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IPEG 2011 The 20 th Annual Congress for Endosurgery in ChildrenMay 3–7, 2011, Prague, Czech Republic

2011; Mary Ann Liebert, Inc.; Volume: 21; Issue: 4 Linguagem: Inglês

10.1089/lap.2011.9999

1557-9034

Congenital Diaphragmatic Hernia Studies

Journal of Laparoendoscopic & Advanced Surgical TechniquesVol. 21, No. 4 Free AccessIPEG 2011The 20th Annual Congress for Endosurgery in ChildrenMay 3–7, 2011, Prague, Czech RepublicPublished Online:12 May 2011https://doi.org/10.1089/lap.2011.9999AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Oral AbstractsBasic ScienceZhu Jie , Sun Qinglin Department of Pediatric Surgery, Children's Hospital Affiliated to Soochow University(S001) The Protective Effects of Ischemic Preconditioning and Postconditioning on Liver Ischemia/Reperfusion Injury in a Rat Model of CO2 PneumoperitoneumObjective: To investigate the protective effects of ischemic preconditioning and postconditioning on liver ischemia/reperfusion injury in a rat model of CO2 pneumoperitoneum (P).Methods: 24 male SD rats were randomly divided into 4 groups, pneumoperitoneum (P group), ischemic preconditioning (IP group), ischemic postconditioning (IPo group), and control (C group). C group was subjected to sham operation. Other groups were subjected to the CO2 pneumoperitoneum, 15 mmHg intra-abdominal pressure (IAP). P group was subjected to 60 min of P, followed by 30 min of deflation (D). IP group was subjected to preconditioning prior to P/D, which consisted of 10 min of P, followed by 10 min of D. IPo group was subjected to 60 min of P, followed by three cycles of 1 min of D and 1 min of P and 30 min of D. Plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as well as homogenized tissue malondialdehyde (MDA) and nitric oxide (NO) levels, glutathione (GSH), and superoxide dismutase (SOD) activities were measured, respectively. The hepatic pathological changes were also observed by light microscopy. The expression of iNOS in liver tissue was examined by immunohistochemical technique in each group.Results: Plasma ALT and AST as well as liver MDA levels were significantly increased, whereas liver SOD values were decreased in groups P, IP, and IPo, as compared to group C (P < 0.05). Plasma ALT, AST, as well as liver MDA and NO levels were significantly decreased, whereas liver SOD and GSH values were increased in groups IP and IPo, as compared to group P (P < 0.05). The biochemical markers except GSH were no significant difference between group IP and IPo. The iNOS concentration markedly decreased in group IP and IPo in comparison with group P.Conclusions: ischemic preconditioning and ischemic postconditioning both can increase SOD and GSH levels and inhibit the expression of iNOS that can induce the production of NO, which may decrease hepatic I/R injury induced by CO2 pneumoperitoneum. Compared with IP, IPo increased GSH more prominently. It is suggested that IPo may play a greater role as protective effect on oxidative stress.Andreas Oberbach , MD, PhD, MPH, Martin von Bergen , PhD, Holger Till , MD, PhDUniversity of Leipzig(S002) The Impact of Integrated Serum Proteomic and Metabolomic Profiling following Sleeve Gastrectomy in Children and AdolescentsAim: Morbid obesity in children and adolescents is increasing dramatically world wide. Bariatric surgery is presently the most effective treatment to provide with long-term weight loss and increased survival in severely obese. However, the consequences of such surgical interventions on central metabolic pathways, adipokines, and myokines are poorly understood yet. The aim of our study is to unravel the complex network of metabolic changes in obese children undergoing bariatric surgery after 6 month treatment. Our proposal is based on a prospective study of 6 children's with morbid obesity.Methods: Applying innovative technology of clinical chemistry for metabolome endocrinological analysis, we aim to identify key biomarkers of the underlying pathways and compare the impact of each treatment modality. Here we used a combined proteomic and metabolomic approach to identify previously unrecognized circulating molecules that discriminate the changes of pathways, following sleeve gastrectomy. In our study, 6 males at the age