We report laparoscopic management of choledochal cysts (CDC) in 10 children. We dissect the CDC using conventional mono- and bi-polar diathermy up to the lower end, ligate or clip it at the lowest possible level and divide it. The proximal end is divided after leaving a sufficient cuff for anastomosis. In the first three cases, we formally opened to complete the biliary-enteric anastomosis. However, in the subsequent seven cases, we made a small midline incision to develop a Roux-en Y loop, and the anastomosis was then completed by intra-corporeal suturing after re-creating the pneumo-peritoneum. Apart from biliary leak in one case, we did not encounter any major complications. The mean operative time was 4.2 h. We have discussed the technical points in the study. We conclude that CDC is eminently suitable for laparoscopic correction; it requires advanced skills and expertise for precise dissection and meticulous suturing in restricted spaces. If the case selection is good and if the team is experienced, CDC can be effectively managed using laparoscopy even without a sophisticated equipment. The wound- and scar-related morbidity is minimized.

Aim:To analyze our experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis for the lessons that we learnt and to study the effect of learning curve.Materials and Methods:This is a retrospective analysis of case records of 101 infants who underwent laparoscopic pyloromyotomy over 6 years. The demographic characteristics, conversion rate, operative time, complications, time to first feed and post-operative hospital stay were noted. The above parameters were compared between our early cases (2007-2009) (n = 43) and the later cases (2010-2013) (n = 58).Results:89 male and 12 female babies ranging in age from 12 days to 4 months (mean: 43.4 days) were operated upon during this period. The babies ranged in weight from 1.8 to 4.7 kg (mean: 3.1 kg). Four cases were converted to open (3.9%): three due to mucosal perforations and one due to technical problem. The mean operative time was 45.7 minutes (49.7 minutes in the first 3 years and 43.0 minutes in the next 3 years). There were 10 complications-4 mucosal perforations, 5 inadequate pyloromyotomies and 1 omental prolapse through a port site. All the complications were effectively handled with minimum morbidity. In the first 3 years of our experience the conversion rate was 9.3%, mucosal perforations were 6.9% and re-do rate was 2.3% as compared to 0%, 1.7% and 6.9%, respectively, in the next 3 years. Mean time for starting feeds was 21.4 hours and mean post-operative hospital stay was 2.4 days.Conclusion:Laparoscopic pyloromyotomy is a safe procedure with minimal morbidity and reasonable operative times. Conversion rates and operative times decrease as experience increases. Our rate of inadequate pyloromyotomy was rather high which we hope to decrease with further experience.

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Laparpscopic Surgery/Minimally Invasive Surgery (MIS) in children have witnessed tremendous progress in the last decade. Presently, there are extensive applications of this novel technique and several advanced level intricate surgeries have been done safely in small children. This is a brief overview of the common indications and utility of MIS in pediatric practice in the Indian Scenario. We discuss some common clinical settings like recurrent abdominal pain, Impalpable testis, intersex disorders Empyema, Thoracis etc., where MIS has had a significant benefit. We also present our experience of MIS in children without using any sophisticated equipment like the harmonic scalpel, endo-staplers etc. MIS has come to stay and it will definitely have lasting impact on surgical problems in children.

Background Human cystic echinococcosis continues to be a public health problem worldwide. The standard treatment of hydatidosis in children is open surgical intervention for removal of the cyst completely without spillage. The limited use of minimal invasive surgery (MIS) in hydatidosis has been due to the concern of inadequate removal and spillage, leading to recurrence or dissemination of the disease. Recently, a few authors have reported the successful use of minimal invasive surgery (MIS) for management of hydatid disease in children. We present our experience with successful use of MIS in the management of hydatid disease involving lung and liver in children. Methods Between 2006 and 2017, data of 22 children treated for hydatid disease in our institute were reviewed. The diagnosis was made radiologically with Computerised Tomography scan of chest and abdomen. All children received albendazole therapy prior to and after the surgery. Thoracoscopic/laparoscopic procedures were undertaken sequentially in all children. Children with synchronous disease involving lung and liver had an interval of 2 weeks between procedures. The techniques of puncture, aspiration, injection and re-aspiration (PAIR) and also our modifications of cyst removal are described. Results There were a total of 22 children with liver and or lung involvement. Four children had synchronous lung and liver involvement and four children had bilateral lung involvement. The duration of the procedure ranged from 60 to 90 min. There were 3 (18) conversions in the thoracic group and 1 (12) in the laparoscopic group. PAIR technique with our modification of cyst extraction was used in all except in one child. Capitonnage of the cyst wall in lung hydatidosis was not done. There were no postoperative events. Recurrence of the lesion at original site was seen in two children, one each in laparoscopic and thoracoscopic group. Occurrence of new lesion or dissemination of the disease was not identified on a mean follow-up of 7 years. Conclusion Our series demonstrates the safe and effective utility of MIS in management of pulmonary and liver hydatid in children. Use of MIS does not lead to dissemination of the disease. Albendazole therapy is an useful adjunct prior to surgery. Single lung ventilation with isolation of uninvolved lung is useful during surgery for lung hydatid.