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Liem N.T.,National Hospital of Pediatrics | Pham H.D.,National Hospital of Pediatrics | Vu H.M.,National Hospital of Pediatrics
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2011

Aim: The aim of this study was to compare the safety of laparoscopic operation with open surgery for choledochal cyst in children. Methods: Early outcomes of open surgery from January 2001 to December 2006 were compared with early outcomes of laparoscopic operations from January 2007 to July 2010. The main outcome variables included intra- and early postoperative complications, operative time, rate of reintervention, and duration of postoperative stay. Results: There were 307 patients in the open operation group and 309 patients in the laparoscopic operation group. There was no significant difference in cyst diameter between the 2 groups. The operative time was longer in the laparoscopic operation group. The number of patients requiring blood transfusion was lower in the laparoscopic operation group. Intraoperative complications were low in both groups and not significantly different. The rate of postoperative complications was lower in the laparoscopic operation group but not significantly. The rate of reintervention was significantly lower in the laparoscopic operation group. The postoperative stay was significantly shorter in the laparoscopic operation group. Conclusion: Laparoscopic operation is as safe as open operation for choledochal cyst. The postoperative stay was significantly shorter in the laparoscopic operation group. © Copyright 2011, Mary Ann Liebert, Inc.


Son T.N.,National Hospital of Pediatrics | Hoan V.X.,National Hospital of Pediatrics
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2013

Pyloric atresia (PA) is rare and may be associated with epidermolysis bullosa (EB). This is the first case report of a successful laparoscopic treatment of PA in a full-term 7-day-old neonate with EB. The laparoscopic approach consists of a longitudinal pyloromyotomy and excision of the thick obstructing pyloric membrane with a Heineke-Mickulicz pyloroplasty closure. Oral feeding was resumed at postoperative Day 7, and the child was discharged 5 days later with satisfactory follow-up at 8 months. Recommendations are provided for the management of the neonate with PA/EB. © 2013, Mary Ann Liebert, Inc.


Liem N.T.,National Hospital of Pediatrics | Dien T.M.,National Hospital of Pediatrics | Ung N.Q.,National Hospital of Pediatrics
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2010

Aim: The aim of this work was to report the technique and result of thoracoscopic repair for a newborn with congenital diaphragmatic hernia (CDH) under high-frequency oscillatory ventilation (HFOV) in the neonatal intensive care unit (NICU). Methods: Ventilation was supported by HFOV. The patient was placed in the right lateral decubitus position. Thoracoscopic surgery was performed through three 5-mm trocars. Carbon dioxide insufflation was maintained in the thoracic cavity at a pressure of 6-8 mm Hg. The hernia defect was repaired by using interrupted sutures with extracorporeal knots. Results: The operation lasted 60 minutes. The intraoperative course was uneventful. Normal vital signs and PO2 value were maintained throughout the operation. The patient had a normal chest X-ray 1 month after discharge. Conclusion: Thoracoscopic repair of CDH in the NICU during HFOV is feasible and safe. © Mary Ann Liebert, Inc.


Liem N.T.,National Hospital of Pediatrics | Quynh T.A.,National Hospital of Pediatrics
Journal of Pediatric Surgery | Year: 2013

Aim To present surgical technique and results of combined laparoscopic and modified posterior sagittal approach (PSAP) saving the external sphincter in the management of rectourethral fistula. Methods The operation was started by a laparoscopic approach to dissect around the rectal pouch and separate the rectal pouch from the upper urethra. The PSAP saving the external sphincter was added to completely separate the rectal pouch from the urethra. The fistula was divided and closed. The rectal pouch was then pulled through a tunnel created at the center of the external sphincter and an anoplasty was performed. Results From September 2011 to September 2012, 19 patients were operated on using the same technique. Mean age of patients was 4.0 ± 1.8 months. Rectourethral fistula was located in the prostatic urethra in 15 patients and in the bulbar urethra in 4 patients. The mean operative time was 82 ± 13 min. There were no intraoperative complications. Postoperative perforation of the posterior wall of the rectum happened in one patient and required a second laparoscopic operation. Follow-up after closure of colostomy from 1 month to 7 months revealed all patients were able to pass stool spontaneously. All patients could urinate easily. No urethral fistula or diverticulum was detected on voiding cysto-urethrography. Conclusions Combined laparoscopic and PSAP saving the external sphincter is the easier and more physiologic approach to manage rectourethral fistula with fewer complications. © 2013 Elsevier Inc.


