Publications by authors named "Craig T Albanese"

59 Publications

Chest wall reconstruction using implantable cross-linked porcine dermal collagen matrix (Permacol).

J Pediatr Surg 2012 Jul;47(7):1472-5

Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA 94305, USA.

Background/purpose: Chest wall reconstruction in children is typically accomplished with either primary tissue repair or synthetic mesh prostheses. Primary tissue repair has been associated with high rates of scoliosis, whereas synthetic prostheses necessitate the placement of a permanent foreign body in growing children. This report describes the use of biologic mesh (Permacol; Covidien, Mansfield, MA) as an alternative to both tissue repair and synthetic prostheses in pediatric chest wall reconstruction.

Methods: A retrospective chart review was performed identifying patients undergoing chest wall reconstruction with biologic mesh at our tertiary referral children's hospital between 2007 and 2011. Data collection included patient demographics, indication for chest wall resection, number of ribs resected, the administration of postoperative radiation, length of follow-up, postoperative complications, and the degree of spinal angulation (preoperatively and at most recent follow-up).

Results: Five patients (age, 9.0-21.7 years; mean, 15.4 years) underwent resection for primary chest wall malignancy followed by reconstruction with biologic mesh (Permacol) during the study period. There were no postoperative mesh-related complications, and none of the patients developed clinically significant scoliosis (follow-up, 1.1-2.6 years; mean 1.9 years).

Conclusion: Biologic mesh offers a safe and dependable alternative to both primary tissue repair and synthetic mesh in pediatric patients undergoing chest wall reconstruction.
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http://dx.doi.org/10.1016/j.jpedsurg.2012.05.002DOI Listing
July 2012

Outcomes of sutureless gastroschisis closure.

J Pediatr Surg 2009 Oct;44(10):1947-51

Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, CA 94305-5733, USA.

Introduction: A new technique of gastroschisis closure in which the defect is covered with sterile dressings and allowed to granulate without suture repair was first described in 2004. Little is known about the outcomes of this technique. This study evaluated short-term outcomes from the largest series of sutureless gastroschisis closures.

Methods And Patients: A retrospective case control study of 26 patients undergoing sutureless closure between 2006 and 2008 was compared to a historical control group of 20 patients with suture closure of the abdominal fascia between 2004 and 2006. Four major outcomes were assessed: (1) time spent on ventilator, (2) time to initiating enteral feeds, (3) time to discharge from the neonatal intensive care unit, and (4) rate of complications.

Results: In multivariate analysis, sutureless closure of gastroschisis defects independently reduced the time to extubation as compared to traditional closure (5.0 vs 12.1 days, P = .025). There was no difference in time to full enteral feeds (16.8 vs 21.4 days, P = .15) or time to discharge (34.8 vs 49.7 days, P = .22) with sutureless closure. The need for silo reduction independently increased the time to extubation (odds ratio, 4.2; P = .002) and time to enteral feeds (odds ratio, 5.2; P < .001). Small umbilical hernias were seen in all patients.

Conclusion: Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces length of intubation and does not significantly alter the time required to reach full enteral feeds or hospital discharge.
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http://dx.doi.org/10.1016/j.jpedsurg.2009.03.027DOI Listing
October 2009

"Stealth surgery": transaxillary subcutaneous endoscopic excision of benign neck lesions.

J Pediatr Surg 2008 Nov;43(11):2070-4

Department of Surgery, Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, CA 94305-5733, USA.

Background: Benign neck lesions are traditionally removed through an overlying incision. The resultant scar can be aesthetically displeasing. We previously reported our experience with a transaxillary subcutaneous endoscopic approach for management of torticollis. We now report a similar technique for removal of benign lesions of the neck.

Methods: The study uses a retrospective review of 5 elective transaxillary endoscopic procedures from March to December 2006. The lesions included an enlarged cervical lymph node, thyroglossal duct cyst, dermoid cyst, ectopic dilated neck vein, and a parathyroid adenoma. Outcome measures included need for conversion, cosmetic outcome, and complications.

Results: All procedures were successfully completed using the endoscopic approach. Postoperative pain was controlled with acetaminophen, and all patients were discharged from the hospital the same day. There were no intraoperative complications. The patient who had a thyroglossal cyst removed developed a postoperative seroma that resolved spontaneously. All families were pleased with the cosmetic results.

Conclusions: A transaxillary subcutaneous endoscopic approach can be applied effectively to a variety of benign lesions of the neck, allowing adequate exposure for dissection, and resulting in a quick recovery. Neck scarring is absent, with small scars well hidden in the axilla.
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http://dx.doi.org/10.1016/j.jpedsurg.2008.03.031DOI Listing
November 2008

Doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations in children.

