No abstract

Needlescopic diagnosis is feasible and appears to be safe, even in critically ill micropremmies less than 1000 g. The technique can provide useful information for surgical decision-making and allows for precise placement of a microlaparotomy incision over the site of perforation, thus minimizing the trauma from open surgery in this special group of patients. We are currently expanding its role in patients with overt perforations to determine if we can limit the extent of surgical exploration without compromising the adequacy of surgical management.

Several surgical options are available for managing varicoceles. Although conventional surgery offers good surgical results, the most common long-term complication of surgery is the development of hydroceles, thought to be due to interruption in the lymphatic outflow from the subservient testis. The authors describe a new technique of in vivo methylene blue mapping of testicular lymphatic vessels at laparoscopy, allowing these vessels to be spared during laparoscopic varicocelectomy. This novel method of in vivo staining of lymphatic vessels should prevent damage to the lymphatic system and avoid the late development of hydroceles. A prospective multicenter trial is currently underway to evaluate the medium- and long-term results.

Purpose and Background:In a subset of patients with severe idiopathic constipation who require massive amounts of laxatives, overflow pseudoincontinence may develop. In some of these cases, a megarectosigmoid develops while the rest of the bowel remains of normal caliber. These patients may benefit from resection of the dilated colonic segment.Patients and Methods: During a 5-year period, 164 patients were referred for the evaluation of severe constipation. Ninety-three patients had idiopathic constipation, 41 had Hirschsprung disease, and 30 had previously undergone anorectal malformation repair. Among those with idiopathic constipation, five required massive amounts of laxatives for bowel management and also had megarectosigmoid on contrast enema. All patients were first managed with a strict bowel management regimen. They all were continent, but to remain clean, they required massive amounts of laxatives. A laparoscopic sigmoid resection was offered to five patients with constipation refractory to optimal medical management. Our goal was to reduce the therapeutic laxative requirements and improve their quality of life.Results: All five patients presented with incontinence and required fecal disimpaction. With an aggressive bowel management regimen, all were in fact found to have overflow pseudoincontinence, and with high doses of laxatives, they were continent and able to have daily bowel movements. All five patients had a dilated megarectosigmoid, whereas the rest of the colon was of normal caliber. They underwent laparoscopically assisted sigmoid resection. Postoperatively, the laxative requirements of all patients were significantly reduced. All are continent and have daily bowel movements.Conclusion: Laparoscopically assisted sigmoid resection is an ideal approach for the management of intractable idiopathic constipation in a select group of patients. 285