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1.
Anna E Wright Ruth Wragg Joana Lopes Andrew Robb Liam McCarthy 《Journal of pediatric surgery》2018,53(2):316-320
Aim
Renal tubular dysfunction (RTD) causing obligate production of hypoosmolar urine in boys with posterior urethral valves (PUVs) has been described. It is not known how clinically significant this is. We hypothesize that a feedback loop is present in many PUV boys who suffer deterioration of their lower urinary tract (LUT). RTD results in hypoosmolar urine, obligate polyuria, and bladder stretch-injury. The increasing back-pressure worsens RTD, thus exacerbating the injury. Coexisting renal dysplasia and acquired renal scarring exacerbate this.We compared the concentrating ability (random clinic urine osmolality) of PUV boys who had no LUT deterioration to those who required intervention, examining the confounding effect of renal impairment with a subgroup analysis comparing those with plasma creatinine ≤ 80 μmol/l.Methods
A retrospective review of our PUV database was performed. Age, intervention, and highest recorded random clinic urine osmolality (> 1 year) with concurrent plasma creatinine were recorded (normal urine osmolality 500–850 mOsm/kg). Data are given as median values, analyzed by Mann–Whitney u-test, with P < 0.05 deemed significant.Main results
Urine osmolality was available in 77 boys with PUV out of 125 in our series. Of these, 34 required subsequent intervention (e.g., Mitrofanoff procedure, bladder augmentation). Age at testing trended towards being higher in the intervention group [7.9 (4.3–10.9) years vs. nonintervention 6.3 (4–8.4); P = 0.06]. Urine osmolality was significantly reduced in the intervention group [411(293–547) vs. 631 (441–805) mOsm/kg; P < 0.001]. Subgroup analysis comparing only those with creatinine ≤ 80 μmol/l was respectively 451 (322–567) mOsm/kg (n = 22) vs. 645 (469–810) mOsm/kg (n = 40), P < 0.01.Conclusion
This study confirms that hypoosmolar urine is highly associated with progression of LUT dysfunction, requiring intervention. Even boys with normal creatinine values have a greater risk of LUT deterioration if they have a RTD and produce hypoosmolar urine.Level of evidence
IV (retrospective service development project). 相似文献2.
Cristen N. Litz Jessica B. Asuncion Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(3):449-451
Purpose
Antibiotic administration within one hour prior to incision is a common quality metric; however, antibiotics are typically started at the time of diagnosis in pediatric patients with acute appendicitis. The purpose was to determine if antibiotic administration within one hour prior to incision reduces the incidence of surgical site infections (SSI) in pediatric patients with acute appendicitis started on parenteral antibiotics upon diagnosis.Methods
A retrospective review was performed of 478 patients aged 0–18 years who underwent appendectomy for acute appendicitis from 7/2013 to 4/2015. Patients were categorized based on timing of antibiotic administration; there were 198 patients in Group A (< 60 min before) and 280 in Group B (> 60 min before).Results
Demographics and operative time (A: 30.5 ± 9.9 vs B: 30.8 ± 12.2 min, p = 0.51) were similar. Procedures were performed laparoscopically and the groups had similar proportions of single-incision operations (A: 53% vs B: 55%, p = 0.64). There was no difference in the incidence of superficial SSI (A: 2.0% vs B: 2.1%, p = 1.0) or intraabdominal abscess (A: 4.0% vs B: 3.6%, p = 0.81) and this remained true when stratified by intraoperative classification.Conclusion
Antibiotic administration within one hour of appendectomy in pediatric patients with acute appendicitis who receive antibiotics at diagnosis did not change the incidence of postoperative infectious complications.Type of study
