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Laparoscopic left pancreatectomy with preservation of splenic vessels

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Laparoscopic Sigmoid Vaginal Replacement

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Bailez Maria,
Htal Garrahan,
Adrogue Buenos Aires

PERSONAL COMMENTS:
This topic may be included in pediatric gynecology as well as pediatric urogenital or colonic surgery . Most of the patients are adolescents because that´s the advisable age for replacements .
We noticed that after developing this technique completely laparoscopically and with very good postoperative results more patients are choosing it .

ABSTRACT:
In April 2000 (IPEG meeting) we presented the first patient who underwent laparoscopic sigmoid vaginal replacement. An update on our experience with this procedure in 14 consecutive patients has been published in Pediatric Endosurgery & InnovativeTechniques. Dec 2004, Vol. 8, No. 4: 295-301
Forty four patients had been operated up till now.
Their mean age was 16.3 y. Thirty eigth had a Mullerian dysgenesis and and 6 a disorder of sexual differentiationj (DSD) .All patients were previously informed about different techniques and chose this procedure
We used 4 ports : A 10mm one (umbilical ), a 12 mm( right lower quadrant) and two 5 mm.(left lower quadrant and hypogastric) .The lens was initially introduced through the umbilical port and afterwards inserted through the right lower quadrant one in order to achieve a better visualization of the vascularization of the sigmoid. After isolating a segment of the sigmoid using bipolar or a bipolar sealer device and two endostapplers , we undertook a perineal dissection creating a space between the urethra and the rectum under laparoscopic vision.Colo-colonic anastomosis was achieved using a circular mechanical suture through the rectum and taking outwards the proximal end of the colon through the umbillicusor the rigth lower quadrant port site.. Both the ensamble and shooting were done under laparoscopic control. The peritoneum near the Douglas space was incised in order to allow the passage of a forceps from the perineum which enabled the descent of the isolated bowel.
Mean operative time was 2,5 hours((1,5 -6hs ). There were no intra or post-operatory complications except for an accidental opening of the bladder that was sutured laparoscopically. All patients were able to tolerate food after 24 hours and 42 were discharged during the third postoperative day. Viability and patency of neovagina are excellent after a mean follow up of 42 months(4- 84 m ) and 22 patients are sexually active.
We conclude that laparoscopy makes the Pratt procedure more attractive while waiting for culture of vaginal epithellium to be available.
ureteral resection and re-anastomosis for infiltrating endometriosis
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