling embryonal and fetal liver cells. The existence of teratoid hepatoblastoma suggests the presence of stem cells in hepatoblastoma. The aim of this study was to analyze the expression of stem cell markers in hepatoblastomas.

Postcholecystectomy syndrome with special regard to children--a review.

The incidence of abdominal symptoms after cholecystectomy in adults is high. Up to one third of the patients consult a doctor because of abdominal complaints within 1 year after the operation. In addition, a higher incidence of colon carcinoma after cholecystectomy has been reported in female patients.

Laparoscopic fenestration of posttransplant lymphoceles in children.

Background/purpose: Lymphoceles are frequently observed as a surgical complication after renal transplantation. Whereas the frequency, pathogenesis, diagnosis, and treatment of lymphoceles has been well described in adult patients, no data are available for the pediatric age group.

Methods: Since December 2000; 5 children (2 boys and 3 girls; median age, 6 years; range, 6 to 15 years) of a total of 21 (10 boys and 11 girls; median age, 13 years; range, 2 to 19 years) children undergoing kidney transplantation had a posttransplant lymphocele.

Laparoscopic fundoplication in neurologically impaired children with percutaneous endoscopic gastrostomy.

Topic: Laparoscopic fundoplication is the preferred surgical procedure for children with gastro-oesophageal reflux. Little data exist on the feasibility of laparoscopic fundoplication after placement of a percutaneous endoscopic gastrostomy (PEG).

Patients And Methods: Thirty-nine children aged 4 months to 18 years (median 3.

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery.

Background: Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than open surgery.

Laparoscopically assisted gastric pull-up for long gap esophageal atresia.

Background: Laparoscopically assisted gastric pull-up procedure has been performed in adults for various conditions. The authors report the first patient, who underwent laparoscopically assisted esophageal replacement for long gap esophageal atresia.

Methods: The patient had Down's syndrome and long gap esophageal atresia without fistula.

Surfactant in newborn compared with adolescent pigs: adaptation to neonatal respiration.

Surfactant composition and function differ between vertebrates, depending on pulmonary anatomy and respiratory physiology. Because pulmonary development in pigs is similar to that in humans, we investigated surface tension function, composition of phospholipid molecular species, and concentrations of surfactant protein (SP)-A to -D in term newborn pigs (NP) compared with adolescent pigs (AP), using the pulsating bubble surfactometer, mass spectrometry, high-performance liquid chromatography, and immunoblot techniques (IT). NP was more potent than AP surfactant in reaching minimal surface tension values near zero mN/m.

What's new in biliary atresia?

The main problem with biliary atresia (BA) is three-fold. Early diagnosis and timely therapy is mandatory in this rare and life-threatening disease. In as much as the aetiology of BA is unknown, all therapeutic attempts are still symptomatically orientated and finally, at the end-stage of the disease, the majority of the patients need organ replacement.

Simultaneous correction of duodenal atresia due to annular pancreas and malrotation by laparoscopy.

We report the case of a 3450 g newborn girl with prenatally diagnosed duodenal obstruction. At operation, duodenal atresia due to annular pancreas and intestinal, partially volvulated malrotation became apparent. Surgical correction was completely laparoscopic with 3-mm instruments.

What's new in minimally invasive paediatric surgery?

There has been substantial progress in minimally invasive techniques in children in recent years. Numerous investigators have shown that laparoscopic and thoracoscopic paediatric surgery can be performed safely. It has been postulated that minimally invasive paediatric surgery is associated with low morbidity, a shorter hospital stay, lower costs and clinical results similar to those achieved by open surgery.

Mesenterico-left portal vein bypass in children with congenital extrahepatic portal vein thrombosis: a unique curative approach.

Objectives: Current management of extrahepatic portal vein thrombosis (EPVT) comprises endoscopic eradication therapy of esophageal varices and conventional shunt surgery. The authors have used the novel technique of mesenterico-left portal bypass (Rex shunt) in seven children with symptomatic EPVT, and report their results here.

Methods: Median age of the children was 12 years (range, 2-16 years).

A prospective study of minimally invasive techniques in pediatric surgical oncology: preliminary report.

Background: Thoracoscopic and laparoscopic techniques play a major role in pediatric surgery. However, minimally invasive surgery (MIS) has not yet established itself in pediatric surgical oncology. The authors present a prospective study investigating the role of MIS in children with cancer.

Quality of life in children with traumatic brain injury--basic issues, assessment, and recommendations.

An international Task Force was convened under the guidance of BMBF Conference so as to review the "State of the art" for measuring quality of life (QoL) in children who have suffered traumatic brain injury (TBI). After expert review of instruments and evaluation of two independent literature reviews this work group established "inclusion criteria" for the review of current tools that could contribute to the measurement of QoL in children with TBI. Six instruments were determined to meet all or most of the criteria required to be used in current clinical practice and research for children with TBI.

Thoracoscopic resection of extralobar sequestration in a neonate.

The authors report a case of extralobar pulmonary sequestration (ELS) located at the right costophrenic recessus and resected thoracoscopically in a 22-day-old girl. Prenatally, spontaneous resolution of a cystic adenomatoid lung lesion (CCAM) occurring independently in the upper right hemithorax was observed. ELS with preceding complete resolution of CCAM in the ipsilateral hemithorax has not been reported before.

Long-term results after laparoscopic Thal procedure in children.

As the laparoscopic approach to gastroesophageal reflux disease (GERD) was introduced in pediatric surgery in the last decade of the 20th century, it became apparent that this approach was beneficial. The favorable results have led to a more general acceptance and implementation of this type of surgery at the beginning of the 21st century. We give an overview of the first decade of laparoscopic antireflux procedures in children with an emphasis on the laparoscopic Thal fundoplication and its implication on morbidity and cure of GERD in the long term both for normal and mentally handicapped children.

Laparoscopic duodenoduodenostomy for duodenal atresia.

A 3,220-g newborn baby with trisomy 21 presented with duodenal atresia. No other congenital malformations were diagnosed. Informed consent for a laparoscopic approach was obtained.