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Laparoscopic Management of Intussusception

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Indications for Workup and Operation The primary and most frequent indication for surgical treatment of intussusception is failure of radiologic reduction. If the condition of the patient allows, the reduction attempt should be repeated up to three times before surgical intervention is initiated. Enema reduction should be performed in all cases (unless free air…

Laparoscopic Ileocolectomy for Crohn Disease

Indications for Workup and Operation Patients with Crohn disease (CD) who have failed to improve with medical therapy and whose symptoms are secondary to a focal area of disease that can be resected should be considered for an operation. The clearest indications are the emergent presentations of perforation or obstruction. However, the far more common reasons for an operation are elective and require deliberation and shared…

Laparoscopic Ladd Procedure

Intestinal malrotation refers to abnormal rotation and/or fixation of the midgut. As the intestine re-enters the abdominal cavity during the 8th to 10th gestational week, it undergoes a 270-degree counterclockwise rotation that causes the duodenum to be fixed to the retroperitoneum, thereby creating the ligament of Treitz. When the intestine does not re-enter or become fixed, various degrees of malrotational anatomy occur, which predisposes the intestine…

Laparoscopic Repair of Duodenal Atresia and Stenosis

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . The first reported case of laparoscopic duodenal atresia repair was in 2001 by Bax et al and was followed by the first significant series in 2002 by Rothenberg. Since then, the operation has become much more common, although the majority of these operations are still performed via a laparotomy. This may be because of the…

Laparoscopic Pyloromyotomy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Hypertrophic pyloric stenosis (HPS) is one of the most common surgical diseases in infants. Most infants present between the ages of 2 and 8 weeks with nonbilious projectile vomiting. They are often dehydrated with a hypochloremic, hypokalemic metabolic alkalosis. The degree of dehydration and electrolyte imbalance is not as dramatic as in the past…

Laparoscopic Gastrostomy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Durable enteral access is a commonly performed operation in pediatric surgery practice today. Methods for gastrostomy include open, percutaneous, endoscopic, and laparoscopic techniques. Laparoscopic gastrostomy in children offers many advantages over the open approach, including excellent visual exposure, improved cosmesis, and reduced pain. Compared to percutaneous endoscopic insertion, laparoscopic gastrostomy allows for secure fixation…

Laparoscopic and Endoscopic Esophagomyotomy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Achalasia is a rare disorder of esophageal dysmotility in which there is absent or incomplete relaxation of the lower esophageal sphincter (LES) in addition to generalized abnormal peristalsis of the esophageal body. The pathophysiologic basis of achalasia is thought to be related to the degeneration of the inhibitory myenteric nerve plexus of the LES…

Laparoscopic Fundoplication

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Gastroesophageal reflux is a frequently seen condition in infants and children. In fact, in premature and young infants, it can be normal until the lower esophageal sphincter (LES) matures. With maturation of the LES, these symptoms often resolve spontaneously. In other infants and children, medical management may be effective in relieving symptoms but is…

Evidence-Based Summary of Guidelines From the Society for Vascular Surgery and the American Venous Forum

Evidence-based medicine is best defined as “the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.” Clinical practice guidelines evaluate the evidence in the scientific literature, assess the likely benefits and harms of a particular treatment, and aid the physicians to select the best care for the patient. The physician's clinical experience is important in this…

Severity Scoring and Outcomes Measurement

Historical Background The past few decades have marked a change of focus in reporting outcomes for venous disease and therapy. Although treatments were regularly being offered for many venous conditions, the outcomes were only sporadically evaluated, and reporting methods were not standardized, preventing comparison trials and confounding reported results. The realization that the language of diagnostic and treatment information needs to be universal has shifted the…

Venous Malformations

Vascular malformations are likely the single most misdiagnosed entity in the vascular system. Essentially, vascular malformations are errors in vasculogenesis with the particular characteristics of the lesion determined by the vessel in the vascular system that is involved. As a result, these malformations can include arteries, veins, lymphatic vessels, or capillaries. These lesions occur in about 1.5% of the population and over 90% are present at…

Endovenous Management of Central and Upper Extremity Veins

Because of the increased use of central venous catheters and implantable pacemakers and defibrillators, upper extremity deep venous thrombosis (UEDVT) has become more frequent. Central vein stenosis and thrombosis, usually from neointimal hyperplasia, are commonly seen in dialysis-dependent patients or in patients who have had placement of an indwelling central venous catheter. Traditional risk factors also include thrombophilia and cancer. It is estimated that approximately 10%…

Treatment of Spider Telangiectasias

Historical Background The treatment of telangiectasias was not seriously attempted until the 1930s, with Biegeleisen taking the credit for initially attempting an injection into the perivascular space around telangiectatic areas. Later, he implemented intravascular injections using homemade microneedles. These early efforts led to disappointing results, primarily because the sclerosing solutions, such as sodium morrhuate, were very caustic. It was not until the 1970s that others attempted…

Nutcracker Syndrome

Compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the abdominal aorta was first described by Grant in 1937, who found the anatomic relationship analogous to a nut in a nutcracker. The first clinical report was by El-Sadr in 1950, although the compression was documented by venography only 2 decades later by Chait. The term nutcracker phenomenon was coined by de…

Pelvic Venous Disorders

Venous disorders of the abdomen and pelvis are often referred to as a number of syndromes, including pelvic congestion, May-Thurner, and nutcracker syndrome (NCS), which are of historical significance, but inadequately reflect the underlying pathophysiology of these disorders. For example, May and Thurner described anatomic “spurs” of the left common iliac vein (CIV) beneath the right common iliac sarterial crossing in 24% of 342 cadavers. Although…

Venous Ulcers

Venous leg ulcers (VLUs) are an important medical problem. The chronic and recurrent nature of VLUs causes morbidity, severely reduces patient quality of life, and increases costs placed on health care systems. Standard care supported by evidence includes compression therapy and the use of adjunctive agents, which have been shown to accelerate healing, improve patient quality of life, and likely reduce health care costs. The American…

Deep Venous Incompetence and Valve Repair

Deep venous insufficiency and the techniques used to repair the valve damage or valve incompetence is technically challenging when compared with the treatment of superficial, perforator, and iliofemoral deep venous occlusive disease, and therefore has been relegated to a “last consideration” in the treatment of patients with advanced clinical stage disease. Whether or not this should be the case can be debated but, in practicality, this…

Iliocaval and Femoral Venous Occlusive Disease

Historical Background In contrast with the right common iliac vein, which ascends almost vertically to the inferior vena cava (IVC), the left common iliac vein takes a more transverse course beneath the right common iliac artery, which may compress it against the lumbar spine before entering the vena cava. This compression causes stasis of the blood, which is one element of Virchow's triad that may precipitate…

Postthrombotic Syndrome

Historical Background Postthrombotic syndrome (PTS) remains an important health care problem in United States. A population-based study showed that the incidence of venous ulcers currently approaches 18 per 100,000 habitants per year. The same study identified that PTS is responsible for economic expenses estimated at least $200 million. Diagnosis of PTS is based on history and clinical presentation. The syndrome consists of signs and symptoms of…