J Pediatr Surg 2008 Mar;43(3):451-60

Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA.

Purpose: The authors report their experience with doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations (LMs) in children.

Methods: A retrospective chart review was used to collect data on 11 patients treated with doxycycline sclerotherapy for LMs of the head and neck at our institution since 2003. Radiographic imaging allowed classification of patient LM as macrocystic, microcystic, or mixed according to previously published guidelines. Only patients with macrocystic or mixed lesions were offered doxycycline sclerotherapy. Radiographic imaging and physical examination were used to determine efficacy of treatment. After each treatment, the clinical and radiographic response was characterized as excellent (> or = 95% decrease in lesion size), satisfactory (> or = 50% decrease in volume and asymptomatic), or poor (< 50% decrease in volume or symptomatic).

Results: Eleven patients underwent a total of 23 sclerotherapies with an average of 2 treatments per patient (range, 1-4). All 7 patients with macrocystic lesions achieved complete clinical resolution with an average radiographic resolution of 93%. The 4 patients with mixed lesions achieved only partial clinical resolution and an average of 73% radiographic resolution. No patient experienced any adverse effects related to the treatment. At a median follow-up of 8 months, 2 patients (18%) experienced lesion recurrence in the setting of concomitant infection.

Conclusion: Doxycycline sclerotherapy is safe and effective as a primary treatment modality for macrocystic and mixed LMs of the head and neck in the pediatric population.
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http://dx.doi.org/10.1016/j.jpedsurg.2007.10.009DOI Listing
March 2008

Transaxillary subcutaneous endoscopic release of the sternocleidomastoid muscle for treatment of persistent torticollis.

J Pediatr Surg 2008 Mar;43(3):447-50

Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA 94305-5733, USA.

Purpose: Surgical correction of torticollis is occasionally necessary to curtail the facial deformity that can result from this condition. The resultant neck scar can be of suboptimal cosmesis, with consequent psychological distress for the child. We have previously described an endoscopic approach to forehead and brow lesions through scalp incisions. We now describe a transaxillary subcutaneous endoscopic approach to division of the fibrotic sternocleidomastoid muscle.

Methods: This study involved a retrospective chart review of 3 consecutive outpatient procedures (male-to-female ratio, 1:2; age range, 8 months to 7 years) from March to October of 2005. The 2 older patients had established sternocleidomastoid fibrosis, and 1 had complicated torticollis refractory to medical management. All procedures were performed using standard 3-mm-laparoscopic instrumentation through hidden incisions in the ipsilateral axilla. Outcome measures included need for conversion, operative time, cosmetic outcome, and complications.

Results: All patients were successfully treated endoscopically. Mean operative time was 50 minutes (range, 45-55 minutes). There were no intraoperative or postoperative complications. All families were pleased with the cosmetic outcome.

Conclusion: This case series demonstrates the simplicity and effectiveness of a transaxillary endoscopic subcutaneous approach to torticollis.
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http://dx.doi.org/10.1016/j.jpedsurg.2007.10.008DOI Listing
March 2008

Laparoscopic adjustable gastric banding in a morbidly obese 18-year-old with hypertrophic cardiomyopathy.

Obes Surg 2008 Mar 12;18(3):332-5. Epub 2008 Jan 12.

Department of Surgery, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA 94305, USA.

In this case report, we present an 18-year-old morbidly obese male with complicating hypertensive cardiomyopathy who underwent laparoscopic adjustable gastric band surgery. The patient had multiple comorbidities associated with his obesity, including obstructive sleep apnea, systemic hypertension, asthma, and depression. Given the severity of his underlying cardiac pathology and multiple previously unsuccessful attempts at weight loss with conventional medical and behavioral therapy, the patient opted to proceed with surgical intervention. We present this laparoscopic adjustable gastric banding surgical case to demonstrate the impact of surgical weight reduction on cardiac risk factors in a morbidly obese adolescent, highlighting the viability of this surgery for patients with existing cardiac dysfunction.
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http://dx.doi.org/10.1007/s11695-007-9330-9DOI Listing
March 2008

National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence.

J Am Coll Surg 2008 Jan 18;206(1):1-12. Epub 2007 Oct 18.

RWJ Clinical Scholars Program, University of Michigan, Ann Arbor, MI 48109, USA.

Background: Bariatric surgery is indicated for severely obese adolescents who have failed nonsurgical treatment. Our objective was to examine national trends in the use of bariatric operations among adolescents.

