Authors: RalfBodo Tröbs M Reza Vahdad Grigore Cernaianu
Publish Date: 2015/06/02
Volume: 46, Issue: 2, Pages: 235-240
Abstract
Data were collected for 556 infants and children Access into the abdominal cavity was gained via a transverse infraumbilical stab incision passing the fibrotic umbilical cord remnant Ninetytwo infants underwent laparoscopic pyloromyotomy LPM 159 female infants underwent herniorrhaphy LHR and 309 infants underwent appendectomy LAP Of the total operations 70 were performed by boardcertified surgeons and 30 were performed by nonboardcertified surgeons The median time of followup was 24 monthsNo cases of acute severe bleeding or organ laceration were noted TUCArelated complications were observed in nine patients 16 Omphalitis and persistent wound secretion were detected in eight children and foreign bodies consisting of cyanoacrylate were removed from three of these patients Meanwhile umbilical pain leading to surgical revision was observed in one child and eight umbilical hernias were repaired during the TUCA procedures No signs of postoperative incisional hernia were recordedSafe entry into the abdominal cavity and the creation of capnoperitoneum via CO2insufflation are the basic steps that allow for laparoscopic surgery This maneuver moves the gut and underlying organs away from the abdominal wall and allows for the safe insertion of additional ports and instruments Access to the peritoneal space can be gained either by blind percutaneous puncture with a springloaded Veress needle according Janos Veress 1938 or by using an open approach 1 2 For many surgeons open infraumbilical access based on the method of Hasson is considered the standard approach in adults and this approach is also often applied in children 3 4 5Potential primary and locoregional complications that may occur during abdominal wall puncture and insufflation of gas include bleeding from the anterior abdominal wall vessels bowel perforation visceral vessel bleeding and/or major retroperitoneal vascular injury 6 Secondary complications include wound infection incisional hernia development bowel adhesion and hypertrophic scar formationThe aim of the present study was to evaluate our experiences with transumbilical cord access TUCA in three different procedures and age groups to analyze the method’s feasibility safety and complication profile In addition we investigated the value of TUCA for pediatric surgical training
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