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  • Thal procedure  (2)
  • Bladder exstrophy  (1)
  • Complications  (1)
  • 1
    Electronic Resource
    Electronic Resource
    Surgical treatment of reflux esophagitis: Nissen versus Thal procedure (1994)
    Springer
    Pediatric surgery international 9 (1994), S. 334-337 
    Details
    ISSN: 1437-9813
    Keywords: Gastroesophageal reflux ; Antireflux procedure ; Nissen fundoplication ; Thal fundoplication ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The Nissen fundoplication has been the most commonly used procedure in the surgical management of reflux esophagitis. Due to unsatisfactory results and the many complications of the Nissen procedure, in 1989 we began using the Thal partial wrap. In a retrospective study, the results from both procedures are compared. Between August 1982 and May 1991, antireflux operations (27 Nissen; 23 Thal) were performed in 44 children. Fifty-eight percent had associated conditions, neurological impairment (12) and esophageal atresia being the most frequent. An uneventfull postoperative course was seen in 29.6% after the Nissen fundoplication and 87% in the Thal group (P 〈0.5). Recurrence or persistence of gastroesophageal reflux was observed in 37% and 4% of the Nissen and Thal groups, respectively. The symptom-free interval following the antireflux procedure averaged 11 months in the Nissen group and 2.8 months in the Thal group. Three out of 4 neurologically impaired children with a Nissen fundoplication had postoperative complications compared to 2 out of 8 with a Thal partial wrap. Eight children, all with a Nissen fundoplication, had to be reoperated for either acute obstruction or a redo procedure. The mean hospitalization times for the Nissen and Thal procedures were 16 and 7.6 days, respectively (P 〈0.1). From our experience, the Thal partial fundoplication appears to be an effective antireflux procedure with fewer perioperative complications than the Nissen operation. In the neurologically impaired child with feeding problems and reflux, a Thal fundoplication in combination with a gastrostomy is our therapy of choice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01685994
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Covered exstrophy associated with an anorectal malformation: A rare variant of classical bladder exstrophy (1994)
    Springer
    Pediatric surgery international 9 (1994), S. 438-440 
    Details
    ISSN: 1437-9813
    Keywords: Bladder exstrophy ; Covered exstrophy ; Exstrophy variant ; Pseudoexstrophy ; Anorectal malformation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report the case of a male newborn with covered bladder exstrophy, high anorectal malformation, and rectourethral fistula. The child had a split symphysis and diverging rectus muscles in the infraumbilical region. The ventral part of the bladder was covered with thin, fragile skin and some portions of the bladder bulged out as abdominal-wall hernias. Two of these hernias were located just above the penis, and the overlying skin showed a resemblance to scrotal skin. The penis was small and slightly laterally displaced, but otherwise normal; the child also had unilateral reflux into a dysplastic left kidney. The bladder neck and posterior urethra were patulous, but there was no urinary incontinence. The child underwent a singlestage reconstruction of the exstrophic lesion and a staged repair of the anorectal malformation. The clinical significance of this entity is discussed and the literature reviewed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01686031
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Laparoscopic Thal fundoplication in mentally retarded children (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 659-661 
    Details
    ISSN: 1432-2218
    Keywords: Antireflux operation ; Thal procedure ; Laparoscopy ; Mentally retarded children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: An increasing number of reports indicate that Thal fundoplication is the procedure of choice in mentally retarded children. With the advent of laparoscopy, Nissen's fundoplication seems to have been repopularized. However, the choice of the operative technique should be based on the merits of the procedure itself rather than the laparoscopic feasibility. The aim of this study is to determine if laparoscopic Thal fundoplication is beneficial for mentally retarded children. Methods: Between November 1993 and 1994 laparoscopic Thal fundoplication was performed in 15 mentally handicapped children; 13 also had a feeding gastrostomy. Age varied from 1.5 to almost 17 years (mean 7 years). Mean weight was 18 kg (5–50 kg). All patients underwent an upper GI study and endoscopy as well as pre- and 3 months postoperative pH study. Indications for the procedure were reflux esophagitis in 11 and feeding problems with silent reflux in 4. Results: The laparoscopic procedure was converted in the second patient because of bleeding in the hiatus. No further procedure-related intra- or postoperative complications occurred. The mean hospitalization was 3.7 days. No symptomatic postoperative gastroesophageal reflux has been observed. All children have undergone postoperative pH studies, which displayed silent reflux in two. Gastrostomy feeding is well tolerated. Conclusion: We conclude that Thal fundoplication can be performed laparoscopically in mentally retarded children. The laparoscopic results are comparable to the open Thal procedure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188523
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Laparoscopic Thal fundoplication in severely scoliotic children (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 1197-1198 
    Details
    ISSN: 1432-2218
    Keywords: Antireflux operation ; Thal procedure ; Laparoscopy ; Scoliosis ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgical treatment of gastroesophageal reflux in severely scoliotic children can be quite bothersome because sometimes the working space between the subcostal margins, iliac crest, and spinal column is very limited; the hiatus lies extremely deep away and is frequently rotated, making exposure more difficult. The laparoscopic approach could lend the necessary extension to the surgeons' hands to reach the deep hiatus. Moreover the entrance of the ports can be adjusted to the special requirements dictated by the scoliosis. Between February and December 1994 laparoscopic Thal fundoplication was performed in five severely scoliotic children; four also had a feeding gastrostomy. There were no intraoperative complications. The laparoscopic approach allowed improved operative visibility. Mean hospital stay was 3 days. The children displayed no symptomatic postoperative gastroesophageal reflux, which was confirmed by 3 months postoperative pH study. The laparoscopic approach of fundoplication allows improved visibility and easier access to the hiatus in severely scoliotic patients in comparison to the open approach. Results so far are good.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00210927
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    Paper (German National Licenses)
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