A 13 year old girl has been successfully treated by total Laparoscopic excision of type 1 –C Choledochal cyst and hepatico-duodenostomy . She has been having recurrent abdominal pain, post feeding discomfort, nausea, occasional fever and vomiting. After thorough evaluation a large type 1c Choledochal cyst associated with hepatosplenomegaly was diagnosed. After preparation, Laparoscopic excision and bilio-enteric anastomosis was carried out. She had highly vascular and thick fibrotic cyst wall with adhesions due to multiple cholangitic attacks. The surgery could be completed completely Laparoscopically with minimal blood loss. Child had a very comfortable post operative recovery, starting oral feeds 48 hours after surgery with excellent cosmetic outcome.
Currently minimally invasive technique is being the procedure of choice for such complex anomalies with excellent outcomes.
Child had antenatally diagnosed progressively increasing bilateral hydroureteronephrosis .Delivered at term and diagnosed to have bilateral duplex kidneys with severe bilateral VUR to lower moieties and cecoureterocele on right upper moiety. Cystoscopic deroofing of ureterocele and laparoscopic ureterostomy were performed successfully to protect the kidney functions
6 year old girl underwent mini-laparoscopic pyeloplasty with 3mm instruments thereby rendering stitch-less abdomimal access. The child had been suffering from frequent intermittent severe pain in left flank associated with vomiting thereby reducing her appetite and general growth. Upon evaluation, she was diagnosed to have severe pelvi-ureteric junction obstruction with enlarged renal pelvis and thinning of left kidney. The child recovered very fast accepting oral feeds and started to move around within 6 hours of surgery. The post- operative pain and discomfort were minimal compared to open surgical repair. The cosmetic outcome, which is one of the major concerns with the child and parents has been outstanding.
There is no scar on her abdomen or perineum which is a great cosmetic benefit to the girl child.
Fetal volvulous is an extremely rare condition and a challenge to diagnose and manage. Only few cases have been reported in the world literature with instances of fetal death , still births in neglected cases. It’s a complex multidisciplinary approach with state of the art NICU care which helps in survival of potentially morbid and lethal condition.
A 4 years old child with bilateral grade 4 Vesico-ureteric reflux and reflux nephropathy had Pneumo-Vesicoscopic ureteric reimplantation. Child had a very comfortable post operative period and discharged on 3rd post op day. This procedure is a paradigm shift from the conventional open cross trigonal ureteric reimplantation where a Pfannensteil (lower transverse) incision is usually made , bladder is opened and post surgery ureteric catheters are exteriorized per abdomen, requiring 7-10 days of postop recovery ,significant amount of analgesia, leaving a large scar; or conventional Laparoscopic extra vesical reimplantation ( not always suitable for dilated high grade refluxing ureters). In this procedure all the reimplantaion steps were carried out entirely within the domain of Urinary bladder by 3mm minilaparoscopic instruments , without any post op stents. The child had very comfortable recovery with minimal analgesia and left with barely appreciable scar.
This relatively new technique has tremendously improved the quality of life of the reimplantation kids. There is no scar on her abdomen or perineum which is a great cosmetic benefit to the girl child. Fetal volvulous is an extremely rare condition and a challenge to diagnose and manage. Only few cases have been reported in the world literature with instances of fetal death , still births in neglected cases. It’s a complex multidisciplinary approach with state of the art NICU care which helps in survival of potentially morbid and lethal condition.