Bruzoni Matias, Steinberg Gary K, Dutta Sanjeev
Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
J Pediatr Surg. 2016 Apr;51(4):592-7. doi: 10.1016/j.jpedsurg.2015.10.048. Epub 2015 Oct 19.
An abundance of angiogenic and immunologic factors makes the omentum an ideal tissue for reconstruction and revascularization of a variety of extraperitoneal wounds and defects. Omental harvesting was historically performed through a large laparotomy and subcutaneous tunneling to the site of disease. Several complications of the open procedure including abdominal wound infection, fascial dehiscence, ventral hernia, and postoperative ileus have been described. The use of laparoscopy to harvest the omentum has the potential to reduce such complications. We describe the surgical technique and outcomes of a series of patients undergoing laparoscopic pedicled omental flap mobilization for cerebral revascularization in moyamoya disease.
A retrospective chart review of all patients undergoing laparoscopic omental cerebral transposition for moyamoya disease between 2011 and 2014 was performed. Clinical indication, surgical technique, operative times, complications, and outcomes at follow-up were reviewed.
A total of 7 children underwent the procedure. The general surgery team performed laparoscopic omental mobilization, extraperitonealization, and subcutaneous tunneling, while the neurosurgical team performed craniotomy and cerebral application of the graft. The patients were followed postoperatively with clinic visits and angiography. There was one intraoperative complication (colon injury) and one postoperative complication (intermittent omental hernia at fascial defect for pedicle). All patients had partial to complete symptomatic resolution and demonstrated adequate intracranial revascularization on angiography.
Laparoscopic omental pedicle flap mobilization and subcutaneous transposition is feasible in children who require salvage cerebral revascularization for moyamoya disease. The procedure should be considered for other conditions requiring extraperitoneal revascularization.
丰富的血管生成和免疫因子使大网膜成为修复各种腹膜外伤口和缺损并实现血管再通的理想组织。历史上，大网膜获取是通过大型剖腹手术并经皮下隧道至病灶部位来进行的。开放手术的几种并发症，包括腹部伤口感染、筋膜裂开、腹侧疝和术后肠梗阻都有过描述。使用腹腔镜获取大网膜有可能减少此类并发症。我们描述了一系列因烟雾病行腹腔镜带蒂大网膜瓣转移以实现脑血运重建的患者的手术技术及结果。
对2011年至2014年间所有因烟雾病接受腹腔镜大网膜脑移位术的患者进行回顾性病历审查。审查临床指征、手术技术、手术时间、并发症及随访结果。
共有7名儿童接受了该手术。普通外科团队进行腹腔镜大网膜游离、腹膜外移位及皮下隧道操作，而神经外科团队进行开颅手术并将移植物应用于脑部。术后对患者进行门诊随访及血管造影检查。有1例术中并发症（结肠损伤）和1例术后并发症（带蒂筋膜缺损处间歇性大网膜疝）。所有患者症状部分或完全缓解，血管造影显示颅内血运重建充分。
对于因烟雾病需要挽救性脑血运重建的儿童，腹腔镜带蒂大网膜瓣游离及皮下移位是可行的。对于其他需要腹膜外血运重建的情况，也应考虑该手术。