Hai L.T.,National Hospital of Pediatrics | Ngai L.K.,National Hospital of Pediatrics | Phuc P.H.,National Hospital of Pediatrics | Hung V.P.,National Hospital of Pediatrics | Liem N.T.,National Hospital of Pediatrics
Emerging Infectious Diseases | Year: 2012

During an outbreak of severe acute respiratory infections in 2 orphanages, Vietnam, 7/12 hospitalized children died. All hospitalized children and 26/43 children from outbreak orphanages tested positive for rhinovirus versus 9/40 control children (p = 0.0005). Outbreak rhinoviruses formed a distinct genetic cluster. Human rhinovirus is an underappreciated cause of severe pneumonia in vulnerable groups.


Liem N.T.,National Hospital of Pediatrics | Quynh T.A.,National Hospital of Pediatrics
Journal of Pediatric Surgery | Year: 2012

Aim: The aim of this study was to describe the surgical technique and initial outcomes of laparoscopic-assisted anorectal pull-through for persistent cloaca. Materials and Methods: From January 2008 to June 2010, laparoscopic-assisted rectal pull-through was performed for 10 patients with persistent cloaca. The patient ages ranged from 3 to 9 months. The operation was carried out using 4 trocars. CO 2 pressure was maintained between 8 and 12 mm Hg. Results: Laparoscopic-assisted rectal pull-through was successfully performed in all patients. Operative time ranged from 80 to 120 minutes (mean, 91.5 ± 10 minutes). There were no intraoperative or postoperative deaths or complications. The mean hospital stay was 4.4 ± 0.5 days (range, 4-5 days). The length of follow-up varied from 6 to 24 months (mean, 12.9 ± 5.7 months) in all 10 patients. Anal stenosis was not observed in any patient. Seven patients had 1 to 2 stools per day, 2 patients had 3 stools per day, and 1 patient had 1 stool every 2 days. No patient had fecal incontinence. Conclusion: Laparoscopic rectal pull-through is a feasible, effective, and less traumatic approach for anorectoplasty in patients with persistent cloaca. © 2012 Elsevier Inc.


Nguyen Thanh L.,National Hospital of Pediatrics | Hien P.D.,National Hospital of Pediatrics | Dung L.A.,National Hospital of Pediatrics | Son T.N.,National Hospital of Pediatrics
Journal of Pediatric Surgery | Year: 2010

Objective: The aim of this study is to report the technical details, early outcomes, and lessons learned from laparoscopic repair of 190 cases of choledochal cyst. Method: The operation was performed using 4 ports. The cystic duct was identified and divided. The liver was elevated by 2 stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and then biliary-digestive continuity was reestablished. Results: From January 2007 to April 2009, 190 patients were operated on. There were 144 girls and 46 boys. Ages ranged from 2 months to 16 years (mean, 46.9 ± 29.3 months). Cyst diameter ranged from 10 to 184 mm. A total of 106 patients were classified as Todani type I cysts, and 84 were type IV. Cystic excision and hepaticoduodenostomy were performed in 133 patients and hepaticojejunostomy in 57 patients. The operating time varied from 70 to 505 minutes (mean, 186 minutes). Conversion to open surgery was required in 2 patients. Intraoperative blood transfusion was required in 4 patients. There were no perioperative deaths. Postoperative anastomotic leakage occurred in 7 patients, resolving spontaneously in 6 and requiring a second operation in 1. Postoperative hospital stay ranged from 5 to 27 days (mean, 7.2 ± 3.3 days). Follow-up occurred between 1 and 24 months postdischarge (mean, 9 ± 2.2 months) and was obtained in 161 patients (84.7%). Of these patients, cholangitis occurred in 4 patients (2.4%). Conclusion: Laparoscopic repair is a safe and effective procedure for choledochal cyst. © 2010 Elsevier Inc. All rights reserved.


