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1.
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2.
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3.
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4.
Jason O. Robertson Cory N. Criss Lily B. Hsieh Niki Matsuko Josh S. Gish Rodrigo A. Mon Kevin N. Johnson Ronald B. Hirschl George B. Mychaliska Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(4):629-634
Purpose
For the last seven years, our institution has repaired infants with CDH that require ECMO early after cannulation. Prior to that, we attempted to decannulate before repair, but repaired on ECMO if we were unable to wean after two weeks. This study compares those strategies.Methods
From 2002 to 2016, 65 infants with CDH required ECMO. 67.7% were repaired on ECMO, and 27.7% were repaired after decannulation. Data were compared between patients repaired ≤ 5 days after cannulation (“early protocol”, n = 30) and > 5 days after cannulation or after de-cannulation (“late protocol”, n = 35). We used Cox regression to assess differences in outcomes between groups.Results
Survival for the early and late protocol groups was 43.3% and 68.8%, respectively (p = 0.0485). For patients that were successfully decannulated before repair, survival was 94.4%. Moreover, the early repair protocol was associated with prolongation of ECMO (16.8 ± 7.4 vs. 12.6 ± 6.8 days, p = 0.0216).After multivariate regression, the early repair protocol was an independent predictor of both mortality (HR = 3.48, 95% CI = 1.28–9.45, p = 0.015) and days on ECMO (IRR = 1.39, 95% CI = 1.07–1.79, p = 0.012). All bleeding occurred in patients repaired on ECMO (29.5%, 13/44).Conclusions
Our data suggest that protocolized CDH repair early after ECMO cannulation may be associated with increased mortality and prolongation of ECMO. However, early repair is not necessarily harmful for those patients who would otherwise be unable to wean from ECMO before repair. Further work is needed to better move towards individualized patient care.Type of study
Treatment Study.Level of evidence
Level III. 相似文献5.
Keisuke Suzuki Makoto Komura Kan Terawaki Tetsuro Kodaka Takumi Gohara Hiroko Komura Yasuhide Nakayama 《Journal of pediatric surgery》2018,53(2):330-334
Background
Prosthetic patches can be used to repair large congenital diaphragmatic hernia defects but may be associated with infection, recurrence, and thoracic deformity. Biosheets (collagenous connective tissue membranes) have been used in regenerative medicine. We evaluated the efficacy of Biosheets in a rabbit model.Methods
Biosheets were prepared by embedding silicone plates in dorsal subcutaneous pouches of rabbits for 4 weeks. In group 1 (n = 11), Gore-Tex® sheets (1.8 × 1.8 cm) were implanted into a diaphragmatic defect. In group 2 (n = 11), Seamdura®, a bioabsorbable artificial dural substitute, was implanted in the same manner. In group 3 (n = 14), biosheets were autologously transplanted into the diaphragmatic defects. All rabbits were euthanized 3 months after transplantation to evaluate their graft status.Results
Herniation of liver was observed in 5 rabbits (45%) in group 1, 8 (73%) in group 2, and 3 (21%) in group 3. A significant difference was noted between groups 2 and 3 (P = 0.017). Biosheets had equivalent burst strength and modulus of elasticity as native diaphragm. Muscular tissue regeneration in transplanted biosheets in group 3 was confirmed histologically.Conclusion
Biosheets may be applied to diaphragmatic repair and replacement of diaphragmatic muscular tissue.Level of evidence
Level III. 相似文献6.
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7.
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8.
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9.
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10.
James K. Wall Tiffany J. Sinclair William Kethman Christina Williams Craig Albanese Karl G. Sylvester Matias Bruzoni 《Journal of pediatric surgery》2018,53(3):503-507
Background
Minimal access surgery (MAS) has gained popularity in infants less than 5 kg, however, significant challenges still arise in very low weight infants.Study design
A retrospective chart review was performed to identify all infants weighing less than 3 kg who underwent an advanced MAS or equivalent open procedure from 2009 to 2016. Advanced case types included Nissen fundoplication, duodenal atresia repair, Ladd procedure, congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, diaphragmatic plication, and pyloric atresia repair. A comparative analysis was performed between the MAS and open cohorts.Results
A total of 45 advanced MAS cases and 17 open cases met the inclusion criteria. Gestational age and age at operation were similar between the cohorts, while infants who underwent open procedures had significantly lower weight at operation (p = 0.003). There were no deaths within 30 days related to surgery in either group. Only 3 MAS cases required unintended conversion to open. There were 2 (4.4%) postoperative complications related to surgery in the MAS cohort and 2 (11.8%) in the open cohort.Conclusion
Advanced MAS may be performed in infants weighing less than 3 kg with low mortality, acceptable rates of conversion, and similar rates of complications as open procedures.Type of study
Prognosis study.Level of evidence
Level III. 相似文献11.
