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
Femoral vein occlusion is not a common complication even after repeated hernia repair. We describe a case of a 14-year-old boy with a visible and soft, yet irreducible, mass below the inguinal ligament after 3 previou...Femoral vein occlusion is not a common complication even after repeated hernia repair. We describe a case of a 14-year-old boy with a visible and soft, yet irreducible, mass below the inguinal ligament after 3 previous inguinal hernia r epairs and heart catheterization in infancy. Further examination showed dilated venous collaterals, bypassing an occluded common femoral vein via the testicular sheaths and across the pelvic floor. We discuss etiology, diagnostic pitfalls, therapeutic options, and possible future complications, with a literature review .展开更多
Purpose The difficulty of performing laparoscopic surgery in small infants rem ains a common complaint of pediatric surgeons. The aim of this study was to eval uate the complications of laparoscopic surgery in small i...Purpose The difficulty of performing laparoscopic surgery in small infants rem ains a common complaint of pediatric surgeons. The aim of this study was to eval uate the complications of laparoscopic surgery in small infants weighing less th an 5 kg. Methods Since 1997, 154 infants weighing less than 5 kg underwent lapar oscopic surgery (group S). During that same period, 96 infants weighing less tha n 10 kg (group M)-and 335 children weighing more than 10 kg (group L) also unde rwent laparoscopic surgery. Intra-and postoperative complications were evaluate d and compared between the 3 groups, especially in the 60 cases that underwent N issen fundoplication. P < .05 was considered a significant difference. Results Complications such as gastrointestinal perforation and wound infection were obse rved in 15 (9.7%), 15 (15.6%), and 32 (9.6%) infants of groups S, M, and L , respectively. There were no significant differences in complication rates amon g the 3 groups. However, in Nissen fundoplication, 5 of 15 patients in group S h ad complications, thereby sig nificantly increasing the complication rate as compared with group L (1 of 23, P = .04). Major complications in group S were gastrointestinal perforation and vagal nerve injury. Conclusions Laparoscopic surgery is feasible even in small infants. However, in Nissen fundoplication, special attention is necessary to av oid severe intraoperative complications.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Femoral vein occlusion is not a common complication even after repeated hernia repair. We describe a case of a 14-year-old boy with a visible and soft, yet irreducible, mass below the inguinal ligament after 3 previous inguinal hernia r epairs and heart catheterization in infancy. Further examination showed dilated venous collaterals, bypassing an occluded common femoral vein via the testicular sheaths and across the pelvic floor. We discuss etiology, diagnostic pitfalls, therapeutic options, and possible future complications, with a literature review .
文摘Purpose The difficulty of performing laparoscopic surgery in small infants rem ains a common complaint of pediatric surgeons. The aim of this study was to eval uate the complications of laparoscopic surgery in small infants weighing less th an 5 kg. Methods Since 1997, 154 infants weighing less than 5 kg underwent lapar oscopic surgery (group S). During that same period, 96 infants weighing less tha n 10 kg (group M)-and 335 children weighing more than 10 kg (group L) also unde rwent laparoscopic surgery. Intra-and postoperative complications were evaluate d and compared between the 3 groups, especially in the 60 cases that underwent N issen fundoplication. P < .05 was considered a significant difference. Results Complications such as gastrointestinal perforation and wound infection were obse rved in 15 (9.7%), 15 (15.6%), and 32 (9.6%) infants of groups S, M, and L , respectively. There were no significant differences in complication rates amon g the 3 groups. However, in Nissen fundoplication, 5 of 15 patients in group S h ad complications, thereby sig nificantly increasing the complication rate as compared with group L (1 of 23, P = .04). Major complications in group S were gastrointestinal perforation and vagal nerve injury. Conclusions Laparoscopic surgery is feasible even in small infants. However, in Nissen fundoplication, special attention is necessary to av oid severe intraoperative complications.
