Aldrink, MD Nationwide Children's Hospital, Ohio State University College of Medicine, Division of Pediatric Surgery, Department of Surgery, Columbus, OH, USA. Aprahamian, MD OSF Children's Hospital of Illinois, Division of Pediatric Surgery, Department of Surgery, Peoria, IL, USA.
Contributors
Lawrence Moss, MD Nemours Children’s Health System, Jacksonville, FL, USA
Shelby, MD Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Department of Pediatric Surgery, Columbus, OH, USA. Jason Zakko, MD Ohio State University Medical Center/Nationwide Children's Hospital, Department of Pediatric Surgery, Columbus, OH, USA.
Rigid and Flexible Esophagoscopy for Foreign Body Removal
The endoscope was then reinserted above the level of the previous foreign body and slowly withdrawn. The endoscope was then re-inserted above the level of the previous foreign body and slowly out-.
Flexible Esophagoscopy and Fluoroscopically Guided
At this point, a guidewire was inserted through the auxiliary port of the endoscope and across the stricture under direct fluoroscopy. A ___-mm balloon dilator was inserted through the endoscope's auxiliary port over the wire.
Repair of Esophageal Atresia with Tracheoesophageal Fistula
A ___-mm port was placed in the anterior axillary line at the level of the ___ intercostal space. The fistula was divided and the distal part of the esophagus was mobilized to minimize tension on the anastomosis.
Esophageal Replacement
If {colon interposition}: {Patient preoperatively received a mechanical/antibiotic preparation of the colon.} The gastrocolic ligament is incised, separating the transverse colon from the greater curvature of the stomach. Transillumination was used to identify the arteries.} The peritoneum was incised on either side of these vessels to isolate them.
Esophagomyotomy
Open and MIS Approaches)
Third and fourth sutures were used to secure the fundus to the opposite edge of the myotomy and the right crus. The right side was similarly attached to the edge of the myotomy and the right crus.
Esophagogastric Fundoplication (Open and MIS Approaches)
A liver retractor was placed to elevate the left liver lobe anterosuperiorly and expose the esophageal hiatus. The liver retractor was positioned to elevate the left lobe of the liver and expose the esophageal hiatus.
Hiatal and Paraesophageal Hernia (Open and MIS Approaches)
The cardia of the stomach is then transferred posteriorly to the esophagus and a "shoe shine". The left side of the fundus is then secured to the esophagus in an interrupted fashion with ___-0 vicryl/prolene/PDS/Ethibond.
Esophagogastroduodenoscopy and Percutaneous Endoscopic
The stomach was then aspirated to remove excess air and the endoscope was withdrawn to the level of the gastroesophageal junction. The endoscope was then slowly withdrawn along the entire course of the esophagus to ensure that there was no esophagitis and no signs of iatrogenic injury.
Gastrostomy Placement (Open and Laparoscopic Approach)
The abdomen was then insufflated and the laparoscope was inserted and the area of the stomach that would be used for the gastrostomy was visualized. A gastrostomy tube was inserted into the stomach and the pouch was tied.
Pyloromyotomy (Open
Local anesthetic was then instilled under direct visualization into the left upper quadrant above and just left of the patient's pylorus. This was done at the center of the dissection line and once inside the muscle it was slowly spread under direct visualization.
Exploratory Laparotomy for Complications of Peptic
If pyloroplasty: Then a longitudinal incision was placed along the anterior part of the pylorus with coagulant flow. The duodenum could be brought to the greater curvature of the stomach to perform a Billroth I reconstruction.
Placement of Gastric Electrical Stimulator
A site for subcutaneous placement of the stimulator generator was identified and marked in the left lower quadrant. A 5 mm umbilical incision was placed and advanced to the level of the fascia using blunt dissection.
Removal of Bezoars and Other Ingested Foreign Bodies
Open and MIS Approaches)
If open: Stay sutures can be applied to the stomach at the site of the gastrotomy. A 12 mm/15 mm sheath trocar/balloon trocar was then placed in the abdominal lumen between the stay sutures.
Sugiura Procedure (Esophagogastric
Before reanastomosis of the anterior mucosal layer, the nasogastric tube must be carefully advanced distal to the anastomosis. During the devascularization of the distal esophagus, the posterior vagus nerve was identified and divided.