Joseph T. Church Nicole L. Werner Meghan A. Coughlin Julia Menzel-Smith Mary Najjar Benjamin D. Carr Hemant Parmar Jeff Neil Dimitrios Alexopoulos Carlos Perez-Torres Xia Ge Scott C. Beeman Joel R. Garbow George B. Mychaliska 《Journal of pediatric surgery》2018,53(6):1234-1239
Purpose
We evaluated whether brain development continues and brain injury is prevented during Artificial Placenta (AP) support utilizing extracorporeal life support (ECLS).Methods
Lambs at EGA 118 days (term = 145; n = 4) were placed on AP support (venovenous ECLS with jugular drainage and umbilical vein reinfusion) for 7 days and sacrificed. Early (EGA 118; n = 4) and late (EGA 127; n = 4) mechanical ventilation (MV) lambs underwent conventional MV for up to 48 h and were sacrificed, and early (n = 5) and late (n = 5) tissue control (TC) lambs were sacrificed at delivery. Brains were harvested, formalin-fixed, rehydrated, and studied by magnetic resonance imaging (MRI). The gyrification index (GI), a measure of cerebral folding complexity, was calculated for each brain. Diffusion-weighted imaging was used to determine fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in multiple structures to assess white matter (WM) integrity.Results
No intracranial hemorrhage was observed. GI was similar between AP and TC groups. ADC and FA did not differ between AP and late TC groups in any structure. Compared to late MV brains, AP brains demonstrated significantly higher ADC (0.45 ± 0.08 vs. 0.27 ± 0.11, p = 0.02) and FA (0.61 ± 0.04 vs. 0.44 ± 0.05; p = 0.006) in the cerebral peduncles.Conclusions
After 7 days of AP support, WM integrity is preserved relative to mechanical ventilation.Type of study
Research study. 相似文献12.
Kohei Otake Keiichi Uchida Michiko Kubo Akira Yamamoto Yuka Nagano Ryo Uratani Kiyoshi Hashimoto Kohei Matsushita Mikihiro Inoue Hirofumi Sawada Masato Kusunoki 《Journal of pediatric surgery》2018,53(3):499-502
Background/purpose
The purpose of this study was to explore clinical characteristics and primary surgical diagnoses associated with in-hospital death in pediatric surgical patients admitted to the neonatal intensive care unit (NICU) of a tertiary hospital.Methods
This retrospective study includes all patients admitted to our NICU for pediatric surgical diseases between January 2001 and December 2015. Univariate and multivariate binary logistic regression were performed to assess independent factors associated with in-hospital death.Results
A total of 440 cases were included and 334 (83.5%) patients underwent one or more surgeries. Thirty six patients (8.2%) died while hospitalized in the NICU. The 5 most common surgical diagnoses were intestinal atresia/stenosis, anorectal malformation, congenital diaphragmatic hernia (CDH), esophageal atresia, and urinary system disorder. Necrotizing enterocolitis (NEC) had the highest mortality rate. Using logistic regression, in-hospital death was predicted by extremely low birth weight (ELBW) (odds ratio (OR) = 6.594; P = 0.006), CDH (OR = 13.954; P < 0.001), and NEC (OR = 8.991; P = 0.049).Conclusions
This study describes CDH, NEC, and ELBW are independent predictive factors associated with in-hospital death of pediatric surgical patients in our NICU. Novel approaches for those conditions are required to improve the survival.Type of study
PrognosticLevels of evidence
II. 相似文献13.
Steven S. Rothenberg 《Journal of pediatric surgery》2018,53(1):121-125
Purpose
This study evaluates the results of thoracoscopic management of complex, non-type C, EA and TEF in infants.Methods
From March 2000 to February 2017, 23 patients were treated for Type A N = 13, Type B N = 4, and Type E N = 6. Patients diagnosed with EA had G-tube feeds for a period of 4–9 weeks. All procedures were performed thoracoscopically. EA gaps were between 4 and 7 1/2 vertebral bodies.Results
All surgeries were completed thoracoscopically. Average operative time was 95 min for Type A, 115 min for Type B, and 50 min for Type E. Two patients with long gaps had small leaks which resolved with conservative management. One patient with an H-type was re-intubated causing a partial disruption of the tracheal repair. This required thoracoscopic re-exploration with repair and placement of an intercostal muscle flap. No patient has any clinical evidence of fused ribs, chest wall asymmetry, shoulder girdle weakness, or winged scapula.Conclusion
Thoracoscopic repair of complex EA and TEF is safe and effective. The excellent visualization of the thoracic inlet allows for extensive mobilization creating sufficient length for long gaps and safely managing high fistulas. This may limit injury to adjacent structures and avoid a neck incision and chest wall deformity.Level of evidence
