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Biomedical subjects

L M Flanigan

Publications and source records attributed to L M Flanigan.

3 recordsLinked to original sources
PubMed1996

Laparoscopy for diagnosis and treatment of recurrent abdominal pain in children.

Extensive radiographic evaluation of children with recurrent abdominal pain (RAP) is rarely diagnostic or cost-effective. The authors sought to define the role of laparoscopy in the evaluation of children with RAP. Fifteen children underwent laparoscopy for RAP in a 2-year period. Their mean age was 12 years (range, 6 to 16 years), 13 (87%) were female, and the mean duration of symptoms was 11 months (range, 2 to 60 months). Thirty-eight imaging studies (excluding plain films) had been obtained before laparoscopy, including 19 abdominal sonograms, 9 upper gastrointestinal series, four abdominal computed tomography scans, 3 barium enemas, 2 isotope scans, and 1 magnetic resonance examination of the head. Only two (5%) of these studies provided an accurate diagnosis. Eleven of the 15 children (73%) had positive findings diagnosed and treated laparoscopically. These included eight appendiceal abnormalities (in six patients), three Meckel's diverticula, one inguinal hernia, one urachal cyst, one para-fallopian tube cyst, and one adhesion to an appendectomy stump. Eight of 11 (73%) children with positive findings had immediate resolution of symptoms after laparoscopic treatment. Three children with pathological findings at the time of laparoscopy had persistent symptoms, which resolved completely within 4 months of the laparoscopy. Laparoscopy is an accurate technique for the evaluation and treatment of children with RAP. Its early application could provide economic benefit by eliminating many low-yield imaging studies and minimizing lost time from school.

Abdominal Pain↗
PubMed1995

Primary button gastrostomy: a simplified percutaneous, open, laparoscopy-guided technique.

PURPOSE: Button gastrostomy (BG) insertion has been a secondary procedure after initial open Stamm or percutaneous endoscopic tube gastrostomy. Previous attempts at primary open BG have been limited by the difficulty in bringing the BG "wings" through the abdominal wall. We employed an innovative technique for primary BG, which eliminates many of the disadvantages inherent in tube gastrostomy. METHODS: From June 1993 to April 1994, primary BG insertion was performed in 34 children, using a silicon BG in a tapered peel-away sheath. Seventeen children had percutaneous endoscopic insertion of the BG. Six (35%) weighed less than 10 kg. Simultaneous laparoscopic guidance was used for percutaneous BG insertion in two children who had had multiple previous abdominal procedures. Open BG was performed during concomitant abdominal procedures in 15 patients and after unsuccessful percutaneous BG in two patients. Twelve patients (71%) weighed less than 10 kg. The standard Stamm technique was used for open BG insertion, and the tapered peel-away sheath was readily brought out through a remote incision in the abdominal wall. RESULTS: The mean operative time for percutaneous primary BG was 12 minutes from needle insertion (range, 10 to 22 minutes). The mean time until BG feeding was 18 hours after insertion (range, 12 to 48 hours). No serious complications occurred in any of the 34 patients. Follow-up (1 to 10 months) has shown minor tissue reaction, minor leakage, and enthusiastic patient and parent satisfaction. CONCLUSION: This innovative technique has proven safe and effective and allows for insertion of a skin-level, nonrefluxing, nonreactive, self-retaining feeding device, which eliminates the need for initial open or percutaneous tube gastrostomy and the associated complications. Potential cost savings may result through elimination of secondary button insertion procedures and the radiological studies often used to confirm proper button placement.

Adolescent↗