Purpose Abnormalities in esophageal motor function underlie various symptoms i n the pediatric population. Manometry remains an important tool for studying eso phageal motor function, whereas its analyses have been co...Purpose Abnormalities in esophageal motor function underlie various symptoms i n the pediatric population. Manometry remains an important tool for studying eso phageal motor function, whereas its analyses have been conducted with considerab le subjective interpretation. The usefulness of videomanometry with topographic analysis was examined in the current study. Methods Videomanometry was conducted in 5 patients with primary gastroesophageal reflux disease (GERD), 4 with posto perative esophageal atresia (EA), 1with congenital esophageal stenosis (CES), an d 1 with diffuse esophageal spasms (DES). Digitized videofluoroscopic images wer e recorded synchronously with manometric digital data in a personal computer. Ma nometric analysis was conducted with a view of concurrent esophageal contour and bolus transit. Results Primary GERD patients showed esophageal flow proceeding into the stomach during peristaltic contractions recorded manometrically, wherea s patients with EA/CES frequently showed impaired esophageal transit during defe ctive esophageal peristaltic contractions. A characteristic corkscrew appearance and esophageal flow in a to-and-fro fashion were seen with high-amplitude sy nchronous esophageal contractions in a DES patient. The topographic analysis sho wed distinctive images characteristic of each pathological condition. Conclusion s Videomanometry is helpful in interpreting manometric data by analyzing concurr ent fluoroscopic images. Topographic analyses provide characteristic images refl ecting motor abnormalities in pediatric esophageal disease.展开更多
Purpose Children with neurologic and neuromuscular handicaps frequently have v arious symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in su...Purpose Children with neurologic and neuromuscular handicaps frequently have v arious symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study. Methods Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), an d gastrostomy was performed concurrently in 52.The main symptoms were emesis/he matemesis in 40 and respiratory symptoms, including repeated respiratory infecti on and distress, in 31.Results There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those w ithout recurrence. Respiratory symptoms were controlled unsuccessfully in 16 pat ients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease o ccurred in 10 patients, 7 of whom underwent a second Nissen fundoplication succe ssfully. Thirteen died within the median follow-up period of 14 months. Conclus ions Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped chi ldren. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.展开更多
Background/Purpose Laparoscopically assisted endorectal pull-through (EPT) vi a a perineal approach using a prolapsing technique (PA) for Hirschsprung’s dise ase (HD) has been reported. However, the clinical outcome ...Background/Purpose Laparoscopically assisted endorectal pull-through (EPT) vi a a perineal approach using a prolapsing technique (PA) for Hirschsprung’s dise ase (HD) has been reported. However, the clinical outcome after this approach ha s not been reported. The purpose of this study was to compare the clinical outco me of PA and the conventional transabdominal approach (TA). Methods In the perio d between 1990 and 2001, 20 cases of HD underwent EPT with TA (group O), and 21 underwent EPT with PA (group L). There was no difference in age and weight distr ibution between the 2 groups. Clinical outcome was assessed 3 years after surger y. Results The operation time was comparable in the 2 groups (4.9 ±0.8 v 5.2 ±0.8 hr), whereas blood loss (98 ±52 v 36 ±30 mL) and postoperative complic ations requiring surgical intervention (26%v 0%) were significantly lower in g roup L. The incidence of postoperative enteritis (27%v 28%) and voluntary defe cation (more than once every/2 days) were compatible in the 2 groups (70%v 87% ). Soiling (small amount of involuntary stooling; > 1 per month)was significantl y less frequent in group L (45%v 14%). Conclusions Laparoscopically assisted E TP with PA is less invasive and can provide a better clinical outcome compared w ith TA in terms of postoperative soiling.展开更多
文摘Purpose Abnormalities in esophageal motor function underlie various symptoms i n the pediatric population. Manometry remains an important tool for studying eso phageal motor function, whereas its analyses have been conducted with considerab le subjective interpretation. The usefulness of videomanometry with topographic analysis was examined in the current study. Methods Videomanometry was conducted in 5 patients with primary gastroesophageal reflux disease (GERD), 4 with posto perative esophageal atresia (EA), 1with congenital esophageal stenosis (CES), an d 1 with diffuse esophageal spasms (DES). Digitized videofluoroscopic images wer e recorded synchronously with manometric digital data in a personal computer. Ma nometric analysis was conducted with a view of concurrent esophageal contour and bolus transit. Results Primary GERD patients showed esophageal flow proceeding into the stomach during peristaltic contractions recorded manometrically, wherea s patients with EA/CES frequently showed impaired esophageal transit during defe ctive esophageal peristaltic contractions. A characteristic corkscrew appearance and esophageal flow in a to-and-fro fashion were seen with high-amplitude sy nchronous esophageal contractions in a DES patient. The topographic analysis sho wed distinctive images characteristic of each pathological condition. Conclusion s Videomanometry is helpful in interpreting manometric data by analyzing concurr ent fluoroscopic images. Topographic analyses provide characteristic images refl ecting motor abnormalities in pediatric esophageal disease.
文摘Purpose Children with neurologic and neuromuscular handicaps frequently have v arious symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study. Methods Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), an d gastrostomy was performed concurrently in 52.The main symptoms were emesis/he matemesis in 40 and respiratory symptoms, including repeated respiratory infecti on and distress, in 31.Results There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those w ithout recurrence. Respiratory symptoms were controlled unsuccessfully in 16 pat ients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease o ccurred in 10 patients, 7 of whom underwent a second Nissen fundoplication succe ssfully. Thirteen died within the median follow-up period of 14 months. Conclus ions Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped chi ldren. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.
文摘Background/Purpose Laparoscopically assisted endorectal pull-through (EPT) vi a a perineal approach using a prolapsing technique (PA) for Hirschsprung’s dise ase (HD) has been reported. However, the clinical outcome after this approach ha s not been reported. The purpose of this study was to compare the clinical outco me of PA and the conventional transabdominal approach (TA). Methods In the perio d between 1990 and 2001, 20 cases of HD underwent EPT with TA (group O), and 21 underwent EPT with PA (group L). There was no difference in age and weight distr ibution between the 2 groups. Clinical outcome was assessed 3 years after surger y. Results The operation time was comparable in the 2 groups (4.9 ±0.8 v 5.2 ±0.8 hr), whereas blood loss (98 ±52 v 36 ±30 mL) and postoperative complic ations requiring surgical intervention (26%v 0%) were significantly lower in g roup L. The incidence of postoperative enteritis (27%v 28%) and voluntary defe cation (more than once every/2 days) were compatible in the 2 groups (70%v 87% ). Soiling (small amount of involuntary stooling; > 1 per month)was significantl y less frequent in group L (45%v 14%). Conclusions Laparoscopically assisted E TP with PA is less invasive and can provide a better clinical outcome compared w ith TA in terms of postoperative soiling.
