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1.
Jeffrey W. Gander Jason C. Fisher Ari R. Reichstein Gudrun Aspelund Keith A. Kuenzler 《Journal of pediatric surgery》2011,46(7):1303-1308
Introduction
Experience in thoracoscopic congenital diaphragmatic hernia (CDH) repair has expanded, yet efficacy equal to that of open repair has not been demonstrated. In spite of reports suggesting higher recurrent hernia rates after thoracoscopic repair, this approach has widely been adopted into practice. We report a large, single institutional experience with thoracoscopic CDH repair with special attention to recurrent hernia rates.Methods
We reviewed the records of neonates with unilateral CDH repaired between January 2006 and February 2010 at Morgan Stanley Children's Hospital. Completely thoracoscopic repairs were compared to open repairs of the same period. In addition, successful thoracoscopic repairs were compared with thoracoscopic repairs that developed recurrence. Data were analyzed by Mann-Whitney U and Fisher exact tests.Results
Thirty-five neonates underwent attempted thoracoscopic repair, with 26 completed. Concurrently, 19 initially open CDH repairs were performed. Preoperatively, patients in the open repair group required more ventilatory support than the thoracoscopic group. Recurrence was higher after thoracoscopic repair (23% vs 0%; P = .032). In comparing successful thoracoscopic repairs to those with recurrence, none of the factors analyzed were predictive of recurrence.Conclusions
Early recurrence of hernia is higher in thoracoscopic CDH repairs than in open repairs. Technical factors and a steep learning curve for thoracoscopy may account for the higher recurrence rates, but not patient severity of illness. In an already-tenuous patient population, performing the repair thoracoscopically with a higher risk of recurrence may not be advantageous. 相似文献2.
Cory N. Criss Megan A Coughlin Niki Matusko Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(4):635-639
Introduction
Indications for thoracoscopic versus open approaches to repair congenital diaphragmatic hernia (CDH) are unclear as the variability in defect size, disease severity and patient characteristics pose a challenge. Few studies use a patient and disease-matched comparison of techniques. We aimed to compare the clinical outcomes of open versus thoracoscopic repairs of small to moderate sized hernia defects in a low risk population.Methods
All neonates receiving CDH repair of small (type A) and moderate (type B) size defects at an academic children's hospital between 2006 and 2016 were retrospectively reviewed and analyzed. Patients < 36 weeks gestation, birth weight < 1500 g, or requiring extracorporeal life support were excluded. Demographics, including CDH severity index, and hernia characteristics were recorded. The primary outcome parameter was recurrence. Secondary outcomes included length of hospital stay, length of mechanical ventilation, time to goal feeds, and mortality.Results
The 51 patients receiving thoracoscopic (35) and open (16) repairs were similar in patient and hernia characteristics, with median 2-year follow-up for both groups. Patients with thoracoscopic repair had shorter hospital stay (16 vs. 23 days, p = 0.03), days on ventilator (5 vs. 12, p = 0.02), days to start of enteral feeds (5 vs. 10, p < 0.001), and days to goal feeds (11 vs. 20, p = 0.006). Higher recurrence rates in the thoracoscopic groups (17.1% vs. 6.3%) were not statistically significant (p = 0.28). Median time to recurrence was 88 days for the open repair and 183 days (IQR 165–218) for the thoracoscopic group. There were no mortalities in either group.Conclusions
In low risk patients born with small to moderate size defects, a thoracoscopic approach was associated with decreased hospital length of stay, mechanical ventilation days, and time to feeding; however, there was a trend towards higher recurrence rates.Level of evidence
Level III. 相似文献3.
