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1.
Mamta Sengar Anup Mohta Sujoy Neogi Alisha Gupta Vivek Viswanathan 《Journal of pediatric surgery》2018,53(11):2346-2348
Purpose
Pediatric spigelian hernias are very rare. They are often missed or misdiagnosed. A series of cases with spigelian hernia, presented to a tertiary care center are presented here with emphasis on different anatomy of spigelian hernias with cryptorchidism and those without associated cryptorchidism.Materials and Methods
Over a period of seven years, nine cases of spigelian hernia presented to our tertiary care center. Male:female ratio was 3:1.There was a preponderance of right sided hernias. Three patients had associated cryptorchidism. One patient had associated lumbar hernia. All three patients with cryptorchidism had low spigelian hernia while others had classical spigelian hernia.Conclusion
There is a likelihood of anatomical variation in SH associated with UDT and those without UDT. Understanding this anatomy may help in correct scrotal placement of testis.Type of Study
Prospective Observational.Level of Evidence
4. 相似文献2.
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3.
Qilei Han Kai Li Kuiran Dong Xianmin Xiao Wei Yao Gongbao Liu 《Journal of pediatric surgery》2018,53(12):2465-2469
Background
Wilms' tumor(WT) is the most common malignant renal tumor of childhood. Despite the good prognosis of WT, bilateral Wilms' tumor (BWT) still has a poor outcome. We systematically reviewed the literature on BWT, aiming to define its clinical features, treatment, and outcomes.Methods
PubMed, OVID EMbase, Web of Science, and Cochrane Library were systematically searched for studies published from 1980 to 2017. Case series and comparative studies reported clinical data of BWT patients were included.Results
A total of 32 studies comprising 1457 patients were retained for primary outcome. Hemihypertrophy, cryptorchidism, and Beckwith–Wiedemann syndrome(BWS) are the most common congenital anomalies and syndrome. 86% of patients had favorable histology (FH). Patients with local stage I or II accounted for 64%, and 12.6% had metastasis at diagnosis. Bilateral nephron-sparing surgery (NSS) was achieved in 33.8%. Recurrence and renal failure occurred in 20% and 8%. The overall survival (OS) was 73%. In comparative studies, OS of patients undergoing bilateral NSS was similar to that of other operation types.Conclusion
Prognosis of BWT has been improved but is significantly poorer than WT. Bilateral NSS was recommended by most centers to preserve more renal volume. However, finding a balance between retaining renal function and avoiding recurrence remains a question.Type of study
Systematic review.Level of evidence
Level IV. 相似文献4.
Brian C Gulack Rachel Greenberg Reese H Clark Marie Lynn Miranda Martin L Blakely Henry E Rice Obinna O Adibe Elisabeth T Tracy P Brian Smith 《Journal of pediatric surgery》2018,53(4):784-788
Purpose
Inguinal hernias are common in premature infants, but there is substantial variation with regards to timing of repair. We sought to quantify and explain this variation.Methods
Cohort study of infants < 34 weeks gestation diagnosed with an inguinal hernia and discharged from one of 329 neonatal intensive units between 1998 and 2012. Multivariable logistic regression clustered by site was used to evaluate demographic, clinical, maternal, and socioeconomic variables associated with pre-discharge repair.Results
A total of 8037 infants met study criteria, and 3230 (40%) received a pre-discharge repair. The frequency of pre-discharge repair varied by site from 9% to 84%, and increased over the study period from 20% in 1998 to 45% in 2012. Concurrent gastrostomy or fundoplication and lower socioeconomic status were associated with an increased odds of receiving a pre-discharge repair.Conclusion
There is substantial variation with regards to the timing of repair of inguinal hernias in premature infants, with an increasing number of infants receiving repair prior to hospital discharge over time. Concurrent gastrostomy or fundoplication and socioeconomic status are associated with timing of repair.Level of evidence