of 9 to15 were involved. We compared serum at basline level with 6 months postsurgery.Results: We applied a global serum proteomics approach (DIGE) that yielded 135 differentially abundant spots representing 39 different unique proteins. Differential abundance of regulated proteins was confirmed positively by Elisa for antithrombin-III, clusterin, complement C3, pigment epithelium derived factor, retinol binding protein, and vitamin-D binding protein. Targeted serum metabolomics of 163 different metabolites resulted in 4 metabolites that were significantly different in respect to 6 months after sleeve gastrectomy. Among those, glycine, glutamine, and glycero-phospatidylcholine 42:0 (PCaa 42:0) serum concentrations were lower, whereas PCaa 32:1 and PCaa 40:5 were increased after 6 months compared to baseline.Conclusion: In this study, an integrated serum proteomic and metabolomic profiling enabled detection of parameters that are related to weight loss after bariatric surgery. In the future, this transomics approach enabled detection of parameters and pathways to understood the physiology regulation of weight loss.Jian Wang Affiliated Children's Hospital of Soochow University(S003) Changes in CR3 and FC?R III/II Expression on Peritoneal Macrophage after Laparoscopic and Open Abdominal Surgery in a Mouse ModelBackground: The stress response after abdominal operations has been associated with impaired phagocytosis by peritoneal macrophages. Compared with the traditional open abdominal surgery, laparoscopic surgery can result in better preservation of the patient's immunological defenses. This study examined the influence of minimally invasive techniques and open abdominal surgery on postoperative expression of CR3 and FcγR III/II on peritoneal macrophage.Methods: 8- to 10-week-old BALB/c mice were randomly divided into 3 groups: control animals (C), open surgery (OS), and laparoscopic surgery (LS). Peritoneal macrophages were harvested via intraperitoneal lavage. The following fluorescence-conjugated antibodies were used: PE CR3 (BioLegend), FITC F4/80, PE FcγR III/II, and the relevant isotype controls. The cells were incubated with the antibodies for 30 min at 4°C and washed with PBS. The cells were then analyzed on a FACSort flow cytometer (Beckam-Coulter). Statistical analysis was performed using SAS 8.0 and t test between groups. A P-value of 0.05 was considered significant.Results: Significant differences were observed between groups. Studying on the MFI of CR3 on peritoneal macrophages, the LS group had a value of 437.40 ± 85.52, which was the same as the C group's 503.17 ± 33.38 (P > 0.05), but was obviously different from the OS group's 292.25 ± 43.88(P < 0.05). However, to the MFI of FcγR III/II on peritoneal macrophages, there is no difference among the C group (43.07 ± 12.01), the LS group (40.72 ± 6.79), and the OS group (51.85 ± 3.75)(P > 0.05).Conclusion: Open abdominal surgery resulted in greater impaired expression of receptors on peritoneal macrophages than laparoscopic surgery.Jeffrey A Blatnik , MD, Karem C Harth , MD, MHS, David M Krpata , MD, Katherine B Kelly , MD, Steve J Schmosich , PhD, Todd A Ponsky , MDUniversity Hospitals Case Medical Center(S008) Stitch Versus Scar: Evaluation of Laparoscopic Pediatric Inguinal Hernia Repair in a Rabbit ModelIntroduction: Laparoscopic repair of pediatric inguinal hernias has been described in great detail in the literature, and numerous techniques have been described. The majority of minimally invasive options rely on the placement of a simple ligating suture. However, when compared with the gold standard open repair, some studies have shown an increased hernia recurrence rate. The purpose of the current study was to evaluate the effectiveness of the ligating stitch in successful hernia repair.Methods: The male New Zealand white rabbit has a congenital inguinal hernia similar to a patent processus vaginalis seen in infants. Twenty two rabbits weighing 2.7–3.0 kg underwent laparoscopic repair of their inguinal hernia defect. Prior to hernia repair the gubernaculum was ligated with electrocautery to internalize the testicles. The defect was closed utilizing the Subcutaneous Endoscopically Assisted Ligation (SEAL) technique, which involves placing a single ligating