Laparoscopic varicocelectomy: Technique and results

212

INTERNATIONAL

Laparoscopic Splenectomy erative Technique and Case

for Massive Splenomegaly: OpReport. E.C. Poulin and C. Thibault.

Can J Surg 38:69-72, (February), 1995. This is a case report of Iaparoscopic splenectomy in a I&year-old girl who weighed 60 kg and had a spleen enlarged four times (600 g) because of congenital spherocytosis. Ultrasonography showed cholecystolithiasis. During surgery, five access ports were used. The small vessels close to the spleen were coagulated. An EndoGIA 30-mm stapler was used around the vessels of the splenic hilum. Back-bleeding from the surface of the spleen was easily controlled with electrocoagulation. (The authors believe that preoperative percutaneous splenic artery embolization may be of some benefit.) A previously sterilized zip-lock bag was wrapped around the spleen, and the spleen and bag were brought to the supraumbilical trocar site. A 3-cm incision was made at this site, and the fascial defect was extended bilaterally by finger dissection. The atraumatic grasper was used to bring the apex of the spleen into the incision, and the spleen was fragmented repeatedly until a quarter of it had been removed. By increasing the intraabdominal pressure to 20 mm Hg, the spleen was brought into the supraumbilical incision by hand, then removed intact with the zip-lock bag. No splenic tissue was left behind. Cholecystectomy was postponed. The estimated amount of blood loss was 250 mL, and 2 U of packed cells were needed to maintain a satisfactory hemoglobin level. She tolerated the 2-hour 40-minute procedure well, and was ambulatory after six hours.Sigmund Outcome A. Zimran,

Ein of Partial Splenectomy for Type D. Elstein, R. Schi$mann, et al.

1 Gaucher

Disease.

J Pediatr 126:596-597,

(April), 1995. Partial splenectomy was introduced to achieve the benefits of splenectomy and avoid the risk of overwhelming infection in patients with symptomatic Gaucher disease. The authors observed regrowth of the splenic remnant, reemergence of preoperative symptoms, and new bone involvement among most of the patients who had undergone partial splenectomy. Enzyme replacement therapy has markedly limited indications for splenectomy, partial or total, for Gaucher disease.-George W Holcomb, Jr

ABSTRACTS

initial repair. The interval between both operations was less than 1 year in 54% of the cases. To get more precise data, the authors explored 148 children younger than 3 years of age for bilateral hernias. The result was positive in 104 cases (70.3%). The bilateral involvement was most frequent below 6 months of age (83.5%) then it dropped gradually. A patent processus vaginalis was found on the asymptomatic side in 74.3% of girls and 61.1% of boys. The authors conclude that bilateral exploration is mainly justified during infancy, but for girls they suggest applying it until 3 years of age.-Thomas

A. Angerpointner

A Multivariate Analysis of Childhood Abdominal Trinidad. 77. AnatoEand Y. Holder. J R Co11Surg Edinb

Pain

in

40:99-103,

(April), 1995. This study was performed to identify certain diagnostic variables that might improve the diagnosis of acute abdominal pain in childhood, thus reducing the incidence of perforated appendicitis and negative laparotomies. A multivariate analysis was performed of the data recorded for 1,158 consecutive admissions of children with acute abdominal pain. Eighteen variables were selected as having discriminating power to assign children to six diagnostic groups (nonspecific abdominal pain, appendicitis, urinary tract infection, constipation, gastroenteritis, and intussusception). The main discriminating factors were positive urine culture, bowel history, findings on rectal examination, site of abdominal tenderness, presence of a mass, and white blood cell count. Minor discriminating factors were dehydration, fluid levels on erect abdominal film, an increase in temperature, tachycardia, urinary symptoms, and the general appearance of the child. The use of this database allowed the authors to produce a diagnostic flow chart, which resulted in the correct diagnosis and classification in 80.7% of cases.-Derrick Wilson-Storq GENITOURINARY

TRACT

Testicular Autotransplantation: A 17-Year Review of an Effective Approach to the Management of the Intra-Abdominal Testis. T.P. Bukowski, J. Wacksman, D.A. Billmire, et al. J Urol

154:558-561, (August), 1995. Partial or Near-Total Pancreatectomy IL Parashar, K Upadhyay, and J.J.

for

Nesidioblastosis?

Corkery. Eur J Pediatr Surg

5:146-148, (June), 1995. The authors report on 11 successfully managed cases of nesidioblastosis. In the preoperative period, all patients were managed by constant glucose administration and hyperglycemic agents such as diazoxide, glucagon, growth hormone, and somatostatin, either singly or in combination. Seven patients undenvent partial pancreatectomy, two of whom needed subsequent near-total resection. Four others had a near-total pancreatectomy as the primary procedure. The five patients who had partial pancreatectomy are healthy without regular medication. Of the six who had near-total pancreatectomy, three require insulin for diabetes mellitus and three are on pancreatin for pancreatic exocrine deficiency. Thus, partial pancreatectomy is recommended as the first procedure in the treatment of nesidioblastosis.-ThomasA. Angerpointner Routine Bilateral Exploration for lguinal Hernia Chiidhood. Z. Hrabosvlq and A.B. Pinier. Eur

in Infancy

and

J Pediatr Surg

5:152-155, (June), 1995. The authors found 138 cases of contralateral hernia that developed secondary to unilateral herniorrhaphy among 2,554 children (5.4%). Of these children, 55% (76) were younger than 1 year of age and 74% (102) were younger than 3 years of age at the time of

Patients with intraabdominal testes represent a small but challenginggroup who require innovative therapy. Testicular autdtransplantation was performed in 23 patients with a total of 27 intraabdominal testes. The success rate was 96%. The average operating time was 4.25 hours, with 40 to 90 minutes for vascular anastomoses. A contralateral Fowler-Stephens procedure had previously failed in three cases. Because the variability of collateral blood supply in patients with high undescended testes may potentially compromise the Fowler-Stephens procedure, the authors believe that testicular autotransplantation should be strongly considered for such patients, particularly those with bilateral undescended testicles.-George W. Holcomb, Jr Laparoscopic Varicocelectomy: Tan, F.C. Ng, T. Ravintharan, 1995.

Technique et al.

and

Results.

S.&f.

Br J Urol 75:523-528, (April),

One hundred seven adult patients underwent laparoscopic ligation of the spermatic veins for Doppler-ultrasound-proven varicocele. Ninety-eight presented with subfertility and nine with pain. Sperm count and quality were improved in all 61 patients who had seminal analysis before and after surgery. It is noteworthy that the testicular vessels were successfully dissected and testicular artery preserved in all patients--MN. de la Hunt