Laparoscopic Sleeve Gastrectomy
Using a favorite power tool, spread it along the greater curvature of the stomach to its angle. The surgeon can direct it along the lesser curvature of the stomach under laparoscopic vision.
Laparoscopic Roux-En-Y Gastric Bypass
The mesentery was further mobilized with the power device and the end of the Roux limb was opened. Using the endostapler (blue/purple charge) the open end of the Roux limb was closed.
Jejunostomy Placement, Open and MIS Approaches
Secure the jejunum to the parietal peritoneum of the posterior abdominal wall at the site of tube insertion. After successive dilatation and access with the tear sheath,. the jejunostomy tube was introduced and passed distally.
Laparotomy for Midgut Volvulus
Lorraine I. Kelley-Quon
The mesentery at the base of the necrotic bowel was taken using serial suture ligation/electrocautery/. A total of ____ cm of small intestine was removed, leaving ___ residual intestine from the duodenum to the terminal ileum.
Ladd’s Procedure
For Hasson Cannula: Using electrocautery, dissection was performed down to the level of the fascia. After completion of the procedure, a debriefing checklist was completed to share information critical to the patient's postoperative care.
Repair of Duodenal Atresia (Open and MIS Approaches)
This confirmed the correct patient, procedure, surgical site and additional critical information prior to the start of the procedure. The position of the ligament of Treitz was evaluated to determine for the presence of malrotation.
Open Repair of Jejunoileal Atresia
The peritoneal defect was then extended by the length of the incision and the small intestine was delivered to the operative field. If there is one atresia: The atretic segment was clearly identified at ___ cm from the ligament of Treitz, and the rest of the examination and small bowel were found to be competent.
Resection of Meckel’s Diverticulum
A stapler was then applied diagonally to the base of the diverticulum and the diverticulum was cut. The staple line was checked for hemostasis and patency of the ileal lumen was confirmed.
Resection of Omphalomesenteric Duct Remnant
The umbilicus was inspected and a small probe was placed in the opening of the patent duct. Dissection was carried down through the subcutaneous tissue along the edge of the canal to the level of the fascia.
Reduction of Intussusception
After completion of the procedure, a debriefing checklist was completed to share information critical to the patient's postoperative care. Upon completion of the procedure, a debriefing checklist was completed to share important information.
Resection of Enteric Duplication or Mesenteric Cyst
At the distal aspect of the intestine, a mesenteric defect was created and the intestine divided. If enteric duplication cyst or mesenteric cyst requires intestinal resection: After complete definition of the extent of the cyst, the amount of overlying/.
Serial Transverse Enteroplasty (STEP)
Once completed, the bowel can be fully straightened and no strictures are present along the length of the small bowel or its mesenchyme. The midline of the antimesenteric border was marked along the length of the dilated small bowel segment(s).
Stricturoplasty and Small-Bowel Stricture Bypass (Open and MIS
The location of the stricture was identified, and further strictures in the bowel ruled out. a) The umbilical incision was then extended and a wound retractor was placed in the minilaparotomy. The small intestine with the narrowed segment was then removed in front of the abdominal wall. a) The umbilical incision was then extended and a wound retractor placed in the minilaparotomy.
Ileostomy Creation (Open and MIS Approaches)
The small intestine is then secured to the fascia with four quadrant 3-0 Vicryl sutures using seromuscular bites. These were tied and then interrupted; full thickness gut bites to the corresponding deep dermis were performed with 3-0 Vicryl until there were no significant gaps.
Appendectomy
The base of the appendix was crushed in a clamp and the clamp was then advanced 1 cm distally. The base of the appendix was then double ligated with pre-tied endoscopic ligatures and cut distally.
Cecal Volvulus
A ring stitch was placed on the cecum around the future site of the cecostomy tube. The seromuscular layer of the cecum was then sutured to the abdominal wall at the exit site of the cecostomy tube/button.
Percutaneous Peritoneal Drain Placement for Necrotizing
The drain and hemostats were advanced towards the anterior abdominal wall with special care to avoid contact with the liver. Once the drain was advanced, the hemostats were withdrawn and the drain was sutured to the skin edge with ___ suture.
Laparotomy for Necrotizing Enterocolitis
The patient then returns to the operating room after 48-72 hours of resuscitation, and the remaining segments are primarily re-anastmosed or proximal stomas are created. At this point, the proximal segment was elevated through the right lateral aspect of the abdominal incision.