Purpose
To investigate whether defect closure in laparoscopic ventral hernia repair reduces the re-operation rate for recurrence compared with no defect closure.Methods
Data were extracted from the Danish Ventral Hernia Database. Adults with an elective laparoscopic ventral hernia repair with tacks used as mesh fixation were included, if their first repair was between the 1st of January 2007 and the 1st of January 2017. Patients with defect closure were compared with no defect closure. Re-operation rates are presented as crude rates and cumulated adjusted re-operation rates. Sub-analyses assessed the effect of the suture material used during defect closure and also whether defect closure affected both primary and incisional hernias equally.Results
Among patients with absorbable tacks as mesh fixation, 443 received defect closure and 532 did not. For patients with permanent tacks, 393 had defect closure and 442 did not. For patients with permanent tacks as mesh fixation, the crude re-operation rates were 3.6% with defect closure and 7.2% without defect closure (p?=?0.02). The adjusted cumulated re-operation rate was significantly reduced with defect closure and permanent tacks (hazard ratio?=?0.53, 95% confidence interval?=?0.28–0.999, p?=?0.05). The sub-analysis suggested that defect closure was only beneficial for incisional hernias, and not primary hernias. We did not find any benefits of defect closure for patients with absorbable tacks as mesh fixation.Conclusion
This nationwide cohort study showed a reduced risk of re-operation for recurrence if defect closure was performed in addition to permanent tacks as mesh fixation during laparoscopic incisional hernia repair.4.
Stan Janssen Kim Heiwegen Iris ALM van Rooij Horst Scharbatke Jolt Roukema Ivo de Blaauw Sanne MBI Botden 《Journal of pediatric surgery》2018,53(3):508-512
Background
Patients born with a congenital diaphragmatic hernia (CDH) have a high mortality and morbidity. After discharge, complications and long-term morbidity are still encountered. This study describes the factors related to the surgical long-term outcomes in CDH survivors.Methods
A cohort of CDH patients born between 2000 and 2014, with a minimum of two years follow up, were included in this retrospective study. Demographics, CDH specific characteristics, treatment, and long-term surgical outcome were evaluated using multivariate logistic regression analyses.Results
112 patients were included, with a mean follow up of 7.3 years (SD 3.8). The majority had primary repair, but 31% received patch repair. Recurrence was reported in 7% of all patients. However, recurrence risk increased for patients with extracorporeal membrane oxygenation (ECMO) treatment (ORadjusted: 6.3, 95% CI: 1.2–33.9). This risk was highest for patients needing both ECMO and patch repair (OR: 11.2, 95% CI: 2.3–54.1). Small bowel obstructions (SBO) were observed in 20% and was associated with patch repair (ORadjusted: 3.5, 95% CI: 1.2–10.0), but ECMO treatment seemed to reduce this risk (ORadjusted: 0.2, 95% CI: 0.0–1.0). Thoracic deformations (36%) was diagnosed most often after patch repair, especially when ECMO was needed (60%) as well.Conclusions
This retrospective study shows that the incidence of surgical long-term morbidity of CDH is relatively high, with different factors accounting for this. Diaphragmatic hernia recurrence was strongest associated with ECMO treatment in combination with patch repair, while SBO's were associated with patch repair, with an unexpected protective effect of ECMO treatment.Type of study
Retrospective comparative study - Level III evidence. 相似文献5.
Joseph T. Church Rodrigo Mon Tiffany Wright Megan A. Coughlin Maria Ladino-Torres Christopher Tapley Heather Bowen Niki Matusko George B. Mychaliska 《Journal of pediatric surgery》2018,53(6):1087-1091
Purpose
Survivors of congenital diaphragmatic hernia (CDH) face high morbidity. We studied the neurodevelopmental outcomes of CDH survivors at a single institution.Methods
CDH survivors born July 2006–March 2016 at a free-standing children's hospital were reviewed. Neurodevelopment was assessed using the Peabody Developmental Motor Scales (PDMS-2) broken into gross, fine, and total motor quotients. Data collected included prenatal variables (liver herniation, defect laterality, observed:expected total fetal lung volume (o:eTFLV) on MRI), birth demographics (sex, race, estimated gestational age (EGA), birth weight (BtWt), 5 min APGAR, associated anomalies), and therapies/hospital course (HFOV/HFJV, ECMO, timing of repair, pulmonary hypertension (PHTN) severity, length of stay, ventilator days). Variables were analyzed using mixed linear modeling.Results
Sixty-eight children were included. Most patients had left-sided CDH (55/68, 81%) without liver herniation (42/68, 62%). ECMO utilization was 25/68 (37%). The mean [95% confidence interval] gross motor quotient for the entire cohort was 87 [84–91], fine motor quotient was 92 [88–96], and total motor quotient was 88 [84–93], representing below average, average, and below average functioning, respectively. o:eTFLV predicted fine motor quotient among prenatal variables. Associated anomalies and ECMO use predicted all quotients in the final model.Conclusions
Associated anomalies and ECMO use predict neurodevelopmental delay in CDH survivors.Type of Study