Treatment study.Level of evidence
III. 相似文献3.
Yangyang R. Yu Jennifer L. Carpenter Annalyn S. DeMello Sundeep G. Keswani Darrell L. Cass Oluyinka O. Olutoye Adam M. Vogel James A. Thomas Cole Burgman Caraciolo J. Fernandes Timothy C. Lee 《Journal of pediatric surgery》2018,53(5):1060-1064
Purpose
This study assesses the impact of extracorporeal membrane oxygenation (ECMO) associated morbidities on long-term quality of life (QOL) outcomes.Methods
A single center, retrospective review of neonatal and pediatric non-cardiac ECMO survivors from 1/2005–7/2016 was performed. The 2012 Pediatric Quality of Life Inventory? (PedsQL?) survey was administered. Clinical outcomes and QOL scores between groups were compared.Results
Of 74 patients eligible, 64% (35 NICU, 12 PICU) completed the survey. Mean time since ECMO was 5.5 ± 3 years. ECMO duration for venoarterial (VA) and venovenous (VV) were similar (median 9 vs. 7.5 days, p = 0.09). VA ECMO had higher overall complication rate (64% vs. 36%, p = 0.06) and higher neurologic complication rate (52% vs. 9%, p = 0.002). ECMO mode and ICU type did not impact QOL. However, patients with neurologic complications (n = 15) showed a trend towards lower overall QOL (63/100 ± 20 vs. 74/100 ± 18, p = 0.06) compared to patients without neurologic complications. A subset analysis of patients with ischemic or hemorrhagic intracranial injuries (n = 13) had significantly lower overall QOL (59/100 ± 19 vs. 75/100 ± 18, p = 0.01) compared to patients without intracranial injuries.Conclusion
Neurologic complication following ECMO is common, associated with VA mode, and negatively impacts long-term QOL. Given these associations, when clinically feasible, VV ECMO may be considered as first line ECMO therapy.Type of study
Retrospective review.Level of evidence
II 相似文献4.
Joana Barbosa Sequeira Ana Coelho Ana Sofia Marinho Berta Bonet Fátima Carvalho João Moreira-Pinto 《Journal of pediatric surgery》2018,53(10):2003-2007
Purpose
To evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes.Methods
A retrospective analysis of all patients with chronic sacrococcygeal pilonidal sinus submitted to EPSiT and EPC during a 12-month period in our institution was performed. Data concerning patients' demographics and surgical outcomes were collected and compared between the two groups.Results
We analyzed a total of 21 cases that underwent EPSiT and 63 cases of EPC, both groups with similar demographic characteristics. Operative time was similar for both groups (30 vs. 38 min; p > 0.05). No major intraoperative complications were reported. Wound infection rate was lower for EPSiT ((5.2% [n = 1] vs. 20.0% [n = 12]); p > 0.05). Healing time was similar for both groups (28 vs. 37.5 days). Recurrence occurred in 18,9% (n = 15), with 2 cases (10.5%) reported in the EPSiT group versus 13 (21.6%) in EPC. There were no differences between groups regarding postoperative complications, complete wound healing and recurrence rates or healing time (p > 0.05).Conclusions
Our results suggest that EPSiT is as viable as excision followed by primary closure in the management of sacrococcygeal pilonidal sinus in the pediatric population.Level of evidence
Therapeutic study – level III. 相似文献5.
Background
Hirschsprung-associated enterocolitis (HAEC) represents the primary cause of high morbidity and mortality in Hirschsprung disease (HSCR) patients. The most common surgical methods for HSCR are the Soave and Duhamel procedures. Therefore, we aimed to compare the HAEC frequency following the Soave and Duhamel procedures.Methods
Medical records were retrospectively analyzed for patients who underwent the Soave and Duhamel pull-through at Dr. Sardjito Hospital, Indonesia from 2010 to 2015. The diagnosis of HAEC was determined using a HAEC scoring system.Results
One hundred patients were involved (Soave: 52 males and 19 females vs. Duhamel: 23 males and 6 females, p = 0.62). There was significant difference in mean age at pull-through (Soave: 29.9 ± 45.2 vs. Duhamel: 50.8 ± 47.5 months, p = 0.04), whereas mean age of HSCR diagnosis and pre-operative enterocolitis frequency did not differ significantly between groups (Soave: 25.4 ± 41.0 vs. Duhamel: 43.7 ± 48.1 months, p = 0.06, and Soave: 7% vs. Duhamel: 14%, p = 0.44, respectively). The HAEC frequency after pull-through was significantly higher in the Duhamel than the Soave group (28% vs. 10%, respectively, p = 0.03). Furthermore, pre-operative enterocolitis showed a significant association with HAEC following pull-through (p = 2.0 × 10–4) and the risk of HAEC after Soave pull-through was increased in long-segment aganglionosis compared to short-segment HSCR (p = 0.015).Conclusions
The frequency of HAEC was significantly higher after the Duhamel than the Soave procedure. Moreover, patients with pre-operative enterocolitis are prone to have HAEC following pull-through.Level of evidence
III 相似文献6.
