Objective To study the characteristic s of laparoscopic operations in infants younger than 6 months. MethodsWe retrospectively analyzed the perio perative course of laparoscopic operations in 98 infants. Results All the 46 cases got definite diagnosis by explorative laparoscopic operations except 1 case shifted to open laparotomy. Two cases were shifted to open laparotomy in 51 therapeutic laparoscopic proced ures. Post-operative complications such as respiratory tract infection, hyperca pnia and elevation of myocardial enzyme were found in 11, 14 and 1 cases respect ively. There was no postoperative mortality, no infection nor hernia of incision s in the peri-operative period. Conclusion Appropriate application of laparoscopy in infantile surgery i s of optimistic future for less trauma and complications.

Objective To explore the method and superiority of laparoscopic management of children's varicocele. Methods High position ligation of varicocele under laparoscope was performed and internal spermatic arteries were reserved intraoperatively. Results 32 cases had smooth recovery after operation, and no complication occurred. The hospital stay was (1～3)days postoperatively. 29 cases had been followed up for 6 months～1 year and no relapse and testis atrophy occurred. Conclusions The method has the advantages of simpleness, minimal invasion and quicker recovery. Reservation of internal spermatic artery can prevent testis atrophy.

Objective To study the value of laparoscope in the diagnosis and treatment of high cryptorchidism. Methods 21 testes in 19 patients were performed by intraperitoneal exploration and cryptorchidopexy. Results The testes of 11 cases were located in inferior extremity of kidneys and the ones of 8 cases in superior part of internal rings.15 testes were fixed in the bottom of scrotums and 4 ones in abdominal cavity for secondary operation; absent testis was found in 1 case; 1 testis was removed due to testis dysplasia. Scrotum emphysema and hematoma occurred in 3 and 1 patients respectively. Wounds of 19 cases healed well postoperatively. 15 patients had been followed up for (3～10) months with an average of 6 months and they recovered well. Conclusions The diagnosis and treatment of high cryptorchidism by means of laparoscope has the advantages of minimal invasion, less bleeding, quicker recovery and no serious complications.

Objective To evaluate the value of laparoscope in the diagnosis and treatment of obstructive jaundice in infants. Methods 52 cases of obstructive jaundice were diagnosed and treated under laparoscope. Results 2 cases were converted to open operation because of a lot of ascitic fluid. The diagnosis of other 50 cases was confirmed under laparoscopic cholangiography, including biliary atresia in 33 cases, bile duct hypoplasia in 10 ones and cholestasis in 7 ones. Hepatic portal-intestinal anastomosis was operated on 43 patients. Liver biopsy was done in 38 cases. Biliary duct cannula and irrigation were performed in 9 cases. Conclusions Laparoscope is an accurate and reliable technique in the diagnosis and treatment of obstructive jaundice in infants and it can avoid open surgery for infants with cholestasis.

Objective To explore the diagnosis and treatment of intestinal duplication by means of laparoscope. Methods 9 cases suspected intestinal duplication before operation underwent intraperitoneal exploration through two-trocar laparoscope. Patients diagnosed as intestinal duplication were performed by enterectomy and end-to-end intestinal anastomosis outside abdominal cavity through a 10mm trocar. Results All cases were operated on under lapascope with a mean operative time of 80min(30min～110min).The postoperative hospital stay was 4d～5d . No complications occurred. Conclusions Two-trocar laparoscope is an effective method to diagnose and treat intestinal duplication.

Objective To explore the feasibility of simple transanal colon pull-through operation in the management of Hirschsprung's disease(HD) in children. Methods 57 case of HD were performed by transanal macrocolon pull-through operation from July 2001 to May 2002. Results 53 cases underwent simple transanal colon pull-through operation successfully. The mean operative time was 1.5h (1h～2h) and blood loss was 5ml～10ml. Dejection and food taking recovered at the first day after operation in 51 patients; dejection recovered at the third day after operation in 2 patients. 4 patients with long segmental macrocolon, implicated in transverse colon, were operated on by laparoscope-assited surgery, and they began to defecate and take food in 2d～3d postoperatively. The mean operative time was 3h(2h～3.5h). 57 cases had been followed up for (2～9)months, and their dejection function recovered well. Conclusions It is feasible to treat HD in children through simple transanal colon pull-through operation. The method has the advantages of minimal invasion, less bleeding, quicker recovery, shorter hospital stay and good recovery of dejection function.