Study Design: The Kids' Inpatient Database was used to identify bariatric surgery patients in the pediatric population (age younger than 18 years) for 1997, 2000, and 2003. Patients were identified by procedure codes for bariatric operations with confirmatory diagnosis codes for obesity. Nationally representative estimates of trends in bariatric procedures, patient characteristics, hospital characteristics, and in-hospital complication rates were calculated. We augmented our analysis with the 2003 Nationwide Inpatient Sample, to ascertain hospitals' overall bariatric surgical volume (adolescents and adults).

Results: From 1997 to 2003, the estimated number of adolescent bariatric procedures performed nationally increased 5-fold from 51 to 282 (p < 0.01). More than 100 hospitals performed bariatric procedures on adolescents in 2003, most of which (87%) performed 4 or fewer adolescent bariatric operations annually. Operations were predominantly performed in adult hospitals (85%). Although most hospitals had high overall bariatric operation volumes (> 200 bariatric procedures for patients of any age), 39% of adolescent bariatric procedures were performed at lower-volume centers. Patients were predominantly Caucasian (68%) and female (72%), with a mean age of 16 years (minimum age 12 years). In-hospital complications occurred in 6% of patients. There were no in-hospital deaths.

Conclusions: Our findings indicate a recent, rapid increase in the frequency of adolescent bariatric procedures. Most hospitals that performed bariatric procedures on adolescents had limited experience with adolescent bariatric patients, although many of these hospitals appear to have been experienced adult centers with high overall bariatric volume (adolescents and adults). Future research must better clarify the institutional qualifications considered mandatory for treatment of eligible adolescents.
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http://dx.doi.org/10.1016/j.jamcollsurg.2007.07.028DOI Listing
January 2008

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome.

Am J Obstet Gynecol 2007 Oct;197(4):396.e1-9

Fetal Care Center of Cincinnati, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital, MLC #2023, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.

Objective: The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS).

Study Design: This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients.

Results: There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) (P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) (P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) (P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) (P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) (P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (P = .055, OR 3.025/point) by logistic regression analysis.

Conclusion: The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.
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http://dx.doi.org/10.1016/j.ajog.2007.07.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754290PMC
October 2007

Laparoscopic Nissen fundoplication during gastrostomy tube placement and noninvasive ventilation may improve survival in type I and severe type II spinal muscular atrophy.

J Child Neurol 2007 Jun;22(6):727-31

Divisions of Pediatric Pulmonology, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, California 94304-5786, USA.

Progressive respiratory muscle weakness with bulbar involvement is the main cause of morbidity and mortality in type I and severe type II spinal muscular atrophy. Noninvasive positive pressure ventilation techniques coupled with laparoscopic gastrointestinal procedures may allow for improved morbidity and mortality. The authors present a series of 7 spinal muscular atrophy patients (6 type I and 1 severe type II) who successfully underwent laparoscopic gastrostomy tube insertion coupled with Nissen fundoplication and early postoperative extubation using noninvasive positive pressure ventilation techniques. The authors measured the length of survival and the frequencies of pneumonia and hospitalization before and after surgery as outcomes of these new surgical and medical interventions. All 7 patients had respiratory symptoms (unmanageable oropharyngeal secretions, cough, pneumonia), difficulty feeding, and weight loss. Six patients had documented reflux via diagnostic testing preoperatively. Five patients were on noninvasive positive pressure ventilation and other supportive respiratory therapies prior to surgery. All 7 patients survived the procedures. By August 2006, 5 patients with type I and 1 with severe type II spinal muscular atrophy were alive and medically stable at home 1.5 months to 41 months post-op. One patient with type I expired approximately 5 months post-op due to obstructive apnea. This case series demonstrates that laparoscopic gastrostomy tube placement coupled with Nissen fundoplication and noninvasive positive pressure ventilation can be successfully used as a treatment option to allow for early postoperative extubation and to optimize quality of life in type I and severe type II spinal muscular atrophy patients.
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http://dx.doi.org/10.1177/0883073807304009DOI Listing
June 2007

Use of a prosthetic patch for laparoscopic repair of Morgagni diaphragmatic hernia in children.

J Laparoendosc Adv Surg Tech A 2007 Jun;17(3):391-4

Department of Surgery, Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University Medical Center, Standford, California 94305-5733, USA.

Background: Morgagni hernias are well suited to laparoscopic repair. A primary suture closure may result in tension on the repair, thereby predisposing the patient to a recurrence. A prosthetic patch (PP) can be used to provide a tension-free repair. In this study, we reviewed our experience with the laparoscopic PP repair of Morgagni hernias in children.

Methods: A retrospective chart review of all patients undergoing a laparoscopic Morgagni hernia repair using a PP was undertaken between November 2002 and January 2006. Outcome measures included age, gender, defect size, use of mesh, and outcome. The time of follow-up was from 6 to 37 months.

