Robotic-assisted proctosigmoidectomy for Hirschsprung's disease: A multicenter prospective study.

BACKGROUND: Robotic surgery is a cutting-edge minimally invasive technique that overcomes many shortcomings of laparoscopic techniques, yet few studies have evaluated the use of robotic surgery to treat Hirschsprung's disease (HSCR). AIM: To analyze the feasibility and medium-term outcomes of robotic-assisted proctosigmoidectomy (RAPS) with sphincter- and nerve-sparing surgery in HSCR patients. METHODS: From July 2015 to January 2022, 156 rectosigmoid HSCR patients were enrolled in this multicenter prospective study. Their sphincters and nerves were spared by dissecting the rectum completely from the pelvic cavity outside the longitudinal muscle of the rectum and then performing transanal Soave pull-through procedures. Surgical outcomes and continence function were analyzed. RESULTS: No conversions or intraoperative complications occurred. The median age at surgery was 9.50 months, and the length of the removed bowel was 15.50 ± 5.23 cm. The total operation time, console time, and anal traction time were 155.22 ± 16.77, 58.01 ± 7.71, and 45.28 ± 8.15 min. There were 25 complications within 30 d and 48 post-30-d complications. For children aged ≥ 4 years, the bowel function score (BFS) was 17.32 ± 2.63, and 90.91% of patients showed moderate-to-good bowel function. The postoperative fecal continence (POFC) score was 10.95 ± 1.04 at 4 years of age, 11.48 ± 0.72 at 5 years of age, and 11.94 ± 0.81 at 6 years of age, showing a promising annual trend. There were no significant differences in postoperative complications, BFS, and POFC scores related to age at surgery being ≤ 3 mo or > 3 mo. CONCLUSION: RAPS is a safe and effective alternative for treating HSCR in children of all ages; it offers the advantage of further minimizing damage to sphincters and perirectal nerves and thus providing better continence function.

Application of endoscopic retrograde cholangiopancreatography for treatment of obstructive jaundice after hepatoblastoma surgery: A case report.

BACKGROUND: We aimed to investigate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for treating obstructive jaundice (OJ) post hepatoblastoma (HB) surgery (post-HB OJ) by analyzing the data of a case and performing a literature review. CASE SUMMARY: Clinical data of one patient with post-HB OJ treated by ERCP were retrospectively analyzed. Furthermore, clinical characteristics and insights into the diagnosis and treatment of post-HB OJ in children were summarized via searching various databases and platforms, such as China National Knowledge Infrastructure, Wanfang database, CQVIP database, PubMed, Ringer Link, and Google Scholar. The patient reported herein underwent five chemotherapy sessions after the diagnosis of HB and right hemihepatectomy after tumor size reduction; these were followed by two postoperative chemotherapy sessions. Three months postoperatively, the patient developed icteric sclera, strong tea-colored urine, and clay-like stools, and showed signs of skin itchiness; blood analysis showed significantly an increased conjugated bilirubin (CB) level (200.3 µmol/L). Following the poor efficacy of anti-jaundice and hepatoprotective treatments, the patient underwent ERCP. Intraoperative imaging showed a dilated bile duct in the porta hepatis with significant distal stenosis. A 5 Fr nasopancreatic tube was placed in the dilated area through the stricture for external drainage, and the patient was extubated on postoperative day 6. Postoperatively, the patient's stool turned yellow, and the CB level decreased to 78.2 µmol/L. Fifteen days later, ERCP was repeated due to unrelieved jaundice symptoms, wherein a 7 Fr nasobiliary drainage tube was successfully placed. Three months post-ERCP, the jaundice symptoms resolved, and the CB level was reduced to 33.2 µmol/L. A follow-up examination one year postoperatively revealed no jaundice symptoms and normal CB level. CONCLUSION: Post-HB OJ is rare. Compared to biliary tract reconstruction, ERCP is less invasive and has a better therapeutic effect.

Serum substance P and vasoactive intestinal peptide levels in infants with acute intussusception.

OBJECTIVE: We aimed to investigate the role of the intestinal neurotransmitters vasoactive intestinal peptide (VIP) and substance P (SP) at different time points in infants with acute intussusception. METHODS: Thirty patients who were diagnosed with acute intussusception were enrolled in the study and classified as the experimental group. Another 30 patients with an indirect inguinal hernia who had no intestinal injury were included as the control group. Serum SP and VIP levels at different time points, including pre- and postoperation, were detected by enzyme-linked immunosorbent assay and compared between the two groups. RESULTS: Serum SP levels in patients with acute intussusception were significantly higher than those in controls. However, with recovery of acute intussusception, SP levels gradually decreased after treatment. Serum VIP levels in patients with acute intussusception were significantly lower than those in controls. However, with recovery of acute intussusception, VIP levels gradually increased after treatment. CONCLUSIONS: SP and VIP levels may have a potential relationship with the pathogenetic process of intussusception.