suture (2-0 polypropylene suture) around the hernia defect under laparoscopic guidance. Group 1 (6 rabbits) was used to determine the time to healing with simple suture placement. These animals underwent suture repair on both sides and had survival periods of 1, 2, 4, 6, 8, and 12 weeks. Group 2 (16 rabbits) was done to evaluate the role of peritoneal trauma on repair. These animals underwent suture repair on the left, whereas on the right underwent trauma to the peritoneum with laparoscopic scissors prior to suture closure. Group 2 was allowed to survive for 2 or 4 weeks. At the time of necropsy the defects would initially be explored laparoscopically at 4 mmHg pressure. The pneumoperitoneum was released and the suture used for repair was cut and removed. The abdomen was then reinsufflated to 4 mmHg, and under direct visualization, the pressure was increased to 36 mmhg looking for opening of the defect.Results: Group 1—At all evaluated time points, defects were closed upon initial examination; however, after stitch removal all defects opened at an average pressure of 5 mmHg. As the pneumoperitoneum was increased the defects enlarged nearly returning to original size. Group 2—At 2 week evaluation, only 25% (2/8) of defects repaired with suture alone remained closed after stitch removal, whereas 87.5% (7/8) of defects which had peritoneal trauma remained closed when insufflated to maximum pressure. At 4 weeks the numbers remained similar with 17% (1/6) of defects repaired with suture alone remaining closed and 100% (8/8) of defects repaired with peritoneal trauma remaining closed.Discussion: Using a rabbit model we have shown that a simple ligating suture alone may not be sufficient for closure of a patent processus vaginalis out to 12 weeks after repair. The addition of sharp trauma to the peritoneum in combination with suture placement may allow for a more permanent repair of the defect.Markus Duersch (1), MD, P. Romero (2), MD, B. Reingruber (1), MD PhD(1)University Department of Paediatric Surgery, Regensburg, Germany(2)University Department of Paediatric Surgery, Heidelberg, Germany(S009) Tackling the Learning Curve: Score Card Training for MIS BeginnersAims: Off-patient laparoscopic training is essential in the expanding variety of instruments, procedures, and techniques available to an increasing number of minimally invasive pediatric surgeons and theater staff alike. We presented our Endo-Paed-Trainer at the IPEG-meeting in Phoenix Arizona 2009. In the last few years we designed a programmed systematic training for students and residents to assess their basic skills and monitor their further development in tasks like camera handling or bimanual interaction with a variety of instruments. In addition, sequential short sessions were compared with one long session in our aim to analyze the most effective way of training.Methods: 34 students and residents with no prior experience in MIS were instructed to perform clearly defined exercises. Every trainee repeated the same exercise 3 to 5 times per session. The first exercise was to use the 30° scope and visualize several defined points of orientation in the abdomen from two sides. In the second exercise the trainees practized the bimanual use of instruments, in this case the dissector and the scissors, to excise and remove objects from the abdomen.Results: The sequential training group consisted of 11 students and residents, who underwent the 5 day workshop in groups of 3 or 4 trainees doing each exercise three times a day. The long session group included 23 trainees, who took part in a 5 hour workshop in groups of 4–5 and performed both exercises 5 times. The sequential training group completed the first exercise in an average time of 155 seconds the first round and 36 seconds on day five. The long session group had an initial average time of 153 seconds, which was reduced to 55 seconds in the last round. The second exercise was completed by the sequential training group in 350 seconds in the first attempt and could be finally reduced to 124 seconds. The long session group needed 342 seconds the first and 181 seconds in the 5th attempt. The intragroup improvements were 73 and accordingly 65 per cent in the sequential, 64 and accordingly 47 percent in the long session