Results: Seven (7) patients (6 male, 1 female) underwent a laparoscopic repair of Morgagni hernia during this time period. Six (6) patients had a congenital hernia, and 1 patient was thought to have an iatrogenic hernia following a sternotomy for heart surgery. Defect size ranged from 4 to 7 cm in maximum dimension. All operations were completed laparoscopically, no patients presented with recurrence, and no PP complications were encountered.

Conclusions: The laparoscopic repair of Morgagni hernia using a PP can be performed with relative ease and with a positive outcome, and may prevent future recurrence by effecting a tension-free repair.
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http://dx.doi.org/10.1089/lap.2006.0113DOI Listing
June 2007

Experience with 144 consecutive pediatric thoracoscopic lobectomies.

J Laparoendosc Adv Surg Tech A 2007 Jun;17(3):339-41

Department of Surgery, Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University Medical Center, Stanford, California 94305-5733, USA.

Objective: The early experience with the technique and short-term outcomes after pediatric thoracoscopic lobectomy were independently reported by the authors several years ago. This paper updates their combined experience, evaluating the safety, efficacy, and long-term outcomes.

Methods: From January 1995 to May 2005, 144 consecutive patients underwent a thoracoscopic lobectomy. Preoperative diagnoses included cystic adenomatoid malformation/sequestration (n = 112), bronchiectasis (n = 19), lobar emphysema (n = 10), and malignancy (n = 3). Ages ranged from 2 days to 18 years, and weight ranged from 2.8 to 78 kgs. Three or four valved ports were used with a controlled pneumothorax. Single-lung ventilation was used in all cases. Follow-up ranged from 1 to 10 years.

Results: All but three procedures were completed thoracoscopically; one was converted to repair an injured upper lobe bronchus during a lower lobectomy, one resulting from bleeding, and another caused by what was believed to be a potentially inadequate margin during the resection of a large tumor. The operating time ranged from 35 to 220 minutes (median, 125). There were 110 lower, 24 upper, and 10 middle lobe resections. There was one intraoperative complication--the compromise of a left upper lobe bronchus. There were four postoperative complications: pneumonia, pneumothorax, empyema, and prolonged chest tube drainage. There were no reoperations. The median duration of hospital stay was 2.8 days. A long-term follow-up revealed no cases of musculoskeletal deformity or weakness.

Conclusions: The current techniques and equipment allow for the complete thoracoscopic resection of pulmonary lobes in any age or size of a child, with low morbidity and no mortality. Long-term outcomes support the efficacy of this technique that spares growing children a thoracotomy that has the potential for late musculoskeletal morbidity.
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http://dx.doi.org/10.1089/lap.2006.0184DOI Listing
June 2007

Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome.

J Pediatr Surg 2007 Jun;42(6):1118-21

Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, Lucile Packard Children's Hospital, Stanford, CA, USA.

Background/purpose: Laparoscopy has advanced the care of children for a variety of pediatric surgical diseases. However, complication rates for laparoscopic interventions in neonates with hypoplastic left heart syndrome (HLHS) have not been well described. The purpose of this study is to present the largest reported series of laparoscopic surgery performed in patients with HLHS.

Methods: We conducted a single-institution, retrospective chart review for all neonates with HLHS who underwent a laparoscopic procedure from September 2002 to March 2005. Data regarding patient characteristics, intraoperative monitoring, previous cardiac surgery, perioperative complications, and postoperative mortality were assessed.

Results: Twelve patients with HLHS underwent a total of 13 operations during the study period (8 combined Nissen fundoplication and gastrostomy tubes, 3 isolated gastrostomy tubes, 1 Ladd procedure, and 1 combined Nissen fundoplication and gastrocutaneous fistula closure). All cases were completed laparoscopically. Patients had undergone palliative cardiac surgery but were not completely corrected; therefore, they were cyanotic. Perioperative complications were observed in 6 patients (3 gastrostomy tube site infections, 1 small bowel obstruction, 1 postoperative sepsis, and 1 urinary tract infection). There was no mortality in this series.

Conclusions: From this experience, it appears that laparoscopy can be performed safely and with satisfactory outcomes in patients with HLHS. However, a multidisciplinary approach, including the availability of a skilled and experienced cardiac anesthesia team, is believed to be critical to optimize outcomes in these critically ill children.
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http://dx.doi.org/10.1016/j.jpedsurg.2007.01.049DOI Listing
June 2007

Minimal access portoenterostomy: advantages and disadvantages of standard laparoscopic and robotic techniques.

J Laparoendosc Adv Surg Tech A 2007 Apr;17(2):258-64

Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, CA 94305, USA.

