[Thoracoscopic anatomical lung resection in children]. / Die thorakoskopische anatomiegerechte Lungenresektion im Kindesalter.

There are only few pediatric surgical centers across the world with expertise for minimally invasive anatomical lung resections in children. Between September 2003 and September 2005, 67 children underwent thoracoscopic surgery at the Department of Pediatric Surgery, University Hospital of Tuebingen, Germany. In 19 of these cases a lung resection was carried out, 8 of them had an anatomical lung resection. All patients underwent general anesthesia without selective intubation for the procedure. Intrathoracic pressure with insufflation of carbon dioxide of 1.5 l / min was held at 3-5 mmHg. Two 5 mm ports for video and instruments and one 12 mm port for a stapling device were used. Resected lung specimens were removed from the thorax through an additional 2-3 cm long incision. A bronchoscopy was carried out during surgery in all patients. Median age at operation was 5.6 years (range 3 months-20 years). Median operation time was 150 minutes (range 94-250 min). Conversion to open surgery was performed in 3 cases. This was due to bleeding in one child, due to a stiff lung in another patient with cystic fibrosis and due to a vascular and bronchial malformation in a third child suffering from middle lobe syndrome. There were no postoperative complications. Our preliminary results show, that thoracoscopic lung resections in children can be performed without major complications and excellent cosmetic results. For the necessity of a conversion to open surgery possible reasons may be insufficient intrathoracic overview as well as congenital anomalies of the vascular and / or the bronchial tract. Co-morbidities such as rib-fusion, deformities of the thorax or scoliosis can be avoided using thoracoscopic procedures.

Semicircular papillotomy: a new surgical technique for removal of bile stones lodged in the ampulla of Vater.

Bile stones lodged in the ampulla of Vater present a rare but often difficult problem. Considering the disadvantages of conventional papillotomy and papillectomy, we developed a technique in which both the anatomic structures and their function are preserved. Histologic studies of the ampulla provided the basis for the technique, in which the muscular layers of the ampulla are not cut through as in conventional papillotomy but are bluntly separated, preserving this important anatomic component of the ampulla saved. The postoperative and long-term outcome of seven patients with bile stones lodged in the ampulla are reported. We found semicircular lateral papillotomy a safe procedure that preserves the muscular structures and function of the ampulla.

Prognosis of extrahepatic bile-duct atresia after hepatoportoenterostomy.

Clinical and histologic findings from 206 patients operated upon for extrahepatic biliary atresia (EHBA) are analyzed in order to define the prognosis of patients with EHBA. The prospective study took into consideration both initial fibrosis of the liver and the morphology of the porta hepatis (PH) at surgery. Kaplan-Meier survival estimates and statistical calculations demonstrated a relationship between long-term survival and histologic findings in the liver and porta hepatis. The efficacy of HPE is significantly influenced by the morphology of the PH and to a lesser extent by the initial liver fibrosis. Surgery should thus achieve pattern 1 morphology of the PH, but this is problematic because of the close relationship of the vascular and biliary structures in its two lateral zones.