Retrospective observational study; Prognostic.Level of Evidence
II. 相似文献6.
Yigit S. Guner Matthew T. Harting Kelly Fairbairn Patrick T. Delaplain Lishi Zhang Yanjun Chen Mustafa H. Kabeer Peter Yu John P. Cleary James E. Stein Charles Stolar Danh V. Nguyen 《Journal of pediatric surgery》2018,53(11):2092-2099
Purpose
Previous studies comparing extracorporeal membrane oxygenation (ECMO) modality for congenital diaphragmatic hernia (CDH) have not accounted for confounding by indication. We therefore hypothesized that using a propensity score (PS) approach to account for selection bias may identify outcome differences based on ECMO modality for infants with CDH.Methods
We utilized ELSO Registry data (2000–2016). Patients with CDH were divided to either venoarterial (VA) or venovenous (VV) ECMO. Patients were matched by PS to control for nonrandom treatment assignment. Subgroup analyses were conducted based on timing of CDH repair relative to ECMO. Primary analysis was the “intent-to-treat” cohort based on the initial ECMO mode. Mortality was the primary outcome, and severe neurologic injury (SNI) was a secondary outcome.Results
PS matching (3:1) identified 3304 infants (VA?=?2470, VV?=?834). In the main group, mortality was not different between VA and VV ECMO (OR?=?1.01, 95% CI: 0.86–1.18) and there was no difference in SNI between VA and VV (OR?=?0.80; 95% CI: 0.63–1.01). For the pre-ECMO CDH repair subgroup, 175 VA cases were matched to 70 VV. In these neonates, mortality was higher for VV compared to VA (OR?=?2.10, 95% CI: 1.19–3.69), without any difference in SNI (OR?=?1.48; 95% CI: 0.59–3.71). For the subgroup that did not have pre-ECMO CDH repair, 2030 VA cases were matched to 683 VV cases. In this subgroup, VV was associated with 27% lower risk of SNI relative to VA (OR?=?0.73, 95% CI: 0.56–0.95) without any difference in mortality (OR?=?0.94, 95% CI: 0.79–1.11).Conclusion
This study revalidates that ECMO mode does not significantly affect mortality or SNI in infants with CDH. In the subset of infants who require pre-ECMO CDH repair, VA favors survival, whereas, in the subgroup of infants that did not have pre-ECMO CDH repair, VV favors lower rates of SNI. We conclude that neither mode appears consistently superior across all situations, and clinical judgment should remain a multifactorial decision.Level of evidence
Level III. 相似文献7.
