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Biomedical subjects

N M Bax

Publications and source records attributed to N M Bax.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Good results of laparoscopic Thal fundoplication for treatment of gastroesophageal reflux in children].

OBJECTIVE: Evaluation of the results of laparoscopic fundoplication according to Thal as a treatment for gastro-oesophageal reflux in children. DESIGN: Prospective, descriptive. SETTING: Department of paediatric surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands. METHODS: Between November 1993 and May 1996, 53 children with reflux and an average age of 6 years underwent laparoscopic fundoplication according to Thal; in 23 of them a gastrostomy was created as well. The most important symptoms were vomiting and lack of growth. There were 18 children with primary reflux and 35 with secondary reflux, 28 of whom had psychomotor retardation. Preoperatively all patients were subjected to 24-hour oesophageal pH-monitoring, upper GI series and oesophagogastroscopy. Pathological reflux was defined as a pH < 4 during 5% or more of the total time measured (24 hours). pH-monitoring was repeated three months postoperatively to evaluate the effect of the fundoplication and esophagogastroscopy was repeated in case of preoperative oesophagitis. RESULTS: In one patient the laparoscopic approach was converted peroperatively because of bleeding that had stopped on exploration. Enteral feeding could be recommenced on day one in 49 of 53 children. The mean hospitalisation time was 4.4 days. One patient was reoperated for a too tight fundoplication and two patients died of unrelated causes. The mean follow-up period for the other 50 patients was 11 months (1-35). On follow-up, 42 of them (84%) were free of symptoms, while 31 of 41 children (76%) in whom pH-monitoring could be done 3 months postoperatively displayed no recurrence of pathological reflux. CONCLUSION: Thal fundoplication can be performed laparoscopically in children. Enteral feeding becomes possible again quickly and the period of hospitalisation is short.

Adolescent↗
PubMed1998

Trocar fixation during endoscopic surgery in infants and children.

The slipping of trocars is a major problem, especially in pediatric laparoscopic surgery. Although the suturing of a trocar, along with its valve housing, to the fascia or skin is common, this technique only serves to prevent the trocar from being pulled out. We have found that the simple procedure of winding a +/- 1-cm broad tape several times around the base of the trocar, which has been sutured to the fascia or skin, will prevent the trocar, from being pushed in, even during lengthy operations. The tape that we use is derived from sterile disposable drapes and is therefore not only readily available but also an inexpensive solution to a chronic problem.

Abdominal Muscles↗
PubMed1998

Is laparoscopic pyloromyotomy superior to open surgery?

BACKGROUND: We set out to determine whether laparoscopic pyloromyotomy (LPM) is superior to open pyloromyotomy (OPM) in babies with hypertrophic pyloric stenosis (HPS). METHODS: We performed a retrospective study of 36 LPM and 36 OPM. Both groups were comparable in terms of sex, age and weight on admission, and blood pH on admission and prior to surgery. In the LPM group, three trocars were used; in the OPM group, a small right upper quadrant transverse muscle-cutting laparotomy was carried out. RESULTS: LPM produces a better cosmetic result, seems to produce less postoperative discomfort, and results in the absence of conversion in a shorter hospital stay. However, the duration of the operation was significantly longer (32 versus 18 min). Moreover, LPM clearly entailed more complications (three mucosal perforations against two, and two reoperations against none in the open group). CONCLUSIONS: The actual series does not favor the laparoscopic approach over the open one, in view of the relatively high complication rate. Babies who are operated laparoscopically, however, seem to have less postoperative discomfort, a shorter hospital stay, and a better cosmetic result. As we are confident that the complication rate and duration of the operation will drop with further experience, we will continue to do LPM. LPM is not easy and should only be carried out when substantial experience has been gained in the field of pediatric laparoscopic surgery.

Female↗
PubMed1998

Laparoscopic clipping of the median sacral artery in huge sacrococcygeal teratomas.

Huge sacrococcygeal teratomas in the newborn can cause significant morbidity and even death due to cardiac failure, hemorrhage, or both. Surgical removal is the treatment of choice, but can indicate these events. Ligation of the median sacral artery, which always supplies the tumor, prior to its removal has been advocated, but in the past this procedure required a formal laparotomy. Nowadays, it can be easily accomplished laparoscopically, as this case report demonstrates.

Blood Loss, Surgical↗
PubMed1998

Laparoscopic treatment of intestinal malrotation in children.

BACKGROUND: Laparoscopic treatment of intestinal malrotation in children is difficult, and most of our pediatric surgeon colleagues active in the field of laparoscopic surgery tell us that more often than not they must convert to an open procedure. Initially, we experienced much difficulty too, but after modification we were able to master the technique, and now we feel confident. We here describe the actual technique we use. METHODS: Our experience encompasses nine children treated during the past 18 months. Five of the children presented in the newborn period and four later. During laparoscopic surgery, it is of paramount importance to concentrate not on the loops of bowel, but on the duodenum. By starting to identify the duodenum, mobilizing it, and carrying on the mobilization of the small bowel down until the whole small bowel has been seen, the pathologic anatomy is easily unraveled. Moreover, an existing volvulus is automatically reduced and the bowel automatically put in a nonrotation position in the abdomen. RESULTS: All patients have done well, and no complications have been noted. Operative time has been reduced to about 1 hour. CONCLUSIONS: Laparoscopic treatment of intestinal malrotation in children is not so difficult provided certain rules, as described, are followed.