Jamie R. Robinson Nicholas H. Carter Corinne Gibson Adam S. Brinkman Kyle Van Arendonk Karen E. Speck Melissa E. Danko Gretchen P. Jackson Harold N. Lovvorn Martin L. Blakely 《Journal of pediatric surgery》2018,53(6):1181-1186
Purpose
Standardized care via a unified surgeon preference card for pediatric appendectomy can result in significant cost reduction. The purpose of this study was to evaluate the impact of cost and outcome feedback to surgeons on value of care in an environment reluctant to adopt a standardized surgeon preference card.Methods
Prospective observational study comparing operating room (OR) supply costs and patient outcomes for appendectomy in children with 6-month observation periods both before and after intervention. The intervention was real-time feedback of OR supply cost data to individual surgeons via automated dashboards and monthly reports.Results
Two hundred sixteen children underwent laparoscopic appendectomy for non-perforated appendicitis (110 pre-intervention and 106 post-intervention). Median supply cost significantly decreased after intervention: $884 (IQR $705–$1025) to $388 (IQR $182–$776), p < 0.001. No significant change was detected in median OR duration (47 min [IQR 36–63] to 50 min [IQR 38–64], p = 0.520) or adverse events (1 [0.9%] to 6 [4.7%], p = 0.062). OR supply costs for individual surgeons significantly decreased during the intervention period for 6 of 8 surgeons (87.5%).Conclusion
Approaching value measurement with a surgeon-specific (rather than group-wide) approach can reduce OR supply costs while maintaining excellent clinical outcomes.Level of Evidence
Level II. 相似文献7.
Nick Lansdale Nadeem Al-Khafaji Patrick Green Simon E Kenny 《Journal of pediatric surgery》2018,53(3):540-544
Objectives
Determine national outcomes for pyloromyotomy; how these are affected by: (i) surgical approach (open/laparoscopic), or (ii) centre type/volume and establish potential benchmarks of quality.Methods
Hospital Episode Statistics data were analysed for admissions 2002–2011. Data presented as median (IQR).Results
9686 infants underwent pyloromyotomy (83% male). Surgery was performed in 22 specialist (SpCen) and 39 nonspecialist centres (NonSpCen). The proportion treated in SpCen increased linearly by 0.4%/year (r = 0.76, p = 0.01). Annual case volume in SpCen vs. NonSpCen was 40 (24–53) vs. 1 (0–3). Time to surgery was shorter in SpCen (1 day [1, 2] vs. 2 [1–3]), but total stay equal (4 days [3–6]). 137 (1.4%) had complications requiring reoperation (wound problem 0.6%; repeat pyloromyotomy 0.5% and perforation, bleeding or obstruction 0.2%): pooled rates were similar between SpCen and NonSpCen (1.4% vs. 1.6%, p = 0.52). Three NonSpCen had > 5% reoperations (within 99.8% C.I. as small denominators). There was no relationship between reoperation and centre volume. Laparoscopic pyloromyotomy had increased risk of repeat pyloromyotomy (OR 2.28 [1.14–4.57], p = 0.029).Conclusions
Pyloric stenosis surgery shifted from centres local to patients, but outcomes were unaffected by centre type/volume. Modest reported benefits of laparoscopy appear offset by increased reoperations. Quality benchmarks could be set for reoperation < 4%.Type of study
Treatment Study.Level of evidence
Level III. 相似文献8.
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9.
Scott S. Short Stephen J. Fenton Eric R. Scaife Brian T. Bucher 《Journal of pediatric surgery》2018,53(3):545-547
Purpose
Awareness of equestrian related injury remains limited. Studies evaluating children after equestrian injury report under-utilization of safety equipment and rates of operative intervention as high as 33%.Methods
We hypothesized that helmets are underutilized during equestrian activity and lack of use is associated with increased traumatic brain injury. We queried the trauma database of a level one pediatric trauma center for all cases of equestrian and rodeo related injury from 2005 to 2015. Analysis was conducted using SAS 9.4.Results
Of 312 children identified, 142 were assessed for use of a helmet. Only 28 children (19.7%) had documented use of a helmet. Most injuries occurred while riding a horse (83%) or bull (13%) with traumatic brain injury being the most common injury (51%). Helmet use was associated with decreased ISS (7.1 vs. 11.3, p < 0.01), TBI (32.4% vs. 55.3%, p = 0.03), and ICU admission (10.7% vs. 29%, p = 0.05). Multivariable analysis reveals lack of helmet use to be an independent predictor of TBI (OR 2.5, 95% CI 1.1–6.3).Conclusion
Helmets are underutilized by children during equestrian related activity. Increased awareness of TBI and education encouraging helmet use may decrease morbidity associated with equestrian activities.Level of Evidence
Retrospective comparative study, Level III. 相似文献10.
