Comparative mid-term results between inguinal herniotomy and single-port laparoscopic herniorrhaphy for pediatric inguinal hernia.

BACKGROUND: Some recent papers have advocated single-port laparoscopic herniorrhaphy and obtained satisfactory results. The aim of this study was to compare the mid-term outcomes of conventional inguinal herniotomy and single-port laparoscopic herniorrhaphy. METHODS: Between April 2007 and March 2009, 202 records of infants and children with inguinal hernia treated were retrospectively reviewed. Of them, 86 patients were treated by conventional inguinal herniotomy (IH group), and 116 patients by single-port laparoscopic herniorrhaphy with preperitoneal hydrodissection, a totally extraperitoneal enclosing suture and extracorporeal knot tying (LH group). Follow-up data were collected using a telephone questionnaire and last outpatient follow-up. RESULTS: Mean follow-up was 35.7±7.2 months. Both procedures could achieve compete repair without recurrence. Operation time of unilateral repair was significantly longer in the LH group than in the IH group (40.1 vs. 20.0 min; P<0.001); however, operation time of bilateral repairs was comparable in both groups (46.0 vs. 37.5 min; P=0.291). Metachronous hernia developed in 6 of 80 patients (7.5%) initially presenting with unilateral hernia in the IH group and in no patient in the LH group (P=0.005). CONCLUSIONS: Accompanied by the method of preperitoneal hydrodissection and a totally extraperitoneal enclosing suture, single-port laparoscopic herniorrhaphy would be an effective procedure as conventional inguinal herniotomy. Single-port laparoscopic herniorrhaphy was associated with long operation time and a reduction in contralateral hernia development. However, every 4 patent processus vaginalis would require intervention to prevent 1 metachronous hernia.

A retroperitoneal gastric duplication cyst mimicking a simple exophytic renal cyst in an adolescent.

Gastric duplications are rare anomalies and usually occur along the greater curvature of the stomach. The authors herein describe an uncommon case of a retroperitoneal gastric duplication, which was not found during previous emergency laparotomy for suspected peritonitis at another institution. On subsequent computed tomography scan, the lesion was misinterpreted as a simple exophytic renal cyst. Laparoscopy was undertaken because of unresolved symptoms, and a retroperitoneal duplication cyst was successfully excised. It was lined with gastric mucosa and islands of pancreatic tissue on pathologic examination.

Transumbilical management for neonatal ovarian cysts.

BACKGROUND/PURPOSE: Since Tan and Bianchi (Br J Surg. 1986;73:399) reported umbilical incision as an access for pyloromyotomy in infantile hypertrophic pyloric stenosis, many pediatric surgeons have used this approach for a number of other procedures. Because of the long pedicle with good mobility and the frequent intraabdominal position of the neonatal ovarian cyst, we attempted to manage it via the transumbilical route. METHODS: All patients were treated under intubation general anesthesia. Semicircular infraumbilical incision was made, and the abdomen was entered through a transverse fascial incision. The partially collapsed cyst after aspiration was exteriorized through the incision for cystectomy, partial deroofing, or adnexectomy. RESULTS: From May 2000 to December 2006, 6 female newborns with ovarian cysts were treated via the transumbilical route. There were no complications from surgery. The operation time and duration of hospital stay were short. The cosmetic appearance after the procedure was good. CONCLUSIONS: The initial result suggests that transumbilical management for neonatal ovarian cysts may be a good alternative procedure when laparoscopic equipment is unavailable or experienced technique is lacking.

Pneumatic dilation in treatment of late-onset primary gastric outlet obstruction in childhood.

Late-onset primary gastric outlet obstruction in childhood is a rare condition. Only 8 cases of such were reported. Diagnosis should be considered while ruling out mechanical and structural lesions. Up to now, Heineke-Mikulicz pyloroplasty has been the standard treatment. However, we succeeded in treating this condition by using pneumatic dilation. There is no sign of recurrence for 1 year. We propose the etiology, diagnosis, and the relationship between late-onset primary gastric outlet obstruction and esophageal achalasia in childhood.