Son T.N.,National Hospital of Pediatrics | Liem N.T.,National Hospital of Pediatrics
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2012

Purpose: The aim of this study is to investigate the feasibility and effectiveness of laparoscopic surgery (LS) in management of abdominal lymphatic cyst (ALC) in children. Subjects and Methods: Medical records of all patients undergoing LS for ALC at the National Hospital of Pediatrics, Hanoi, Vietnam, from May 2007 to June 2011 were reviewed. For LS, one umbilical port of 10 mm and up to three other 3-5-mm ports were used. Cystic fluid was aspirated prior to removal of the cyst. When intestinal resection was indicated, the mesenteric cyst with the bowel loop was delivered out of the abdomen through a minimally enlarged umbilical incision; resection of the intestinal segment together with the cyst and the bowel anastomosis were both performed extracorporally. Results: Forty-seven patients were identified, with a mean age of 4.3±3.7 years. The most common symptoms were abdominal pain (72.3%) and abdominal distention (34.0%). Four patients presented with acute abdomen due to infection or hemorrhage of the cyst. Mean size of the ALC was 9.5±5.5 cm (range, 3.4-30 cm). In 12 cases the ALC was omental, and in 35 cases it was mesenteric. Laparoscopic cyst excision was performed in 36 cases (76.6%) versus laparoscopy-assisted bowel resection en bloc with the cyst in 8 cases (17.0%); in 3 patients (6.4%), conversion to open surgery was required. Mean operative time was 79±39 minutes. There were no intra- or postoperative complications. Mean length of hospital stay after laparoscopic management was 3.8±1.6 days. The results of pathologic investigation showed benign cystic lymphangioma in all cases. During follow-up ranging from 1 month to 4 years, recurrence was seen in 1 patient (2.1%) with complex mesenteric cyst. All other patients remained in good health. Conclusions: Laparoscopic management is safe, feasible, and effective and should be the treatment of choice for most cases of ALC in children. © Copyright 2012, Mary Ann Liebert, Inc.


Liem N.T.,National Hospital of Pediatrics
Journal of Hepato-Biliary-Pancreatic Sciences | Year: 2013

Laparoscopic cystectomy has become a common procedure for choledochal cysts. The cyst should be removed completely just above the confluence of the common biliopancreatic channel at the distal end and approximately 5 mm from the confluence of the right and left hepatic ducts at the proximal end to avoid complications of the cystic remnant. The operation is feasible and safe. The rate of conversion to open surgery is low. The rate of complication under skill laparoscopic surgeons is also low, even lower than in open surgery. There was no difference between hepaticoduodenostomy and hepaticojejunostomy concerning the rate of cholangitis. Gastritis due to bilious reflux occurred with a low rate in hepaticoduodenostomy. Both techniques could be used for choledochal cysts; however, hepaticoduodenostomy should be applied for choledochal cysts without intrahepatic dilatation of biliary tract. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer Japan.


Liem N.T.,National Hospital of Pediatrics | Pham H.D.,National Hospital of Pediatrics | Dung L.A.,National Hospital of Pediatrics | Son T.N.,National Hospital of Pediatrics | Vu H.M.,National Hospital of Pediatrics
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2012

Objective: The aim of this study is to report early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 cases. Patients and Methods: The operation was performed using four ports. The cystic duct was identified and divided. The liver was suspended by two stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and biliary-digestive continuity was reestablished by hepaticoduodenostomy (HD) or hepaticojejunostomy (HJ). Results: From January 2007 to June 2011, 400 patients were operated on. There were 305 girls and 95 boys. Ages ranged from 1 month to 16 years (mean, 47.5±2.1 months). Cystic excision and HD were performed in 238 patients and HJ in 162 patients. The mean operating time was 164.8±51 minutes for the HD group and 220±60 minutes for the HJ group. Conversion to open surgery was required in 2 patients. There were no perioperative deaths. Postoperative biliary leakage occurred in 8 patients (2%), resolving spontaneously in 7 and requiring a second operation in 1 patient. The mean postoperative hospital stay was 6.4±0.3 days for the HD group and 6.7±0.5 days for the HJ group. Follow-up between 5 months and 57 months postdischarge (mean, 24.2±2.7 months) was obtained in 342 patients (85.5%). Cholangitis occurred in 5 patients (1.5%) in the HD group and 1 patient (0.6%) in the HJ group. Gastritis due to bilious reflux was 3.8% in the HD group. Conclusions: Laparoscopic repair is a safe and effective procedure for choledochal cyst. The rate of cholangitis and anastomotic stenosis is low. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

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