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1.
William Bonadio Syeda Shahid Lior Vardi Carly Buckingham Allison Kornblatt Chloe Free Peter Homel 《Journal of pediatric surgery》2018,53(3):441-445
Importance
Appendicitis is a common, potentially serious pediatric disease. An important factor in determining management strategy [whether/when to perform appendectomy, duration of antibiotic therapy/hospitalization, etc.] and predicting outcome is distinguishing whether perforation is present.Objective
The objective was to determine efficacy of commonly assessed pre-operative variables in stratifying perforation risk in children with appendicitis.Design
A retrospective analysis of consecutive cases was performed.Setting
The setting was a large urban hospital pediatric emergency department.Participants
Four hundred forty-eight consecutive cases of CT [computerized tomography]-confirmed pediatric appendicitis during a 6-year period in an urban pediatric ED [emergency department]: 162 with perforation and 286 non-perforated.Main outcome(s) and measure(s)
To determine efficacy of clinical and laboratory variables with distinguishing perforation outcome in children with appendicitis.Results
Regression analysis identified 3 independently significant variables associated with perforation outcome – and determined their ideal threshold values: duration of symptoms > 1 day; ED-measured fever [body temperature > 38.0 °C]; CBC WBC absolute neutrophil count > 13,000/mm3. The resulting multivariate ROC [receiver operating characteristic] curve after applying these threshold values gave an AUC [area under curve] of 89% for perforation outcome [p < 0.001]. Risk for perforation was additive with each additional predictive variable exceeding its threshold value, linearly increasing from 7% with no variable present to 85% when all 3 variables are present.Conclusions
A pre-operative scoring system comprised of 3 commonly assessed clinical/laboratory variables is useful in stratifying perforation risk in children with appendicitis.Physicians can utilize these factors to gauge pre-operative risk for perforation in children with appendicitis, which can potentially aid in planning subsequent management strategy.Level of evidence
III. 相似文献2.
Yasmine Yousef Fouad Youssef Michael Homsy Trish Dinh Hayden Stagg Robin Petroze Robert Baird Jean-Martin Larberge Dan Poenaru Pramod Puligandla Kenneth Shaw Sherif Emil 《Journal of pediatric surgery》2018,53(5):991-995
Background
Total parenteral nutrition (TPN) is often used in children with perforated appendicitis, despite the absence of clear indications. We assessed the validity of specific clinical indications for initiation of TPN in this patient cohort.Methods
Data were gathered prospectively on duration of nil per os (NPO) status and TPN use in a cohort of children treated under a perforated appendicitis protocol during a 19-month period. TPN was started in the immediate postoperative period in patients who had generalized peritonitis and severe intestinal dilatation at operation, or later per the discretion of the attending surgeon. At discharge, TPN was considered to have been used appropriately, according to consensus guidelines, if the patient was NPO ≥ 7 days or received TPN ≥ 5 days.Results
During the study period, TPN was initiated in 31 (25.4%) of 122 patients operated for perforated appendicitis. Sixteen (51.6%) received TPN per operative finding indications and 15 (48.4%) for prolonged ileus. The operative indications demonstrated 47% sensitivity, 86% specificity, a positive predictive value (PPV) of 35%, and a negative predictive value (NPV) of 91%, when adherence to TPN consensus guidelines was considered the gold standard.Conclusion
Patients without severe intestinal dilatation and generalized peritonitis at operation should not be placed on TPN in the immediate postoperative period. Refinement of selection criteria is necessary to further decrease inappropriate TPN use in children with perforated appendicitis.Type of study
Diagnostic Test.Level of study
II 相似文献3.
Sona Sehgal Anthony D. Sandler A Alfred Chahine Parvati Mohan Clarivet Torres 《Journal of pediatric surgery》2018,53(10):1989-1995
Introduction
Despite medical and surgical management, a subset of children with short bowel syndrome (SBS) who have discrepancy between proximal small bowel and distal colon have persistent feeding intolerance. We propose the use of an Ostomy in Continuity (OIC) (Bishop-Koop or Santulli) as a salvage procedure to decompress the proximal bowel while still maintaining maximal intestinal length, in these patients.Methods
A retrospective chart review of 104 SBS patients identified sixteen patients who underwent an OIC. Measures of reliance on parenteral nutrition (PN), growth, intestinal failure associated liver disease, the rate of central venous catheter infections and enterocolitis were collected. These parameters were compared before and after the placement of OIC in the same patients at a median follow-up period of 24 months (range 3–52 months). Outcome measures include intestinal autonomy and survival without intestinal and liver transplant.Results
All 16 patients showed significant improvement in their enteral tolerance after OIC. The mean PN caloric requirement decreased from 95% to 21% (p = 0.0001). The median weight Z score improved from ? 1.18 to 0.20 (p = 0.0006) and the median height Z score improved from ? 2.74 to ? 1 (p = 0.0001). The mean conjugated bilirubin decreased from 10.3 mg/dl to 0.3 mg/dl (p = 0.0001) in nine patients with hyperbilirubinemia. There was no decrease in central venous catheter infections (CVCI) but there was a decrease in the rate of enterocolitis. None of the patients required intestinal or liver transplant. There was one minor skin excoriation complication in one patient with a Bishop-Koop stoma.Conclusions
The application of an ostomy in continuity within a comprehensive intestinal rehabilitation program is a novel approach in the treatment of refractory short bowel syndrome that improves intestinal autonomy and decreases the rate of enterocolitis.Type of Study
Case Series.Level of evidence
IV (Cohort Study). 相似文献4.
