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Morgagni-Larrey hernia correction by laparoscopic surgery
536
INTERNATIONAL
Choledocholithiasis was found in SIX cases; 3 of them were managed by papillotomy before laparoscopic cholecystectomy and three were treated openly (2 of whom had converted laparoscopic procedures). No major duct injuries occurred. The open procedures were more common in children less than 10 years old. The incidence of intraoperative complications did not differ between the groups. Open procedures were more often emergency operations than laparoscopic procedures. Laparoscopic cholecystectomies resulted in a shorter hosprtal stay, shorter time to diet resumption, shatter operating time, and less requirement for postoperative analgesics. It is concluded that laparoscopic cholecystectomy is the method of choice for chiidhood gallbladder disease.-ZY We&r Conservative Surgery for Benign A.J.A. Holland, WD.A. Ford, andA.J. 355, (July), 1997.
Nonparasitic Spienic Cysts. Boume. Pediatr Surg Int 12:353-
Nonparasitic true epithelial-lined cysts have tradttionally been mataged with splenectomy. The authors report their experience with partial splenectomy in two cases. In both cases the cyst was excised and the transection site “fish-mouthed” and closed with “sandwrch-technique” over oxidase cellulose gauze. One patient had an intravenous cathetersite infection postoperatively, but otherwise the postoperattve recovery was uncomplicated. Radionucleotide scans performed 2 and 5 months after the operation demonstrated normal splenic uptake in both cases.-? Puri Risk of Hemorrhage and Appropriate Use of Blood Transfusions in Pediatric Blunt Splenic Injuries. ,S. Shaj, J.C. Gilbm, ,Y. Carden, ef al. J Trauma 42:1029-1032, (June), 1997. The authors report a retrospective series of 74 children with blunt splemc injuries during a 6-year period with the objective of determining hematocrit changes and indications for transfusions. Fifteen children (20%) received transfusion, all but one of whom had sustained multiple injuries (mean ISS, 27). The transfusion rate for the entire group decreased from 38% in 1990 to 10% by 1995 (P = NS). Thirty-one chtldren had isolated splenic inJuries, and all were successfully treated without operation. All but one of these 31 patients were treated without transfusion. Hematocrit values stabilized by 24 hours in all patients with isolated splenic inJuries. The authors concluded that transfusions are now used almost exclusively in children who have multiple injuries.Steven Stylianos Conservative Management M.S. Kellec PM? Stafford, (June), 1997.
of Pancreatic Trauma and D.W Vane. .I Trauma
in Children. 42:1097-1100,
The authors reviewed the outcome for 154 children with pancreatic inJuries over a 7-year period. Twelve children (8%) were from the authors’ two institutions. and 142 patients were from the National Pediatric Trauma Registry. The authors defined grade I and II injuries as those witb lacerations and/or contusion but without maJor ductal injuries. Grades III. IV, and V injuries indicated major tissue disruption and ductal injuries. Seventy-nine percent of children with grades I or II injuries were treated successfully without operation, and the outcome for these children was no worse than that of patients who underwent early operation. The authors recommend nonoperative strategies for children with pancreatic injuries who have no evidence of major ductal disruption or clinical deterioration. The study had several limitations: 92% of data were from registry review. radiological dtagnostic crtteria were not reported, and penetrating injuries were included.Afeveti Stylianos Morgagni-Larrey Hernia Correction by Laparoscopic Surgery. l? Georgacopulo, A. Franchella, G. Mandrioli, et al. Eur J Pediatr Surg 7:241-242, (August), 1997.
ABSTRACTS
A new method of closure of Morgagni-Larrey hernia by videoassisted surgery in a 4-yearold child is described, A barium enema demonstrated the diaphragmatic hernia, and the authors decided to correct the hernia by means of a laparoscopic technique. The procedure took less than 1 hour. Tbe postoperative course was uneventful, and the child was dismissed 48 hours later.-Thomas A. Angerpointner
GENITOURINARY
TRACT
Morphogenesis of the Human External Ammini, U. Sabherwal, C. Mukhopadi~yay, 12:401-406, (July), 1997,
Male Genitalia, A.C. et al. Pediatr Surg Int
The authors studied the morphogenesis of the human male external genitalia from the 6th to 26th gestational week, At 9 weeks’ gestation, a cylindrical 2-mm-long genital tubercle with distinguishable coronary sulcus, glans, and genital swellings was observed as the first part of differential male and female development. Later, on the ventral aspect of the penis, a groove was observed, the boundaries of which formed the urethral folds. These folds fused. and a tubularized urethra started to develop from the proximal end in the distal direction, At 12 weeks’ gestation, the urethra had closed to the coronary sulcus, and subsequently the glandular urethra also closed. Mesodermal tissue migrated ventrally and medially to form genital swellings, and skin between the genital swellings elevated to form a skin fold. The prepuce developed over the glans, which was covered at 20 weeks’ gestation.-T. Wester
Pedicled Penile Skin for Hypospadias wood and C. Feame. Br J Ural 80:145-146,
‘Rescue’. A.M.K. (July), 1997.
