Gunter H Willital

Surgical correction of pectus excavatum: the Münster experience.

Objectives: Pectus excavatum is the most common congenital hereditary chest-wall deformity. This study analyses a single-center experience of pectus excavatum– thoracic wall reconstruction using a uniform technique of internal stabilization employing stainless steel struts. Methods: From June 1984 to December 1997, we performed correction operations on 777 patients with pectus excavatum. The condition occurred more frequently in boys (621 patients) than girls (156 patients). Surgical repair was performed using a standard method of double bilateral chondrotomy parasternally and at points of transition to normal ribs. This was followed by detorsion of the sternum, retrosternal mobilization and correction of the inverted ribs. The anteriorly displaced sternum was stabilized by one trans-sternal and two bilateral parasternal metal struts. Results: The corrections were completed with successful repair in 765 pati-ents (98.5%) with a low complication rate of 6.7%. The follow-up period ranged from 4 weeks to 12 years, mean 6.4 years. Major recurrences were observed in 12 patients (1.5%) and mild recurrence were observed in 35 patients (4.5%). Conclusion: Significant reduction in postoperative cardiorespiratory disorders, low lethality, improvement of subjective complaints, satisfactory long-term results and improvement in psychological problems indicate the need to offer this method of surgical correction to low-risk children.

Laparoscopic appendectomy in children with Enterobius vermicularis.

As surgeons gain more experience with laparoscopy in children, it is becoming apparent that one of the best applications of the technique is for appendicitis. The advantages of laparoscopic appendectomy include a better cosmetic result, particularly in young female patients, a shorter recovery time, and an early return to normal activities. In the differential diagnosis of appendicitis, the association of Enterobius vermicularis (pinworms) inflammation in the pediatric age group is not uncommon. The endo-loop technique for laparoscopic appendectomy is the standard technique used in our department. In three patients with E. vermicularis undergoing appendix removal using this technique, pinworms were found to be set free into the abdomen after dividing the appendix between the loop ligatures. Bipolar coagulating forceps were used carefully to thermally desiccate the worms, which were then removed using a blunt grasper. E. vermicularis being released into the abdomen in children undergoing laparoscopic appendectomy using the endo-loop technique has not been reported. Careful evaluation of the appendix stump and simple but careful thermal desiccation and removal of pinworms, if present, must be considered when using the endo-loop technique.

Advances in the diagnosis of anal and rectal atresia by ultrasonic-echo examination.

Summary An ultrasonic-echo examination developed specifically for determining the site of the blind-ending rectum in anorectal anomalies has been used successfully in eight cases. This investigation is indicated in those cases in which a fistula from the blind-ending rectum cannot be demonstrated. The accuracy of this method is affirmed by autopsies and by roentgen loopograms and contrast filling of the rectum via fistulas.

Thermography of Clostridium perfringens infection in childhood

Abstract Gas gangrene is not a frequently encountered toxic wound infection in childhood. We present a case of postoperative Clostridium perfringens infection with proximal forearm myonecrosis. In order to reveal the full extent of tissue viability in the right upper extremity, infrared thermography was performed. Although dyschromia was evident in the proximal forearm, thermographs revealed viable tissue only up to the supracondylar region. Angiography, which provided valuable clues to the patency of the vascular supply, and subsequent intraoperative findings confirmed the extent of tissue perfusion as revealed by infrared thermography.

Laparoscopic suture rectopexy for rectal prolapse in a 22-month-old child.

We present the case of a 22-month-old female child who presented with severe recurrent rectum prolapse. The patient was successfully managed using the laparoscopic simple suture rectopexy approach with 5-mm instruments employing two 3-0 nonabsorbable sutures on either side of the rectum to secure it to the presacral fascia. There was no blood loss, and the procedure was completed without complication. The child was followed up for a period of 24 months with good results.

Look Twice before You Clamp: Decapitation of an Omphaloenteric Duct

Objective: To report a case of accidental decapitation of a persistent omphaloenteric duct (POD) in congenital hernia of the umbilical cord in a newborn male. Case Presentation and Intervention: The newborn was transferred to an intensive care unit, where under closer inspection the diagnosis of an omphalocele was presumed. Surgical exploration at our Pediatric Surgical University Clinic revealed a clamped and decapitated POD in the umbilical cord. The decapitation had gone unnoticed due to severe asphyxia resulting from meconium aspiration encountered at the time of delivery. Using general anesthesia, the clamp was removed under sterile conditions. The decapitation of the POD in the herniated umbilical cord was confirmed at this time. The severed intestine was sutured and closed using 5-0 Vicryl sutures. The further course was uneventful. Conclusion:Herniation of the umbilical cord at the time of birth by intestinal loops or POD is rare, but caution should be taken by midwives before clamping in order to avoid the type of injury seen in this case.

Hyperbilirubinemia associated with a cystic abdominal mass in a 6-week-old girl: case report.

Abstract Abdominal cysts in girls are frequently observed by abdominal ultrasound (US) and are usually ovarian. In this case a cystic structure located in the right abdomen was seen in a female newborn without symptoms and was initially described as a possible ovarian cyst. Frequent US examinations showed an increase in volume and diameter, and temporary, recurring episodes of hyperbilirubinemia were observed. The US scans showed no relationship to the biliary tree. During a diagnostic laparoscopy, a cystic structure attached to the pyloric region was seen. A laparotomy revealed a cystic duplication of the stomach, which could be resected completely. The finding is discussed emphasizing the importance of clinical findings and diagnostic methods in the diagnosis and management of abdominal cystic masses in females.

The Willital-Hegemann Procedure

Willital-Hegemann is an open procedure to repair Chest Wall Deformities. It is performed using a midline chest incision, following which the costal cartilages are excised bilaterally to free the sternum. The sternum and the flail chest wall segments are stabilized by 3 metal struts are to support the reconstructed chest wall. In patients with severe asymmetry as well as those presenting with complex forms, a 4th strut could be employed. Corrections have been performed on over 1262 patients with severe asymmetric forms of pectus excavatum and pectus carinatum or combined pectus excavatum-carinatum deformities using this technique with excellent result. Excellent aesthetic results and low rates of recurrences after the procedure indicate the need to offer this method of surgical correction patients with severe asymmetric and complex chest wall deformities.

Giant pedunculated lipofibroma of the elbow

Lipofibromas are rare hamartomatous lesions almost exclusively involving the medial nerve and have been reported to date only in the adult population. The case of a giant pedunculated lipofibroma involving the radial nerve in the elbow of a 1-year-old child is presented.

Angiomyolipoma with hypertension mimicking a malignant renal tumor.

Abstract.A 13-month-old girl with a unilateral renal angiomyolipoma causing severe hypertension is reported. The differential diagnosis of renal masses, a review of the literature, and the diagnostic algorithm for renal masses used at our center are presented.