Emily H. Steen Timothy C. Lee Adam M. Vogel Sara C. Fallon Caraciolo J. Fernandes Candace C. Style Mariatu A. Verla Swathi Balaji Oluyinka O. Olutoye Sundeep G. Keswani 《Journal of pediatric surgery》2019,54(1):50-54
Background
The benefits to early repair (< 72?h postcannulation) of infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) are increasingly recognized. Yet it is not known if even earlier repair (< 24?h) results in comparable or improved patient outcomes. The goal of this study was to compare “super-early” (< 24?h) to early repair (24-72?h) of CDH patients on ECMO.Methods
A retrospective review of infants with CDH placed on ECMO (2004–2017; n?=?72) was performed. Data collected on the patients repaired while on ECMO within 72?h of cannulation (n?=?33) included pre- and postnatal disease severity stratification variables and postnatal outcomes. Comparison groups were those patients repaired within 24?h of cannulation (n?=?14) and those repaired between 24 and 72?h postcannulation (n?=?19).Results
Patients undergoing “super-early” (< 24?h) repair had an average survival of 71.4% compared to the average survival of 59.7% in the early repair group. Pre- and postnatal variables predicting disease severity were not significantly different between the groups. Mean hospital stays, ventilator days, and cannulation days were statistically similar between the groups.Conclusions
Repair of patients with CDH patients on ECMO at less than 24?h postcannulation achieves outcomes that are comparable to those of repair between 24 and 72?h. While the present data suggest that there is not a “too early” time point for CDH repair on ECMO, larger multicenter studies are needed to validate our findings and determine the overall benefits.Type of study
Retrospective comparative study.Level of evidence
Level III. 相似文献8.
Carmen Mesas Burgos Björn Frenckner Matias Luco Matthew T. Harting Pamela A. Lally Kevin P. Lally 《Journal of pediatric surgery》2018,53(1):113-117
Background
Right-sided congenital diaphragmatic hernias (CDH) and bigger defect sizes have been associated with poorer outcomes.Aim
The aim of this study was to evaluate right- and left-sided CDH in terms of size, survival, associated anomalies, and morbidity.Material and methods
We used information from a multicenter, multinational database including patients with CDH born between 2007 and 2015. All infants with data on defect side were included for this analysis. We compared differences in outcomes between right- and left-sided CDH. Further analysis on the association between side, size of the defect, and outcome was performed.Results
A total of 3754 cases of CDH were entered in the registry between January 2007 and September 2015, with an overall survival of 71%. Of those, 598 (16%) were right-sided and 3156 left-sided, with a survival rate of 67% and 72%, respectively. Right-sided CDH had a larger proportion of C and D defects (p < 0.001 and 0.04, respectively). Survival rates for the same size defect were similar, independent of the side of the defect. Multivariable logistic regression analysis with survival as dependent variable identified a significant correlation with defect size, but not side.Conclusions
The higher proportion of large defects (C & D) in right-sided CDH, not the side itself, accounts for the reported poorer survival in right-sided CDH.Level of evidence
Level I for a prognosis study – This is a high-quality, prospective cohort study with 99% of patients followed to the study end point (death or discharge). 相似文献9.
Background
Chronic pain affects 10%–12% of patients after inguinal hernia repairs. Some have suggested that less foreign material may theoretically prevent pain. If the prevalence of chronic pain is less after nonmesh repairs, selected hernias might be repaired without mesh. Our aim was to clarify if nonmesh repairs are superior to mesh repairs regarding chronic pain.Methods
For this systematic review, searches were conducted in five databases. The main outcome was chronic pain reported a minimum of six months after mesh and nonmesh repair in adult patients with a primary inguinal hernia. Only randomized controlled trials (RCTs) were included.Results
A total of 23 RCTs with 5,444 patients were included. The median follow up was 1.4 years (range 0.5–10). Twenty-one studies reported crude chronic pain rates, and when considering moderate and severe pain, the prevalences of pain after nonmesh repairs and mesh repairs were similar: median 3.5% (0%–16.2%) versus median 2.9% (0%–27.6%), respectively. Both the meta-analyses and the network meta-analysis indicated no difference in chronic pain rates when comparing nonmesh repairs with open- and laparoscopic mesh repairs.Conclusion
Mesh may be used without fear of causing a greater rate of chronic pain. 相似文献10.
Matthew Wong Janette Reyes Eveline Lapidus-Krol Monping Chiang Tilman Humpl Malikah Al-Faraj Greg Ryan Priscilla P.L. Chiu 《Journal of pediatric surgery》2018,53(5):918-924
Prenatal observed/expected lung–to-head ratio (O/E LHR) by ultrasound correlates with postnatal mortality for congenital diaphragmatic hernia (CDH) patients. The aim of this study is to determine if O/E LHR correlates with pulmonary hypertension (PH) outcomes for CDH patients.
