Samuele Leggio

Complications of mechanical suturing in pediatric patients

BACKGROUND/PURPOSE Although it is widely accepted that staplers are effective in reducing operating time, potential complications related to their use in the pediatric population are not well defined yet. The aim of this study is to evaluate the safety of mechanical suturing. METHODS Between 1996 and 2001, 174 procedures were performed using circular staplers in gastrointestinal anastomosis, whereas linear staplers were used in gastrointestinal and lung resection. Intraoperative and early complications of each intervention were recorded. RESULTS Overall, 12 complications occurred (6.9%). Two were caused by technical problems: In one case the stapler broke, in the other the anvil detached from the instrument shaft. Ten (5.7%) were major complications: 2 cases of leakage and 3 of bleeding in gastrointestinal procedures, and one case of bronchopleural fistula and 4 cases of bleeding during lung surgery. There was a significant correlation (P <.05) between type of stapler used and development of complications, suggesting a safer use of endoscopic staplers compared with conventional linear ones. CONCLUSIONS Mechanical suturing in children is not used frequently, but some procedures could be used more widely because they are fast and safe.

Laparoscopic Nissen-Rossetti fundoplication in children.

From the Department of Surgery, School of Pediatric Surgery, Giannina Gaslini Research Institute for Children, University of Genova, Italy. Address reprint requests to Girolamo Mattioli, Department of Surgery, School of Paediatric Surgery; Giannina Gailini Research Institute for Children, University of Genova, Italy Largo G. Gaslini 5, 16100, Genova, Italy. Copyright 2002, Elsevier Science (USA). All rights reserved. 1071-5517/02/0903-0004135.00/0

Preperitoneoscopic approach for bladder neck sling suspension in a boy: Preliminary experience

OBJECTIVES This report is aimed at describing our preliminary experience with the preperitoneoscopic approach to the bladder neck for rectus fascial sling suspension in neurogenic bladder. MATERIALS AND METHODS A 13-year-old boy with spina bifida was admitted to our institution to treat bladder incontinence. A bladder neck suspension and bladder augmentation was planned. The preperitoneal space was progressively gained by blunt dissection under direct vision (laparoscopy with a single left subcostal trocar), and a total of three preperitoneal ports were inserted. Dissection of the bladder proved to be relatively easy, and the retropubic space as well as the deep pelvis were safely exposed. Owing to the excellent endoscopic visualization, the bladder was dissected downward from the rectum. Once complete mobilization of the bladder neck was achieved, an umbilical tape was passed around the proximal urethra to create an adequate passage for the fascial sling. RESULTS The preperitoneoscopic procedure lasted 2 hours. No complications occurred. A good daytime dry period was achieved at the 4-month follow-up. DISCUSSION Direct visualization of the bladder neck and minimal dissection to the deep pelvis are the key points of this approach. Provided certain technical details are considered, the minimally invasive preperitoneal access is a valuable alternative to the open approach for the rectus fascial sling procedure, particularly when dealing with male patients. Technical advances will, presumably, lead to a complete minimally invasive treatment of urinary incontinence in male patients with spina bifida.