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Biomedical subjects

S S Rothenberg

Publications and source records attributed to S S Rothenberg.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic redo Nissen fundoplication in infants and children.

From January 1994 to December 2004, 118 patients with recurrent gastroesophageal reflux disease (GERD) after fundoplication underwent laparoscopic redo Nissen fundoplication. The patients ranged in age from 6 months to 19 years (mean, 7 years), and weighed from 6.4 to 85 kg. Of the 118 patients, 64 had previous open fundoplications, 53 had previous laparoscopic fundoplications, and 19 had more than one previous fundoplication. All the procedures had been successfully completed laparoscopically. The average operative time was 100 min. The intraoperative complication rate was 1.1%. The average time to full feeding was 1.8 days, and the average hospital stay was 2.2 days. The postoperative complication rate was 3.6%. The wrap failure rate during an average follow-up period of 48 months was 6%. Laparoscopic redo Nissen fundoplication for a failed antireflux procedure is a safe and effective procedure. It has the same benefits as a primary laparoscopic Nissen for GERD, with low morbidity and a quicker recovery. Early follow-up evaluation suggests that the long-term outcome is superior to that associated with open redo fundoplication.

Adolescent↗
PubMed2003

Total intracorporeal laparoscopic resection of Crohn's disease.

BACKGROUND/PURPOSE: The benefits of laparoscopic resection for Crohn's disease have been well established in the adult literature. This modality more recently has been applied to children. The authors report their experience in this age group. METHODS: A prospective series of all pediatric Crohn's patients treated laparoscopically in one surgical practice was studied for demographic data, operative details, and outcome. RESULTS: Fifteen patients with diagnosis of Crohn's disease, ages 9 to 17 years, underwent laparoscopic ileocolic resection between February of 1998 and 2002. Patients' weights ranged from 42 to 80 kg. All patients had fixed strictures involving the terminal ileum and ileocecal valve and had failed medical therapy. A 4-port approach (one 12-mm and 3 5-mm) was utilized in all cases. Resection and anastomosis was performed intracorporeally, and the specimen was retrieved through the 12-mm port site. The average operating time was 110 minutes (range, 90 to 180 minutes). Oral feedings were started after 24 hours of nasogastric suction. Hospital stay averaged 4 days (range, 3 to 8 days). One patient had a fever on postoperative day 3. Contrast study showed a small anastomotic leak with no associated collection, and the patient responded to conservative management. One other patient whose pathologic diagnosis questioned the initial Crohn's diagnosis presented with an anastomotic stricture and underwent redo resection laparoscopically with good outcome. No other complications were noted, and all patients were symptom free at follow-up. CONCLUSIONS: Laparoscopic resection of Crohn's disease in children is safe and effective.

Adolescent↗
PubMed2001

Endosurgery and the senior pediatric surgeon.

BACKGROUND: Endosurgery is difficult for the senior pediatric surgeon to master because the technique has a steep learning curve, lacks tactile sense, uses elongated instruments, and is ergonomically tiring. METHODS: The senior author, starting at age 53, has performed more than 300 endoscopic procedures at both children and community hospitals. A full year was required to master laparoscopic Nissen fundoplications. Conversion to open procedures from bleeding and enterotomies were committed in the first year of endosurgery. Facility with endosurgery is gained by performing common and frequent procedures as appendectomies. CONCLUSION: The advantages of endosurgery in pain control and shortened hospitalization make the technique deserving of commitment by the senior pediatric surgeon.

Adolescent↗
PubMed2001

Evaluation of minimally invasive approaches to achalasia in children.

