INTRODUCTIONThe emergence of operative laparoscopy has brought a great demand for training surgical residents, but there are no clear guidelines regarding choice of procedure for training, proficiency assessment and accreditation. We aim to examine from a trainee's point of view, the safety and efficacy of laparoscopic appendicectomy (LA) as a laparoscopic training procedure.

MATERIALS AND METHODSA retrospective analysis of all the consecutive cases of LA done by a trainee in paediatric laparoscopic surgery from September 2003 to February 2005 was done.

RESULTSA total of 70 consecutive patients (37 males and 33 females) aged 3 to 15 years (mean, 10.5 +/- 2.5) with suspected appendicitis underwent LA. Twelve (17.1%) patients had acute appendicitis, 25 (35.7%) had acute suppurative appendicitis adherent to the caecum with localised and/or pelvic pus pocketing, 29 (41.4%) had perforated appendicitis with generalised peritonitis and 4 (5.7%) had normal appendix [mesenteric adenitis (1), omental infarct (1), torted Meckel's diverticulum (1) and primary peritonitis (1)]. There were no operative complications and none required conversion to open surgery. The operative duration ranged from 25 to 110 minutes (mean, 55.6 +/- 23.4). There were two complications; one had adhesive intestinal obstruction and underwent successful laparoscopic adhesiolysis and one had umbilical wound infection.

CONCLUSIONSLA is a safe and effective laparoscopic training procedure, in addition to being effective for all stages of appendicitis, as well as concurrent lesions encountered in children with suspected appendicitis.

Acute Disease ; Adolescent ; Appendectomy ; education ; methods ; Appendicitis ; surgery ; Child ; Child, Preschool ; Education, Medical, Graduate ; Female ; Hospitals, Pediatric ; standards ; Humans ; Internship and Residency ; Laparoscopy ; Male ; Retrospective Studies ; Safety ; Singapore

INTRODUCTIONThe aim of this study was to analyse the feasibility, safety and benefits of laparoscopic appendicectomy (LA) in comparison with open appendicectomy (OA) for perforated appendicitis (PA) in children.

MATERIALS AND METHODSA retrospective analysis of all consecutive cases of PA who underwent OA or LA between July 2001 and April 2004 was done. The patient demographics, duration of symptoms and operative findings were noted and the feasibility, safety and benefits of LA were analysed with respect to postoperative recovery and complications.

RESULTSOne hundred and thirty-seven consecutive patients with PA underwent either OA (n = 46) or LA (n = 91). Both groups were comparable with respect to patient demographics, duration of symptoms and operative findings. The mean operative time was 106.5 min (95% CI, 100.2 - 112.8) in the LA group and 92.8 min (95% CI, 82.9-102.7) in the OA group (P = 0.02). The return to afebrile status after surgery was significantly faster in the LA group [mean, 45.4 hours (95% CI, 36.8-54)] than the OA group [mean, 77 hours (95% CI 56.7-97.3)] (P = 0.007). The mean duration for postoperative opioid analgesia was 2.5 days (95% CI, 2.2-2.7) for LA and 3.2 days (95% CI, 2.9- 3.6) for OA (P = 0.001). The resumption of oral feeds after surgery was at 3.1 days (95% CI, 2.8-3.3) for LA and 3.7 days (3.4-4.1) for OA (P = 0.005). The length of the hospital stay was shorter in the LA group [mean, 6.5 days (95% CI, 6.1-6.8)] as compared to that of the OA group [mean, 8.2 days (95% CI, 7.1-9.3)] (P = 0.006). Postoperative complications included wound infection, adhesive intestinal obstruction and pelvic abscess formation. The incidence of these complications was 5.6% in the LA group and 19.6% in the OA group (P = 0.01). Nine patients (9.8%) needed conversion to open surgery in the LA group. None of the LA patients had wound infection.

CONCLUSIONLA is feasible, safe and beneficial in children with PA.

Age Factors ; Appendectomy ; methods ; Appendicitis ; surgery ; Child ; Feasibility Studies ; Female ; Humans ; Laparoscopy ; adverse effects ; methods ; Male ; Outcome and Process Assessment (Health Care) ; Pilot Projects ; Retrospective Studies ; Safety ; Time Factors ; Treatment Outcome

INTRODUCTIONBile duct perforation (BDP) with resultant biliary ascites in children is a rare clinical condition. The aetiopathogenesis is still an enigma, with increasing evidence suggesting anomalous union of pancreaticobiliary ductal (AUPBD) system as the prime causative factor.

CLINICAL PICTUREWe report 2 cases of spontaneous perforation of the bile duct confirmed on histopathological examination as choledochal cyst, in a 6-month-old female child and a 4-year-old boy who presented with subtle clinical symptoms.

TREATMENT AND OUTCOMEBoth patients were successfully managed by excision of the gall bladder and common bile duct and Roux-en- Y hepaticojejunostomy. This procedure was performed following initial cholecystostomy drainage in the second case.

CONCLUSIONSFrom the available literature and experience with our patients, BDP is not merely spontaneous but may be related to AUPBD and choledochal cyst.

Ascites ; etiology ; surgery ; Bile Ducts ; injuries ; Child, Preschool ; Cholangiography ; Cholecystectomy ; Choledochal Cyst ; complications ; surgery ; Common Bile Duct ; diagnostic imaging ; injuries ; surgery ; Female ; Humans ; Infant ; Jejunostomy ; Laparoscopy ; Male ; Tomography, X-Ray Computed

INTRODUCTIONUnderstanding baseline epidemiology of intussusception (IS) in different geographical settings is important for the safety assessment of rotavirus vaccines. This paper presents IS surveillance data from Singapore between 1997 and 2007, including the period between November 2005 and December 2007 when rotavirus vaccines (primarily Rotarix) were available to newborns in Singapore.

MATERIALS AND METHODSCase ascertainment, collection, analyses and presentation of IS data was done as per recommendations of the Brighton Collaboration Working Group. For estimating the IS incidence rate in infants, live births for the years of the study were used as denominators, while for incidence in children age <2 years, the expected numbers of infant deaths occurring between 1 and 2 years of age was deducted from the combined live births for the 2 years, to obtain the denominator.

RESULTSThe incidence of IS among children aged <1 year throughout this 10-year period was higher than the incidence of IS in children between 1 and 2 years of age. In 2005, 2006 and 2007, the incidence of IS per 100,000 was 39.9, 26.4 and 35.6 in children aged <1 year and 26.2, 23.8 and 28.7 in children <2 years.

CONCLUSIONThis IS surveillance study provides reassuring preliminary evidence that there is no increase in the incidence of IS in Singapore after the introduction of rotavirus vaccines (including Rotarix) in Singapore.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Intussusception ; epidemiology ; prevention & control ; virology ; Male ; Population Surveillance ; Risk Assessment ; Rotavirus Vaccines ; Singapore ; epidemiology ; Time Factors