This prospective study shows that the laparoscopic Kasai procedure for biliary atresia is technically feasible. However, the study was stopped after inclusion of 12 laparoscopically operated infants due to a lower survival with the native liver after laparoscopic versus conventional Kasai operation. Superior results after conventional operation were confirmed at follow-up after 24 months. Study registration ID: EBAR 9260/NCT01063699.
Fast-track elements in pediatric surgery increase patient comfort, reduce hospital stay, and achieve a high patient satisfaction. We wish to emphasize the benefits of using fast-track elements irrespective of whether a whole fast-track protocol is applicable.
OBJECTIVE
To determine whether the association of seminal vesicle cyst (SVC) and renal anomaly in young children correlates with previously reported cases of SVCs in adolescent and adult patients, as congenital SVCs, although rare, are frequently described in association with ipsilateral renal agenesis, mainly in adolescent and adult patients, whereas reports on SVCs in younger children are sparse.
PATIENTS AND METHODS
We report on nine infants (median age 4 months) with congenital SVCs, all of them associated with ipsilateral dysplastic kidneys. All patients had ultrasonography of the renal system and voiding cysto‐urethrography. Magnetic resonance imaging was used in two patients.
RESULTS
The SVCs were found incidentally during ultrasonography for the renal anomaly. Three patients had dysplastic and six had multicystic dysplastic kidneys. In previous reported adult cases of SVCs the most common associated renal anomaly was agenesis of the ipsilateral kidney (25 of 44 cases), whereas only one case of dysplastic kidney was reported.
CONCLUSION
As the appearance of renal agenesis might result from a former congenital dysplastic kidney, our findings indicate that cases of ipsilateral renal agenesis in adult patients with congenital SVCs might represent former dysplastic or multicystic dysplastic kidney.
Introduction The pros and cons of video-assisted thoracoscopic versus conventional thoracic surgery in infants and children are still under debate. We assessed reported advantages and disadvantages of video-assisted thoracoscopy in pediatric surgical procedures, as well as the evidence level of the available data.
Materials and Methods A systematic literature search was performed to identify manuscripts comparing video-assisted thoracoscopic and the respective conventional thoracic approach in classic operative indications of pediatric surgery. Outcome parameters were analyzed and graded for level of evidence (according to the Oxford Centre of Evidence-Based Medicine).
Results A total of 48 comparative studies reporting on 12,709 patients, 11 meta-analyses, and one pilot randomized controlled trial including 20 patients were identified. More than 15 different types of advantages for video-assisted thoracoscopic surgery were described, mostly with a level of evidence 3b or 3a. Most frequently video-assisted thoracoscopic surgery was associated with shorter hospital stay, shorter postoperative ventilation, and shorter time to chest drain removal. Mortality rate and severe complications did not differ between thoracoscopic and conventional thoracic pediatric surgery, except for congenital diaphragmatic hernia repair with a lower mortality and higher recurrence rate after thoracoscopic repair. The most frequently reported disadvantage for video-assisted thoracoscopic surgery was longer operative time.
Conclusion The available data point toward improved recovery in pediatric video-assisted thoracoscopic surgery despite longer operative times. Further randomized controlled trials are needed to justify the widespread use of video assisted thoracoscopy in pediatric surgery.
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