Thoracoscopic repair of congenital diaphragmatic hernia by inflation-assisted bowel reduction, in a resuscitated neonate: a better access?

Elective endoscopic diaphragmatic hernia repairs have been reported. But endoscopic surgery was regarded unsuitable for emergency repair of diaphragmatic hernia in ventilated newborn children in bad general condition. We report a new method for inflation-assisted reduction and thoracoscopic repair of congenital diaphragmatic hernia diaphragmatic in a vitally endangered neonate. From three 2.7 mm to 5 mm accesses warmed low-pressure, low-volume CO2 was inflated into the thorax at 100 ml/min and 2 mm mercury. This allowed spontaneous reduction of the thoracic viscera into the abdomen and diaphragmatic suture with minimal handling. The 65-min procedure was tolerated well without perioperative deterioration. The baby was weaned off the respirator and breast-fed within 2 days, mediastinal shift normalized in 6 days. In suitable infants thoracoscopic repair and inflation-assisted reduction of thoracic contents is a more physiological access to congenital diaphragmatic hernia than laparoscopy or laparotomy.

A technique for thoracoscopic aortopericardiosternopexy.

BACKGROUND: A left thoracotomy is the standard access for aortosternopexy in severe tracheomalacia. We report a modified technique for thoracoscopic aortopericardiosternopexy. METHODS: The thymus is mobilized, and the needle is passed through the sternum and back. In extensive or recurrent tracheomalacia, not only the ascending aorta but also the innominate artery and pericardial base are fixed to the sternum. The effect is monitored bronchoscopically. RESULTS: This technique showed dramatic success in two children, one 4-year-old and a 2-year-old. In the younger child, the thoracoscopy was a redo procedure after a previous open aortosternopexy. CONCLUSIONS: Thoracoscopic aortopericardiosternopexy is an effective procedure that does not impair postoperative respiration. It should therefore be considered for severe tracheomalacia or even redo operations.

[Pyogenic periproctitis infections in childhood]. / Pyogene periproktitische Infektionen des Kindesalters.

A total of 128 pediatric pyogenic perianal infections were recorded prospectively in 1984-1995; over 70% arose in children below the age of 2 years. A quarter of all perianal abscesses developed a recurrence between 3 weeks and 3 years after the initial operation, while five children had an anal fistula after deroofing of anal abscesses. The early age of onset and frequent anomaly of anal crypts (12%) suggests a partly congenital etiology due to impaired fusion of the proctodaeal membrane or rudimentary anorectal duplications for both conditions.