groups. In summary, the sequential training group achieved better improvements in both exercises.Discussion: The programmed systematic score card training had a very high acceptance by all trainees. It is possible to measure the individual progress in a realistic setting and to compare the own results with the rest of the group, which seemed to be a very strong motivator. We could prove that the sequential training is superior to a single long-term session, altough it may be more difficult to implement it as the regular training. All trainees improved significantly throughout the training. The score card training is also suitable for the testing and implementation of new instruments and methods by advanced MI surgeons.Andrey Volobuev , PhD, Andrey Rybov , PhD, Polad Kerimov , PhD, Anatoliy Kazantchev , Diana Rybakova , PhD, Mihail Rybansky , PhDScientific Research Institute of Children's Oncology and Hematology of N.N. Blokhin RAMS(S062) Endoscopic Surgery in Children's OncologyAims: To define performance possibility endoscopic surgery in children's oncology.Materials and Methods: In Scientific Research Institute of in children's oncology and hematology of N.N. Blohin RAMS endoscopic operations in patients with tumors are regularly performed since 2007. At the present moment the score of performed operations is 249 of which 112 were laparosopic and 106 were thoracoscopic. Operation specter includes biopsies of large formations (92), lung resections (59), nephrectomies (23), adrenectomies (18), kidney resections (1), gastric resections (1), hepatic resections (5), hemihepatectomies (8), retroperitoneal tumorectomies (11), mediastinal tumors (24), operations performed on the organs of minor pelvis (5), appendectomies (1), and splenectomies (1). Operated children aged form 2 months to 18 years (average 8.3 years). Diagnostic operation's average time was 28 minutes. Therapeutic operations took from 30 minutes (in cases of standard adrenectomies) to 280 minutes (hemihepatectomies). Maximal blood loss was 400 ml in cases of hemihepatectomies. Performing endoscopic surgical interventions in children has its specific features: small abdominal cavity volume, lesser sizes of all anatomical structures, and specific features of performing prolonged pneumoperitoneum; it is also impossible to separately intubate selected bronchi when performing thoracoscopic operations in children under 6 years old.Summary: Advantages of using laparoscopy in children with tumors are earlier possibility of starting specific postoperative treatment, less traumatic operation, minimal blood loss, decreased rate of postoperative complications, earlier recovery of physical activity in operated children, decreased time of staying in the hospital, and better cosmetic effect after surgical intervention.Conclusion: Performing endoscopic operations in children with malignant tumors is possible from the age of several weeks without breaking the principles of oncological surgery; in such operations the age of the child is not a limiting factor for performing surgical interventions.ColorectalShao-tao Tang , MD, Ying Yang , MD, Guo-bin Wang , MDDepartment of Pediatric Surgery, Union Hospital of Huazhong University of Science and Technology, Wuhan 430022, China(S067) Laparoscopic-Assisted Endorectal Soave Pull-Through Procedure for Hirschsprung's Disease: A 10-Year Experience from a Single Institution in ChinaPurpose: Laparoscopic-assisted endorectal pull-through (LAEPT) was safe and it had a good clinical outcome. The aims of the present study were to describe some technical refinements and evaluate complications and functional results.Methods: The clinical courses of 218 patients who underwent LAEPT for HSCR were reviewed. LAEPT was described by Georgeson. The main modifications were minimal dissection of pelvic floor, the hepatic or splenic flexure divided before rectosigmoid dissection in patients with long forms, indirect electrocautery during the submucosal dissection, and a “V” incision in posterior muscular sheath. Patient data were collected according to the period of operation-group I, routine LAEPT was used in 80 patients (1999–2002); group II, selective LAEPT was used in 138 patients (2003–2009). The patients were evaluated for age, problems encountered during