Although longer follow-up to evaluate continence is to come, laparoscopically assisted anorectal pull-through should be considered for the correction of the high imperforate anus and, according to our experience, it represents the gold standard. It offers the advantage of good visualization of the fistula and the surrounding structures and minimally invasive abdominal and perineal wounds. With the laparoscopic Peña stimulator the direct observation of the contraction of the puborectalis sling allows an evaluation of the functional contractility and an accurate colonic pullthrough in the center of the muscle complex.
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Necrotizing enterocolitis (NEC) is an important complication for premature newborns.
Infants who survive NEC have a greater possibility of poor long-term physiological and neurodevelopmental
growth.
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The objective of this paper is to give a comprehensive description of the long-term consequences of
NEC. Despite the rise in incidence of NEC there is a scarcity of data regarding long-term outcomes
of these infants that can be divided into two groups. The first group includes gastrointestinal complications
that could occur in relation to the bowel disease, the surgical treatment and quality of the
residual bowel. These complications are strictures and short bowel syndrome (SBS).
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Intestinal strictures are a common occurance after recovery from NEC that should be investigated
with a contrast study in case of suspicious clinical findings of bowel obstruction or before reversal
ostomy. After this diagnostic investigation, if a stricture is detected in a symptomatic patient, resection
of the affected loop of bowel with anastomosis is required. SBS is the result of a massive intestinal
resection or of a dysfunctional residual bowel and it can occur in a fourth of patients affected
by NEC.
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The second group includes neurodevelopmental impairment and growth.
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Infants with NEC is a population of patients at high risk for adverse neurodevelopmental outcomes
whose cause can be multifactorial and linked to perinatal events, severity of disease, surgical treatment
and its complications and hospitalization. Understanding the morbidity of NEC with a longterm
follow-up would aid neonatologists and pediatric surgeons to make informed decisions in providing
care for these patients. Further research on this topic is needed.
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Neurodevelopmental outcomes of patients after NEC recovery have not been widely reported.
Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.
Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.
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