Methods
A single center retrospective chart review was performed for CDH neonates from January 1, 2006, to December 31, 2015, (REB #1000053124) to include prenatal O/E LHR, liver position, first arterial blood gas, repair type, echocardiogram (ECHO), and lung perfusion scan (LPS) results up to 5 years of age.Results
Of 153 newborns, 123 survived (80.4%), 58 (37.9%) had prenatal O/E LHR, and 42 (27.5%) had postnatal ECHO results. High mortality risk neonates (O/E LHR ≤ 45%) correlated with higher right ventricular systolic pressure (RVsp) at birth. Generally PH resolved by age 5 years. LPS results did not change over time (p > 0.05) regardless of initial PH severity, suggesting that PH resolution did not correlate with increased ipsilateral lung perfusion to offload the right ventricle.Conclusion
Prenatal prognostic markers correlated with initial PH severity for CDH newborns, but PH resolved over time despite fixed perfusion bias to the lungs. These results suggest favorable PH outcomes for CDH patients who survive beyond infancy.Type of Study
Retrospective Cohort Study.Level of Evidence
3b 相似文献11.
Purpose
To evaluate the management and outcomes of modified Marcy repair for inguinal hernia in a large series of children.Methods
We analyzed the case records of 6826 pediatric patients who underwent surgery for inguinal hernia between January, 1991 and January, 2015 at Split University Hospital in Croatia. The following parameters were examined: sex, age, location of the hernia, intraoperative or postoperative complications, recurrence, and surgical method.Results
The 6826 patients included 4751 boys and 2075 girls operated on for inguinal hernia. The mean age was 3.5 years, and mean followup was 14 years. Right-side predominance was noted with 59.50 % right hernia repairs, 33.72 % left hernia repairs, and 6.78 % bilateral hernia repairs. There were 6410 (93.90 %) elective procedures and 416 (6.10 %) emergency procedures for incarceration. The mean duration of surgery was 26 min (14–90 min), and the mean hospital stay was 1 day. Marcy repair was the most commonly performed operation (95.76 %), whereas Ferguson’s technique was performed in only 3.98 % of the children. The overall recurrence rate was 0.43 %, with a recurrence rate of 0.36 % for Marcy repair and 1.83 % for Ferguson repair (p = 0.0003).Conclusion
Modified Marcy hernia repair is a safe and effective procedure for inguinal hernia in children with excellent outcomes and a low incidence of recurrence.12.
Purpose
Lightweight meshes (LWM) have shown benefits compared to heavyweight meshes (HWM) in terms of less postoperative pain and stiffness in open inguinal hernia repair. It appears to have similar advantages also in TEP, but concerns exist if it may be associated with higher recurrence rates. The aim of the study was to compare reoperation rate for recurrence of LWM to HWM in laparoscopic totally extra-peritoneal (TEP) repair.Methods
All groin hernias operated on with TEP between 1 January 2005 and 31 December 2013 at surgical units participating in The Swedish Hernia Register were eligible. Data included clinically important hernia variables. Primary endpoint was reoperation for recurrence. Median follow-up time was 6.1 years (0–11.5) with minimum 2.5 years postoperatively.Results
In total, 13,839 repairs were included for statistical analysis and 491 were re-operated for recurrence. Multivariate analysis demonstrated significantly increased risk of reoperation for recurrence in LWM 4.0% (HR 1.56, P?<?0.001) compared to HWM 3.2%. This was most evident in direct hernias (HR 1.75, P?<?0.001) and in hernia repairs with a defect >?3 cm (HR 1.54, P?<?0.021). The risk of recurrence with use of LWM in indirect hernias and in hernia repairs with a defect <?1.5 cm was more comparable to HWM.Conclusions
Lightweight meshes were associated with an increased risk of reoperation for recurrence compared to HWM. While direct hernias and larger hernia defects may benefit from HWM to avoid increased recurrence rates, LWM is recommended to be used in indirect and smaller hernia defects in TEP repair.13.