Humans↗
PubMed1998

Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension.

BACKGROUND: Decompression of extrahepatic portal hypertension by directly bypassing the thrombosed portal vein has never been reported in cases of children with idiopathic (or neonatal) portal vein obstruction and cavernoma. METHODS: Seven children (15 years or younger) with portal vein obstruction requiring surgical decompression (urgently in two cases), and in whom preoperative Doppler had shown that the intrahepatic portal branches were hypoplastic but free of thrombus, were included in a pilot study. The cavernoma was bypassed by interposing a venous jugular autograft between the superior mesenteric vein and the distal portion of the left portal vein. Patients received follow-up using routine clinical parameters, upper gastrointestinal endoscopy, and Doppler ultrasound. RESULTS: The mesenterico-portal bypass restored a direct (physiological) hepatopetal portal flow. The operation resulted in effective portal decompression as demonstrated by decrease of the pressure gradient, rapid regression of clinical signs of portal hypertension, and definitive control of bleeding. CONCLUSIONS: This study shows that direct bypassing of portal cavernoma is possible and results in effective portal decompression. Restoration of the hepatic portal flow is a major advantage compared with conventional surgical shunting procedures. This new technique is potentially applicable to two thirds of children with portal vein thrombosis and should be considered when shunting procedures are indicated.

Adolescent↗
PubMed1997

Cetrimide overdose.

Explore the source record for details and available documents.

Anticestodal Agents↗
PubMed1996

Laparoscopic Thal fundoplication in mentally retarded children.

BACKGROUND: An increasing number of reports indicate that Thal fundoplication is the procedure of choice in mentally retarded children. With the advent of laparoscopy, Nissen's fundoplication seems to have been repopularized. However, the choice of the operative technique should be based on the merits of the procedure itself rather than the laparoscopic feasibility. The aim of this study is to determine if laparoscopic Thal fundoplication is beneficial for mentally retarded children. METHODS: Between November 1993 and 1994 laparoscopic Thal fundoplication was performed in 15 mentally handicapped children; 13 also had a feeding gastrostomy. Age varied from 1.5 to almost 17 years (mean 7 years). Mean weight was 18 kg (5-50 kg). All patients underwent an upper GI study and endoscopy as well as pre- and 3 months postoperative pH study. Indications for the procedure were reflux esophagitis in 11 and feeding problems with silent reflux in 4. RESULTS: The laparoscopic procedure was converted in the second patient because of bleeding in the hiatus. No further procedure-related intra- or postoperative complications occurred. The mean hospitalization was 3.7 days. No symptomatic postoperative gastroesophageal reflux has been observed. All children have undergone postoperative pH studies, which displayed silent reflux in two. Gastrostomy feeding is well tolerated. CONCLUSION: We conclude that Thal fundoplication can be performed laparoscopically in mentally retarded children. The laparoscopic results are comparable to the open Thal procedure.

Aged↗
PubMed1996

Iron therapy resistant microcytic anaemia in a 13-year-old girl with Castleman disease.

UNLABELLED: We describe the case history of a 13-year-old girl with chronic fatigue and prolonged microcytic anaemia. She received oral iron since the age of 11 but failed to respond to it. Laboratory studies revealed elevated C-reactive protein and hypergammaglobulinaemia. A large solitary mesenterial lymph node could be demonstrated by ultrasonography and CT. A diagnosis of Castleman disease was suspected and confirmed histologically. After surgical removal of the lymphoma the patient recovered completely. CONCLUSION: Castleman disease should be considered in cases of chronic fatigue, unexplained fever, microcytic anaemia and hypergammaglobulinaemia.

Adolescent↗
PubMed1996

Duhamel-Martin procedure for Hirschsprung's disease in neonates and infants: one-stage operation.

BACKGROUND: A retrospective study was performed to demonstrate that a one-stage Duhamel-Martin procedure is feasible for Hirschsprung's disease, even in neonates and infants. METHODS: In a 2 1/2-year period, 32 children with Hirschsprung's disease were treated according to the method of Duhamel-Martin. In 22 of them the diagnosis had been established within the first 2 months of life. RESULTS: Twenty-nine children did not receive a preliminary enterostomy. In the three neonates who did have a preliminary enterostomy, it was closed during the Duhamel-Martin procedure. In the last 2 years, no enterostomies have been performed. CONCLUSION: The one-stage Duhamel-Martin procedure is now feasible in almost all children, irrespective of age and weight.

Anastomosis, Surgical↗