Yu-Wei Fu

Background: As surgical techniques progress, laparoscopic herniorrhaphy is now performed more often in premature babies. The aim of this study was to analyze the outcomes of newborns and infants who underwent single-incision laparoscopic herniorrhaphy (SILH) at our center. Methods: We retrospectively reviewed patients younger than 12 months old who received SILH at our department from 2016 to 2020. SILH involved a 5 mm 30-degree scope and 3 mm instruments with a 3-0 Silk purse-string intracorporeal suture for closure of the internal ring. At the time of surgery, Group 1 newborns, whose corrected age was 2 months and below, were compared to the Group 2 infants, whose age was above 2 months. We assessed the patients’ characteristics, anesthesia, surgical data, and complications. Results: A total of 197 patients were included (114 newborns in Group 1 and 83 infants in Group 2). The mean age and body weight in Group 1 were 1.2 months and 3.8 kg, respectively, whereas in Group 2, they were 3.2 months and 6.7 kg, respectively. There were no significant differences in operative time (Group 1 = 34.1 min vs. Group 2 = 32.3 min, p = 0.26), anesthetic time (Group 1 = 80.0 min vs. Group 2 = 76.3 min, p = 0.07), length of hospitalization (Group 1 = 2.3 days vs. Group 2 = 2.4 days, p = 0.88), postoperative complications including omphalitis (Group 1 = 5.3% vs. Group 2 = 1.2%, p = 0.13), wound infection (Group 1 = 0.9% vs. Group 2 = 1.2%, p = 0.81), and hydrocele (Group 1 = 0.35% vs. Group 2 = 8.4%, p = 0.14). No recurrence, testicular ascent or atrophy, or mortality was observed in either group during the 2-year follow-up period. Conclusions: Single-incision laparoscopic herniorrhaphy is a safe and effective operation for inguinal hernia repair in infants, even those with prematurity, lower body weight at the time of surgery, or cardiac and/or pulmonary comorbidities. Comparable results revealed no significant differences in perioperative complications despite younger ages and lower body weights.

Splenic torsion is an unusual condition that results in congenital abnormality, especially in the visceral abnormal arrangement. We report the case of an 8.5-year-old boy with features in the right upper quadrant. Radiological investigations revealed heterotaxy syndrome with polysplenia and a hypodense tumor in the right upper quadrant adjacent to several spleens. We initially treated it as an intra-abdominal tumor. Laparoscopy was performed to check the tumor condition and revealed a congestive tumor located in the abdomen of the right upper quadrant below the central liver, which was suspected to be a torsion spleen without attaching ligaments. Laparoscopic splenectomy was successfully carried out without complications. The pathological report shows splenic tissue with hemorrhagic infarction. Physicians should be vigilant of the differential diagnosis of the acute abdomen in adolescents.

Background: A prostatic utricle (PU) is an unusual pathology with most patients being asymptomatic. However, approximately 29% of patients may show lower urinary tract symptoms, recurrent urinary tract infections (UTI), postvoid dribbling, urethral discharge, epididymo-orchitis, stones, and secondary incontinence caused by urine trapping in the pouch and urinary retention. The standard treatment is through surgical resection, but it is only offered to patients with symptoms. Case summary: We report a case involving a six-year-old boy with congenital hypothyroidism and penoscrotal hypospadias who had previously undergone onlay urethroplasty for the proximal shaft, chordee release, orchidopexy for bilateral undescended testis, and laparoscopic herniorrhaphy for left inguinal hernia. However, the patient later evolved the repetition of UTI and right epididymo-orchitis. Cyclic voiding cystourethrography confirmed the presence of a cystic lesion communicating with the prostatic urethra from the utricle. The PU was then excised laparoscopically. The utricle was identified posterior to the bladder, and insertions of the vas deferens crossover into the utricle were detected by laparoscopy. The post-procedure course was uneventful. Conclusions: Laparoscopic resection of PUs offers a better exposure field, improved wound appearance, complete resection, and reduces the incidence of complications. During laparoscopy, the PU was clearly distinguished from the bladder or other pelvic organs. An incidental finding of vas deferens crossover has rarely been reported. A combined cystoscopy and laparoscopy for PU resection is executable, safe, and valid in this patient population.

In children, urologic complications are rare after laparoscopic appendectomy (LA). In this article, we report the case of a 9-year-old boy with bilateral hydronephrosis caused by ureteral calculi 10 days after he had undergone LA. The patient's urinary output normalized and renal function recovered after stone extraction and bilateral ureteral stent insertion.

Introduction: Traditionally, the Swenson pullthrough for Hirschsprung disease (HD) was considered potentially risky for sphincter injury and subsequent fecal incontinence. Recent studies have demonstrated that the continence mechanism can be well preserved when a HD case is approached transanally and it avoids any long-term problems related to the cuff.^1,2 However, the anal canal can be overstretched, which can hurt the sphincter mechanism. It is clear that over time, the Soave done transanally is being performed with a shorter and shorter cuff, approaching a Swenson procedure. The laparoscopic approach is mostly used for biopsy and colon mobilization, but less so for the deep pelvic rectal dissection. We propose a technique of laparoscopic Swenson pullthrough that dissects the rectum deep into the pelvis to minimize the transanal dissection and then avoid overstretching and that takes advantage of the Swenson plane. Materials and Methods: We present a 1-month-old female infant with HD, a transition zone at the rectosigmoid junction. Four ports were used for a laparoscopic approach: umbilicus, right upper and lower quadrants, and left upper quadrant. A biopsy from the proximal sigmoid colon confirmed ganglion cells and no hypertrophic nerves. A mesenteric window was made at the rectosigmoid junction, sigmoid branch vessels were divided, and marginal arteries were preserved. The left colon and splenic flexure were mobilized. Circumferential rectal dissection was accomplished laparoscopically, staying intimately close to the rectal wall. An avascular Swenson plane can be clearly identified between rectal serosa and mesorectum, which is the key plane required to avoid complications. Dissection can be carried out inferiorly. At this point, a transanal full-thickness dissection is performed with assistance from a lone-star retractor, which requires only a few centimeters of dissection to reach the previously dissected colon, allowing the ganglionic colon to be pulled through. Results: The postoperative recovery was uneventful. An episode of enterocolitis and transient constipation occurred, which was resolved by early implementation of bowel management. The patient developed regular bowel habit without enemas or laxatives at the age of 1 year. Conclusions: This technique is safe and feasible. Minimization of anal dissection is helpful to avoid overstretching of anal canal. No Soave cuff would be left behind. No competing financial interests exist. Runtime of video: 4 mins 36 secs This work was presented at the International Pediatric Endosurgery Group meeting in Nashville, Tennessee on April 17, 2015.