IV. 相似文献14.
Tamer E. Helmy Wael Ghanem Hesham Orban Helmy Omar Mahmoud El-Kenawy Ashraf T. Hafez Mohammed Dawaba 《Journal of pediatric surgery》2018,53(8):1461-1463
Objective
To detect whether grafting the incised plate during Snodgrass repair would improve outcome.Materials and methods
Sixty patients with primary distal hypospadias were included. Patients were equally randomized using closed envelop method to either Snodgrass or grafted tubularized incised plate repair (GTIP). All operations were performed by a single surgeon. All intaroperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum.Results
All 60 patients were evaluated at 1 year of follow-up. Mean age at surgery was 40 ± 15 months. Both groups were comparable as regard to patients' age, meatus location, length and width and depth of urethral plate and glans width. Success was documented in 29/30 patients (96.7%) in the Snodgrass group. The only complication was meatal stenosis in one patient, whereas success was documented in 28/30 patients (93.3%) in the GTIP group. The two failures were secondary to partial glans dehiscence. Success rate was not statistically different. Flow rate data at 1 year showed insignificant difference between both groups as regards Q-max and voiding time. The only statistically significant difference between both groups was a longer operative time 106 ± 12 min in the GTIP group compared to only 77 ± 9 for the Snodgrass group (p = 0.005).Conclusions
Snodgrass and GTIP techniques for primary distal hypospadias repair have similar outcome. With a significantly shorter operative time, Snodgrass repair remains the first choice for primary distal hypospadias repair.Type of the study
Prospective randomized study.Level of evidence
Level I. 相似文献15.
Robert J. Obermeyer Nina S. Cohen Sheema Gaffar Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson 《Journal of pediatric surgery》2018,53(6):1226-1229
Background/Purpose
Our previously published data suggested several risk factors for infection after the Nuss procedure. We aimed to further elucidate these findings.Methods
An IRB-approved (14–03-WC-0034), single institution, retrospective review was performed to evaluate the incidence of postoperative Nuss bar infections associated with seven variables. These were subjected to bivariate and multivariable analyses. A broad definition of infection was used including cellulitis, superficial infection with drainage, or deep infection occurring at any time postoperatively.Results
Over 7 years (4/1/2009–7/31/2016), 25 (3.2%) of 781 patients developed a postoperative infection after primary Nuss repair. Multivariable analyses demonstrated an increased risk of infection with perioperative clindamycin versus cefazolin for all infections (AOR 3.72, p = .017), and specifically deep infections (AOR 5.72, p = .004). The risk of a superficial infection was increased when antibiotic infusion completed > 60 min prior to incision (AOR 10.4, p = .044) and with the use of peri-incisional subcutaneous catheters (OR 8.98, p = .008).Conclusion
Following primary Nuss repair, the rate of deep bar infection increased with the use of perioperative clindamycin rather than cefazolin. The rate of superficial infection increased when perioperative antibiotic infusion was completed more than 60 min prior to incision and with the use of peri-incisional subcutaneous catheters. Further studies are needed to better understand these findings.Type of study
Retrospective chart review.Level of evidence
Level III treatment study. 相似文献16.
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17.