Yew-Wei Tan Debasish Banerjee Kate M. Cross Paolo De Coppi Simon C. Blackburn Clare M. Rees Stefano Giuliani Joe I. Curry Simon Eaton 《Journal of pediatric surgery》2018,53(10):1883-1889
Background/Purpose
Morgagni diaphragmatic hernia (MH) is rare. We report our experience based on routine patch use in MH repair to curb recurrence. A systematic review and meta-analysis were performed to study the recurrence and complications associated with minimally invasive surgery and the use of patch.Methods
We retrospectively reviewed all cases of MH who underwent first-time repair in 2012-2017 in our institution to determine recurrence and complication rate. A MEDLINE search related to minimally invasive surgery (MIS) and patch repair of MH was conducted for systematic review. Eligible articles published from 1997-2017 with follow-up data available were included. Primary outcomes measured were recurrence and complication. Meta-analysis to compare open versus MIS and primary versus patch repair in the MIS group were performed in comparative cohorts. Continuous data were presented as median (range), and statistical significance was P < 0.05.Results
In our institution, 12 consecutive patients aged 17-month-old (22 days-7 years), underwent laparoscopic patch repair of MH, with one conversion to laparotomy. No recurrence or significant complication occurred over a follow-up period of 8 months (1-48 months).Thirty-six articles were included from literature review and were combined with the current series. All were retrospective case reports or series, of which 6 were comparative cohorts with both MIS and open repairs. A total of 296 patients from 37 series were ultimately used for analysis: 80 had open repair (4 patch) and 216 had MIS repair (32 patch), with a patch rate of 12%. There were 13 recurrences (4%): no difference between open and MIS repairs (4/80 vs 9/216, p = 0.75); recurrence rate following primary repair was 13/260 (5%), but no recurrence occurred with 36 patch repairs. Meta-analysis showed no difference in recurrence between open and MIS repair (p = 0.83), whereas patch repair was associated with 14% less recurrence compared with primary repair, although it did not reach statistical significance (p = 0.12). There were 13 complications (5%): no difference between open and MIS repairs (5/80 vs 8/216, p = 0.35). One small bowel obstruction occurred in a patient who had laparoscopic patch repair.Conclusion
In MH, recurrence and complication rates are comparable between MIS and open repairs. Use of patch appeared to confer additional benefit in reducing recurrence.Type of Study
Systematic reviewLevel of Evidence
3A 相似文献14.
Background
The use of neurally adjusted ventilator assist (NAVA) in congenital diaphragmatic hernia (CDH) patients has been historically deemed unwise, since the trigger for breaths is the electromyographic activity of the diaphragmatic muscle. We report on our NAVA experience in CDH patients.Methods
We performed an IRB-approved retrospective review of newborns from 1/1/2012–1/1/2017 at a Level I Children's Surgery Center undergoing CDH repair. Data obtained included demographics, defect type and repair, respiratory support, and outcomes.Results
Seven infants with CDH were placed on noninvasive-NAVA (NIV-NAVA) after extubation. All seven patients underwent open transabdominal repair, with five requiring patch repair. All survived to discharge, and one year after birth. When we compared this group to a contemporary cohort of patients who also underwent CDH repair, we found no significant differences in birth weight, postmenstrual age, or gender. However, there was a significantly higher need for inhaled nitric oxide (p?=?0.002), high frequency oscillatory ventilation (p?=?0.016), and extracorporeal membranous oxygenation support (p?=?0.045) in the NIV-NAVA cohort.Conclusion
This is the first report of NIV-NAVA being successfully utilized as an adjunct to wean infants from conventional ventilation after CDH repair, even in those who require patch repair or with more significant disease severity.Levels of Evidence
III- Retrospective Comparative Study. 相似文献15.
