RESUMEN
BACKGROUND: For the last 20 years, laparoscopy management of anorectal malformations (ARM) has been challenged due to the development of postoperative urethral diverticulum or injury caused by the imprecise transection of rectourethral fistulae, particularly rectobulbar fistulae situated deep in the pelvis. We have developed a combined approach of enteroscopy and laparoscopy for intraluminal incision of a rectourethral fistula. METHODS: We retrospectively reviewed 47 ARM patients who underwent surgical corrections using the combined approach between January 2019 and June 2020. Early postoperative and subsequent follow-up results were evaluated. RESULTS: The median follow-up period was 12 months. The average age at surgery was 3.18 ± 0.64 months. The mean operative time of a single-incision laparoscopic-assisted anorectoplasty (SILAARP) was 1.19 ± 0.29 h. The time for intraluminal incision of the fistula was shortened from 14 to 2 min. No patients underwent a conversion. The average postoperative hospital stay, time to full feeds and placement of an anal tube were 10 days, 1 day, and 5 days, respectively. No urethral diverticulum, urinary injury, wound infection, rectal retraction, anal stenosis or rectal prolapse was encountered in the cohort. CONCLUSIONS: The combined enteroscopy and laparoscopy approach offers precise management of rectourethral fistulae. It could effectively obviate urethral complications, eliminating the obstacles of laparoscopy application in the management of ARMs.
Asunto(s)
Enteroscopia de Balón , Laparoscopía , Fístula Rectal/cirugía , Uretra/cirugía , Enfermedades Uretrales/cirugía , Malformaciones Anorrectales/diagnóstico por imagen , Malformaciones Anorrectales/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Periodo Posoperatorio , Fístula Rectal/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
PURPOSE: Single-incision laparoscopic surgery (SILS) as a surgical approach in treatment of pancreatic disease has recently been reported in adults. However, its application in pancreatic surgery in children is limited. In this article, we report our preliminary experience of SILS in children with pancreatic disease. METHODS: Three children with pancreatic tumor underwent single-incision laparoscopic partial pancreatectomy between July 2011 and August 2013. Two of three children were girls, and one was a boy. The ages ranged from 2 to 10 months, with an average age of 6.7 months. RESULTS: All operations were successfully performed. There was no conversion to the conventional multi-incision surgery. The mean operation time of the 3 cases was 153.3 minutes (range 120-200 minutes). The postoperative hospital stay was 7 days. The drainage tubes were kept for 3 to 4 days after surgery. There was no pancreatic juice leak in this case series. All patients were followed up and there was no recurrence. CONCLUSIONS: Single-incision laparoscopic partial pancreatectomy for children with pancreatic tumor is feasible.