Endoscopic surgery in children is a rapidly expanding field of interest to all pediatric surgeons. Many common pediatric disorders can be treated using
laparoscopy.
Common pediatric laparoscopy procedures are 1) appendectomy, 2) cholecystectomy, 3) contralateral exploration for inguinal hernia, 4) pyloromyotomy, 5) fundoplication for gastroesophageal reflux, 6) splenectomy, 7) staging for cancer, 8) laparoscopy for undescended testes, 9) laparoscopy for ovarian pathology, 10) Meckel's diverticulectomy, 11) laparscopy-assisted transanal pull-through operation for Hirschsprung's disease, and 12) anorectal pull-through for high imperforate anus.
The degree of benefit from the laparoscopic approach varies from procedure to procedure. Laparoscopic appendectomy is a beneficial procedure especially for the obese patient, a teenage female patient, and for the patient with chronic abdominal pain in whom the diagnosis of appendicitis is in question. Laparoscopic splenectomy may be the procedure of choice for removal of the normal or near-normal-sized spleen. Laparoscopic fundoplication is of special benefit to neurologically impaired children most of whom have a scoliosis. Due to the high incidence of postoperative pulmonary complications, this group of patients can benefit immensely from a minimally invasive approach. For Hirschsprung's disease, the Soave, Swenson, and Duhamel type laparoscopy-assisted transanal colo-anal pull-through procedures have all been performed by a laparoscopy-assisted transanal approach. For repair of high imperforate anus, the rectourethral fistula is divided laparoscopiclly and the anorectum can be pulled-through with laparocopic assistance. Although long-term follow-up is needed for validation of laparoscopic techniques in the management of Hirschsprung's disease and high imperforate anus, however, the laparoscopic pull-through procedure for these disorders is much less invasive than open procedure.
The author will present the institutional experiences of pediatric laparoscopic procedures, and the efficacy of the laparoscopic procedures is discussed. (作者:TakeshiMiyano)(查看原文)
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