BACKGROUND: Achalasia is an uncommon disease in children, but when present can result in severe disabling symptoms often requiring surgical intervention. This report describes the authors' experience with thoracoscopic (TH) and later laparoscopic Heller (LH) myotomy for definitive treatment of this disease. METHODS: Nine patients with achalasia were referred for surgical therapy. Ages ranged from 5 to 17 years and weight from 23 to 78 kg. All had undergone at least one dilatation with recurrence of symptoms. The first 4 were treated by TH and the last five by LH. The 5 LH procedures also included a partial fundoplication. RESULTS: All procedures were completed successfully using minimally invasive techniques. Operating times averaged 95 minutes for TH and 62 minutes for LH. One patient undergoing TH had a small esophageal perforation repaired primarily. The other 3 TH patients were started on clear liquids within 1 day and discharged on day 2. One patient had recurrent symptoms at 6 months and underwent a LH for an incomplete TH. All 5 LH patients were discharged on postoperative day 1. One had an esophageal perforation 4 days after operation requiring laparoscopic repair. Seven of 9 patients are asymptomatic. Studies of pH levels in 2 asymptomatic TH patients show mild gastroesophageal reflux (GER). CONCLUSIONS: Minimally invasive Heller myotomy is a safe and effective procedure in children. TH results in a slightly longer operating time and hospital stay and, without a partial fundoplication, also may be associated with a higher incidence of silent GER. From these results, we prefer LH with a Dor fundoplication for treatment of achalasia in children.

Adolescent↗
PubMed2001

Thoracoscopic resection of mediastinal masses in infants and children: an evaluation of technique and results.

BACKGROUND: Thoracoscopy has been accepted as a technique in pediatric surgery for diagnosis of thoracic pathology, but there has been little experience using it as a therapeutic modality as well. The purpose of this report is to describe and critically evaluate a 7-year experience with thoracoscopic diagnosis and resection of mediastinal masses in infants and children. METHODS: From February 1993 to June 2000, 39 patients presented with mediastinal masses and no tissue diagnosis. Age ranged from 5 months to 18 years old and weight from 3.6 to 110 kg. Twelve children had anterior mediastinal masses, 27 posterior. The patients were positioned in a modified prone or supine position, and single lung ventilation was performed on the contralateral side. Three or 4 valved trocars were utilized with 3 and 5 mm instrumentation. RESULTS: A total of 38 of 39 procedures were completed successfully endoscopically. The procedure in 1 patient with a sarcoma was converted to thoracotomy because of extensive disease. Operating times ranged from 20 to 185 minutes. Diagnosis was obtained in all cases, and complete excision was performed in 33. All children were extubated in the operating room; 8 chest tubes were placed but removed within 24 hours. Hospital stay ranged from 12 hours to 4 days. Pathology included 12 foregut duplications, 7 ganglioneuromas, 6 neuroblastomas, 6 lymphomas, 3 teratomas, 2 sarcomas, and 3 other lesions. CONCLUSION: Thoracoscopy is a safe and effective method to evaluate, biopsy, and in most cases resect lesions of the anterior and posterior mediastinum in infants and children.

Adolescent↗
PubMed2000

Thoracoscopic lung resection in children.

PURPOSE: The aim of this study was to evaluate the technique of video-assisted thoracic surgery (VATS) in lung resections in infants and children. METHODS: From December 1992 to December 1998 113 consecutive patients, ages 3 weeks to 19 years, underwent VATS for biopsy or resection of various lung pathology. This included 88 wedge biopsies, 12 resections of bullous or cystic disease, 9 lobectomies or segmental resections, and 4 bronchogenic cysts. RESULTS: All procedures were completed successfully. Two patients with metastatic disease had surgery converted to a standard thoracotomy for extensive resections. The average operating time for a wedge biopsy of 2 sites was 26 minutes and 210 minutes for a lobectomy. The average hospital stay after wedge resection was 1.1 days. There were no complications related to the VATS approach. CONCLUSION: VATS is a safe and effective technique in the diagnosis and treatment of pediatric pulmonary disease.

Adolescent↗
PubMed1999

Primary laparoscopic placement of gastrostomy buttons for feeding tubes. A safer and simpler technique.

