Context: Choledochal cyst (CHC) is one of the most common causes of surgical jaundice in infants. In 1955, Farello et al. were the first to introduce the laparoscopic approach for treatment of CHC. Aim of the Study: Minimally invasive approaches to the management of CHC excision have been done in pre-schoolers and above but have not yet been described in toddlers, let alone infants. Herein, we review the results of 10 consecutive children <1 year managed with laparoscopic CHC excision and hepaticoduodenostomy. Methods: This retrospective study investigated 10 infants who underwent laparoscopic resection of a CHC with creation of a hepaticoduodenostomy. Results: This study was performed on 10 consecutive patients <1 year. Liver fibrosis was found in 4 patients. We had 7 cases with Type 1 CHCs and 3 cases with Type IV A cysts. Total cyst excision was done in all patients, no cases needed blood transfusion and the mean operative time was 200 min. The mean hospital stay was 6 days. Overall, morbidity occurred in 20% of the cases presenting with bouts of cholangitis that resolved without any intervention, once at 6 months, the other at 1-year post-operative. There were neither anastomotic strictures nor biliary fistula formation; magnetic resonance cholangiopancreatography was done to these two cases revealed no stricture and mortality at 30 and 90 days was nil. Conclusion: Laparoscopic hepaticoduodenostomy in CHC in children <1 year is safe, with satisfactory short-term results.
Objective To investigate the effect of laser bio-modulation irradiation therapy on the scar after surgical correction of unilateral cleft lip. Design a comparative, open-label study. Setting we conducted the study in a university based tertiary hospital that recruited early wound healers of unilateral cleft lip correction. Patients Eighty patients were divided into two groups: In study's group, patients undergo laser bio-modulation irradiation (n = 60); in the control group, patients were followed-up without intervention (n = 20). Intervention In the study's group, patients underwent low-power diode Laser with wavelength of 806 nm and power of 100 mw. Main outcome The change in the scar of cleft lip patients, which was assessed by clinical examination and ultrasound. Results The median pigmentation score was significantly lower in the laser group (median = 1; IQR = 1–2) than the control group (median 2; IQR 1–3), with p-value of <0.001. Likewise, the median height score was significantly lower in the laser group (median = 1; IQR = 1–1) than the control group (median 1.5; IQR 1.5–2), with p-value of 0.001. The median pliability score was significantly lower in the laser group (median = 1; IQR = 1–1) than the control group (median 2.5; IQR 1–3), with p-value of <0.001. Finally, the median vascularity score was significantly lower in the laser group (median = 1; IQR = 1–1) than the control group (median 1.5; IQR 1–2), with p-value of <0.001. Conclusion laser bio-modulation irradiation therapy demonstrates a potential efficacy in managing the hypertrophic scars after surgical repair of unilateral cleft lip.
Context: Hirschsprung's disease (HD) is a congenital anomaly affecting the enteric nervous system commonly the rectosigmoid region. Treatment is surgical where the aganglionic segment is resected, and bowel continuity is achieved by a colo-anal anastomosis. In 1999, Georgeson et al. proposed a new technique of primary laparoscopic-assisted pull through for HD as a new gold standard. Aim of the Study: To evaluate the outcome of the laparoscopic Duhamel procedure for the management of HD in children older than 3 years. Methods: This study was performed on 8 patients who were more than 3-year-old, with confirmed diagnoses of HD. Patients who initially presented with enterocolitis or obstruction were excluded from this study. In all cases, laparoscopic-assisted Duhamel was done. Results: We reported our results for the 1st year follow-up period and divided our results into early outcome for the first 3 months postoperative during which we had 2 cases complaining of enterocolitis that responded to conservative treatment, we observed 2 cases of perianal excoriation that responded to medical treatment while the late outcome was reported after 3 months postoperative: We had two cases with attacks of enterocolitis at 6 months and 9 months postoperatively that needed conservative treatment in the hospital in the form of parenteral antibiotics, rectal irrigation, intravenous fluids and NP0. There was neither anastomotic leak nor stenosis. Conclusion: Laparoscopic Duhamel for the management of HD in children older than 3 years is safe and useful procedure.
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