Rick-
The authors discuss their technique of reconstmction with pedicled penile flaps, which they have used with success m I4 patients requiting hypospadias “rescue” procedures.-MN. de la Hunt
Significantly Increased Complication cisions. E. &demic Br J Urol80:136-139,
Risks With Mass (July), 1997.
Circum-
This is a part retrospective and part prospective study of complications after circumcision in Turkish boys. Three groups were studied: (1) 220 boys who underwent circumcision through emergency or outpatient departments over the last decade, (2) 700 boys who underwent ritual mass circumcision over a 5-day period, and (3) 600 boys circumcised in the operating room over the last decade. The rate of complications was significantly higher after mass circumcisions. Medically untrained, traditional circumcisers accounted for 85% of the complications, includmg almost all the disastrous ones. The authors make a plea for circumcision to be carried out in a safe environment by appropriately trained personnel.-M.N. de la Hunt
Rare Congenital Abnormalities of the Anterior Urethra. Karnak, M.E. Senocak, N. Biiyiikpamukcu, et al. Pediatr Surg 12:407-409, (July), 1997.
I. Int
Five cases of rare abnormalities of the anterior urethra are reported. Three cases had urethral diverticula, one had an anterior urethral valve, and one had megalourethra, The patients presented with dysuria, dribbling, poor stream, infection, or urolithiasts. In the cases with megalourethra, penile swelling was obvious. The abnormalities were diagnosed with micturition-cysto-uretbrography except for the patient with megalourethra, who underwent ultrasonography and retrograde urethrography. The urethral diverticula were treated with diverticulectomy and urethroplasty, witb good results. The patient with the anterior urethral valve did well after valve ablation. The boy with megalourethra underwent perineal urethrostomy and subsequently was lost to follow-up.-? Puri
INTERNATIONAL
Choledocholithiasis was found in SIX cases; 3 of them were managed by papillotomy before laparoscopic cholecystectomy and three were treated openly (2 of whom had converted laparoscopic procedures). No major duct injuries occurred. The open procedures were more common in children less than 10 years old. The incidence of intraoperative complications did not differ between the groups. Open procedures were more often emergency operations than laparoscopic procedures. Laparoscopic cholecystectomies resulted in a shorter hosprtal stay, shorter time to diet resumption, shatter operating time, and less requirement for postoperative analgesics. It is concluded that laparoscopic cholecystectomy is the method of choice for chiidhood gallbladder disease.-ZY We&r Conservative Surgery for Benign A.J.A. Holland, WD.A. Ford, andA.J. 355, (July), 1997.
Nonparasitic Spienic Cysts. Boume. Pediatr Surg Int 12:353-
Nonparasitic true epithelial-lined cysts have tradttionally been mataged with splenectomy. The authors report their experience with partial splenectomy in two cases. In both cases the cyst was excised and the transection site “fish-mouthed” and closed with “sandwrch-technique” over oxidase cellulose gauze. One patient had an intravenous cathetersite infection postoperatively, but otherwise the postoperattve recovery was uncomplicated. Radionucleotide scans performed 2 and 5 months after the operation demonstrated normal splenic uptake in both cases.-? Puri Risk of Hemorrhage and Appropriate Use of Blood Transfusions in Pediatric Blunt Splenic Injuries. ,S. Shaj, J.C. Gilbm, ,Y. Carden, ef al. J Trauma 42:1029-1032, (June), 1997. The authors report a retrospective series of 74 children with blunt splemc injuries during a 6-year period with the objective of determining hematocrit changes and indications for transfusions. Fifteen children (20%) received transfusion, all but one of whom had sustained multiple injuries (mean ISS, 27). The transfusion rate for the entire group decreased from 38% in 1990 to 10% by 1995 (P = NS). Thirty-one chtldren had isolated splenic inJuries, and all were successfully treated without operation. All but one of these 31 patients were treated without transfusion. Hematocrit values stabilized by 24 hours in all patients with isolated splenic inJuries. The authors concluded that transfusions are now used almost exclusively in children who have multiple injuries.Steven Stylianos Conservative Management M.S. Kellec PM? Stafford, (June), 1997.