BACKGROUND: During a 4-year period, 240 gastrostomy buttons were placed in children, as the initial surgical feeding tube, using laparoscopic techniques. MATERIALS AND METHODS: The technique requires the use of a minilaparoscope (1.6-mm) and a single 5-mm trocar placed at the exit site for the gastrostomy button. It can also be performed in addition to a laparoscopic fundoplication using the same trocar sites. The technique requires no special instrumentation or kits. When performed alone, operative times average 15 min. When performed with fundoplication, it adds approximately 5-10 min to the time for the procedure. RESULTS: There were no intraoperative complications and five (2.1%) postoperative complications. CONCLUSIONS: This technique has proven to be simple and effective. It allows primary placement of a gastrostomy button that is cosmetically and functionally superior to a gastrostomy tube.

Adolescent↗
PubMed1999

Primary laparoscopic-assisted endorectal colon pull-through for Hirschsprung's disease: a new gold standard.

OBJECTIVE: To describe the surgical technique and early clinical results after a one-stage laparoscopic-assisted endorectal colon pull-through for Hirschsprung's disease. SUMMARY BACKGROUND DATA: Recent trends in surgery for Hirschsprung's disease have been toward earlier repair and fewer surgical stages. A one-stage pull-through for Hirschsprung's disease avoids the additional anesthesia, surgery, and complications of a colostomy. A laparoscopic-assisted approach diminishes surgical trauma to the peritoneal cavity. METHODS: The technique uses four small abdominal ports. The transition zone is initially identified by seromuscular biopsies obtained laparoscopically. A colon pedicle preserving the marginal artery is fashioned endoscopically. The rectal mobilization is performed transanally using an endorectal sleeve technique. The anastomosis is performed transanally 1 cm above the dentate line. This report discusses the outcome of primary laparoscopic pull-through in 80 patients performed at six pediatric surgery centers over the past 5 years. RESULTS: The age at surgery ranged from 3 days to 96 months. The average length of the surgical procedure was 2.5 hours. Almost all of the patients passed stool and flatus within 24 hours of surgery. The average time for discharge after surgery was 3.7 days. All 80 patients are currently alive and well. Most of the children are too young to evaluate for fecal continence, but 18 of the older children have been reported to be continent. CONCLUSION: Laparoscopic-assisted colon pull-through appears to reduce perioperative complications and postoperative recovery time dramatically. The technique is quickly learned and has been performed in multiple centers with consistently good results.

Child↗
PubMed1998

Experience with minimally invasive surgery in infants.

BACKGROUND: This study evaluates the feasibility, safety, and efficacy of performing advanced endoscopic procedures in infants under 5 kg. METHODS: Over a 51-month period 183 infants weighing 1.3 to 5.0 kg underwent 195 procedures using minimally invasive techniques. The majority of the procedures were performed using 3.5-mm instruments and 2.7-mm scopes. Procedures include Nissen fundoplication, pyloromyotomy, colon pull-through, patent ductus arteriosus closure, Ladd's procedure, colon resection, congenital diaphragmatic hernia repair, ovarian cyst excision, and exploration. RESULTS: All but two procedures were completed successfully endoscopically. There were two intraoperative complications and no mortality. Days to discharge for patients admitted for their specific procedure were Nissen 2.1, patent ductus arteriosus 2, pyloromyotomy 1, and pull-through 3.4. CONCLUSIONS: This study demonstrates that advanced endosurgical techniques in infants is safe, effective, and associated with the same benefit as that seen in older patients.

Endoscopy↗
PubMed1998

Experience with 220 consecutive laparoscopic Nissen fundoplications in infants and children.

BACKGROUND/PURPOSE: Fundoplication for gastroesophageal reflux disease is a common procedure performed in infants and children. This report describes a 4-year experience with 220 consecutive laparoscopic Nissen fundoplications. METHODS: Ages ranged from 5 days to 18 years and weight from 1.4 to 100 kg. The procedures were performed using a five-trocar technique and with 5- or 3.4-mm instruments depending on the size of the patient. RESULTS: Two hundred eighteen fundoplications were completed successfully. Average operative time dropped dramatically from 109 to 55 minutes for the first 30 cases compared with the last 30. Intraoperative and postoperative complication rates were 2.6% and 7.3%, respectively. Average time to discharge postfundoplication was 1.6 days. The wrap failure rate is 3.4%. CONCLUSIONS: This study shows that although the learning curve for laparoscopic fundoplication may be steep, the procedure is safe and effective in the pediatric population. The clinical results are comparable to the traditional open fundoplication but with a significant decrease in morbidity and hospitalization.