Purpose: Minimal access portoenterostomy (Kasai procedure) for biliary atresia represents a technically challenging operation. The standard laparoscopic approach yields results comparable to the open technique. After an initial experience with standard laparoscopy, we assessed the potentially superior optics and dexterity of a surgical robotic system for performing portoenterostomy. We reviewed our experience with minimal access portoenterostomy to compare the relative advantages and disadvantages of standard laparoscopic and robotic approaches to biliary atresia.

Materials And Methods: We reviewed the charts of all patients who underwent either laparoscopic or robotic portoenterostomy at our institution between October 2002 and October 2005. Outcome measures included the need to convert to laparotomy, complications, functional outcome expressed either as the direct bilirubin at most recent follow-up (> or = 3 months) or age at transplant, and density of adhesions at transplant. Surgeons' impressions of the two minimal access modalities were also reviewed.

Results: A total of 10 patients underwent minimal access portoenterostomy (7 standard laparoscopy; 3 robotic-assisted). Mean follow-up was 20 months (range, 1-36 months). There were no conversions to laparotomy and no intraoperative complications. There was one port site infection that resolved with antibiotics. Five patients (4 laparoscopic, 1 robotic) had progressed to transplantation at the time of follow-up. At transplant, one patient had mild adhesions and two had dense adhesions. Adhesions were not noted for 2 patients.

Conclusion: We believe both surgical modalities are feasible from a technical point of view. However, the optical and dexterity advantages of the robotic system were offset by the large instrument size and lack of force feedback.
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http://dx.doi.org/10.1089/lap.2006.0112DOI Listing
April 2007

IPEG panel on clinical investigation.

J Laparoendosc Adv Surg Tech A 2007 Feb;17(1):67-76

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http://dx.doi.org/10.1089/lap.2006.9998DOI Listing
February 2007

Clinical resolution of severely symptomatic pseudotumor cerebri after gastric bypass in an adolescent.

Surg Obes Relat Dis 2007 Mar-Apr;3(2):198-200. Epub 2007 Feb 26.

Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Standford, California 94305, USA.

Pseudotumor cerebri is a disease characterized by increased intracranial pressure, often manifested by headaches, and occasionally leading to severe visual impairment or even blindness. Most cases in adolescents, as in adults, are associated with obesity. We report a 16-year-old morbidly obese adolescent girl (body mass index 42.3 kg/m(2)) with severely symptomatic pseudotumor cerebri who had progressive visual field deficits and elevated intracranial pressure (opening pressure on lumbar puncture of 50 cm H(2)O) despite intensive medical management and placement of both ventriculoperitoneal and lumboperitoneal shunts. Six months after she underwent gastric bypass surgery, she had lost 43% of her excess body weight and had had near complete regression of her visual field deficits, along with normalization of her intracranial pressures. This case demonstrates the dramatic reversal of symptoms of pseudotumor cerebri with surgically induced weight loss. Gastric bypass should be considered as a treatment option for adolescents with severe and progressive pseudotumor cerebri.
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http://dx.doi.org/10.1016/j.soard.2006.11.015DOI Listing
May 2007

Endoscopic excision of benign forehead masses: a novel approach for pediatric general surgeons.

J Pediatr Surg 2006 Nov;41(11):1874-8

Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, CA 94305-5733, USA.

Purpose: Benign tumors of the brow and forehead are commonly managed by pediatric general surgeons by excision through an overlying incision. Cosmetic results in children can be suboptimal. Plastic surgeons have used endoscopic brow-lift techniques for the removal of these lesions. We review our experience after adopting this endoscopic technique in a pediatric general surgery practice.

Methods: We conducted a retrospective chart review of 9 consecutive outpatient procedures (5 girls and 4 boys; age range, 5 months to 12 years) between March and October 2005. Seven patients had lesions located on the lateral brow (left, n = 4; right, n = 3), 1 patient had a lesion on the left mid forehead, and 1 patient had a nasoglabellar cyst. All procedures were performed using endoscopic brow-lift equipment through a single small scalp incision 2 cm posterior to the hairline. Outcome measures included need for conversion, operative time, cosmetic outcome, and complications.

Results: All lesions (6 dermoid cysts and 3 pilomatrixomas) were successfully excised endoscopically. The mean operative time was 56 minutes (range, 22-90 minutes). There was no intraoperative or postoperative complication. All families were pleased with the cosmetic outcomes.

Conclusion: This case report shows that endoscopic excision of forehead masses is a safe and efficacious procedure in the hands of pediatric general surgeons.
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http://dx.doi.org/10.1016/j.jpedsurg.2006.06.047DOI Listing
November 2006

Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies.

