Modifications to Expose Porta Hepatis for Laparoscopic Portoenterostomy Easier in Biliary Atresia.

BACKGROUND: Laparoscopic Kasai portoenterostomy (LKPE) is generally regarded to have a poorer outcome for surgical treatment of uncorrectable biliary atresia. We herein described our initial experience of some modifications to make LKPE easier in the treatment of type III biliary atresia (BA). METHODS: During the period July 2012-October 2016, a total of 25 infants with type III BA were treated with a modified LKPE technique. A percutaneous suture was introduced just below the xiphoid process to snare the round ligament and retract the liver; other percutaneous stay sutures were then introduced to the fundus and neck of the gallbladder to elevate the liver and expose the porta hepatis. In 15 cases, part of the hepatic lobus quadratus was removed laparoscopically to expose the porta hepatis. The two elastic rubber bands were put around the portal vein and hepatic artery, and the porta hepatis was exposed by stretching the two rubber bands laterally to facilitate laparoscopic portoenterostomy. RESULTS: Patients were divided into two groups according to their ages at operation: group I: age between 30 and 75 days (n = 18), and group II: age between 76 and 85 days (n = 8). There were no operative deaths, but two patients died of repeated cholangitis and liver failure. Blood loss during operation was minimal and no blood transfusions were required. Operating times varied from 210 to 270 min (mean 232.4 ± 19.0 min). Among the two groups, there were no differences in blood loss (P > 0.05), but there were differences in operating time (P < 0.05). All patients survived the surgery without any intraoperative complications, and the median follow-up time was 25.3 months. Total bilirubin dropped to normal in 18 patients with an additional 5 patients showing a significant overall drop after surgery. CONCLUSIONS: With the original concepts of Kasai portoenterostomy, perfect laparoscopic skills and some key modifications to expose the porta hepatis, our LKPE can be performed safely and successfully with improved outcome for infants with type III BA.

Acquired ileal atresia induced by adhesive intestinal obstruction.

Three female infants, aged 13, 7 and 18 mo respectively with acquired ileal atresia induced by adhesive small bowel obstruction are reported. Case 1 was diagnosed with urachal cyst and cyst excision was performed when she was 7-mo-old. Case 2 was diagnosed with mesenteric cyst and cyst excision was performed by laparoscopic-assisted procedure when she was 3-mo-old. Case 3 had no history of abdominal operation previously. At laparotomy ileal atresia induced by adhesive band was found.

Laparoscope-assisted diagnosis and treatment of prepyloric web in children--report of three cases.

Prepyloric web is a rare diagnosis in pediatrics; only sporadic cases were described in the literature. Treatment is classically performed by open surgery; laparoscope-assisted diagnosis and treatment of prepyloric web in children have not been reported. Three cases with prepyloric web were diagnosed and treated by laparoscope-assisted procedure in our hospital from June 2009 to October 2010. There were no conversions to open surgery and no intraoperative various complications. After following up for 31-42 (mean 36.3) months postoperatively, the 3 infants remained asymptomatic and thriving. The early experiences suggest that the outcomes are excellent.

Transumbilical laparoendoscopic single-site surgery in the treatment of neonatal intestinal atresia and stenosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the experiences and advantages of laparoendoscopic single-site (LESS) surgery for neonatal intestinal atresia and stenosis.</p><p><b>METHODS</b>Twenty patients of neonatal intestinal atresia and stenosis were treated with LESS procedure in Huai'an Women and Children's Hospital of Jiangsu Province between October 2010 and April 2012. The clinical data were retrospectively analyzed.</p><p><b>RESULTS</b>Among these patients, 13 were male, 7 were female. Age at admission ranged from 10 min to 1 d. Four cases were premature, and 3 were born with low birth weight (<2500 g). One was diagnosed with duodenal atresia, 1 with duodenal stenosis, 9 with jejunal atresia, 2 with jejunal stenosis, and 7 with ileal atresia. Laparoscopic exploration was performed in all the cases by transumbilical procedure, the proximal and distal ends were exteriorized from the umbilical port site for anastomosis. Twenty neonates with intestinal atresia and stenosis were performed using this new minimally invasive approach, with no cases converted to open operation or standard laparoscopy. The operative time was 35-60 (mean, 40) min. The intraoperative bleeding was 3-5 ml. Two cases were given up treatment by their parents on the second postoperative day. For the other 18 patients, oral intake started on postoperative day 5-10 (mean, 7), and discharged from hospital on the postoperative day 10-20 (mean, 13). The follow up ranged from 1 to 11 months, during which 1 case died, 3 cases were managed with conservative treatment for diarrhea or malnutrition. The other 14 cases grew up healthily.</p><p><b>CONCLUSION</b>The technique of LESS in the treatment of neonatal atresia and stenosis is simple and the outcomes are satisfactory.</p>