surgery, complications, and functional outcomes after the operation. Mean follow-up was 68 months.Results: Patients aged 15 days to 12 years, mean operating times were 127 ± 20 minutes in short forms and 226 ± 35 minutes in long forms. Intraoperative complications were 7.3%. The overall surgical technique related complication rate fell from 12.5% in the group I to 4.3% in the group II (P = 0.026). Early postoperative complications included intestine herniated from trocar site (1.4%), perianal excoriation (9.6%), enterocolitis (2.8%), stricture (4.1%), and anastomotic leak (1.8%). Late postoperative complications included perianal excoriation (5.5%), postoperative adhesive bowel obstruction (1.8%), anal stenosis (2.8%), recurrent constipation (1.4%), and enterocolitis (3.7%). 86% had excellent and good bowel function. Continence showed an increasing trend during growth (P = 0.044) and soiling showed a decreasing trend in patients with HSCR (P = 0.035).Conclusions: LAEPT is progressively demonstrating its durability in application, with minimal morbidity and satisfactory functional results. A laparoscopic assist before the transanal dissection adds versatility to the pull-through procedure makes the operation simple, and complications such as recurrent constipation less.Soo-Min Jung , MD, Hyun-Baek Shin , MD, Suk-Bae Moon , MD, Suk-Koo Lee , PhD, Jeong-Meen Seo , PhDDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University(S068) Perioperative Outcomes of Laparoscopically Assisted Anorectal Pull through: Rectal Mucosa Prolapse—Is it a Rare Complication?Background: Laparoscopically assisted anorectal pull through (LAARP) is a recently developed technique for treating high and intermediate anorectal malformations (ARM). This procedure is becoming an established operation for high type anorectal malformations. Since 2000, several articles on LAARP have been published, yet there has not been not much discussion about the complications and perioperative outcomes. The aim of this study is to report on the perioperative outcomes and to discuss the most common complication (rectal mucosa prolapse) after performing LAARP at our center.Methods: Between 2003 and 2010, we performed 25 LAARPs in patients with intermediate-high type anorectal malformations. We retrospectively analyzed the perioperative outcomes; the patients' ages, the types of anorectal malformation, the associated anomalies, the follow-up duration, the hospital days, the operation times, the postoperative complications, the readmissions, and the reoperations of the patients.Results: All 25 patients were male. The median age was 2.78 months (range: 0.5–6.2 months). The most common type of anorectal malformation was rectoprostatic urethral fistula (n = 17), followed by rectovesical fistula (n = 3), rectobulbar fistula (n = 3), and recto-bladder neck fistula (n = 2). There were various associated anomalies like gastoschisis (n = 1), duodenal atresia (n = 1), and tracheoesophageal fistula (n = 1); however, spine anomaly (n = 10) were majority. The median length of hospitalization was 8 days (range: 6–42 days), the median operation time was 4 hrs (range: 2.29∼8.20 hrs), and immediate postoperative complications occurred in only 3 patients: urinary tract infection, atelectasis, and ileus, respectively. They recovered after conservative treatment. The median follow-up duration was 27.47 months (range: 2.53–75.70 months). The most common cause of re-admission was prolapsed rectal mucosa (n = 15, 60%); among them, 13 patients received excision of the prolapsed rectal mucosa after 13 months later from LAARP on average, and the next common readmission cause was constipation (n = 7, 28%). All re-admission patients were discharged uneventfully. A urethral diverticulum occurred in one rectobulbar urethral fistula patient.Conclusion: LAARP was a technically safe procedure for the high-intermediate type ARM. However, rectal mucosa prolapse occurred in more than 50% of the patients after LAARP. Most of them received excision of the prolapsed rectal mucosa. Therefore, further evaluation and effort to find the method that decrease the incidence of rectal mucosa prolapse is needed.Takeo Yonekura , MD PhD, Takuya Kosumi , MD PhD, Katuji Yamauchi , MD PhD, Takuya Kimura , MD PhD, Toshio