Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York (all authors).

ABSTRACT

Introduction: Abdominal mesenteric cystic lymphangiomas are congenital lymphatic malformations found most commonly within the small bowel mesentery, omentum, and mesocolon. These lesions may be detected incidentally on imaging studies or may present with bowel obstruction. Treatment of choice is surgical enucleation with possible segmental intestinal resection.

Case Description: This report describes the use of minilaparoscopy in the treatment of abdominal mesenteric cystic lymphangioma (MCL) in a child, along with a review of the current literature on laparoscopic treatment. Our patient, who had a prenatal diagnosis of an intra-abdominal mass, had developed postprandial emesis. Imaging work-up with ultrasonography and CT scan revealed an intra-abdominal mass suspicious for lipomatous tumor. The patient underwent minilaparoscopy-assisted resection of the intra-abdominal mass, along with the resection of small bowel that was adherent to the tumor. The final pathology showed that the mass was an MCL.

Discussion: The traditional treatment for MCL has been open surgical resection. Recently, laparoscopic surgical excision of mesenteric cysts in children has been reported in the literature.

Key Words: Abdominal mesenteric cystic lymphangioma, Minilaparoscopy

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Department of Surgery, Westchester Medical Center, Valhalla, NY, USA (Dr. Alemayehu). Department of Pediatric Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY (Drs. Pandya, McBride, Stringel).

ABSTRACT

Introduction: Thoracoscopic repair of congenital diaphragmatic hernia has increased with the use of prosthetic material. When the defect cannot be repaired primarily, a variety of materials have been used. The ideal prosthetic material has not been identified yet. The use of biologic tissue matrix prosthesis is appealing because this material may serve as a framework to support the patient’s own tissue regeneration. We report on 2 newborns with congenital diaphragmatic hernia repaired by thoracoscopy with placement of a Strattice patch (LifeCell, Branchburg, New Jersey). The hernia recurred in both cases.

Case Description: Two neonates born at term, weighing 3.5 kg and 4.0 kg, had left-sided congenital diaphragmatic hernias repaired by thoracoscopy with a Strattice patch. The repairs were performed at 1 and 4 days of age after a period of stabilization. There were no other congenital anomalies. There were no operative complications. The neonates recovered uneventfully and were discharged in good condition. Recurrence of the diaphragmatic hernia was identified by chest radiographs at routine follow-up visits 16 and 22 months postoperatively. One patient had mild abdominal pain and increasing shortness of breath, whereas the other patient was asymptomatic. One patient had an abdominal open primary repair of the recurrent diaphragmatic hernia, whereas the other patient had a laparoscopy-assisted repair with AlloDerm patch (LifeCell). They both recovered uneventfully.

Discussion: Postoperative follow-up at regular intervals is extremely important after repair of diaphragmatic hernia, especially when prosthetic material is used, because of the high incidence of recurrence. We do not recommend the repair of diaphragmatic hernia with the Strattice patch at this time.

Key Words: Congenital diaphragmatic hernia repair, Thoracoscopy, Strattice mesh

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