Adolescent↗
PubMed1998

Laparoscopic Ladd's procedure in infants with malrotation.

PURPOSE: This clinical study was undertaken to examine the feasibility of a laparoscopic approach for the treatment of documented malrotation. METHODS: From May 1994 through January of 1997, 12 patients, aged 5 days to 4 months, weighing 3 to 7 kg, underwent laparoscopic Ladd's procedure for malrotation. All patients had symptoms of intermittent upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study. None of the patients had acute volvulus or compromised bowel. The procedure was performed using 3 trocars of 3.5 mm diameter. Ports were placed in the infraumbilical ring, and the right and left mid to lower quadrants. A standard Ladd's procedure with appendectomy was performed in all cases. RESULTS: All procedures were completed successfully through the laparoscope. Operative times averaged 58 minutes (35 to 120 minutes). One patient with Pierre-Robin underwent a laparoscopic Nissen fundoplication and gastrostomy tube placement at the same time requiring 120 minutes. Feedings were started on postoperative day (POD) 1 in 10 cases and POD 2 in two cases. Hospital stay ranged from 2 to 4 days (average, 2.2) in the patients with isolated malrotation. The patient with Pierre-Robin had a prolonged hospitalization because of chronic respiratory problems not associated with surgery. There were no complications. All patients had resolution of their symptoms. CONCLUSIONS: Laparoscopic Ladd's procedure is a safe and effective technique. It can be performed in neonates in times equivalent to standard open techniques, and it appears to allow for earlier feeds and decreased hospital stays.

Congenital Abnormalities↗
PubMed1998

Thoracoscopy in infants and children.

The recent advances in technology and technique in endoscopic surgery have dramatically altered the approach to intrathoracic lesions in the pediatric patient. Now most operations can be performed using a video-assisted approach, which has markedly decreased the associated morbidity for the patient. This has allowed for an aggressive approach in obtaining tissue for diagnostic purposes in cases of interstitial lung disease or questionable focal lesions in immunocompromised patients, without fear of the significant pulmonary complications previously associated with standard thoracotomy. In general, a lung biopsy now can be performed with little more morbidity than that of a transbronchial biopsy yet the tissue obtained is far superior. The same is true for mediastinal masses or foregut abnormalities. Patients who undergo a limited biopsy procedure can be released on the day of surgery. Lesions such as esophageal duplications can be excised thoracoscopically, with the patient ready for discharge the following day. Even closure of patent ductus arteriosus is now performed safely thoracoscopically, with a hospitalization period of less than 24 hours. Although a thoracoscopic approach may not always result in a significant decrease in the length of hospital stay, it may be associated with a significant decrease in morbidity for the patient. For example, in cases of severe scoliosis, thoracoscopic anterior spinal fusion results in earlier extubation, a stay in the intensive care unit, and earlier mobilization. It is clear that thoracoscopic surgery has significant advantages over the standard open thoracotomy in many cases. With continued improvement and miniaturization of the equipment, the procedures we can perform and the advantages to the patient should continue to grow.

Biopsy↗
PubMed1998

Laparoscopic pull-through procedure for Hirschsprung's disease.

Contemporary surgical management of Hirschsprung's disease (HD) has evolved toward resection and reconstruction earlier in life. The introduction and miniaturization of laparoscopic instrumentation currently permits the application of this approach to the treatment of HD in the neonate. The authors' experience with this technique demonstrates several potential advantages over the "classical" two-stage operation.

Female↗
PubMed1998

Laparoscopic splenectomy in children.

