M. Lima

Italian multicenter survey on laparoscopic treatment of gastro-esophageal reflux disease in children

Background: Skepticism is still present today about the laparoscopic treatment of gastro-esophageal reflux (GER) in children. We present the prospective experience and short-term results of eight Italian pediatric surgical units. Methods: We included all the children with complicated GER, operated after January 1998 by single surgeons from eight different centers. Diagnostic aspects, type of fundoplication, and complications were considered. All the patients were followed for a minimum period of 6 months in order to detect complications or recurrences. Results: 288 children were prospectively included. Mean age was 4.8 years (3 m–14 y). Nissen fundoplication was done in 25%, floppy Nissen in 63%, Toupet in 1.7%, and anterior procedures (Lortat Jacob, Thal) in 10%. Gastrostomy was associated, if neurological impairment or feeding disorders were present. Mean follow-up was 15 months and reoperation was necessary in 3.8% of cases. Conclusions: This experience underlines that minimal invasive access surgery in children is safe and that the laparoscopic approach is considered in eight centers the golden standard for surgical repair of gastro-esophageal reflux disease maintaining the same indications and techniques of the open approach.

Laparoscopic Treatment of Bilateral Direct Inguinal Hernia by Using the Vesical Ligament as an Autologous Patch

We report our experience in a case of direct inguinal hernia in a boy that seemed to be a recurrence of a previous herniorraphy. We describe the efficacy of laparoscopic exploration and treatment in a rare pediatric direct inguinal hernia.

Laparoscopic Treatment of Morgagni-Larrey Hernia in a Pediatric Patient

We report the case of a 2-year-old boy affected by a Morgagni-Larrey hernia discovered accidentally. The hernia was large, and it contained an accessory hepatic lobe. The repair was performed easily utilizing a laparoscopic approach. On the basis of our experience, we can affirm that laparoscopic correction of Morgagni-Larrey hernia is not a difficult operation. In our opinion, the minimally invasive procedure may be the first-choice treatment for this kind of diaphragmatic defect.

Congenital Esophageal Stenosis

Congenital esophageal stenosis (CES) is a rare entity with an estimated incidence of 1:25,000–50,000 live births. Three causes for CES have been described: tracheobronchial remnant, segmental fibromuscular hypertrophy, and membranous web. CES can be associated with other anomalies such as esophageal atresia, chromosomal anomalies, cardiac anomalies, intestinal atresia, anorectal malformation, and trisomy 21.