Akram J. Jawad

Laparoscopy for ovarian pathology in infancy and childhood

Abstract Conventionally, adnexal pathology in pediatric patients is treated by open laparotomy. As laparoscopic procedures are constantly finding wider application in pediatric surgery, the female child presenting with a suspected acute or chronic ovarian lesion may be an ideal candidate for laparoscopic surgery. From June 1994 to June 1996, eight girls aged 4 months to 11 years (mean 6.1 years) underwent laparoscopic procedures for various ovarian pathologies at King Khalid University Hospital (7) and Hamad Medical Corporation in Qatar (1). Four children had emergency laparoscopic surgery for lower abdominal crises; three of them were managed successfully for twisted adnexal lesions (2 simple ovarian cysts, 1 benign cystic teratoma), the fourth patient was converted to an open salpingo-oophorectomy. The other four patients had elective laparoscopic excision of adnexal lesions (two antenatally diagnosed ovarian cysts and two mature ovarian cystic teratomas). There were no operative complications; the mean operative time was 76.25 min, the mean hospital stay 2.25 days. Our initial experience and technique are presented. It appears that the laparoscopic approach to ovarian lesions in infancy and childhood is an effective and safe method for diagnosis as well as definitive therapy.

Laparoscopic cholecystectomy for cholelithiasis during infancy and childhood: cost analysis and review of current indications.

Abstract. Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical, clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for cholecystectomy was symptomatic gallstones. Other indications include mucocele of the gallbladder and chronic cholecystitis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced laparoscopic surgeon. There is a learning curve to pass through with LC. The operating time for LC ranged between 65 and 135 minutes (mean ± SD 89.81 ± 21.89 minutes). There was no major morbidity or mortality. The average postoperative parenteral analgesia required for LC (50.45 ± 24.57 mg) was significantly less than for OC (135.14 ± 62.02 mg), and the mean length of hospitalization for LC was significantly shorter than that for OC (1.68 ± 0.46 vs. 6.07 ± 0.30) days. Although the average operative cost per LC (2522 SR) was significantly more expensive than for OC (350 SR), the ultimate cost of LC was significantly less than for OC (5790.00 ± 787 vs. 12,343 ± 139 SR) because the total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the approach of choice for cholecystectomy in children.

Congenital para-oesophageal hiatal hernia in infancy.

Abstract Congenital para-oesophageal hiatal hernia (PEHH) is a rare problem in infancy, however, it constitutes a clinical entity that mandates surgical repair once the diagnosis is made. In the paediatric age group, acquired PEHH has been described as a major complication in a number of patients who were treated surgically for gastro-oesophageal reflux (GER) by Nissen fundoplication. PEHH is a frequently encountered condition in elderly patients; it accounts for 5% of diaphragmatic hiatal hernias. In both paediatric and adult patients PEHH, whether congenital or acquired in origin, is usually associated with potentially lethal complications such as gastric volvulus, incarceration, and perforation. In clinical practice true PEHH is extremely rare. The term has been expanded to include large gastric hiatal hernias where most of the stomach and the gastro-oesophageal junction are in the chest. Six infants with congenital PEHH are presented, together with an attempt to understand its possible aetiology and a review of its current surgical management.

Laparoscopic removal of an autoamputated ovarian cyst in an infant.

Ovarian cysts autoamputation is an extremely rare complication. All reported cases were removed by laparotomy. A successful laparoscopic removal is presented.

Laparoscopic cholecystectomy for cholelithiasis in infancy

Laparoscopic cholecystectomy for a symptomatic infantile cholelithiasis is reported. The technique and management are also discussed.

Pediatric Esophagogastroduodenoscopy in Saudi Arabia

Seventy-two pediatric patients (44 females and 28 males) had esophagogastroduodenoscopy over a 2-year period. In 27 of 32 patients with a history of epigastric pain and heartburn, the endoscopy was...

The management of esophageal strictures in children.

During a 10-year period from 1982 to 1992, 36 children and infants were treated for esophageal stricture. The severity of the stricture was indicated by the degree of feeding intolerance manifested by delays in growth and development and confirmed by fluoroscopy and endoscopy. Their ages ranged from one month to seven years. During the first eight years, the initial treatment was the conventional use of Savory dilators. Balloon dilatation was applied in all patients with esophageal stricture during the last two years. According to the etiology of the stricture, patients were divided into three groups. Group A: (seven patients) due to peptic esophagitis following persistent gastroesophageal reflux (GER). Group B: (15 patients) following ingestion of corrosive material. All had severe strictures; two had stomach outlet obstruction in addition. Group C: (14 patients) following repair of esophageal atresia. There was no mortality; however, overall morbidity was 5.5%, as one patient had esophageal perforation during the initial esophageal dilatation and one patient developed anastomotic leak.