Malone Continent Appendicostomy
We then performed a Y-to-V anastomosis from the appendix to the umbilical skin and then closed the umbilical dermis to itself, concealing the appendiceal mucosa. The patient tolerated the procedure well, was extubated in the operating room, and then transported to the post-anesthesia unit in stable condition.
Total Abdominal Colectomy with End-Ileostomy
A 4 cm transverse incision was placed at the planned ileostomy site and brought down to the level of the fascia using electrocautery. This mobilized the descending colon along the white line of Toldt at the level of the splenic flexure.
Completion Proctectomy and Ileal Pouch-Anal Anastomosis,
Diverting Loop Ileostomy
The blue load of the GIA stapler was then used to remove the distal ileum (former ileostomy site) flush with the edge of the bag to minimize the blind tip length. Attention was then returned to the abdomen and correct orientation of the terminal ileum and pouch was reconfirmed.
Swenson-Like Transanal Pull-Through
Using electrocautery, perform full-thickness rectal dissection along the retraction line to the level of the peritoneum. At this level, we placed a deep layer of sutures circumferentially at the level of the resection margin, from muscle to colonic serosa, which was again 1.0 cm proximal to the dentate line.
Duhamel Procedure
The end of the proximal rectum was then grasped and pulled through this incision until the entire colon was externalized, up to the transition zone. The posterior wall of the colon was divided and similarly attached to the lower part of the rectal wall.
Soave-Like Transanal Endorectal Pull-Through
The previous contrast enema is compatible with a transition zone at the level of the rectosigmoid. At this level, we placed a deep layer of sutures peripherally at the level of the resection margin, from muscle to colonic serosa, which was again 1.0 cm proximal to the dentate line.
Laparoscopic Colonic Mapping
The patient was placed in the supine position and prepped and draped in standard surgical fashion. If you notice a transition zone: the colon was examined and at sig-.
Laparoscopic Leveling Colostomy for Colonic Aganglionosis
If loop colostomy: The bowel at this biopsy site is brought up at the medial/lateral end of the incision/through a separate ___ cm incision placed in the right/left upper/lower quadrant and secured to the fascia using interrupt ___-0. As loop colostomy: The bowel at this biopsy site is secured to the fascia using interrupted ___-0 ___sutures.
Posterior Sagittal Anorectoplasty
Male
Tension was then placed on the rectum and Vicryl sutures were used to suture the rectum to the posterior border of the muscle complex all the way to the rectum. Tension was then applied to the rectum and Vicryl sutures were used to suture the rectum to the posterior border of the muscle complex through the small perineal incision.
Female
If rectovesibular defect: Inspection of the perineum revealed that the distal rectum was in the vestibule. After completion of the cystoscopy, the patient was placed in the supine position to begin the repair.
Cloacal Reconstruction with Total Urogenital Mobilization
This incision is opened to the level of the perineum, including the entire common canal. The completed closure of the posterior sagittal incision was performed in layers down to the skin.
Anal Stricturoplasty
These confirmed the correct patient, procedure, surgical site and additional critical information before starting the procedure. After completion of the procedure, a debriefing checklist was completed to share information critical to the patient's postoperative care.
Vaginoplasty and Vaginal Replacement
The proximal end of the neovagina was then closed in two layers, with interrupted 4/0 absorbable suture. We approximated the vaginal replacement to the distal part of the superior vaginal pouch to perform the proximal anastomosis.
Augmentation Enterocystoplasty
The bowel segment was anastomosed to the bladder with running but intermittently locked 2-0 Vicryl sutures in a full-thickness layer from the posterior wall of the bladder and working laterally. The anterior wall of the bowel-to-bladder anastomosis was then completed with full-thickness 2-0 Vicryl.
Urinary Conduit
The ileum was then reanastomized in the standard side-to-side fashion using a stapler technique. The distal end of the bowel was then brought through the fascia and the stoma was created and sutured in the standard manner.
Appendicovesicostomy/
Mitrofanoff
A 3-0 Vicryl suture was placed at the top of the gutter through the detrusor and mucosa and brought to the appendix. Once tied, the appendix was attached to the bottom of the trough.
Circumcision
Once the penis is fully extended, mark the distal (inner) incision line under the glans, leaving a 1-2 cm collar. Instead of removing the penis after the initial incision, both circumferential incisions (internal and external) can be made, followed by careful dissection of the foreskin from the underlying tissue and shaft to allow removal.