Semin Pediatr Surg 2006 Nov;15(4):267-75

Stanford University School of Medicine, Stanford, California 94305, USA.

Minimal access surgery (MAS) is now commonplace in the armamentarium of the pediatric surgeon, and is being applied to a growing list of pediatric surgical diseases. Robot-assisted surgery and image guided therapy (IGT) have evolved as innovative minimal access approaches, and hold the promise of advancing MAS far beyond what is currently possible. The aims of this article are to describe the currently available robotic, and image guided therapy systems, review their present and potential applications, and discuss the future directions of these converging technologies.
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http://dx.doi.org/10.1053/j.sempedsurg.2006.07.006DOI Listing
November 2006

Methamphetamine use following bariatric surgery in an adolescent.

Obes Surg 2006 Jun;16(6):780-2

Department of Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, CA 94305, USA.

Bariatric surgery is increasingly popular as a therapeutic strategy for morbidly obese adolescents. Adolescence represents a sensitive period of psychosocial development, and children with considerable weight loss may experience greater peer acceptance, accompanied by both positive and negative influences. Substance abuse exists as one of these negative influences. We present the case of an adolescent bariatric surgical patient who abused methamphetamines in the postoperative period, with consequent nutritional instability. A concerted effort must be made in the preoperative assessment of adolescent bariatric patients to delineate a history of illicit drug use, including abuse of diet pills and stimulants. Excessive postoperative weight loss or micronutrient supplementation non-compliance should raise a suspicion of stimulant use and appropriate screening tests should be performed. The consequent appetite suppression may manifest with signs of malnutrition such as bradycardia, hypotension, and weakness. Inpatient nutritional rehabilitation and psychiatric assessment should be considered.
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http://dx.doi.org/10.1381/096089206777346646DOI Listing
June 2006

Robot-assisted laparoscopic resection of a type I choledochal cyst in a child.

J Laparoendosc Adv Surg Tech A 2006 Apr;16(2):179-83

Department of General Surgery, Stanford University Medical Center, Stanford, California.

Although the laparoscopic approach to the treatment of complex biliary disease is possible, it is technically challenging. In an attempt to overcome these difficulties, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, California) was used to facilitate the minimally invasive treatment of a type I choledochal cyst in a 5-year-old, 22 kg, girl. Complete resection of the choledochal cyst and a Roux-en-Y hepaticojejunostomy were performed using the robotic surgical system. Total robotic setup time (preparation, port placement, docking) was 40 minutes. Total procedure time was 440 minutes. Total robotic operative time was 390 minutes. No intraoperative complications or technical problems were encountered. At 6-month follow-up, the child is doing well with no episodes of cholangitis. Robot-assisted laparoscopic type I choledochal cyst resection appears safe and feasible. The three-dimensional visualization and wristed instrumentation greatly aids in the dissection of the cyst and in the biliary reconstruction.
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http://dx.doi.org/10.1089/lap.2006.16.179DOI Listing
April 2006

A novel laparoscopic technique for the repair of pediatric umbilical and epigastric hernias.

J Pediatr Surg 2006 Apr;41(4):859-62

Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305-5733, USA.

Background/purpose: The aim of this study was to determine whether a novel laparoscopic technique for pediatric umibilical and epigastric hernia repair is safe, quick, effective, durable, and cosmetically acceptable.

Methods: Forty-one consecutive umbilical and 13 epigastric hernias were repaired laparoscopically. Six patients had concomitant epigastric and umbilical hernias repaired during one procedure. Two 3-mm ports were used via a lateral approach. Mean age was 4.2 years for those with an umbilical hernia and 2.0 years for those with an epigastric hernia.

Results: All procedures were completed laparoscopically. The mean operative time was 27 minutes for umbilical hernia repair and 16 minutes for epigastric hernia repair. There were no intraoperative or postoperative complications. Follow-up was 100% and ranged from 6 to 35 months. There have been no recurrent hernias, and patient/parent satisfaction was subjectively excellent.

Conclusion: This case series demonstrated that this novel technique of laparoscopic anterior abdominal wall hernia repair is safe, quick, effective, durable, and cosmetically acceptable. It requires few instruments and minimal advanced laparoscopic techniques.
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http://dx.doi.org/10.1016/j.jpedsurg.2005.12.033DOI Listing
April 2006

Successful thoracoscopic repair of esophageal atresia with tracheoesophageal fistula in a newborn with single ventricle physiology.

Anesth Analg 2005 Oct;101(4):1000-1002

*Department of Anesthesia, University of California at San Diego School of Medicine, San Diego, California; †Department of Anesthesia, ‡Department of Surgery, Division of Pediatric Surgery, §Department of Anesthesia, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, California.

