Laparoscopic repair for choledochal cyst: lessons learned from 190 cases.

OBJECTIVE: The aim of this study is to report the technical details, early outcomes, and lessons learned from laparoscopic repair of 190 cases of choledochal cyst. METHOD: The operation was performed using 4 ports. The cystic duct was identified and divided. The liver was elevated by 2 stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and then biliary-digestive continuity was reestablished. RESULTS: From January 2007 to April 2009, 190 patients were operated on. There were 144 girls and 46 boys. Ages ranged from 2 months to 16 years (mean, 46.9 +/- 29.3 months). Cyst diameter ranged from 10 to 184 mm. A total of 106 patients were classified as Todani type I cysts, and 84 were type IV. Cystic excision and hepaticoduodenostomy were performed in 133 patients and hepaticojejunostomy in 57 patients. The operating time varied from 70 to 505 minutes (mean, 186 minutes). Conversion to open surgery was required in 2 patients. Intraoperative blood transfusion was required in 4 patients. There were no perioperative deaths. Postoperative anastomotic leakage occurred in 7 patients, resolving spontaneously in 6 and requiring a second operation in 1. Postoperative hospital stay ranged from 5 to 27 days (mean, 7.2 +/- 3.3 days). Follow-up occurred between 1 and 24 months postdischarge (mean, 9 +/- 2.2 months) and was obtained in 161 patients (84.7%). Of these patients, cholangitis occurred in 4 patients (2.4%). CONCLUSION: Laparoscopic repair is a safe and effective procedure for choledochal cyst.

Thoracoscopic repair for right congenital diaphragmatic hernia.

PURPOSE: The aim of this study is to describe the surgical technique and initial results of thoracoscopic repair for the right congenital diaphragmatic hernia (CDH). METHODS: Patients underwent surgery under conventional general anesthesia. The operation was carried out by using one optical and two operating trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 2-4 mm Hg. The hernia defect was repaired by using nonabsorbable interrupted sutures with extracorporeal knots. RESULTS: There were 16 patients, including 13 boys and 3 girls. Six patients were newborns and the other 10 patients were infants or elders. The mean operative time was 82 minutes. Conversion was required in 1 patient. There were no operative or postoperative complications. However, there was one postoperative death. There was one recurrence on postoperative day 39. Follow-up ranged from 2 to 77 months. A normal chest X-ray was shown in all patients. CONCLUSION: Thoracoscopic repair is feasible and safe for children with a right CDH, including selected newborns.

Tubularized longitudinal island flap of the mucosa and skin on the dorsum of the penis in the treatment of hypospadias: experience from 176 cases.

OBJECTIVE: To report the result of the treatment of hypospadias using tubularized longitudinal island flap of the mucosa and skin on the dorsum of the penis. METHODS: Between January 1995 and December 2003, 176 patients were operated on using this technique. Among them, 124 patients had penile hypospadias, 35 had the penoscrotal form, four had the scrotal form and three patients had the perineal form. After removing the whole chordee, a longitudinal pedicle island flap of mucosa and skin was created. The flap was transposed to the ventral side of the penis by the buttonhole manoeuvre, and anastomosed to the meatus. The flap was tubularized creating a neourethra. RESULTS: The length of urethral defect varied from 1.5 to 10 cm (mean, 3.5 cm). The single longitudinal flap was used in 171 patients. The combination of a longitudinal flap and a local flap was used in five patients. Fistulae occurred in 13 patients (7.4%). Torsion of the penile axis did not occur in any patient. All children voided with a single straight urinary stream, and had a normal appearance of the meatus. CONCLUSION: The technique has a low fistula occurrence rate and a good cosmetic result.

Effect of L-tryptophan on the acquisition of tolerance to ethanol-induced motor impairment and hypothermia.

Rats were rendered tolerant to ethanol by daily gavage of 4--5 g/kg. The degree of motor impairment on the moving belt test and of hypothermia after i.p. test doses of ethanol was measured prior to and at various times during the chronic treatment, to assess the rates of tolerance development. L-Tryptophan (75 mg/kg twice daily) was administered chronically to elevate brain serotonin level. This treatment did not alter the motor impairment or hypothermia produced by the initial test doses of ethanol (2.0 and 2.5 g/kg respectively). However, the development of tolerance to both the motor impairment and hypothermia effects of ethanol was accelerated in the tryptophan-treated rats. This finding complements our earlier observations that depletion of 5-HT with p-CPA slows down tolerance. Blood ethanol measurements at 20 min (motor impairment) or 90 min (hypothermia) after the administration of the test dose reveal no significant difference between the control and tryptophan-treated rats, suggesting that tryptophan did not influence the metabolism of ethanol. This finding supports the hypothesis that brain serotonin modulates the development of tolerance to ethanol.