Etienne St-Louis Annie Chabot Hayden Stagg Robert Baird 《Journal of pediatric surgery》2018,53(5):968-972
Background
Subcutaneous endoscopically-assisted ligation (SEAL) for pediatric inguinal hernia repair has gained in popularity although variations in techniques exist. Peritoneal scarring by thermal injury has been described as an adjunct. We explored the hypothesized inverse-correlation between peritoneal scarring and recurrence after SEAL.Methods
We conducted a single-center retrospective review of all patients < 18 years old undergoing SEAL between 2010 and 2016 (REB-20172727). Demographics and outcomes were investigated. Univariate and multivariable logistic regressions were performed to evaluate the association between peritoneal scarring and recurrence.Results
We identified 272 patients. Median age was 3 years, 35% were female, and 19% were born premature. Median follow-up was 30 months, ≥ 1 visit/patient. Bilaterality was noted in 35%. There were no reported cases of metachronous hernia, vas injury, testicular atrophy or chronic pain, and recurrence rate was 4.6%. Prematurity, unilateral repair, incarceration, and suture-type (Ti-Cron® vs. Ethibond®) had significant correlation with recurrence on univariate analysis (p < 0.25). Surgeon experience did not. Peritoneal scarring, performed in 195 cases (72%), was not predictive of recurrence (adjusted OR = 0.87, p = 0.830) on multivariable analysis.Conclusion
The rate of complications with SEAL compares favorably to published data. Thermal injury was not associated with improved recurrence rates. The benefits of peritoneal scarring may not outweigh the risks.Level of Evidence
III – Retrospective Case–Control Study. 相似文献11.
David I. Chu Jonathan M. Tan Peter Mattei Allan F. Simpao Andrew T. Costarino Aseem R. Shukla Joseph W. Rossano Gregory E. Tasian 《Journal of pediatric surgery》2018,53(10):1980-1988
Background
Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD.Methods
We performed a retrospective cohort study using the 2013–2015 National Surgical Quality Improvement Project-Pediatrics. We matched 45,012 children < 18 years old who underwent laparoscopic surgery to 45,012 children who underwent open surgery. We determined the associations between laparoscopic (versus open) surgery and 30-day mortality, in-hospital mortality, 30-day morbidity, and postoperative length-of-stay.Results
Among children with minor CHD, laparoscopic surgery was associated with lower 30-day mortality (Odds Ratio [OR] 0.34 [95% Confidence Interval 0.15–0.79]), inhospital mortality (OR 0.42 [0.22–0.81]) and 30-day morbidity (OR 0.61 [0.50–0.73]). As CHD severity increased, this benefit of laparoscopic surgery decreased for 30-day morbidity (ptrend = 0.01) and in-hospital mortality (ptrend = 0.05), but not for 30-day mortality (ptrend = 0.27). Length-of-stay was shorter for laparoscopic approaches for children at cost of higher readmissions. On subgroup analysis, laparoscopy was associated with lower odds of postoperative blood transfusion in all children.Conclusions
Intraabdominal laparoscopic surgery compared to open surgery is associated with decreased morbidity in patients with no CHD and lower morbidity and mortality in patients with minor CHD, but not in those with more severe CHD.Level-of-evidence
Level III: Treatment Study. 相似文献12.
