Faculty Bibliography

Portal vein thrombosis is a rare but well-recognized complication of splenectomy. We present the case of a 31-year-old woman with transfusion-dependent b-thalassemia who underwent a laparoscopic splenectomy to reduce her transfusion requirements. Postoperatively, she developed portal vein thrombosis, diagnosed by abdominal CT scanning on postoperative day 4. After being treated with anticoagulation and antibiotic therapy, she obtained prompt resolution of her symptoms. This report summarizes the first reported incidence of portal vein thrombosis following laparoscopic splenectomy and presents the current theories regarding the etiology and treatment of postsplenectomy portal vein thrombosis

Use of the laparoscopic approach for intra-abdominal malignancy remains controversial because there have been multiple reports of tumor metastases at port sites after laparoscopy. Although several randomized trials have documented no difference in recurrence rates between laparoscopic and open surgery, there are still many questions about the behavior of tumor cells in laparoscopic conditions. The speed of tumor spread and time to recurrence appear to be variable. Abdominal insufflation and other effects of laparoscopy are only now being delineated. It is not clear whether tumor characteristics, preoperative tumor stage, or the laparoscopic milieu itself affect tumor spread during and after laparoscopic surgery. We present an unusual case of very rapid tumor dissemination in a young patient who underwent diagnostic laparoscopy

BACKGROUND AND OBJECTIVES: Adult laparoscopic Nissen fundoplication has been steadily growing since its introduction to the United States in the 1990s. Its advantage over the traditional open approach is manifold. Application of laparoscopic fundoplication to children is slowly but surely following this trend. This study evaluates our initial experience with pediatric laparoscopic Nissen fundoplications. PATIENTS AND METHODS: We reviewed the records of 25 consecutive laparoscopic Nissen fundoplications performed by a single surgeon (GS) at our institution in the past three years. The patient ages ranged from 7 months to 18 years (mean, 7 years). All patients had documented gastroesophageal reflux disease. Complications from the reflux included vomiting in 15 patients, failure to thrive in nine, esophagitis in nine, and pulmonary symptoms in six. RESULTS: All Nissen fundoplications were performed laparoscopically without need for conversion to open technique. Blood loss was less than 50 cc in all cases. A tube gastrostomy was concurrently performed in 17. Mean operative time in all cases was 221 minutes. Average postoperative day on which feedings were begun was day 2, with an average resumption of regular feedings on postoperative day 3.5. Average date of discharge was postoperative day 6.8. Complications included difficulty controlling glucose in an insulin-dependent diabetic, and a lost needle, which added an additional hour to the operative time. There were eight admissions to the pediatric intensive care unit, all for observation secondary to their underlying medical problems. There was one postoperative death due to an underlying medical condition. CONCLUSIONS: Laparoscopic Nissen fundoplication is a safe and effective treatment option for children suffering from significant reflux. Time to regular feeding, analgesia requirements and hospital stay are decreased when compared to traditional procedures. Laparoscopic Nissen fundoplication may well become the procedure of choice for pediatric gastroesophageal reflux disease