Splenectomy is frequently performed in children for various hematologic and autoimmune diseases. Advanced laparoscopic techniques have now been adapted to the pediatric patient making laparoscopic splenectomy an effective and desirable technique. This article reviews the indications for splenectomy, the selection criteria for the laparoscopic approach, and the technique of laparoscopic splenectomy in children. A review of surgical results is included.

Adolescent↗
PubMed1997

Outcome after exploratory laparoscopy for unexplained abdominal pain in childhood.

BACKGROUND: Abdominal pain in childhood is common yet frustrating when unexplained. OBJECTIVE: To describe the clinical features and outcome of 8 children (6 girls and 2 boys; mean[+/- SD] age, 13 +/- 2 years) with unexplained abdominal pain who underwent exploratory laparoscopy. SETTING: All 8 patients were examined at an academic pediatric gastroenterology center and referred for exploratory laparoscopy because of unexplained abdominal pain. Laparoscopy was offered after family agreement to pursue behavioral management if the pain and disability did not improve. RESULTS: In all 8 children, laparoscopy detected an anomaly at a site corresponding to that of the abdominal pain. Findings were adhesions in 7 children (3 colonic, 2 ileocecal, 1 gastric, and 1 appendiceal) and ovarian torsion in 1 child. At a mean follow-up of 12.6 months, the abdominal pain had completely resolved in 6 children, notably improved in 1 child, and continued unchanged in 1 child. Disability completely resolved in 2 of 3 children. CONCLUSIONS: In children with unexplained abdominal pain that is acute in onset, well described, and suggestive of peritoneal involvement, exploratory laparoscopy (1) successfully ends the cycle of abdominal pain in most cases; and (2) commonly identifies abnormalities, usually adhesions. However, whether laparoscopy, the placebo effect, or both promote the healing process is unclear. Further study is needed to develop criteria for referral for laparoscopic evaluation of unexplained abdominal pain.

Abdominal Pain↗
PubMed1997

Thoracoscopic decortication in infants and children.

BACKGROUND: The treatment of pediatric empyemas remains controversial. While thoracentesis and tube thoracostomy appear adequate for relatively benign organisms, virulent bacteria cause thick fibrinous pleural peels entrapping the lung. Open thoracotomies have been effectively used for decortication but are painful. METHODS: We report the use of minimally invasive thoracoscopic decortication in 12 patients (mean age 5 years). All failed conventional management with persistent fever, increasing oxygen requirement, recurrent effusion, and pleural consolidation; 5- and 10-mm trocars were used and complete decortication was accomplished. RESULTS: Ten of 12 patients were afebrile by 72 h and discharged 4-12 days after surgery. Eleven of 12 patients had clear chest x-rays by 1 month. CONCLUSION: Thoracoscopic decortication is a safe and effective means of treating pediatric empyemas.

Adolescent↗
PubMed1997

Laparoscopic fundoplication to enhance pulmonary function in children with severe reactive airway disease and gastroesophageal reflux disease.

BACKGROUND: The relationship between severe reactive airway disease (RAD) and gastroesophageal reflux disease (GERD) has been noted but the relationship is poorly understood. This study reports our experience with laparoscopic fundoplication and its effect on the pulmonary status of children with severe steroid-dependent reactive airway disease. METHODS: Fifty-six patients with severe steroid-dependent RAD and medically refractory GERD underwent laparoscopic Nissen fundoplications. Mean age was 7 years and mean weight was 20 kg. All patients had the procedure completed successfully laparoscopically with an average operative time of 62 min. Average hospital stay was 1.6 days. RESULTS: Forty-eight of 56 patients noted significant improvement in their respiratory symptoms in the first week. Fifty of 56 patients have been weaned off their oral steroids and four others have had a greater than 50% decrease in their dose. Sixteen patients had a documented increase in their FEV1 in the initial postoperative period (avg. 26%). CONCLUSION: Patients with steroid-dependent RAD and GERD refractory to medical management show improvement in their respiratory status following fundoplication and the majority can be weaned off of their oral steroids. Laparoscopic techniques allow this procedure to be performed safely even in this high-risk group of patients.

Adolescent↗