Guillermo J. Ares Irene Helenowski Catherine J. Hunter Marybeth Madonna Marleta Reynolds Timothy Lautz 《Journal of pediatric surgery》2018,53(4):704-707
Background
The utility of mechanical bowel preparation (MBP) to minimize infectious complications in elective colorectal surgery is contentious. Though data is scarce in children, adult studies suggest a benefit to MBP when administered with oral antibiotics (OAB).Methods
After IRB approval, the Pediatric Health Information System (PHIS) was queried for young children undergoing elective colon surgery from 2011 to 2014. Patients were divided into: no bowel preparation (Group 1), MBP (Group 2), and MBP plus OAB (Group 3). Statistical significance was determined using univariate and multivariate analysis with GEE models accounting for clustering by hospital.Results
One thousand five hundred eighty-one patients met study criteria: 63.7% in Group 1, 27.1% in Group 2, and 9.2% in Group 3. Surgical complication rate was higher in Group 1 (23.3%) compared to Groups 2 and 3 (14.2% and 15.5%; P < 0.001). However, median length of stay was shorter in Group 1 (4, IQR 4 days) compared to Group 2 (5, IQR 3) and Group 3 (6, IQR 3) (P < 0.001). 30-day readmission rates were similar. In multivariate analysis compared to patients in Group 1, the odds of surgical complications were 0.72 (95% CI 0.40–1.29, P = 0.28) with MBP alone (Group 2), 1.79 (95% CI 1.28–2.52, P = 0.0008) with MBP + OAB (Group 3), and 1.13 (95% CI 0.81–1.58, P = 0.46) for the aggregate Group 2 plus 3.Conclusion
Utilization of bowel preparation in children is variable across children's hospitals nationally, and the benefit is unclear. Given the discrepancy with adult literature, a three-armed pediatric-specific randomized controlled trial is warranted.Level of evidence
Level III treatment study – retrospective comparative study. 相似文献13.
Brenna S. Fullerton Charles R. Hong Cristine S. Velazco Charles E. Mercier Kate A. Morrow Erika M. Edwards Karla R. Ferrelli Roger F. Soll Biren P. Modi Jeffrey D. Horbar Tom Jaksic 《Journal of pediatric surgery》2018,53(1):101-107
Purpose
This study characterizes neurodevelopmental outcomes and healthcare needs of extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to ELBW infants without NEC.Methods
Data were collected prospectively on neonates born 22–27 weeks’ gestation or 401–1000 g at 47 Vermont Oxford Network member centers from 1999 to 2012. Detailed neurodevelopmental evaluations were conducted at 18–24 months corrected age. Information regarding rehospitalizations, postdischarge surgeries, and feeding was also collected. “Severe neurodevelopmental disability” was defined as: bilateral blindness, hearing impairment requiring amplification, inability to walk 10 steps with support, cerebral palsy, and/or Bayley Mental or Psychomotor Developmental Index < 70. Diagnosis of NEC required both clinical and radiographic findings.Results
There were 9063 children without NEC, 417 with medical NEC, and 449 with surgical NEC evaluated. Significantly higher rates of morbidity were observed among infants with a history of NEC. Those with surgical NEC were more frequently affected across all outcome measures at 18–24 months corrected age: 38% demonstrated severe neurodevelopmental disability, nearly half underwent postdischarge operations, and a quarter required tube feeding at home.Conclusion
At 18–24 months, extremely low birth weight survivors of necrotizing enterocolitis were at markedly increased risk (p < 0.001) for severe neurodevelopmental disability, postdischarge surgery, and tube feeding.Level of evidence
II (prospective cohort study with < 80% follow-up rate). 相似文献14.
Matthew C. Hernandez Ryan M. Antiel Karthik Balakrishnan Martin D. Zielinski Denise B. Klinkner 《Journal of pediatric surgery》2018,53(2):352-356
Introduction
Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM).Methods
We reviewed pediatric multisystem trauma patients (2005–2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS).Results
Ninety patients were included (SGA, n = 17 and BVM, n = 73). SGA patients displayed increased median head AIS (5 [4–5] vs 2 [0–4], p = 0.001) and facial AIS (1 [0–2] vs 0 [0–0], p = 0.03). SGA indications were multiple failed intubation attempts (n = 12) and multiple failed attempts with poor visualization (n = 5). Median intubation attempts were 2 [1–3] whereas BVM patients had none. Compared to BVM, SGA patients demonstrated inadequate oxygenation/ventilation (75% vs 41%), increased tracheostomy rates (31% vs 8.1%), and increased 24-h (38% vs 10.8%) and overall mortality (75% vs 14%) (all p < 0.05).Conclusions
Escalating intubation attempts and severe facial AIS were associated with tracheostomy. Inadequacy of oxygenation/ventilation was more frequent in SGA compared to BVM patients. SGA patients demonstrate poor clinical outcomes; however, SGAs may be necessary in increased craniofacial injury patterns. These factors may be incorporated into a management algorithm to improve definitive airway management after SGA. 相似文献15.
