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Introduction: Inguinal hernias are among the most common pediatric surgical operations. For pediatric patients a high ligation of the hernia sac is the most common type of repair, which ca...

We sought to characterize our recent experience with thoracoscopic congenital diaphragmatic hernia (CDH) repair and identify patient selection factors.We reviewed the medical records of full-term neonatal (1 month of age) patients who underwent thoracoscopic CDH repair between 2004 and 2008 (n = 15). We obtained data on prenatal diagnosis, characteristics of the CDH and repair, complications, and outcome.All patients were stabilized preoperatively and underwent repair at an average of 5.7 +/- 1.3 days. Six patients were prenatally diagnosed, including the 5 inborn. Thirteen defects were left-sided. All were intubated shortly after birth and 2 required extracorporeal membrane oxygenation (ECMO). Twelve of 15 (80%) patients underwent successful thoracoscopic primary repair, including 1 of the patients who required ECMO prior to repair. Conversion to open repair occurred in 3 of 15 (20%) patients because of the need for patch closure or intraoperative instability. Among those converted to open, all had left-sided CDH defects and 3 had stomach herniation (of 5 such patients). Patients spent an average of 6.9 +/- 1.0 days on the ventilator following repair. The average time until full-enteral feeding was 16.7 +/- 2.25 days, and average length of hospital stay was 23.8 +/- 2.73 days. All patients survived to discharge, and average length of follow-up was 15.3 +/- 3.6 months.Thoracoscopic repair of CDH is a safe, effective strategy in patients who have undergone prior stabilization. Stomach herniation is associated with, but does not categorically predict, conversion to open repair. ECMO use prior to repair should not be an absolute contraindication to thoracoscopic repair.

Esophageal leiomyomas are the most common benign mesenchymal esophageal tumors, but they occur rarely in the pediatric population. Leiomyomas are conventionally treated with extramucosal enucleation via an open thoracotomy. In this paper, we report a case of a complex massive retrocardiac esophageal leiomyoma that was successfully extirpated by using a robotic-assisted thoracoscopic technique. Intraoperative esophagoscopy and transillumination were useful adjuncts in identifying the esophagus and developing a safe extramucosal dissection plane.

Purpose: To evaluate a modified approach to a proctocolectomy for ulcerative colitis using a laparoscopy-assisted technique. Methods: Four 5-mm ports (epigastric, umbilical, and left and right lower quadrants) are used for colonic mobilization without ligation of the mesenteric vessels. A low suprapubic transverse incision is then made, and the colon is pulled out with sequential ligation of mesenteric vessels. The remainder of the endorectal dissection and pull-through is performed in a conventional manner. At the end of the procedure, the right lower quadrant port site is converted to an ileostomy. Results: Seven patients underwent this approach over 2 years. There were five girls, and the mean age was 10.3 ± 3.9 years. All operations were successfully performed, and the mean operating time was 8.5 ± 1.1 hours. The operative time decreased from 10 hours for the first case to 7.25 hours for the last case. The mean number of hospital days was 5.5 ± 0.5. There was one postoperative small-bowel obstruction,...

Congenital paraesophageal hiatal hernias are rare and can be associated with gastric incarceration, volvulus,mucosal ulceration, and anemia. Primary repair of the hernia and fundoplication are recommended. In this paper,we report a case of a 3-year-old child with abdominal pain who was noted to have a paraesophageal hiatal hernia with partial gastric volvulus. A 5 mm robot platform was utilized to facilitate hernia sac dissection,hiatal repair, and fundoplication.