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Background: Laparoscopic treatment of intestinal malrotation in children is difficult, and most of our pediatric surgeon colleagues active in the field of laparoscopic surgery tell us that more often than not they must convert to an open procedure. Initially, we experienced much difficulty too, but after modification we were able to master the technique, and now we feel confident. We here describe the actual technique we use.Methods: Our experience encompasses nine children treated during the past 18 months. Five of the children presented in the newborn period and four later. During laparoscopic surgery, it is of paramount importance to concentrate not on the loops of bowel, but on the duodenum. By starting to identify the duodenum, mobilizing it, and carrying on the mobilization of the small bowel down until the whole small bowel has been seen, the pathologic anatomy is easily unraveled. Moreover, an existing volvulus is automatically reduced and the bowel automatically put in a nonrotation position in the abdomen.Results: All patients have done well, and no complications have been noted. Operative time has been reduced to about 1 hour.Conclusions: Laparoscopic treatment of intestinal malrotation in children is not so difficult provided certain rules, as described, are followed. [ABSTRACT FROM AUTHOR]

Background: We set out to determine whether laparoscopic pyloromyotomy (LPM) is superior to open pyloromyotomy (OPM) in babies with hypertrophic pyloric stenosis (HPS).Methods: We performed a retrospective study of 36 LPM and 36 OPM. Both groups were comparable in terms of sex, age and weight on admission, and blood pH on admission and prior to surgery. In the LPM group, three trocars were used; in the OPM group, a small right upper quadrant transverse muscle-cutting laparotomy was carried out.Results: LPM produces a better cosmetic result, seems to produce less postoperative discomfort, and results in the absence of conversion in a shorter hospital stay. However, the duration of the operation was significantly longer (32 versus 18 min). Moreover, LPM clearly entailed more complications (three mucosal perforations against two, and two reoperations against none in the open group).Conclusions: The actual series does not favor the laparoscopic approach over the open one, in view of the relatively high complication rate. Babies who are operated laparoscopically, however, seem to have less postoperative discomfort, a shorter hospital stay, and a better cosmetic result. As we are confident that the complication rate and duration of the operation will drop with further experience, we will continue to do LPM. LPM is not easy and should only be carried out when substantial experience has been gained in the field of pediatric laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: This study investigates the feasibility of performing a subsequent laparoscopic antireflux procedure after former placement of a percutaneous endoscopic gastrostomy (PEG).Methods: Between 1997 and 1998, five patients with a gastrostomy in place presented with an indication for laparoscopic antireflux procedure due to persisting vomiting.Results: All patients were managed laparoscopically with a four-trocar technique.Conclusions: Primary PEG placement has no adverse effects on a later secondary antireflux procedure. In some cases, four rather than five trocars can be used. [ABSTRACT FROM AUTHOR]

Background: Gastroesophageal fundoplication currently is one of the three most common major operations performed on infants and children by pediatric surgeons in the United States. With the advent of laparoscopic surgery, the number of gastroesophageal fundoplications has virtually exploded. Morbidity always was substantial with this operation, and laparoscopy has not changed this. We describe our results with laparoscopic refundoplication in infants and children.Methods: From December 1993 to December 1998 100 children underwent a laparoscopic 180 degrees anterior wrap using the Thal procedure. Four children had to undergo a laparoscopic refundoplication. Two of these children were mentally handicapped. All of the children had recurrent symptoms, but only two of the four had an abnormal pH study. In three of the children, the Thal procedure was changed to a Nissen (n = 2) and Toupet (n = 1) fundoplication. One child with an intrathoracic wrap and a giant hiatal hernia underwent hernia repair with a Goretex patch and a redo-Thal.Results: In two of the children, the operation was relatively simple. For one child, the procedure had to be converted for anesthesiologic reasons. The procedure in the fourth child was more difficult because of a large hiatal hernia. Within a follow-up time of 2 to 4 years, all the children were free of pathologic gastroesophageal reflux symptoms and afterward displayed no recurrence.Conclusion: In children, laparoscopic refundoplication after a previous laparoscopic antireflux Thal procedure is feasible and does not increase morbidity. [ABSTRACT FROM AUTHOR]

Huge sacrococcygeal teratomas in the newborn can cause significant morbidity and even death due to cardiac failure, hemorrhage, or both. Surgical removal is the treatment of choice, but can indicate these events. Ligation of the median sacral artery, which always supplies the tumor, prior to its removal has been advocated, but in the past this procedure required a formal laparotomy. Nowadays, it can be easily accomplished laparoscopically, as this case report demonstrates. [ABSTRACT FROM AUTHOR]

The slipping of trocars is a major problem, especially in pediatric laparoscopic surgery. Although the suturing of a trocar, along with its valve housing, to the fascia or skin is common, this technique only serves to prevent the trocar from being pulled out. We have found that the simple procedure of winding a +/- 1-cm broad tape several times around the base of the trocar, which has been sutured to the fascia or skin, will prevent the trocar, from being pushed in, even during lengthy operations. The tape that we use is derived from sterile disposable drapes and is therefore not only readily available but also an inexpensive solution to a chronic problem. [ABSTRACT FROM AUTHOR]