Abdullah Alshehri Kourosh Afshar Julie Bedford Graeme Hintz Erik D Skarsgard 《Journal of pediatric surgery》2018,53(5):1046-1051
Introduction
Anthropometric measurements can be used to define pediatric malnutrition. Our study aims to: (1) characterize the preoperative nutritional status of children undergoing abdominal or thoracic surgery, and (2) describe the associations between WHO-defined acute (stunting) and chronic (wasting) undernutrition (Z-scores <?2) and obesity (BMI Z-scores > + 2) with 30-day postoperative outcomes.Methods
We queried the Pediatric NSQIP Participant Use File and extracted data on patients’ age 29 days to 18 years who underwent abdominal or thoracic procedures. Normalized anthropometric measures were calculated, including weight-for-height for < 2 years, BMI for ages ≥ 2 years, and height for age. Logistic regression models were developed to assess nutritional outlier status as an independent predictor of postoperative outcome.Results
23,714 children (88% ≥ 2y) were evaluated. 4272 (18%) were obese, while 2640 (11.1%) and 904 (3.8%) were stunted and wasted, respectively, after controlling for gender, ASA/procedure/wound classification, preoperative steroid use, need for preoperative nutritional support, and obese children had higher odds of SSIs (OR 1.29, 95% CI 1.1–1.5, p = 0.001), while stunted children were at increased risk of any 30-day postoperative complication (OR 1.16, 95% CI 1.0–1.3, p = 0.036).Conclusion
Children who are stunted or obese are at increased risk of adverse outcome after abdominal or thoracic surgery.Level of Evidence
III 相似文献16.
William C. Kethman Chad M. Thorson Tiffany J. Sinclair William E. Berquist Stephanie D. Chao James K. Wall 《Journal of pediatric surgery》2018,53(8):1532-1536
Background
Achalasia is a primary esophageal motility disorder characterized by aperistalsis of the esophagus and failed relaxation of the lower esophageal sphincter that presents rarely in childhood. The peroral endoscopic myotomy (POEM) procedure is an emerging treatment for achalasia in adults that has recently been introduced into pediatric surgical practice.Methods
This is a prospective case series of all children referred to Stanford University Lucile Packard Children's Hospital with manometry-confirmed achalasia who underwent a POEM procedure from 2014 to 2016.Results
We enrolled 10 subjects ranging in age from 7 to 17 years (M = 13.4). The mean pre- and 1-month post-procedure Eckardt scores were 7 (SD = 2.5) and 2.4 (SD = 2) (p < 0.001), respectively. The median procedure time for the entire cohort was 142 min (range 60–259 min) with ongoing improvement with increased experience (R2 = 0.6, p = 0.008). There were no major adverse events.Conclusion
The POEM procedure can be successfully completed in children for the treatment of achalasia with demonstrated short-term post-operative improvement in symptoms. The adoption of advanced endoscopic techniques by pediatric surgeons may enable development of unique intraluminal approaches to congenital anomalies and other childhood diseases.Level of evidence
Treatment Study – Level IV 相似文献17.