Sawai , MD PhDDepartment of Pediatric Surgery, Nara Hospital, Kinki University School of Medicine(S069) Long-Term Outcomes after Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung Disease in InfantsPurpose: The laparoscopic-assisted one-stage endorectal pull-through procedure has become the standard treatment for Hirschsprung disease. We evaluated complications, the occurrence of enterocolitis after the operation, and long-term outcomes of fecal continence after a one-staged laparoscopic-assisted endorectal pull-through procedure for Hirschsprung disease in infants.Materials and Methods: Sixteen infants (10 males, 6 females) found to have Hirschsprung disease, with 3 of them associated with Down syndrome, underwent one-staged laparoscopic-assisted pull-through using transanal endorectal coloanal anastomosis. The procedure was carried out using three 5-mm ports in 15 cases, and four 5-mm ports in a neonate with total colonic aganglionosis. The transition zone was identified by seromuscular biopsies laparoscopically or full-thickness biopsies transanally. The affected colon was laparoscopically mobilized distally beyond the peritoneal reflection, facilitating subsequent perineal dissection, pull-through, and coloanal anastomosis. Transanal endorectal mucosal dissection and a coloanal anastomosis were conducted. The diagnosis of enterocolitis after the operation was based on the clinical presentation of diarrhea, abdominal distension, and fever. All patients were followed up for 3 to 9 years (median: 7 years) after the operation. Evaluations of early and late complications, occurrence of enterocolitis, and long-term outcomes of fecal continence were examining by patients' records.Results: Eight neonates aged 16 to 30 days and 8 infants aged 1 to 4 months underwent this procedure laparoscopically. The transition zone was identified by seromuscular biopsies laparoscopically in 13 patients, and by full-thickness biopsies using a prolapsed procedure in 3 patients. Ten cases had rectosigmoid aganglionosis, 5 cases long-segment aganglionosis, and 1 case total colonic aganglionosis. Entire colon was excised through the umbilical site in a neonate with total colonic aganglionosis. Other patients had transanal resection of the aganglionic segment. Endorectal mucosal dissection was performed using a prolapsed procedure in 13 patients, and transanally in 3. Early complications occurred in 10 infants. Seven infants showed perineal excoriations in an early postoperative period. A 3-month-old infant associated with Down syndrome underwent a re-pull-through procedure due to ischemia of the pull-through intestine 2 days after the operation. Seven infants had mild anastomotic stenosis and required dilatation with Hegar dilators. An infant with Down syndrome who underwent redo surgery required long-term anal dilatation. Postoperative enterocolitis occurred once within 3 months after the operation in 2 infants with rectosigmoid aganglionosis and an infant with long-segment aganglionosis. An infant with total colonic aganglionosis had 5 episodes of enterocolitis in a period of 5 years after the operation. Enterocolitis of these infants resolved with conservative management. An infant with total colonic aganglionosis and 2 with Down syndrome suffered from intermittent fecal incontinence. The rest of the infants showed satisfactory continence and normal bowel movement. None of the children showed signs of neurogenic bladder dysfunction.Conclusions: One-stage laparoscopic-assisted transanal endorectal pull-through permits the early diagnosis of the transition zone as well as an adequate mobilization of the bowel for long- type aganglionosis. Enterocolitis occurs at the high rate of 18%; long-term bowel movement and continence, however, are satisfactory in most children after the one-stage laparoscopic-assisted pull-through procedure for Hirschsprung disease.Stefano Giuliani , MD PhD, Pietro Betalli , MD, Alessandra Narciso , MD, Paola Midrio , MD, PG Gamba , MDDivision of Pediatric Surgery, Department of Pediatrics-Salus Pueri, University of Padova, Italy(S070) Outcome Comparison among Laparoscopic, Laparotomic-Duhamel, and Transanal Endorectal Pull-Through: A Single-Center 18-Year ExperiencePurpose: Transanal endorectal pull-through has drastically