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
Background
An Artificial Placenta (AP) utilizing extracorporeal life support (ECLS) could revolutionize care of extremely premature newborns, but its effects on gastrointestinal morphology and injury need investigation.Methods
Lambs (116–121 days GA, term = 145; n = 5) were delivered by C-section, cannulated for ECLS, had total parenteral nutrition (TPN) provided, and were supported for 7 days before euthanasia. Early and Late Tissue Controls (ETC, n = 5 and LTC, n = 5) delivered at 115–121 days and 125–131 days, respectively, were immediately sacrificed. Standardized jejunal samples were formalin-fixed for histology. Crypt depth (CD), villus height (VH), and VH:CD ratios were measured. Measurements also included enterocyte proliferation (Ki-67), Paneth cell count (Lysozyme), and injury scores (H&E). ANOVA and Chi Square were used with p < 0.05 considered significant.Results
CD, VH, and VH:CD were similar between groups (p > 0.05). AP demonstrated more enterocyte proliferation (95.7 ± 21.8) than ETC (49.4 ± 23.4; p = 0.003) and LTC (66.1 + 11.8; p = 0.04), and more Paneth cells (81.7 ± 17.5) than ETC (41.6 ± 7.0; p = 0.0005) and LTC (40.7 ± 8.2, p = 0.0004). Presence of epithelial injury and congestion in the bowel of all groups were not statistically different. No villus atrophy or inflammation was present in any group.Conclusions
This suggests preserved small bowel mucosal architecture, high cellular turnover, and minimal evidence of injury.Study type
Research paper/therapeutic potential.Level of evidence
N/A 相似文献18.
Priya H. Dedhia Yasmine White Jonathan R. Dillman Jeremy Adler Marcus D. Jarboe Daniel H. Teitelbaum Ronald B. Hirschl Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(3):477-482
Background and objectives
Sarcopenia, defined as reduced muscle mass, is typically assessed by CT scans, which are infrequently performed in children. Using MRI to measure sarcopenia, we determined the association with postoperative complications after colectomy for ulcerative colitis (UC).Methods
Clinical and preoperative MRI data for 13–18-year-old UC patients who underwent colectomy were retrospectively reviewed. Bilateral paraspinous muscle area (PSMA) and psoas muscle area (PMA) at L3 vertebra were measured and averaged. Composite complications were infection, wound dehiscence, postoperative leak/abscess, prolonged ileus, pulmonary embolism, venous thromboembolism, or readmission.Results
Twenty-nine patients with average age 15.9 ± 1.36 years and weight 61.5 ± 19.8 kg had a preoperative MRI. The 18/29(62%) with complications had significantly reduced PSMA (4.71 ± 1.44 vs 5.64 ± 1.38 cm2, p = 0.04) and PMA (7.16 ± 2.60 vs 8.93 ± 2.44, p = 0.04). When stratified and compared to highest PSMA, patients with lowest PSMA had increased complication rates (88% vs 29%, p = 0.04). There were no differences in age, BMI, albumin, CRP, ESR, or preoperative steroid or anti-TNFα use. Odds of complication in the lowest tertile were 25.0-fold higher than the highest tertile (p = 0.04, 95% CI = 1.2–520.73).Conclusion
This is the first study to show low PSMA on MRI is associated with complications and increased hospital stay after colectomy in children with UC.Levels of evidence
Level III retrospective comparative study. 相似文献19.
Luciano A. Favorito Kleber M. Anderson Suelen F. Costa Waldemar S. Costa Francisco JB Sampaio 《Journal of pediatric surgery》2018,53(4):780-783
Objective
To analyze the structure of the cremaster in patients with retractile testis (RT), comparing the distribution of nerves, elastic system and muscles with patients having cryptorchidism and inguinal hernia (IH).Patients and methods
We studied 31 patients, 17 with RT (mean age = 5.17years); 9 with IH (mean age = 2.6) and 5 with cryptorchidism (mean age = 3). A cremaster biopsy was performed and submitted to routine histological processing and studied using histochemistry and immunohistochemistry. The samples were photographed under an Olympus BX51 microscope. The images were processed with the Image J software and the cremaster muscle structures were quantified. Means were compared statistically using ANOVA and the unpaired t-test (p < 0.05).Results
There were no differences (p = 0.08) in diameter of muscle fiber between the groups. The muscle fiber density differed between patients with RT and IH (p = 0.02): RT (mean = 17.71%, SD = 16.67), IH (mean = 38.06%, SD = 14) and cryptorchidism (mean = 21.47%, SD = 16.18). There was no difference (p = 0.07) in the density of elastic fibers in the three groups. We observed a lower concentration of cremaster nerves of patients with RT compared with IH (p = 0.0362): RT (mean = 1.72%, SD = 0.58), IH (mean = 3.28% SD = 0.94) and cryptorchidism (mean = 2.52%, SD = 0.53).Conclusions
Retractile testis is not a normal variant, and presented a similar cremaster muscle structure as in patients with cryptorchidism.Level of evidence
II; prospective comparative study. 相似文献20.
David L. Sigalet Viona Lam Mary Brindle Dana Boctor Laurie Wallace Elaine de Heuval Bollette Hartmann Jens J. Holst 《Journal of pediatric surgery》2018,53(5):898-904