Congenital diaphragmatic hernia(CDH) is characterized by a spectrum developmental defects in the diaphragm caused by embryogenesis disorders,and lead to incomplete fusion of elements which results in rise of the diaphragm.With the promotion of antenatal diagnosis,postoperation rehabilitation and neonatal intensive care unite,the mortality of CDH has been remarkably decreased.Nevertheless,the condition is uncommon enough that it has proven to be difficult to conduct prospective studies,leading to the lack of evidence of evidence-based medicine to explore the pathological mechanism and therapies.With the rise of endoscopic technique,the laparoscopy and thoracoscopy are also gradually carried out for the surgical management of CDH.Now,the minimally invasive surgery for CDH was reviewed.

Objective To explore the method, safety, and efficacy of laparoscopic intracorporeal sutured gastrojejunostomy.Methods Three children with gastric outlet obstruction underwent laparoscopic sutured gastrojejunostomy from May to September 2005. Of them, two patients with pyloric stenosis secondary to peptic ulceration received a concomitant highly selective vagotomy. A suitable segment of jejunum was lifted over the transverse colon and apposed to the gastric antrum. A continuous 4/0 suture was conducted at the seromuscular layer making the two organs together. Then the stomach and adjacent jejunum were incised with an ultrasonic scalpel. A side-to-side gastrojejunostomy was performed with full-thickness continuous suture of gastric and jejunal wall followed by anterior interrupted suture of seromuscular layers. Results All the intracorporeal sutured gastrojejunostomies were completed successfully under laparoscope. The operating time was 135, 150, and 180 min, respectively. The postoperative hospital stay was 6 d. There was no surgical complications. Postoperative follow-up at 8, 10, and 12 months, respectively, showed that all patients had normal diet and nutriture. Conclusions Laparoscopic sutured gastrojejunostomy is a safe and feasible technique, with advantages of minimal invasion, rapid recovery, and good cosmetic outcomes.

Objective To explore the feasibility and efficacy of laparoscopic rectopexy with peritoneal strips for severe complete rectal prolapse (SCRP) in children. Methods From August 2004 to October 2008,6 patients (aged 2 to 6 years with a mean of 3.5) with SCRP were treated in our hospital. The clinical data of the patients were reviewed. Under the laparoscope,two L-shaped peritoneal strips with the pedicle were cut from the incrassated and slack peritoneum of the pelvic cavity on bilateral sites of the rectum,and then were folded and sutured with the lateral wall of the free rectum with the ends being stitched on the fascia in front of the sacral promontory to suspend the rectum. Afterwards,the incisal margin of the peritoneum was sutured together with the anterior wall of the rectum in order to embed the peritoneal strips and reconstruct the pelvic peritoneum. Results All of the 6 cases of laparoscopy were completed successfully with a mean operation time of (120?24) min (ranged from 95 to 210 min). The blood loss was less than 10 ml in all of the cases. The patients received a mean of 28-month follow-up (range,6 to 54 months),during the period,none of them had recurrence or abnormal bowel movement. Conclusions Laparoscopic rectopexy with peritoneal strips is an effective and satisfactory treatment for SCRP with minimal invasion,quick recovery and a low-recurrence rate.

Objective To evaluate the effectiveness of laparoscopic sutured anastomosis of the duodenum for children with congenital duodenal obstruction (CDO). Methods From February 2003 to July 2008,13 patients (aged 2 days to 12 years) with CDO underwent laparoscopic sutured anastomosis of the duodenum in our hospital. Among the cases,7 were newborns,3 were infants,and 3 were children. Laparoscopy showed duodenal atresia or stenosis in 7 cases,annular pancreas in 2 cases,superior mesenteric artery syndrome (SMAS) in 3 cases,and preduodenal portal vein in 1 case. Results Excepting the patient with preduodenal portal vein,who was converted to mini-laparotomy for duodenojejunostomy,all the cases were treated by laparoscopy. In 5 cases,the diaphragm was excised partially after a vertical incision was made at the anterior part of the duodenum,and then a transverse suture was completed; the 2 patients with duodenal atresia and the 2 with annular pancreas received diamond-shaped side-to-side duodenoduodenal anastomosis under a laparoscope; and the 3 cases of SMAS were treated by Roux-en-Y duodenojejunostomy. The mean operation time in this series was (97.0?18.2) min (range,75 to 180 min). No intraoperative complications occurred. The patients started oral intake in 2 to 5 days after the surgery,and resume a normal diet in 7 to 9 days. Before being discharged from the hospital,upper gastrointestinal tract imaging showed no evidence of obstruction in the patients.A follow-up up to 6 months to 4 years were available in 11 patients,among which 8 were followed for more than 1 year. During the period,the patient developed well. Conclusions The laparoscopic sutured anastomosis of the duodenum is feasible and effective for children. It can be performed in neonates securely as an excellent minimally invasive treatment for congenital duodenal obstruction.