of Pancreatic Trauma and D.W Vane. .I Trauma
in Children. 42:1097-1100,
The authors reviewed the outcome for 154 children with pancreatic inJuries over a 7-year period. Twelve children (8%) were from the authors’ two institutions. and 142 patients were from the National Pediatric Trauma Registry. The authors defined grade I and II injuries as those witb lacerations and/or contusion but without maJor ductal injuries. Grades III. IV, and V injuries indicated major tissue disruption and ductal injuries. Seventy-nine percent of children with grades I or II injuries were treated successfully without operation, and the outcome for these children was no worse than that of patients who underwent early operation. The authors recommend nonoperative strategies for children with pancreatic injuries who have no evidence of major ductal disruption or clinical deterioration. The study had several limitations: 92% of data were from registry review. radiological dtagnostic crtteria were not reported, and penetrating injuries were included.Afeveti Stylianos Morgagni-Larrey Hernia Correction by Laparoscopic Surgery. l? Georgacopulo, A. Franchella, G. Mandrioli, et al. Eur J Pediatr Surg 7:241-242, (August), 1997.
ABSTRACTS
A new method of closure of Morgagni-Larrey hernia by videoassisted surgery in a 4-yearold child is described, A barium enema demonstrated the diaphragmatic hernia, and the authors decided to correct the hernia by means of a laparoscopic technique. The procedure took less than 1 hour. Tbe postoperative course was uneventful, and the child was dismissed 48 hours later.-Thomas A. Angerpointner
GENITOURINARY
TRACT
Morphogenesis of the Human External Ammini, U. Sabherwal, C. Mukhopadi~yay, 12:401-406, (July), 1997,
Male Genitalia, A.C. et al. Pediatr Surg Int
The authors studied the morphogenesis of the human male external genitalia from the 6th to 26th gestational week, At 9 weeks’ gestation, a cylindrical 2-mm-long genital tubercle with distinguishable coronary sulcus, glans, and genital swellings was observed as the first part of differential male and female development. Later, on the ventral aspect of the penis, a groove was observed, the boundaries of which formed the urethral folds. These folds fused. and a tubularized urethra started to develop from the proximal end in the distal direction, At 12 weeks’ gestation, the urethra had closed to the coronary sulcus, and subsequently the glandular urethra also closed. Mesodermal tissue migrated ventrally and medially to form genital swellings, and skin between the genital swellings elevated to form a skin fold. The prepuce developed over the glans, which was covered at 20 weeks’ gestation.-T. Wester
Pedicled Penile Skin for Hypospadias wood and C. Feame. Br J Ural 80:145-146,
‘Rescue’. A.M.K. (July), 1997.
Rick-
The authors discuss their technique of reconstmction with pedicled penile flaps, which they have used with success m I4 patients requiting hypospadias “rescue” procedures.-MN. de la Hunt
Significantly Increased Complication cisions. E. &demic Br J Urol80:136-139,
Risks With Mass (July), 1997.
Circum-
This is a part retrospective and part prospective study of complications after circumcision in Turkish boys. Three groups were studied: (1) 220 boys who underwent circumcision through emergency or outpatient departments over the last decade, (2) 700 boys who underwent ritual mass circumcision over a 5-day period, and (3) 600 boys circumcised in the operating room over the last decade. The rate of complications was significantly higher after mass circumcisions. Medically untrained, traditional circumcisers accounted for 85% of the complications, includmg almost all the disastrous ones. The authors make a plea for circumcision to be carried out in a safe environment by appropriately trained personnel.-M.N. de la Hunt
Rare Congenital Abnormalities of the Anterior Urethra. Karnak, M.E. Senocak, N. Biiyiikpamukcu, et al. Pediatr Surg 12:407-409, (July), 1997.
I. Int
Five cases of rare abnormalities of the anterior urethra are reported. Three cases had urethral diverticula, one had an anterior urethral valve, and one had megalourethra, The patients presented with dysuria, dribbling, poor stream, infection, or urolithiasts. In the cases with megalourethra, penile swelling was obvious. The abnormalities were diagnosed with micturition-cysto-uretbrography except for the patient with megalourethra, who underwent ultrasonography and retrograde urethrography. The urethral diverticula were treated with diverticulectomy and urethroplasty, witb good results. The patient with the anterior urethral valve did well after valve ablation. The boy with megalourethra underwent perineal urethrostomy and subsequently was lost to follow-up.-? Puri