Unlabelled: A neonate with VACTERL association including tricuspid atresia was scheduled for thoracoscopic esophageal atresia with tracheoesophageal fistula (EA/TEF) repair and laparoscopic gastrostomy tube placement. In addition to standard noninvasive monitoring, arterial blood pressure, central venous pressure, and cerebral oxygen saturation were monitored. Gastric distension resulting from positive pressure ventilation prevented laparoscopic gastrostomy tube placement. Thoracoscopy with a CO2 insufflation pressure of 6 mm Hg at low flow (1 L/min) was well tolerated hemodynamically despite hypercarbia and cerebral oxygen saturation was maintained. Careful monitoring and good communication were critical to the safe management of this single ventricle patient during thoracoscopic EA/TEF repair.

Implications: Esophageal and tracheoesophageal fistula in conjunction with single ventricle physiology carries a significant risk of mortality. We present the anesthetic management of a neonate with unpalliated tricuspid atresia who underwent thoracoscopic tracheoesophageal fistula repair.
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http://dx.doi.org/10.1213/01.ANE.0000175778.96374.4FDOI Listing
October 2005

The safety and efficacy of laparoscopic adrenalectomy in children.

Arch Surg 2005 Sep;140(9):905-8; discussion 909

Division of Pediatric General Surgery, British Columbia Children's Hospital, Vanvouver, Canada.

Hypothesis: Laparoscopic adrenalectomy (LA) has become standard therapy for benign adrenal masses in adults. The utility of LA in children with adrenal masses is less well defined because of the infrequency and pathologic variability of pediatric adrenal masses, and body size and instrumentation considerations that exist in small children. Evaluation of a case series of children undergoing lateral, transperitoneal LA will reflect the safety and efficacy of this procedure in pediatric patients and identify preferred patient selection criteria.

Design: A combined case series including patients treated between March 1999 and November 2004.

Setting: Urban tertiary referral pediatric teaching hospitals.

Patients And Interventions: All children with pathologic adrenal masses undergoing LA were included.

Main Outcome Measures: The primary study outcome measures included operative duration, conversions to open adrenalectomy, complications, length of hospital stay, and freedom from recurrence of the original pathologic adrenal mass.

Results: A total of 21 LAs (including a staged, bilateral LA) were performed in 20 patients (13 girls, 7 boys) with a mean age of 6.4 years (range, 14 months to 18 years). Nine patients (43%) had neuroblastic tumors. Operative duration averaged mean +/- SD 101 +/- 48 minutes, and there was a single conversion to open adrenalectomy in a patient with a left adrenal carcinoma and tumor thrombus extending into the renal vein. There were no perioperative complications, and no patients required blood transfusions. The postoperative hospital stay averaged 1.5 days (range, 1-4.5 days). At a mean +/- SD follow-up of 31 +/- 17 months, all patients remained clinically (radiologically and/or biochemically) free of their original adrenal disease.

Conclusion: Laparoscopic adrenalectomy can be used to safely treat suspected benign and selected malignant adrenal masses in children.
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http://dx.doi.org/10.1001/archsurg.140.9.905DOI Listing
September 2005

Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis.

Ann Surg 2005 Sep;242(3):422-8; discussion 428-30

Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.

Objectives: For the past 60 years, successful repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) has been performed via a thoracotomy. However, a number of reports have described adverse musculoskeletal sequelae following thoracotomy in infants and young children. Until now, only a few scattered case reports have detailed an individual surgeon's success with thoracoscopic repair of EA/TEF. This multi-institutional review represents the largest experience describing the results with this approach.

Methods: A cohort of international pediatric surgeons from centers that perform advanced laparoscopic and thoracoscopic operations in infants and children retrospectively reviewed their data on primary thoracoscopic repair in 104 newborns with EA/TEF. Newborns with EA without a distal TEF or those with an isolated TEF without EA were excluded.

Results: In these 104 patients, the mean age at operation was 1.2 days (+/-1.1), the mean weight was 2.6 kg (+/-0.5), the mean operative time was 129.9 minutes (+/-55.5), the mean days of mechanical ventilation were 3.6 (+/-5.8), and the mean days of total hospitalization were 18.1 (+/-18.6). Twelve (11.5%) infants developed an early leak or stricture at the anastomosis and 33 (31.7%) required esophageal dilatation at least once. Five operations (4.8%) were converted to an open thoracotomy and one was staged due to a long gap between the 2 esophageal segments. Twenty-five newborns (24.0%) later required a laparoscopic fundoplication. A recurrent fistula between the esophagus and trachea developed in 2 infants (1.9%). A number of other operations were required in these patients, including imperforate anus repair in 10 patients (7 high, 3 low), aortopexy (7), laparoscopic duodenal atresia repair (4), and various major cardiac operations (5). Three patients died, one related to the EA/TEF on the 20th postoperative day.

