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astric transposition in children is a well-established treatment for long-gap esophageal atresia and long caustic strictures when preservation of the native esophagus is impossible, but does involve laparotomy and, often, thoracotomy incisions. The minimally invasive approach to this operation has been attempted in 7 patients to date in the UK, all at Great Ormond Street Hospital (London, UK). Four patients were male, 3 were female, with a mean age of 3 years and 7 months (range, 5 months to 13 years). Indications were long-gap esophageal atresia where primary anastomosis was impossible (5 patients) and caustic ingestion with long esophageal strictures (2 patients). The stomach was mobilized laparoscopically by using 5-mm instruments and a pneumoperitoneum of 10 mm Hg. Following pyloromyotomy or pyloroplasty, a tunnel in the posterior mediastinum was developed. The fundus of the stomach was drawn to the neck and sutured to the cervical esophagus. The patients were ventilated on our intensive care unit and then returned to the surgical ward before discharge. Gastric transposition was completed laparoscopically in 6 of 7 patients. The mean duration of surgery was 327 minutes (range, 240-455). All patients survived. Minor complications were pneumonia (2), pleural effusion (1), and hiatus hernia (2). The mean hospital stay was 16 days (range, 8-36). Our preliminary experience would suggest that laparoscopic gastric transposition is a safe alternative to open surgery with satisfactory results.

Laparoscopic fundoplication can be safely performed in infants. There was no predictor of recurrence. However, there is a 20% late mortality in patients with severe co-morbidities, which needs to be taken into account when counseling patients.

Degradable thermoplastic polyurethane (TPU) elastomers incorporating poly(D,L-lactide-co-glycolide) (PLGA) were synthesized and characterized. The soft segments consisted of a mixture of poly(butylene adipate) (PBA) and PLGA with PBA/PLGA ratios of 100/0, 75/25, and 50/50 wt %. Two PLGA polyesters were used. BD-PLGA was initiated from butanediol; whereas BHMBA-PLGA was initiated from 2,2-bis-(hydroxymethyl)butanoic acid. The hard segments consisted of dicyclohexylmethane-4,4 0 -diisocyanate (H 12 MDI) and 1,4-butanediol (BD). The hard segment content, expressed as the weight ratio of BD to polyol used in the TPU formulation, was set either at 8 or 12% (31.2 or 38.1% hard segment by weight, respectively). In all cases initial [NCO]/[OH] ratio was 1.03. The tensile modulus of the TPUs ranged from 9 to 131 MPa and ultimate strains ranged from 100 to 750%. DMA was used to probe the thermomechanical transitions of the TPUs and indicated useful application temperatures from well below zero up to 60-80 C depending on the formulation. Hydrolytic degradation of the TPUs was tested in seawater at 37 C. All of the PLGA-containing TPUs showed enhanced degradation compared to those with only PBA as the soft segment. The latter compositions remained essentially unchanged throughout the test while the PLGAcontaining TPUs lost as much as 45% of their initial mass in 153 days. Molecular weights of TPUs containing degradable polyols were lower than those derived from 100% PBA polyol.

This is the largest series of L2(nd)FSO to date. A successful outcome is recorded in 85 out of 102 (83.3%) testicles. Atrophy occurred in 8.8% and ascent in 8.8%.

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