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Abstract: Purpose: Minimally invasive procedures in small infants and neonates are being performed in increasing numbers. In this study, we describe our institution''s experience with laparoscopic Nissen fundoplications (LNFs) in children weighing less than 5 kg. Methods: All cases of LNF attempted in children weighing less than 5 kg since January 2003 at a tertiary-care pediatric hospital were reviewed after Institutional Review Board approval. Results: One hundred twenty-two children weighing less than 5 kg underwent LNF during the study period. They ranged from 2 weeks to 3 years of age (mean, 94 ± 61.3 days) and weighed 1.94 to 4.99 kg (mean, 3.68 ± 0.77 kg). Twenty-nine percent (n = 35) were neurologically impaired. Eighty-eight percent (n = 107) had concurrent gastrostomy tube placement. Eight (7%) were converted to laparotomy. The average operative time was 112 ± 46 minutes. Seventy-one percent (n = 87) required intensive care unit use for an average of 14.3 ± 17.4 days. The average time to start enteral feeds was 2.6 ± 2.6 days. Thirty-one percent (n = 38) required postoperative mechanical ventilation for an average of 12.0 ± 20.6 days. The average hospital length of stay was 36.6 ± 36.0 days (range, 3-175 days). Six patients (5%) had a complication or recurrent gastroesophageal reflux. Three patients had recurrent reflux, one of which underwent another LNF. One patient had a gastric perforation. Another required a redo LNF after a disrupted wrap was noted at a recurrent hiatal hernia repair. Lastly, one patient had bleeding from an accessory hepatic artery with liver retractor placement. Conclusions: Laparoscopic Nissen fundoplication can safely and effectively be performed in small children (<5 kg) with similar outcomes and rates of complication as previously published reports in larger children. These children, however, do have prolonged intensive care unit and mechanical ventilation use associated with their prematurity and significant comorbidities. [Copyright &y& Elsevier]

The number of minimally invasive surgery (MIS) for adenocarcinoma of esophagogastric junction (AEG) has been increasing year by year. The key technical points such as surgical approach, lymph node dissection and GI tract reconstruction have gradually reached their maturity. With the emergence of proofs of evidence-based neoadjuvant therapy, neoadjuvant chemotherapy or neoadjuvant radiochemotherapy for advanced AEG is also gradually accepted by most surgeons and oncologists. European scholars have previously started researches on MIS after neoadjuvant therapy for esophageal cancer and AEG. Domestic scholars also raise practical suggestions on the application of neoadjuvant therapy for AEG via the cooperation between gastrointestinal and thoracic surgeons, demonstrating the trend in standardization and individualization. But there is still no consent to the indication of MIS after neoadjuvant therapy. Furthermore, there is also a lack of the standardization of technical points for MIS, GI tract reconstruction, short- and long-term outcomes. Such associated problems have been the hot controversy and exploration in recent years. This article describes current progress of neoadjuvant therapy for AEG, current status of MIS after the neoadjuvant therapy in Europe, America, East Asia, including China, and related researches plus future prospects, hoping for better clinical outcomes.

Background: The use of laparoscopic technique for management ofsymptomatic liver cysts is documented to be a feasible and safeprocedure with good short-term symptomatic relief. However, it cannotbe recommended as the standard of care as long-term results arescarce. The present study was initiated to review the long-termresults of this approach in the management of symptomatic livercysts. Methods: A retrospective review of all patients with symptomaticliver cysts that were treated by laparoscopic fenestration in ourdepartment over an 8-year period from 1993 to 2001. The clinicaland radiographical data were analysed at follow-up to assess the ­outcome. Results: Eleven patients were treated using a laparoscopic approach;10 patients with solitary cysts and one with adult polycystic liverdisease. All patients achieved short-term alleviation of symptomsand an uneventful postoperative course. The mean hospital stay was3 days. Long-term follow up was available for 9 patientswith a mean of 44 months. Histologically, one of the patientswas diagnosed with a biliary cystadenoma and she had a symptomaticrecurrence and a liver resection at 20 months. In the otherseven patients, there was no clinical recurrence but a radiographicalrecurrence of 28.5%. The patient with adult polycysticliver disease had two symptomatic recurrences: at 26 monthswhere he underwent a repeat laparoscopic fenestration and at 43 monthswhere he underwent an open fenestration. Conclusion: The present study confirms that with adequate patientselection, long-term alleviation of symptoms can be achieved withthe laparoscopic approach for solitary simple liver cysts but notfor polycystic liver disease or cystic tumours of the liver. [ABSTRACT FROM AUTHOR]