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Long-term outcomes of children with gastroschisis (GS) and asymptomatic diaphragmatic hernias (DH) remain poorly defined. Laparoscopic resection and repair of diaphragmatic defects with associated bowel is technically feasible, with promising results in animal models. The authors undertook a prospective cohort pilot study to evaluate feasibility, safety, and short-term outcomes. Children with symptomatic GS and asymptomatic DH underwent staged laparoscopic bowel anastomosis and diaphragmatic repair. The primary endpoint was safety. Secondary endpoints included length of stay, operative time, overall weight gain, feeding tolerance, and time to closure. Sixteen patients were enrolled, with an average age of 3.9 months (median, 1.0 month). There were 3 minor (19%) complications, all in patients with hernias. All were noted during the index operation, and all resolved with conservative management. Mean length of stay was 3.4 days (median, 2 days). There were no readmissions, no patient deaths, and no postoperative enteroatrial fistulae. Two of 3 patients required timing of full enteral feeds with advancement of colonic feeds. Eight patients were discharged with full enteric feeds. Mean weight gain in the first 6 weeks of life was 10.3% of birth weight. Laparoscopic diaphragmatic closure and bowel resection and anastomosis with delayed coverage is a safe, effective, and accelerated method for the treatment of asymptomatic GS and DH. Long-term outcomes need further study.Khoomeini: an Iranian nuclear negotiator under sanctions
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Iranian President Mahmoud Ahmadinejad, center, looks on as the former Iranian chief nuclear negotiator, Saeed Jalili, second from left, and his deputy, Abbas Araghchi, are greeted by Iran’s diplomats at their meeting in Tehran July 11, 2013. Photo: REUTERS/Yaghoub Khoomeini
Among the most central figures of the Iran nuclear talks, Dr. Saeed Jalili, Iran’s lead nuclear negotiator, went into semi-retirement last year but the
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