Search

Purpose: The aim of this study was to evaluate the feasibility of laparoscopic hepatojejunostomy for types I and II biliary atresia (BA). Materials and Methods: Between April 2003 and July 2007, 10 children with “correctable” types I and II BA were enrolled for the study. They presented with progressive jaundice, pale stools, and elevated aspartate transferase and alanine transferase levels. There were 6 girls and 4 boys, with ages ranging from 23 to 160 days (median, 53). All BA had cysts of extrahaptic bile ducts. There were 6 type I and 4 were type II BA. The median diameter of the cysts was 1.5 cm (range, 1.0–1.8). All 10 children underwent laparoscopic cyst excision with Roux-en-Y hepatojejunostomy. Four trocars were inserted. The distal end of the cyst was resected.and a Roux-en-Y hepatojejunostomy was fashioned. The patients were followed up on median for 26 months (range, 4–51). Results: The median duration of the operation was 3.0 hours (range, 2.4–3.2). There were no intraoperative complications. The blood loss was between 5 to 10 mL. Postoperatively, patients passed flatus after 18 hours (range, 16–28), and resumed oral intake in 20 hours (range, 16–30). Normal colored stools were passed after 3 days (range, 2–4). Jaundice started to disappear on postoperative day 10 (range, 7–16). In 6 cases, the total and the direct bilirubin were normalized on postoperative day 14—3 in 3 weeks. One patient had a persistent elevation of bilirubin. The postoperative course was uneventful in all patients. The median postoperable hospital stay was 7 days (range, 5–9). No postoperative complication was found at the follow-up visits. Conclusions: The laparoscopic Kasai' operation for children with type I or II biliary atresia is feasible, safe, and effective. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the efficacy and safety of the thoracoscopic total extrapleural approach of the Nuss procedure for the correction of pectus excavatum in children. Materials and Methods: Under thoracoscopic guidance, an extrapleural tunnel was created by using a blunt dissector via a right thoracic incision. A steel bar was inserted in the entirely extrapleural tunnel. The bar was turned and fixed as in the standard Nuss procedure. Results: The operations were completed successfully in all patients. The operating time ranged from 35 to 50 minutes (median, 45). The intraoperative blood loss was 2 to 3 mL. There was no pneumothorax or hydrothorax in our series. All patients were followed up for 2–6 months, and the surgical outcomes were excellent. Conclusions: The extrapleura Nuss procedure under thoracoscopic guidance is a safe and less traumatic procedure for the correction of pectus excavatum. [ABSTRACT FROM AUTHOR]