Objective To investigate the feasibility of laparoscopically assisted anorectal pull-through in the repair of high imperforate anus. Methods Four infants (3 boys and 1 girl, age range, 1 d～90 d) with high imperforate anus entered this study. During operations, the rectum was exposed via laparoscope down to the rectourethral fistula, which was ligated and dissected out laparoscopically; and then, by way of a passage through the center of pelvic floor musculature, the rectum was exteriorized to the perineum to perform anorectal anastomosis. Results Laparoscopically assisted anorectal pull-through was successfully performed in all the 4 cases as a primary procedure. The mean duration of the laparoscopy was 71 8 min (range, 45 min～90 min) and the mean blood loss 8 3 ml (range, 5 ml～20 ml), no blood transfusion required and no intraoperative complications occurred. All patients recovered uneventfully. In 3～12 months of follow-up, 1 patient was found anal stenosis at 1 month after the operation and was cured with secondary anorectoplasty. No postoperative complications were seen in the other 3 cases. By now, all the 4 patients have normal fecal continence. Conclusions Laparoscopically assisted anorectal pull-through is an effective technique in the repair of high imperforate anus. Experience has shown that this approach offers minimally invasive wounds, excellent visualization of the rectal fistula and accurate identification of the center of pelvic floor musculature.

1 week,7 cases of pneumothorax,11 cases of subcutaneous emphysema,3 cases of bar rotation,and 4 cases of unilateral stabilizing bar displacement.Incisional infection was found in 3 cases,2 of which received a removal of the bar and 1 of which was cured with debridement and dressing changes.During a follow-up evaluation for 3~28 months,the outcomes were calssified as excellent in 42 cases,good in 4 cases,fair in 3 cases,and poor in 4 cases. Conclusions The Nuss procedure is safe and effective for the correction of pecrus excavatum in children.

Objective To explore the safety and feasibility of laparoscopy in diagnosis and treatment of neonates and infants diseases.Methods Laparoscopic operations were performed in 297 neonates and infants aging from 2 hours to 6 months,from January 2001 to May 2007.The diseases of 297 cases included 80 cases of congenital hypertrophic pyloric stenosis,67 cases of obstructive jaundice,35 cases of indirect inguinal hernia,31 cases of biliary atresia,21 cases of middle or high anal atresia,21 cases of biliary hyperviscosity,7 cases of congenital diaphragmatic hernia,7 cases of jejunal atresia,6 cases of choledochal cyst,5 cases of Hirschsprung's disease,5 cases of duodenal web,3 cases of uronephrosis,2 cases of esophageal hernia,2 cases of esophageal atresia,2 cases of intestinal malrotation,1 case of intestinal obstruction,1 case of intussuception,,and 1 case of congenital muscular troticollis.Results The laparoscopic operations were completed in 294 cases,of which 67 received diagnostic cholangiography,80 received pyloromyctomy,35 received hernia sac high ligation,21 received biliary irrigation,5 received operations for membranous stenosis of duodenum,2 received Ladd operations for malrotation of intestine,1 received reduction of intussusception,1 received enterolysis,and 1 received incision of lower end of sternocleidomastoid muscle;and some complicated procedures including 31 cases of hepatic portal duct-jejunostomy,21 anoplasty,7 repair of diaphragmatic hernia,7 enterectomy and entero-anastomosis of intestinal atresia,6 hepatic duct-jejunostomy,5 radical surgery for Hirschsprung's disease(megadolicho-colon),3 pyeloplasty,2 operations for esophageal atresia,and 2 fundoplication for hiatus hernia.No massive hemorrhage,intra-or post-operative blood infusion,accidental damage or peri-operative death was reported.Three cases of biliary atresia were converted to open surgery due to oozing of blood in hepatic portal.All case were followed for 2 months-6 years,and no long-term or short-term complication was found.Conclusions Laparoscopic technique is safe and reliable in the diagnosis and treatment of diseases in neonates and infants,which is characterized by minimal invasion,quick recovery and satisfactory cosmetic effects.

Objective To study the feasibility of laparoscopic repair of congenital diaphragmatic hernia (CDH) in children. Methods Two neonates (age 2 and 7 day) and 4 infants (age 7, 10, 21 and 24 months, averaged 15.5 month), one of them was male, underwent laparoscopic repair of diaphragmatic hernia under general endotracheal anesthesia. Two of them were on the left side, and 4 on the right. 3 or 4 trocars were used. The hernia contents were reduced and the hernia defect was repaired using interrupted sutures. Results The laparoscopic procedures were completed without intra-operative complication in 4 infants. The operating time ranged from 55 to 180 minutes (averaged 121 minutes). Amount of bleeding was less than 5ml. In them full activity and feeding were normal within 1-2 days. 1-2 years follow-up showed no complication or recurrence. In one newborn open abdominal operation was required, and recurrence occurred in the other necessitating re-operation by laparotomy in the other newborn. Conclusions Laparoscopic repair of congenital diaphragmatic hernia in infants is feasible, and its result was satisfactory. The role of laparoscopic correction of diaphragnatic hernia in the newborn period, however, remains to be determined.