IV. 相似文献5.
Joseph C. Fusco Brittani K.N. Seynnaeve Alexander J. Davit Michael R. Czachowski Judith M. Joyce Barbara A. Gaines Marcus M. Malek 《Journal of pediatric surgery》2018,53(1):77-80
Background
Lymphatic mapping to guide sentinel lymph node biopsy (SLNB) typically requires lymphoscintigraphy prior to surgery. In young pediatric patients, this process often requires intubation in the nuclear medicine suite followed by transport to the operating room (OR).Methods
We reviewed 14 pediatric cases in which a portable nuclear imaging camera was utilized to perform the entirety of the SLNB in the OR.Results and Conclusion
This method, utilizing intraoperative nuclear imaging, helped to confirm removal of the sentinel lymph node in real time, decreased anesthesia time, and avoided transport of a sedated or intubated child.Level of Evidence
III. 相似文献6.
In Geol Ho Kyong Ihn Eun-Jung Koo Eun Young Chang Jung-Tak Oh 《Journal of pediatric surgery》2018,53(10):2008-2012
Purpose
This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR).Methods
We retrospectively analyzed the clinical data of 465 infants treated for inguinal hernia from January 2006 to December 2015. Among them, 124 underwent LR and 341 underwent OR.Results
In the OR group, 16.1% (55/341) primarily underwent bilateral inguinal hernia repair and 13.6% (42/308) subsequently developed metachronous contralateral inguinal hernia during follow-up. In the LR group, 75.8% (94/124) underwent primary bilateral inguinal hernia repair and only 1.6% (2/123) developed metachronous contralateral inguinal hernia. The mean operation times of unilateral inguinal hernia repair showed no statistical differences between LR and OR. However, the mean operation times of bilateral inguinal hernia repair were shorter in LR (39.8 ± 10.4 vs. 51.1 ± 14.4 min, p < 0.001). Postoperative recurrence and wound infection showed no statistical differences between the groups, but postoperative scrotal swelling was more common in OR (0.0% vs. 4.0%, p = 0.006).Conclusion
LR in infants showed a lower incidence of metachronous hernia, shorter operation times, and better postoperative course than OR. LR could be considered the primary operation method in infants with inguinal hernia.Levels of Evidence
Prognosis Study, Retrospective Study, Level III. 相似文献7.
Patrick C. Bonasso Melvin S. Dassinger Deidre L. Wyrick Lori A. Gurien Jeffrey M. Burford Samuel D. Smith 《Journal of pediatric surgery》2018,53(11):2279-2289
Purpose
Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS.Methods
PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status and echocardiography), hypertrophic pyloric stenosis diagnosis, appendicitis diagnosis, the Focused Assessment with Sonography for Trauma (FAST), thoracic evaluation, and soft tissue infection evaluation.Results
There are no standards for the practice of PSPBUS.Conclusions
As the role of the pediatric surgeon continues to evolve, PSPBUS will influence practice patterns, disease diagnosis, and patient management.Type of Study
Review Article.Level of Evidence
Level III. 相似文献8.
Yi Wang Chun Wu Zhengxia Pan Yuhao Wu Quan Wang Gang Wang Jiangtao Dai 《Journal of pediatric surgery》2018,53(11):2136-2139
Purpose
To describe the diagnosis and treatment of 34 cases of congenital tracheobronchial cartilage remnants of esophagus.Methods
The diagnosis and treatment of 34 cases of congenital tracheobronchial cartilage remnants of esophagus were analyzed retrospectively in our hospital.Results
Congenital tracheobronchial cartilage remnants of esophagus could be specifically diagnosed by clinical situation and esophageal barium meal examination. The anterior wall of the esophagus was cut longitudinally with the posterior wall of the esophagus preserved. And the cartilage was removed and the open anterior wall of the esophagus was sutured horizontally with full layer. In our study, 34 patients who underwent the operation had a satisfactory outcome. However, one patient underwent submucosal cartilage stripping, which resulted in a complication involving fistulae from the esophagus to the abdominal cavity that were healed after gastrostomy and nutritional support.Conclusion
Congenital tracheobronchial cartilage remnants of esophagus caused symptoms when the infants were started on adjunct foods. Vomiting the food without gastric fluid and bile was the leading clinical manifestation. Distinguishing signs on esophageal barium contrast could be used as preoperative diagnosis evidence. Surgically removing the cartilage and horizontally suturing the esophagus provides a reliable outcome.Level of Evidence
Level IV.Type of Study
Retrospective study. 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.