Michael Joseph Emma C. Hamilton Andrea Hayes-Jordan Winston W. Huh Mary T. Austin 《Journal of pediatric surgery》2018,53(1):169-173
Purpose
The purpose of this study was to determine whether racial/ethnic disparities exist in disease presentation, treatment, and survival among children and adolescents with extremity sarcoma.Methods
The Surveillance, Epidemiology, and End Results (SEER) data were analyzed for patients < 20 years old with soft-tissue extremity sarcomas from 1973 to 2013. Multivariate logistic regression was performed to determine the association between race/ethnicity and disease stage at presentation and likelihood of surgical resection. Overall survival (OS) was evaluated using hazard ratios with 95% confidence intervals.Results
1261 cases were identified: 650 (52%) non-Hispanic whites (NHW), 313 (25%) Hispanics, 182 (14%) non-Hispanic blacks (NHB), and 116 (9%) other race/ethnicity. Logistic regression results showed that Hispanics and NHB were 51% and 44%, respectively, less likely to undergo surgical resection compared to NHW (OR = 0.49, 95% CI: 0.30–0.80; OR = 0.56, 95% CI: 0.32–0.98, respectively). Factors associated with failure to undergo surgical resection included histology, lower extremity site, tumor size, and distant metastases. OS based on race/ethnicity significantly differed using the log-rank test, with NHB having the worst survival (p < 0.05).Conclusions
We conclude that NHB, Hispanics, and other race/ethnicity were less likely to undergo surgical resection for extremity sarcoma. Further work is needed to better characterize and eliminate disparities in the management and outcomes of children with extremity sarcomas.Type of study
Prognosis study.Level of evidence
IV 相似文献18.
Suna Sun Weihua Pan Wenjie Wu Yiming Gong Jia Shi Jun Wang 《Journal of pediatric surgery》2018,53(8):1584-1587
Objectives
The treatment of long gap esophageal atresia (LGEA) is one of the most challenging congenital malformations in neonatal surgery. A preoperative bougienage stretching technique for elongation of the two segments of esophagus is applied to achieve utilizing the native esophagus to establish esophageal continuity by open or thoracoscopic approach.Methods
From January 2015 to May 2017, 12 neonates who suffered from LGEA were admitted to our department. They were divided into 2 groups (A and B) according to their admission time. They all accepted bougienage stretching technique before esophageal anastomosis.Results
Initially the lengths of esophageal gap in 12 infants ranged from 4 to 7.5 vertebral bodies (M = 5.8 ± 1.1). The gap lengths became –1 to 2.5 vertebral bodies after bougienage stretching technique and tension-free anastomosis were performed successfully for all 12 cases: Group A (n = 5) by thoracotomy and group B (n = 7) by thoracoscopic approach. 12 cases have been followed up for 1–25 months (M = 12.4 ± 8.5) after definitive surgery.Conclusions
Bougienage stretching technique for LGEA is feasible with satisfactory clinical results. Thoracoscopic approach is a good choice for primary anastomosis in LGEA.Levels of evidence
Treatment Study Level IV 相似文献19.
Caroline Maloney Michelle Kallis Ibrahim Abd El-Shafy Aaron M. Lipskar John Hagen Michelle Kars 《Journal of pediatric surgery》2018,53(3):431-436
Introduction
Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic single-incision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge.Methods
We retrospectively reviewed 275 children, ages 4 to 17 years old, who underwent TULA for uncomplicated appendicitis in a single institution from August 2014 to July 2015. We compared those that received preincision bilateral RSB (n = 136) with those who received LAI (n = 139). The primary outcome was narcotic administration. Secondary outcomes included initial and mean scores, time from anesthesia induction to release, operative time, time to rescue dose of analgesic in the PACU and time to PACU discharge.Results
Total narcotic administration was significantly reduced in patients that underwent preincision RSB compared to those that received conventional LAI, with a mean of 0.112 mg/kg of morphine versus 0.290 mg/kg morphine (p < 0.0001). Patients undergoing RSB reported lower initial (0.38 vs. 2.38; p < 0.0001) and mean pain scores (1.26 vs. 1.77; p < 0.015). Time to rescue analgesia was prolonged in patients undergoing RSB compared to LAI (58.93 min vs. 41.56 min; p = 0.047).Conclusion
Preincision RSB for TULA in uncomplicated appendicitis in children is associated with decreased opioid consumption and lower pain scores compared with LAI. As the addition of this procedure only added 6.67 min to time under anesthesia, we feel that it is a viable option for postoperative pain control in pediatric single-incision laparoscopic surgery.Retrospective comparative study
LEVEL III EVIDENCE. 相似文献20.
Gastrointestinal mucosal development and injury in premature lambs supported by the artificial placenta 总被引：1，自引：0，他引：1
Jennifer S. McLeod Joseph T. Church Prathusha Yerramilli Megan A. Coughlin Elena M. Perkins Raja Rabah Robert H. Bartlett Alvaro Rojas-Pena Joel K. Greenson Erin E. Perrone George B. Mychaliska 《Journal of pediatric surgery》2018,53(6):1240-1245