John Emil Wennergren Erik P. Askenasy Jacob A. Greenberg Julie Holihan Jerrod Keith Mike K. Liang Robert G. Martindale Skylar Trott Margaret Plymale John Scott Roth 《Surgical endoscopy》2016,30(8):3231-3238
Background
Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates.Methods
A multicenter, retrospective database of all ventral hernia repairs performed from 2010–2012 was accessed. Patients who underwent LVHR with mesh were reviewed. Patients who had PFC were compared to bridged repair. Primary outcome was hernia recurrence determined by clinical examination or CT scan. Secondary outcomes included SSI and seroma formation.Results
A total of 1594 patients were identified. Following exclusion, a total of 196 patients were left who underwent LVHR with a mean follow-up period of 17.5 months. Ninety-seven patients underwent PFC, while 99 underwent bridged repairs. Initial comparisons between both groups was negative for any significant statistical difference in terms of recurrence, seroma formation, SSI, deep/organ space SSI, reoperation, and readmission. The same initial findings held true during subgroup analysis. Propensity score analysis was then performed for recurrence, seroma, and SSI controlling for age, gender, immune status, ASA class, BMI, smoking status, and acute repair. No statistically significant differences were identified in either group.Conclusion
Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on these parameters in future investigations.16.
Nicole Mennie Geoff Frawley Joe Crameri Sebastian K. King 《Journal of pediatric surgery》2018,53(4):740-743
Background/aims
The Nuss procedure is the most commonly performed operation to correct pectus excavatum (PE). Thoracoscopic assistance has been anecdotally noted to improve the safety of this operative approach. This study aimed to compare complications and clinical outcomes before and after the introduction of thoracoscopy in a single-center.Methods
A retrospective review was performed of all patients who underwent the Nuss procedure at The Royal Children's Hospital over an 11-year period (2005–2015), collecting data on all intra-operative and post-operative outcomes.Results
A total of 217 Nuss procedures were performed (122 non-thoracoscopic pectus repairs, 95 thoracoscopic pectus repairs). Median patient age was 14.9 years, with the majority male (185/217, 84.3%). Patient demographics (age, gender, defect severity) and postoperative recovery were comparable between the two groups. Major complications included cardiac arrest requiring internal cardiac massage, hemothorax, pneumothorax, empyema, bar displacement and infection. The overall major complication rate was low (19/217, 8.8%); however, there was a significant reduction in major complications in the thoracoscopic pectus repair group (13.1% versus 3.2%, p = 0.02).Conclusions
Thoracoscopic vision during the Nuss procedure reduces the risk of major complications.Level of evidence
Treatment study – Level III (Retrospective comparative study). 相似文献17.
Suolin Li Xuelai Liu Kenneth K.Y. Wong Lin Liu Yingchao Li 《Journal of pediatric surgery》2018,53(12):2507-2510
Background
Laparoscopic percutaneous extraperitoneal closure (LPEC) with variable devices seems to be one of the most simple and reliable methods. We described our modifications of single-port laparoscopic herniorrhaphy using an inner two-hooked cannula device with preperitoneal hydrodissection.Patients and methods
1568 children with 2114 inguinal hernias were treated by single-port LPEC. Under laparoscopic visualization, the two-hooked cannula device carrying a silk suture was inserted at the point of the internal ring and could be readily kept in an identical path. The hernia orifice was completely lassoed extraperitoneally by the suture with the assistance of hydrodissection. Any huge hernias of more than 1.5?cm were repaired with the incorporation of medial umbilical fold flap as reinforcement.Results
All hernia repairs were successfully performed by LPEC. 1022 patients had unilateral inguinal hernia repair, and 546 patients underwent bilateral inguinal hernia repair. Of these, additional medial umbilical flap reinforcement was necessary in 68 cases, and an assisted grasping instrument was used in 19 cases owing to omental adhesion or sliding hernia. Mean operating times for unilateral and bilateral inguinal hernia repairs were 9.8?±?2.1?min and 13.6?±?2.2?min, respectively. There were no operative complications. Two recurrences and three hydroceles were observed during 6 to 30?months of follow-up.Conclusions
One-puncture LPEC using the two-hooked cannula device with preperitoneal hydrodissection has proved to be a safe and effective procedure with excellent cosmetic results.Level of evidence
IV 相似文献18.
