tailieunhanh - Pediatric Laparoscopy - part 4

Các đầu của khâu này là nắm bắt trong một hemostat để sử dụng sau này để bảo đảm nút. Một khâu thứ hai được đặt trong một thời trang tương tự bên các trang web được đề xuất. Một Nấu mạch gân làm trương một khí quản thiết lập (Cook Inc, Bloomington, IN) được giới thiệu bằng cách sử dụng kỹ thuật Seldinger | Mini-Laparoscopy 73 wall. The ends of this suture are grasped in a hemostat to use later to secure the button. A second suture is placed in a similar fashion just lateral to the proposed site. A Cook vascular dilator set Cook Inc Bloomington IN is introduced using the Seldinger technique to dilate the track and the selected button is passed over the guidewire using the 8 F vascular dilator as a stent guide. Once the balloon tip of the button is well into the stomach the balloon is filled with 5 cc of normal saline and the ends of the two sutures are tied over the ends of the button to hold it in place. Before withdrawing the umbilical cannula we test the button by filling the stomach with saline to make certain that there are no leaks. This is an extremely effective way to place a primary button in a precise location on the gastric wall using relatively atraumatic techniques. We leave the feeding tubing connected to the button for about 5-7 days before removing it and instructing the parents in its use. We cut the sutures at about 48 hours and discontinue antibiotics usually a cephalosporin at that time. Pyloromyotomy Laparoscopic pyloromyotomy is performed in many centers on a routine basis. We prefer to use the needle scope for this operation as it requires no sutures and is quicker to perform. Patients with idiopathic hypertrophic pyloric stenosis are prepared for surgery by rehydrating them and correcting their metabolic derangement. The umbilical trocar is placed as described above the abdomen is inspected and the diagnosis is confirmed. A second cannula is inserted in the left upper abdomen at about the anterior axillary line between the level of the umbilicus and rib margin. This is for the stomach grasper. A mirror image stab wound is made on the right side using a 11 scalpel blade. A disposable retractable arthroscopy blade Linvatec Corporation Largo FL and pyloric spreader Jarit Hawthorn NY are used through this stab wound. The gastric antrum is grasped .