Journal of laparoendoscopic & advanced surgical techniques. Part A
-
J Laparoendosc Adv Surg Tech A · Jun 2007
Case ReportsSuccessful repair of a diaphragmatic hernia through a pericardial window with acellular dermal matrix.
A successful placement of a transabdominal pericardial window is associated with diaphragmatic hernia. In this paper, we present the case of a 5-month-old ex-31-weeks-premature baby who developed a symptomatic diaphragmatic hernia following a chronic pericardial effusion who was treated successfully with a laparoscopic transabdominal pericardial window. Laparoscopy and a pericardial window were used to manage the symptomatic effusion that developed following a bilateral thoracotomy and median sternotomy for the patient's massive hygroma. ⋯ Recovery and subsequent followup at 1 year revealed no hernia, full symptom resolution, and no recurrence of the pericardial effusion. A pericardial window is an effective approach for the management of chronic pericardial effusion. Diaphragmatic herniation through a pericardial window can be successfully repaired with an acellular dermal matrix.
-
J Laparoendosc Adv Surg Tech A · Jun 2007
Case ReportsCombined laparoscopic and endoscopic approach for the management of two ingested sewing needles: one migrated into the liver and one stuck in the duodenum.
In this paper, we present the case of a 35-year-old Caucasian female, instituted for depression, who swallowed two sewing needles. Despite the fact that the patient on presentation was asymptomatic with a normal clinical examination and blood tests, the workup revealed a contained perforation of the upper gastrointestinal tract (GI) and a migration of one needle to the liver. Moreover, the endoscopy alone failed to remove the other needle, which was stuck in the duodenal wall and, therefore, a combined endoscopic and laparoscopic approach was successfully applied to remove both needles through the abdominal wall. ⋯ Moreover, we want to discuss the safety and efficacy of the laparoscopic approach in the management of the rare cases of migrated sharp objects from the upper GI tract to the abdominal cavity, provided there is a good preoperative localization. This combined technique has shown excellent results; it is safe and easy to perform and a laparotomy can be avoided. Moreover, the laparoscopic approach is a safe, efficient approach to remove those sharp objects that have migrated into the peritoneal cavity.
-
J Laparoendosc Adv Surg Tech A · Jun 2007
Cost analysis of minimally invasive surgery in a pediatric setting.
The aims of this study was to determine whether an active policy of cost curtailment would impact on the theater cost of laparoscopic surgery in a pediatric setting; to document the extent of cost changes over time and to identify factors that adversely influence expenditure; and to investigate whether the surgeon is a significant factor in the price of the procedure. ⋯ The costs of commonly performed laparoscopic procedures are falling year by year. The surgeon is a factor in the costs of some procedures. A cost-saving strategy has not been compromised of patient safety; however, some cost-saving measures, though attractive, are labor intensive and are not practical. An overall commitment to the sensible use of health care resources translates into savings for hospitals, thereby strengthening the case for laparoscopic surgery.
-
J Laparoendosc Adv Surg Tech A · Jun 2007
Case ReportsThe use of biosynthetic mesh to separate the anastomoses during the thoracoscopic repair of esophageal atresia and tracheoesophageal fistula.
Recurrent tracheoesophageal fistula following the repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) is a difficult complication to manage, which makes prevention the dominant concern of surgeons performing the primary repair. To this end, the surrounding pleural tissues are usually brought over the tracheal closure to prevent the development of a recurrence during the open repair. This maneuver is not usually feasible when using the thoracoscopic approach. Therefore, in this paper, we describe a case in which we interposed a biosynthetic mesh between the esophageal and tracheal suture lines during the thoracoscopic repair of EA/TEF on a 2.9-kg newborn girl.