Heather B. Howell Christiana Farkouh-Karoleski Marilyn Weindler Rakesh Sahni 《Journal of pediatric surgery》2018,53(11):2100-2104
Background
Infants with congenital diaphragmatic hernia (CDH) are at risk for growth failure because of inadequate caloric intake and high catabolic stress. There is limited data on resting energy expenditure (REE) in infants with CDH.Aims
To assess REE via indirect calorimetry (IC) in term infants with CDH who are no longer on respiratory support and nearing hospital discharge with advancing post-conceptional age and to assess measured-to-predicted REE using predictive equations.Methods
A prospective cohort study of term infants with CDH who were no longer on respiratory support and nearing hospital discharge was conducted to assess REE via IC and caloric intake. Baseline characteristics and hospital course data were collected. Three day average caloric intake around time of IC testing was calculated. Change in REE with advancing post-conceptional age and advancing post-natal age was assessed. The average measured-to-predicted REE was calculated for the cohort using predictive equations [22].Results
Eighteen infants with CDH underwent IC. REE in infants with CDH increased with advancing postconceptional age (r2?=?0.3, p?<?0.02). The mean REE for the entire group was 53.2 +/? 10.9?kcal/kg/day while the mean caloric intake was 101.2 +/? 17.4?kcal/kg/day. The mean measured-to-predicted ratio for the cohort was in the normal metabolic range (1.10 +/? 0.17) with 50% of infants considered hypermetabolic and 11% of infants considered hypo-metabolic.Conclusions
Infant survivors of CDH repair who are without respiratory support at time of neonatal hospital discharge have REE, as measured by indirect calorimetry, that increases with advancing post-conceptional age and that is within the normal metabolic range when compared to predictive equations.Level of Evidence
III 相似文献19.
Theadore Hufford Jean-Francois Tremblay Mohammad Taha Mustafa Sheikh Slawomir Marecik John Park Ina Zamfirova Kunal Kochar 《American journal of surgery》2018,215(1):88-90
Purpose
The goal of this study was to evaluate the efficacy, morbidity and safety of local parastomal hernia repair using biological mesh.Patients and methods
A retrospective analysis of a prospectively maintained database was performed for parastomal hernia repairs. All patients who underwent local parastomal hernia repair with biological mesh between July 2006 and July 2015 were included in the study. Non-local (laparoscopic or midline incision) procedures were excluded. The type of repair, incision used, mesh placement and morbidity were analyzed. Time to recurrence was measured as an independent variable.Results
58 procedures with a median follow up of 3.8 years were analyzed. The majority (91%) of repairs were performed on an elective basis. Underlay technique was used in 24 patients (39%), overlay in 4 (7%) and both overlay and underlay (sandwich technique) in 33 (54%) of the cases. Overall, 11 patients (18.1%) experienced recurrence. Recurrence occurred in 8 patients in the underlay group (33%), 1 in the overlay group (25%), with 2 recurrences identified in the sandwich technique group (6%; p = 0.02). There was one occurrence of 30-day morbidity in our study population (0.016%). No difference was observed for recurrence or morbidity according to the type of biologic mesh used (human, bovine, or porcine).Conclusion
Our results demonstrate that local parastomal hernia repairs are associated with moderate recurrence rates, very low morbidity and consistent with the current literature. The sandwich technique was found to have a significantly lower recurrence rate compared to underlay or overlay techniques. Keyhole incisions were associated with less recurrence than traditional circular incisions. Our findings further reveal biologic mesh type was not associated with any difference in outcomes. Local parastomal hernia repair with biologic mesh is a safe procedure with very low morbidity and acceptable recurrence rate, especially using the sandwich repair technique. 相似文献20.