Ira L. Leeds Mitchell R. Ladd Margaret H. Sundel Melissa L. Fannon Jessica A. George Emily F. Boss Eric B. Jelin 《Journal of pediatric surgery》2018,53(11):2266-2272
Background/purpose
The role of process measures used to predict quality in pediatric colorectal surgery enhanced recovery protocols has not been described. The purpose of this study was to demonstrate the feasibility of abstracting and monitoring process measures over protocol improvement iteration.Methods
Patients enrolled in the Pediatric Colorectal Enhanced Recovery After Surgery pathway at our institution were grouped by stage of implementation. We used a quality improvement database to compare multistage enhanced recovery process measures and 30-day patient outcomes.Results
We identified 58 surgical patients with 28(48%) cases enrolled in the pathway. There was increased use of regional anesthesia techniques in pathway patients (83% versus 20%, p?<?0.001). All preoperative process measures clinically improved between early and full implementation. Improvements included a dramatic increase in formal preoperative education (56% versus 0%, p?=?0.004) and administration of preoperative medication (p?=?0.025). Overall, 12 (21%) patients experienced postoperative complications, which were similarly distributed between implementation groups. Readmissions were highest during the early implementation phase (40%, p?=?0.029). Children in the late implementation group experienced fewer complications, which clinically correlated with process measure adherence.Conclusions
Process measures complement outcome measures in assessing quality and effectiveness of a pediatric colorectal recovery protocol. Adherence to processes may reduce complications.Level of evidence
Treatment study, Level III. 相似文献11.
Yasmine Yousef Sabrina Drudi Ana Maria Sant&#x;Anna Sherif Emil 《Journal of pediatric surgery》2018,53(8):1606-1610
Introduction
Parental presence at induction of general anesthesia (PPI) is highly desired by children and parents. However, it often faces resistance from medical personnel. We conducted a survey evaluating the perceptions of surgeons before and after establishment of a PPI program.Methods
Internal web-based surveys using Likert Scale questions were administered to all members of a pediatric surgical department before and after the introduction of PPI at a freestanding children's hospital. Pre and post results were compared by Wilcoxon rank-sum tests. A p-value ≤ 0.0026 was considered significant due to the Bonferroni correction.Results
The survey was sent to 59 surgeons 1 year before and 5 years after gradual implementation of PPI. Response rates were 46% and 54%, pre and post implementation, respectively. After implementation, there was a statistically significant increased level of agreement with the statement: “PPI improves the parents' level of satisfaction” (p = 0.0025) and a statistically significant decreased level of agreement with the statement “PPI lengthens the duration of induction” (p = 0.0001). Before initiation, 56% wanted to see PPI implemented, while after implementation, 97% wanted PPI to remain.Conclusions
A majority of pediatric surgeons favored maintaining PPI after implementation. Resistance to initiation of PPI should not hinder implementation.Type of study
SurveyLevel of evidence
Not applicable 相似文献12.
Maziar M. Nourian Angelina L. Schwartz Austin Stevens Eric R. Scaife Brian T. Bucher 《Journal of pediatric surgery》2018,53(9):1839-1842
Background
The optimal time to reinsert central venous catheters (tCVC) after a documented central line associated blood stream infection (CLABSI) is unclear. The goal of this study is to identify risk factors for children who develop persistent bacteremia after tCVC removal due to CLABSI.Methods
We performed a retrospective cohort study from a tertiary children’s hospital. Children who underwent removal of a tCVC due to CLABSI were included in our analysis. Our primary outcome was persistent bacteremia after tCVC removal defined by a persistently positive blood culture. Salient patient demographic and clinical factors were extracted from the medical record.Results
A total of 140 patients met inclusion criteria and 27 (19%) had a persistent CLABSI after removal of the tCVC. There were no significant differences between the patients who cleared their bacteremia and those who develop persistent bacteremia. The median (IQR) time to positive blood culture after tCVC removal was 2.7 days (1.7– 4.0).Conclusions
We did not identify any patient risk factors distinguishing between a child who will clear a CLABSI versus develop a persistent CLABSI after tCVC removal. Blood stream infection clearance was rapid after tCVC removal, supporting a brief line holiday prior to tCVC reinsertion.Level of Evidence
Level III Retrospective Case-Control Study 相似文献13.