Treatment for incarcerated indirect hernia with "Cross-Internal Ring" inguinal oblique incision in children.

BACKGROUND: This study aims to evaluate the utility of the "Cross-Internal Ring" inguinal oblique incision for the surgical treatment of incarcerated indirect hernia (IIH) complicated with severe abdominal distension. MATERIALS AND METHODS: Patients of IIH complicated with severe abdominal distension were reviewed retrospectively. All patients received operation through the "Cross-Internal Ring" inguinal oblique incision. RESULTS: There were totally 13 patients were included, male to female ratio was 9-4. The time for patients to resume oral feeding varying from 2 to 5 days after operation, no complications include delayed intestinal perforation, intra-abdominal abscess, and incision infection happened. Average postoperative hospital stay was 5.2 days. All cases were followed up for 6-18 months. No recurrence or iatrogenic cryptorchidism happened. CONCLUSION: "Cross-Internal Ring" inguinal oblique incision is a simple, safe, and reliable surgical method to treat pediatric IIH complicated with severe abdominal distension.

Gastroscopic treatment of membranous duodenal stenosis in infants and children: report of 6 cases.

OBJECTIVE: To investigate the efficacy of gastroscopic treatment in the treatment of membranous duodenal stenosis. METHODS: We performed a retrospective study of 6 patients with membranous duodenal stenosis, aging from 7days to 37months, who underwent gastroscopic balloon dilatation in a children's hospital between January 2012 and December 2013. All surgical procedures of balloon dilatation were performed under direct gastroscopic vision. The balloon dilators with diameter 8mm and 10mm for neonates and children aged over one month, respectively, were placed through the foramen of the membranous stenosis. The septum in the membranous stenosis was gradually extended by increasing diameter of the balloon dilator. The residual septum was removed by gastroscopic electrocauterization. RESULTS: The membranous stenosis in duodenum of all children was successfully expanded by gastroscopic balloon dilatation, and only one case with residual septum received gastroscopic electrocauterization. No complications such as bleeding, intestinal perforation, etc., were observed. Postoperative radiography using iodine-based contrast media showed that the gastrointestinal tract was unobstructed. During a follow-up period ranging from 3 to 24months, all patients ate normally without vomiting and abdominal distension and grew normally. CONCLUSION: Gastroscopic balloon dilatation is an effective method in the treatment of membranous duodenal stenosis in children. For the patients with residual septum, they can be cured by using gastroscopic electrocauterization.

[Logistic regression analysis of high-risk factors for neonatal incarcerated hernia with intestinal necrosis].

OBJECTIVE: To investigate the high-risk factors for neonatal incarcerated hernia with intestinal necrosis by logistic regression analysis. METHODS: Retrospective analysis was performed on the clinical data of 131 neonates with incarcerated oblique inguinal hernia containing the intestine. Of the 131 cases, 14 suffered from intestinal necrosis. The high risk factors for neonatal incarcerated hernia with intestinal necrosis were determined by logistic regression analysis. RESULTS: Manual reduction after incarceration (>2 times) (χ2 = 69.289, P<0.01), incarceration history (>2 times) (χ2 = 84.731, P<0.01), and mesentery incarceration (χ2 = 80.233, P<0.01) were the high-risk factors for neonatal incarcerated hernia with intestinal necrosis. CONCLUSIONS: Intestinal necrosis tends to occur in neonates with incarcerated hernia who have incarceration or received manual reduction more than twice and suffer from mesentery incarceration. Manual reduction is prohibited for these cases, which should be surgically treated immediately.

[Transumbilical laparoscopic operation for the incarcerated oblique inguinal hernia in the infants].

OBJECTIVE: To evaluate the clinical application of transumbilical double-hole laparoscopic operation for incarcerated inguinal hernia in the infants. METHODS: Forty-eight cases with incarcerated inguinal hernia (male 39, female 9) aging from 4 months to 3 years (mean 1.2 +/- 0.8 years) received the laparoscopic transumbilical double-hole operation (LTO group) during April.2003 to April.2004. Thirty cases were left side incarcerated inguinal hernia, 12 cases were right side and 6 cases were bilateral. Fifty infants of incarcerated inguinal hernias treated with traditional operation served as controls (TO group). The mean operation time, length of stay, return of bowel function and postoperative complication were compared between the two groups. RESULTS: All cases of both groups recovered without any complication. The operation time, average hospitalization and return of bowel function in LTO were (30 +/- 5) min, (7.8 +/- 0.3) h and (4.4 +/- 0.3) d, respectively, and in TO were (43 +/- 6) min, (23.3 +/- 2.4) h and (6.7 +/- 0.4) d, respectively. There was a significant difference in the two groups (P < 0.05). The patients in both groups were followed up for 3 months to one year. LTO group had no recurrence or atrophy of testis and TO group had one relapse of hernia. CONCLUSIONS: Transumbilical double-hole laparoscopic operation is safe and microinvasive. It is a useful microinvasive procedure in the treatment of incarcerated inguinal hernia for infant.