BACKGROUND: Minimally invasive pediatric surgery (MIPS) has a solid tradition in which technique and technology have made key contributions to an already broad range of indications. This surgical method still has a deficiency with regard to tissue management of large-area defects, however. Sealing techniques can further expand the range of application. METHOD: Technological evaluation provided outstanding data of fleece-bound collagen- and fibrinogen-based sealing systems (TachoComb) on biodegradability, adhesive strength and practicability. A relevant instrument was developed for MIS application and was introduced as the ATCS (AMISA-TachoComb-System). PATIENTS: From 1993-2000, ATCS sealing was carried out in the scope of thoracoscopy (105 procedures) and laparoscopy (53 procedures) and specifically for recurring pneumothorax, traumatic chylothorax and splenic trauma. RESULTS: Pneumothorax: 59 ACTS procedures in 49 patients (mean age: 11.4 yrs) with 6 reoperations (10.2%) and one recurrence (1.7%). The drainage dwell time was reduced (p < 0.05) using a conventional comparison (31.9 hours vs. 17 days) and further relevant parameters were also reduced. Chylothorax: 3 ATCS procedures in 3 patients (mean age: 6.3 years) with reduction in the drainage dwell time (p < 0.05) based on a conventional comparison (35 hours vs. 18 days). Splenic trauma: 17 ATCS procedures in 16 patients (mean age: 8.9 years) with one re-operation (5.9%) for associated liver trauma, organ conservation in each case and no significant drainage volumes. CONCLUSION: The ATCS is an innovative instrument for MIPS and ca be employed for efficient and socio-economic (e.g. DRGs) closure of large-area defects.

Abdominal Injuries↗

PubMedDate not supplied

[Prenatal ultrasonic diagnosis of a cystic abdominal tumor--liver cyst and its differential diagnosis].

A report is presented on the prenatal development of a solitary hepatic cyst in a fetus of the 39th week of pregnancy. Sonography revealed that nearly the entire abdomen was filled by a cyst that caused displacement of the stomach and intestine as well as elevation of the diaphragm. Abdominal distension necessitated delivery before term by cesarean section. The laparotomy subsequently performed because of increasing dyspnea of the newborn showed the left lobe of the liver to be the point of origin of a solitary hepatic cyst that could be removed in toto. Possibilities of post partum therapy are discussed in addition to obstetrical management. The incidence, localisation and size of solitary hepatic cysts as well as their differential diagnosis are also described.

Adult↗