changed the treatment of Hirschsprung's disease (HD) in the past decade. The aim of the study is to compare outcomes, in a single center, obtained with laparotomic Duhamel (LTD), laparoscopic Duhamel (LSD), and laparoscopic assisted transanal endorectal pull-through (LTEPT).Materials and Methods: We have retrospectively reviewed the charts of all the patients operated on for HD since 1992. Preoperative, operative, and postoperative data were collected to compare short- and long-term outcomes among the three groups of patients operated with different techniques.Results: From 1992 to 2010, 70 children were treated for HD. Our patients were divided into three groups based on the surgical technique used for the repair: 14 LTEPT, 32 LSD, and 24 LTD. Mean ages at diagnosis were (in months) 4.67, 14.61, and 13.28, respectively. Patients of the LTEPT group had significant shorter operating times (195 vs. 257 vs. 291 minutes, p = 0.03), earlier start of oral feeding (1.2 vs. 3.1 vs. 4.7 days, p < 0.01), and shorter length of hospital stay (4.4 vs. 6.8 vs. 9.7 days, p < 0.011). Complications rate was lower in the LTEPT group (14%) compared with the LSD and LTD (18.7% and 20%). Postoperative enterocolitis episodes, ranging between 6% and 10%, were not different among groups. The mean follow-up period for the LTEPT group was 26 months with no constipation and good continence results for age.Conclusions: This study further supports the technical advantages, the lighter impact of the surgical procedure on the infants, the decreased incidence of complications, and the better long-term outcome of the transanal pull-through compared to the Duhamel approach.Brian W Gray , MD, Ronald Hirschl , MD, James Geiger , MDUniversity of Michigan, Ann Arbor, MI, USA(S071) Laparoscopic-Assisted Restorative Proctocolectomy in Children with Ulcerative Colitis: Is Diverting Ileostomy Necessary?Purpose: Laparoscopic-assisted restorative proctocolectomy (LAP) with J-pouch ileoanal anastomosis (IPAA) is routinely performed for children with ulcerative colitis (UC). Controversy exists whether this can be done without diverting ileostomy due to risk of early pouch leak and sepsis. Our goal was to compare complications and functional outcomes of children who underwent LAP with IPAA with and without diversion.Methods: We performed a single-institution retrospective review of UC patients who had LAP with IPAA without diverting ileostomy (−Os) from 2002–2010 compared with a historically matched group of consecutive patients undergoing LAP and IPAA with diversion (+Os) and subsequent takedown. Decision for or against ileostomy was based on surgeon and patient preference. 38 patients were studied (19 +Os, 19 −Os). Demographics, early complications, and functional outcomes were examined. Comparisons were made using the t-test for equality of means.Results: Preoperative demographics were similar in mean age (14.31yrs −Os vs. 14.21 yrs +Os), serum albumin (3.64 −Os, 3.62 +Os), BMI (20.57 −Os, 21.17 +Os), and immunosuppression use (74% in both groups). Mean total hospital length of stay was significantly less in −Os (12.36 days vs. 17.68, p < 0.05), and the −Os group has less total OR time on average (6:15 vs. 9:56). Each group had one episode of pouch leak, with 5 patients experiencing complications in −Os and 7 in +Os. The −Os group required less pouch dilations in the OR (0.47 vs. 1.79, p < 0.05). Functional outcomes were not significantly different regarding pouchitis occurrences per patient (0.53 −Os, 0.53 +Os), bowel movements per day (5.39 −Os, 7.17 +Os, p = 0.13), and postoperative loperamide dose (9.07 mg qday −Os, 6.29 mg qday +Os, p = 0.09).Conclusion: LAP with IPAA without diverting ileostomy is a viable treatment option for children with medically refractory UC. Although questions remain about optimal patient selection, quality of life impact, and cost benefits, short- and long-term outcomes can be equivalent to those patients with diverting ileostomy.Igor V Poddoubnyi , MD, Mikhail Y Kozlov , Elmira I Alieva , MD, Kirill N Tolstov , MDMoscow State University of Medicine and Dentistry, Department of Pediatric Surgery; Izmailovo Children's Hospital(S072) Laparoscopic Bowel Resection in Pediatric ColoproctologyPurpose: To analyze our 7-year experience in pe