Conclusions: The thoracoscopic repair of EA/TEF represents a natural evolution in the operative correction of this complicated congenital anomaly and can be safely performed by experienced endoscopic surgeons. The results presented are comparable to previous reports of babies undergoing repair through a thoracotomy. Based on the associated musculoskeletal problems following thoracotomy, there will likely be long-term benefits for babies with this anomaly undergoing the thoracoscopic repair.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357750PMC
http://dx.doi.org/10.1097/01.sla.0000179649.15576.dbDOI Listing
September 2005

Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: a novel technique.

J Pediatr Surg 2005 Jul;40(7):1177-80

Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, CA 94143-0570, USA.

Subcutaneous endoscopically assisted ligation (SEAL) is a technique for high ligation of the patent processus at the internal ring without a groin incision or dissection of the vas and vessels. Under endoscopic visualization through a single umbilical port, a suture is guided extraperitoneally around the internal ring, avoiding the vas and vessels. The safety, efficacy (recurrence risk), and cost-effectiveness of this unproven procedure must be tested against standard open repair in a trial.
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http://dx.doi.org/10.1016/j.jpedsurg.2005.03.075DOI Listing
July 2005

Anesthetic management of infants with palliated hypoplastic left heart syndrome undergoing laparoscopic nissen fundoplication.

Anesth Analg 2005 Jun;100(6):1631-1633

Department of Anesthesia, University of California at San Diego School of Medicine, San Diego, California; Department of Anesthesia, Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California.

The safety of laparoscopic surgery in infants with single ventricle physiology has been a subject of controversy despite potential benefits over open surgery. We present the anesthetic management of five infants with palliated hypoplastic left heart syndrome that underwent laparoscopic Nissen fundoplication. After anesthetic induction and tracheal intubation, an intraarterial catheter was placed for hemodynamic monitoring. Insufflation pressure was limited to 12 mm Hg and was well tolerated by all patients. There were no intraoperative or postoperative complications. In patients with hypoplastic left heart syndrome, laparoscopic Nissen fundoplication can be safely performed with careful patient selection and close intraoperative monitoring.
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http://dx.doi.org/10.1213/01.ANE.0000149899.03904.3FDOI Listing
June 2005

The "skinny" on adolescent bariatric surgery.

Authors:
Craig T Albanese

J Laparoendosc Adv Surg Tech A 2005 Feb;15(1):70

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http://dx.doi.org/10.1089/lap.2005.15.70DOI Listing
February 2005

Anesthetic concerns for robot-assisted laparoscopy in an infant.

Anesth Analg 2004 Dec;99(6):1665-1667

Department of *Anesthesia and †Surgery, Division of Pediatric Anesthesia, Stanford University Medical Center, California.

A 2-mo-old infant with biliary atresia was scheduled for laparoscopic Kasai with robot assistance. Before surgery, a practice trial maneuvering the cumbersome robotic equipment was performed to ensure rapid access to the patient in case of emergency. IV access, tracheal intubation, and arterial line placement followed inhaled anesthesia induction with sevoflurane. Robotic setup took 53 min and severely limited patient access. No adverse events occurred during the procedure requiring the removal of the robotic equipment, and the patient was discharged after a stable postoperative recovery. Advance preparation is required to maximize patient safety during robotic surgery.
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http://dx.doi.org/10.1213/01.ANE.0000137394.99683.66DOI Listing
December 2004

Spontaneous resolution of prenatal megalourethra.

J Pediatr Surg 2004 Sep;39(9):1421-3

Fetal Treatment Center, University of California, San Francisco Medical Center, San Francisco, CA 94143-0570, USA.

Urethral obstruction in the fetus is rare. Whereas proximal obstruction most often is caused by posterior urethral valves, causes of distal obstruction are less well recognized and can include urethral atresia, urethral webs, and anterior urethral valves. These latter abnormalities can lead to urinary retention, incontinence, enuresis, spontaneous bladder rupture, and megacystis. The authors present 3 fetuses (gestational age range, 18 to 20 weeks) in whom distal urethral obstruction was suspected by prenatal ultrasonography in the absence of a demonstrable lesion. All 3 experienced spontaneous resolution of the presumed obstruction. On follow-up, all are alive and well with no adverse genitourinary tract sequelae. No postpartum intervention was required.
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http://dx.doi.org/10.1016/j.jpedsurg.2004.05.026DOI Listing
September 2004
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