0.05).Compared to OA group,the patients in the LA group had shorters periods of absolute diet and hospital stay(P=0.000,P=0.000).Conclusions LA has less influence on the humoral immunity and protein metabolism in children.Meanwhile the procedure is minimally invasive,patients recover quickly and are discharged earlier after the operation.

Objective To summarize the experience of laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique. Methods By using silk ligature and hamonic scapel or the LigaSure, 6 patients with portal hypertension and esophagogastric varices underwent laparoscopic massive splenectomy and selective pericardial devascularization. Results All the operations were completed successfully under laparoscope. The intraoperative blood loss was 80~200 ml (mean, 130 ml). None of the patients required blood transfusion or conversion to open procedure. The operation time was 150~210 min (mean, 190 min). There were no surgical complications. All the patients resumed to normal activities 5 days after operation. Follow-up observations for 3~10 months (mean, 8 months) revealed no recurrent variceal hemorrhage. Conclusions Laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique is a feasible, effective, safe, little hemorrhagic, and minimally invasive procedure for portal hypertension with esophagogastric varices.

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.

Biliary atresia is the most common obstructive cholangiopathy in infants.Its etiology and pathogenesis still remains unclear.Hypothetical mechanisms include genetic predisposition,viral infection,chronic inflammation or autoimmune-mediated bile duct injury,and congenital malformations of vessels or biliary tracts.The key pathogenesis is related to viral infection and immunoreaction.This review overviewed the research progress in the pathogenesis of biliary atresia in the past few years.

Objective To explore the feasibility and t he efficacy of laparoscopic splenectomy of massive splenomegaly in the treatment o f hereditary spherocytosis in children. Methods Seven children with massive splenomegaly underwent laparoscopic splenectomy. Their age ranged 1~14 years (mean, 8.8 years), and their body weight was 10~57 kg (mean, 33.8 kg) . Three children had an accompanying cholelithiasis: 2 of them received a concom itant cholecystectomy and 1 of them, cholecystotomy. Results A ll the operations were successfully performed under laparoscope, and hand-assist ed splenectomy through a small incision was applied in 1 child because of bleedi ng of the splenic vein. The duration of operation was 50~150 min (mean, 90 min), the intraoperative blood loss was 30~500 ml (mean, 117 ml), and the length of h ospitalization, 4~10 d (mean, 5.5 d). The red blood cell counts had significantl y increased 3 days following the operation (t=2.652, P

Objective To evaluate intraoperative cholangiopancreatography in understanding pathologic changes of congenital choledochal cyst(CCC) with anomalous junction of pancreaticobiliary duct(APBD) and for rational operative procedure. Methods Eighty-two CCC cases were examined by intraoperative cholangiopancreatography(ICP). The morphologies of the biliary tract and types of APBD were recorded. Results Of the 82 CCC cases there were 35 cases of Todani Ia,9 cases of Ib,28 cases of Ic and 10 cases of Ⅳ.APBD was diagnosed in 73 cases and classified according to Komi classification. Of them,37 cases were classified as type I of APBD (bile duct drains into pancreatic duct),30 cases as type II (pancreatic duct drains into bile duct) and 6 cases as type III (complicated APBD with patent accessory pancreatic duct). Of the 44 cases with choledochal cystic dilatations,33 cases were of type I. Of the 29 biliary fusiform dilatations,21 were of type II. Of 21 patients with pancreatitis,17 were of type II (? 2=33.14,P