PHẪU THUẬT NỘI SOI MỘT ĐƯỜNG RẠCH ĐIỀU TRỊ DỊ TẬT RUỘT QUAY BẤT THƯỜNG Ở TRẺ SƠ SINH

Abstract

Objectives: We present our technique of single incision laparoscopic surgery (SILS) for malrotation in a neonate. Methods: This is a case report and review of the literature. Results: The patient was a eight- day-old boy admitted to our department for bilious vomiting and jaundice (indirect hyperbilirubinemia). Based on the clinical presentations and imaging studies, the diagnosis of malrotation was made and the patient was indicated for laparoscopic surgical repair. An inferior curvilinear umbilical incision was made. One 5.5mm trocar and two 3.5mm trocars were placed at different points in the same incision. A standard 5mm, 30⁰ laparoscope and conventional straight laparoscopic instruments were used. Intraoperatively we found malrotation with 360^o midgut volvulus without vascular compromise. A Ladd’s procedure was performed: derotation, division of the Ladd’s ligament, widening of the mesentery, repositioning of the bowels (the small bowel on the right and the large bowel on the left) and appendectomy. There was no significant blood loss, no intraoperative complications. The operative duration was 90 minutes. The patient resumed oral feeding on postoperative day 3, but suffered from bronchopneumonia. He was treated with antibiotics and was discharged on POD 9. At a follow up 9 months he was asymptomatic. The postoperative cosmesis was excellent as the patient had no visible scar. Conclusions: Our technique of SILS for malrotation in neonates can be feasible, safe with excellent post-operative cosmesis.