By Arndt Von Hippel
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Extra resources for Manual of Thoracic Surgery, 2nd Edition
Page xii Acknowledgements from First Edition I claim no originality for the greater part of this material, having always been a willing, if difficult, student. My graditude continues to Doctors Neptune, Overholt, Ehrenhaft and M. Lawrence, for all their teaching efforts during residencies in Boston and Iowa. Doctors Tector, Mateika, Johnson, and Lepley were similarly of inestimable assistance during my cardiac fellowship in Milwaukee. Doctor Lawrence Cohn of Boston and Doctor Tector also contributed greatly through many tedious hours spent on manuscript review and criticism.
Such suction is most readily applied by an occasional syringe-aspiration of air from the chest tubing above a water seal bottle (to gradually lift a water column into straw and tubing). In the absence of air leak, this simple, low-volume, suction system allows accurate application of chest tube suction (see Chapter 8). On the other hand, a small (accidental, or purposely retained) pneumothorax will also absorb uneventfully within a few days, barring ongoing pulmonary air leak. I have minimal experience with this passive, less controlled, "no chest tube" method for expanding hypoplastic lung (although equally satisfactory results are alleged).
Selection of laparotomy over thoracotomy is not simply a question of whether one prefers to "pull" or "push" viscera through the hernial defect, or even which method allows better exposure for diaphragm repair, for these infants also have potential intestinal obstruction from malrotation or peritoneal band across the duodenum. ) None the less, at laparotomy, it is relatively simple and atraumatic to stuff intestines back in proper order, while eliminating an occasional Meckel's diverticulum or other likely cause for future bowel obstruction.