Pedro Palazón Laura Saura Irene de Haro Oriol Martín-Solé Asteria Albert Xavier Tarrado Victoria Julià 《Journal of pediatric surgery》2018,53(10):1945-1950
Purpose
Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. Aim: to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD.Methods
The records of all females with HD since 1980 were reviewed. Only patients who reached menarche were included. Prevalence of hydrosalpinx and hydrosalpinx-free survival were compared after abdominoperineal (A) or transanal (T) surgery. Treatment for hydrosalpinx was reviewed.Results
Seventeen out of 27 patients had reached menarche (Group A: 13 patients; Group T: 4 patients). Five patients in group A and none in group T presented bilateral hydrosalpinx (p = 0.261). There were no statistical differences in hydrosalpinx-free survival between groups (p = 0.344). Hydrosalpinx treatment: two bilateral and one unilateral salpingectomy, one pyosalpinx evacuation and one untreated. Three patients had conception desire: one has children; two are on IVF program.Conclusion
An association between hydrosalpinx and HD was observed. The development of hydrosalpinx was not associated with surgical approach in our study. Females with HD should have a gynecological follow-up for the development of hydrosalpinx, which can impair fertility.Level of evidence
Level III, retrospective comparative study. 相似文献14.
Evangeline Woodford Dilharan Eliezer Aniruddh Deshpande Rajendra Kumar 《Journal of pediatric surgery》2018,53(12):2495-2497
Background/Purpose
Vanishing Testes Syndrome1 (VTS) is one of the most common causes of impalpable testes in children. The role of removal of testicular nubbins owing to malignant potential in VTS is unclear. We sought to evaluate whether testicular nubbins need to be excised owing to this potential.Methods
We conducted a retrospective review of children with a clinical diagnosis of impalpable testes aged 0–18 who presented to our tertiary hospital between 2007 and 2017. VTS was defined as the presence of hypoplastic vas entering a closed internal inguinal ring or remnants of gonadal tissue distally. Data collected included: age at operation, need for laparoscopy, location of nubbin and histopathological findings.Results
We identified 50 consecutive children (mean age 2.4?years, range: 7?months to 12?years) with a clinical diagnosis of impalpable testis. Forty-eight of the 50 underwent laparoscopy with no testicle palpable when examined under anesthesia. Thirty-three children had VTS confirmed at laparoscopy and testicular nubbins identified with three of these being bilateral. Thirty-two children had these nubbins excised with histopathology available for 31 individual testes. Thirty were confirmed testicular nubbins with no viable testicular tissue. No malignancies were identified.Conclusion
Results from this study show that testicular nubbins do not have viable germ cells and therefore do not need to be excised on the basis of malignant potential of residual testicular tissue.Level of evidence
Level IV treatment study. 相似文献15.
Doris Hebenstreit Dagmar Csaicsich Karin Hebenstreit Thomas Müller-Sacherer Gabriela Berlakovich Alexander Springer 《Journal of pediatric surgery》2018,53(11):2256-2260
Purpose
To determine whether there is a difference in the outcome of renal transplantation (RT) in patients with posterior urethral valves (PUV) and children with non-uropathy related end stage renal disease.Methods
Data were acquired retrospectively. We analyzed possible factors that influence the function of renal allografts and graft survival. Between 1995 and 2016 there were 149 RT. Out of them, there were 27 boys with PUV, who received 29 kidneys. Thirty patients, who received a total of 31 renal grafts due to a non-uropathic (NU) diagnosis, served as control group. Mean follow-up was 7.4 to 10.2 years.Results
There was no difference in estimated graft survival between patients with PUV and NU patients. Graft failure occurred in 23.1% of PUV patients and 34.5% patients of the NU group. There was no statistically significant disparity in graft function between the two groups. Age at transplantation and donor age were the only factors that had a significant impact on renal function. There was a higher incidence of UTI in the PUV group (96%) than in the NU group (67%). Vesicostomy was the favourable intervention in regards of graft function.Conclusions
RT in PUV patients is successful with the same outcome as in NU patients. Bladder dysfunction may not have a major impact on graft function and graft survival. It seems that the type of pre-transplant surgical procedures may influence outcome. Therefore, these interventions -if necessary- should be limited to a minimum.Type of Study
Retrospective Comparative StudyLevel of Evidence
Level III 相似文献16.
