Takeshi Miyano
Tokyo, Japan
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.