There are only few pediatric surgical centers across the world with expertise for minimally invasive anatomical lung resections in children. Between September 2003 and September 2005, 67 children underwent thoracoscopic surgery at the Department of Pediatric Surgery, University Hospital of Tuebingen, Germany. In 19 of these cases a lung resection was carried out, 8 of them had an anatomical lung resection. All patients underwent general anesthesia without selective intubation for the procedure. Intrathoracic pressure with insufflation of carbon dioxide of 1.5 l / min was held at 3-5 mmHg. Two 5 mm ports for video and instruments and one 12 mm port for a stapling device were used. Resected lung specimens were removed from the thorax through an additional 2-3 cm long incision. A bronchoscopy was carried out during surgery in all patients. Median age at operation was 5.6 years (range 3 months-20 years). Median operation time was 150 minutes (range 94-250 min). Conversion to open surgery was performed in 3 cases. This was due to bleeding in one child, due to a stiff lung in another patient with cystic fibrosis and due to a vascular and bronchial malformation in a third child suffering from middle lobe syndrome. There were no postoperative complications. Our preliminary results show, that thoracoscopic lung resections in children can be performed without major complications and excellent cosmetic results. For the necessity of a conversion to open surgery possible reasons may be insufficient intrathoracic overview as well as congenital anomalies of the vascular and / or the bronchial tract. Co-morbidities such as rib-fusion, deformities of the thorax or scoliosis can be avoided using thoracoscopic procedures.

There are only few pediatric surgical centers across the world with expertise for minimally invasive anatomical lung resections in children. Between September 2003 and September 2005, 67 children underwent thoracoscopic surgery at the Department of Pediatric Surgery, University Hospital of Tuebingen, Germany. In 19 of these cases a lung resection was carried out, 8 of them had an anatomical lung resection. All patients underwent general anesthesia without selective intubation for the procedure. Intrathoracic pressure with insufflation of carbon dioxide of 1.51/min was held at 3-5 mmHg. Two 5 mm ports for video and instruments and one 12 mm port for a stapling device were used. Resected lung specimens were removed from the thorax through an additional 2-3 cm long incision. A bronchoscopy was carried out during surgery in all patients. Median age at operation was 5.6 years (range 3 months-20 years). Median operation time was 150 minutes (range 94-250 min). Conversion to open surgery was performed in 3 cases. This was due to bleeding in one child, due to a stiff lung in another patient with cystic fibrosis and due to a vascular and bronchial malformation in a third child suffering from middle lobe syndrome. There were no postoperative complications. Our preliminary results show, that thoracoscopic lung resections in children can be performed without major complications and excellent cosmetic results. For the necessity of a conversion to open surgery possible reasons may be insufficient intrathoracic overview as well as congenital anomalies of the vascular and/or the bronchial tract. Co-morbidities such as rib-fusion, deformities of the thorax or scoliosis can be avoided using thoracoscopic procedures.

Die Oesophagusachalasie ist im Kindesalter eine sehr seltene Erkrankung. Als Therapie wird die Ballondilatation als ältestes und die Botulinustoxin-injektion als modernstes endoskopisches Verfahren, die Hellersche Myotomie mit Fundoplicatio offen oder laparaskopisch als definitives operatives Verfahren empfohlen.

Einleitung: Die Prognose von Omphalocele (OC) und Gastroschisis (GS) hängt heute fast ausschließlich von assoziierten Fehlbildungen ab. Methodik: Wir haben in einer retrospektiven Studie klinische Daten und Begleitfehlbildungen bei 44 Kindern mit OC und 51 mit GS, die zwischen 1983 und 1999 primär in unserer Klinik operiert wurden, ausgewertet und unter Berücksichtigung mit den aus der Literatur bekannten Hypothesen zur Embryogenese von OC und GS diskutiert. Ergebnisse: Der Inzidenz der Begleitfehlbildungen betrug bei der OC 65,9% und davon handelte es sich in72,4% um Syndrom-assoziierte Fehlbildungen. Bei 35,3% der Kinder mit GS fanden wir Begleitfehlbildungen, überwiegend intestinal lokalisiert und nur zweimal Syndrom-assoziiert. Schluβfolgerung: Häufigkeit und Art der Begleitfehlbildungen in unserer Studie sprechen für eine unterschiedliche Embryogenese von OC und GS, aber für eine einheitliche Betrachtung von kleinen und großen OC, mit oder ohne Leberherniation.

Anhand von 2 Patientenkasuistiken möchten wir auf eine wegen des möglichen Kurzdarmes sehr schwerwiegende Variante des Gastroschisis aufmerksam machen. Bei einem Patienten ohne präpartalen Nachweis einer Gastroschisis fand sich nach der Geburt in der 31. SSW ein nekrotischer Darmrest an einer spontan verschlossenen Gastroschisis, der gesamte Dünndarm vom Duodenum bis zum Querkolon fehlte. Bei der zweiten Patientin mit bekannter Gastroschisis erfolgte wegen kindlicher Probleme in der 34. SSW eine Sectio. Hierbei fand sich der prolabierte Dünndarm durchblutungsgestört in einer sich verschließenden Bauchdeckenlücke; er erholte sich nach sofortiger Entlastung. Es wird über die spärlichen Literaturmitteilungen dieser Komplikation berichtet und eine Strategie zur Vermeidung vorgeschlagen.

Bile stones lodged in the ampulla of Vater present a rare but often difficult problem. Considering the disadvantages of conventional papillotomy and papillectomy, we developed a technique in which both the anatomic structures and their function are preserved. Histologic studies of the ampulla provided the basis for the technique, in which the muscular layers of the ampulla are not cut through as in conventional papillotomy but are bluntly separated, preserving this important anatomic component of the ampulla saved. The postoperative and long-term outcome of seven patients with bile stones lodged in the ampulla are reported. We found semicircular lateral papillotomy a safe procedure that preserves the muscular structures and function of the ampulla.

Clinical and histologic findings from 206 patients operated upon for extrahepatic biliary atresia (EHBA) are analyzed in order to define the prognosis of patients with EHBA. The prospective study took into consideration both initial fibrosis of the liver and the morphology of the porta hepatis (PH) at surgery. Kaplan-Meier survival estimates and statistical calculations demonstrated a relationship between long-term survival and histologic findings in the liver and porta hepatis. The efficacy of HPE is significantly influenced by the morphology of the PH and to a lesser extent by the initial liver fibrosis. Surgery should thus achieve pattern 1 morphology of the PH, but this is problematic because of the close relationship of the vascular and biliary structures in its two lateral zones.