Heather L. Short Natalie Taylor Kaitlin Piper Mehul V. Raval 《Journal of pediatric surgery》2018,53(4):592-598
Purpose
Despite Enhanced Recovery After Surgery (ERAS) protocols demonstrating improved outcomes in a wide variety of adult surgical populations, these protocols are infrequently and inconsistently being used in pediatric surgery. Our purpose was to develop a pediatric-specific ERAS protocol for use in adolescents undergoing elective intestinal procedures.Methods
A modified Delphi process including extensive literature review, iterative rounds of surveys, and expert panel discussions was used to establish ERAS elements that would be appropriate for children. The 16-member multidisciplinary expert panel included surgeons, gastroenterologists, anesthesiologists, nursing, and patient/family representatives.Results
Building upon a national survey of surgeons in which 14 of 21 adult ERAS elements were considered acceptable for use in children, the 7 more contentious elements were investigated using the modified Delphi process. In final ranking, 5 of the 7 controversial elements were deemed appropriate for inclusion in a pediatric ERAS protocol. Routine use of insulin to treat hyperglycemia and avoidance of mechanical bowel preparation were not included in the final recommendations.Conclusions
Using a modified Delphi process, we have defined an appropriate ERAS protocol comprised of 19 elements for use in adolescents undergoing elective intestinal surgery. Prospective validation studies of ERAS protocols in children are needed.Level of evidence
Level V, Expert opinion. 相似文献17.
Philip K. Frykman Sungjin Kim Tomas Wester Agneta Nordenskjöld Akemi Kawaguchi Thomas T. Hui Daniel H. Teitelbaum Anna L. Granström Andre Rogatko 《Journal of pediatric surgery》2018,53(4):708-717
Objective
To identify the optimal clinical criteria to diagnose Hirschsprung-associated enterocolitis (HAEC) in children with Hirschsprung disease (HSCR).Background
HAEC is the most common life-threatening complication in HSCR patients, yet the diagnostic criteria for HAEC remain unclear. The consensus-based HAEC scoring system was not validated using patient data, thereby making its diagnostic accuracy uncertain.Methods
From 2009 to 2015, consecutive children with HSCR underwent retrospective evaluation of their medical records, and questionnaire-directed parent interviews to identify treatment of suspected HAEC episodes and the 16 clinical criteria in the HAEC score. Logistic regression modeling was employed to identify criteria predicting suspected HAEC episodes.Results
One hundred sixteen HSCR patients met inclusion criteria, 43 patients (37.1%) were treated for at least one suspected HAEC episode. An HAEC score of 4 maximized the sum of sensitivity (83.7%) and specificity (98.6%) while the previously established cut-off score of 10 showed lower sensitivity (41.9%) with perfect specificity. Multivariable analysis identified four criteria utilized to create a new HAEC Risk score with performance characteristics similar to the HAEC score cutoff of 4.Conclusion
When using the HAEC score, a cutoff of 4 should be used rather than 10, which under-diagnosed patients with HAEC. Alternatively, the new HAEC Risk score could be employed.Level of Evidence
Diagnostic Study, Level 3. 相似文献18.
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19.
Loren Berman Jordan Jackson Kristen Miller Rebecca Kowalski Paul Kolm Francois I. Luks 《Journal of pediatric surgery》2018,53(8):1592-1599
Background
Pediatric surgeons frequently offer prenatal consultation for congenital pulmonary airway malformation (CPAM) and congenital diaphragmatic hernia (CDH); however, there is no evidence-based consensus to guide prenatal decision making and counseling for these conditions. Eliciting feedback from experts is integral to defining best practice regarding prenatal counseling and intervention.Methods
A Delphi consensus process was undertaken using a panel of pediatric surgeons identified as experts in fetal therapy to address current limitations. Areas of discrepancy in the literature on CPAM and CDH were identified and used to generate a list of content and intervention questions. Experts were invited to participate in an online Delphi survey. Items that did not reach first-round consensus were broken down into additional questions, and consensus was achieved in the second round.Results
Fifty-four surgeons (69%) responded to at least one of the two survey rounds. During round one, consensus was reached on 54 of 89 survey questions (61%), and 45 new questions were developed. During round two, consensus was reached on 53 of 60 survey questions (88%).Conclusions
We determined expert consensus to establish guidelines regarding perinatal management of CPAM and CDH. Our results can help educate pediatric surgeons participating in perinatal care of these patients.Level of Evidence
V. 相似文献20.
Li Long Chen Zhen Wei Yandong Dong Ning Li Qi Gao Qing 《Journal of pediatric surgery》2018,53(3):537-539