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5.
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6.
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7.
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8.
Kristine S. Corkum Catherine J. Hunter Julia E. Grabowski Timothy B. Lautz 《Journal of pediatric surgery》2018,53(7):1295-1300
Background
Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children.Methods
Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined > 38.0 °C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained.Results
We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥ 38.9 °C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever < 38.9°.Conclusion
Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively.Level of evidence
Level IV. 相似文献9.
Katerina Dukleska Loren Berman Allison A. Aka Charles D. Vinocur Erin A. Teeple 《Journal of pediatric surgery》2018,53(6):1154-1159
Introduction
Patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) commonly undergo restorative proctocolectomy with ileal-pouch anal anastomosis (RP-IPAA). We sought to describe patient characteristics and postoperative outcomes in this patient population.Methods
Using the National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who were 6–18 years old who underwent RP-IPAA for FAP or UC were identified. Postoperative morbidity, including reoperation and readmission were quantified. Associations between preoperative characteristics and postoperative outcomes were analyzed.Results
A total of 260 children met the inclusion criteria, of which 56.2% had UC. Most cases were performed laparoscopically (58.1%), and the operative time was longer with a laparoscopic versus open approach (326 [257–408] versus 281 [216–391] minutes, p = 0.02). The overall morbidity was 11.5%, and there were high reoperation and readmission rates (12.7% and 21.5%, respectively). On bivariate analysis, preoperative steroid use was associated with reoperation (22.5% versus 10.9%, p = 0.04). On multivariable regression analysis, obesity was independently associated with reoperation (odds ratio: 3.34 [95% confidence intervals: 1.08–10.38], p = 0.04).Conclusions
Children who undergo RP-IPAA have high rates of overall morbidity, reoperation, and readmission. Obesity was independently associated with reoperation. This data can be used by practitioners in the preoperative setting to better counsel families and establish expectations for the postoperative setting.Type of Study
Retrospective Comparative Study.Level of Evidence
Level III. 相似文献10.
Ludger Sieverding Andreas Busch Jens Gesche Gunnar Blumenstock Ekkehard Sturm Ilias Tsiflikas Femke Piersma Anja Hauser Gesa Wiegand Steffen Hartleif Michael Hofbeck Jörg Fuchs Steven W. Warmann 《Journal of pediatric surgery》2018,53(3):553-557
Purpose
The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access.Methods
Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions.Results
Median age at intervention was 47 months (interquartile range (IQR),29–74), median time for interventions was 66 min (IQR,42–111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2 Gy*cm2 (IQR, 0.2–0.6), no complications occurred during or after interventions.Conclusions
Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients.Type of study
Treatment Study.Level of evidence
Level IV. 相似文献11.
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12.
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13.
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14.
Toshiharu Matsuura Yusuke Yanagi Makoto Hayashida Yoshiaki Takahashi Koichiro Yoshimaru Tomoaki Taguchi 《Journal of pediatric surgery》2018,53(4):671-675
Background
No protocol has been established for the diagnosis and management of chylous ascites after liver transplantation (LT). In this study, we retrospectively reviewed our cases of posttransplant chylous ascites (PTCA) and aimed to propose a diagnostic and management protocol.Patients and methods
We retrospectively reviewed the clinical records of 96 LT recipients who underwent LT at our department. The incidence of PTCA and the associated risk factors were analyzed and our protocol for chylous ascites was evaluated.Results
PTCA occurred in 6 (6.3%) patients (mean age: 10.7 ± 11.0 years) at a mean of 10.8 ± 3.6 days after LT. The primary disease in all of PTCA cases was biliary atresia (BA). The periportal lymphadnopathy was an independent risk factor for PTCA. In all cases PTCA successfully resolved according to our protocol. Octreotide was administered in 4 of our 6 PTCA cases. The mean postoperative hospital stay was 40.2 ± 8.4 days, which was similar to that of cases without PTCA.Conclusions
The incidence of PTCA in LT patients, especially in those with BA, is relatively high. Our diagnostic criteria and our management protocol were helpful for patients with refractory ascites after LT.Type of study
Diagnostic test: Level II. Treatment study: Level III. 相似文献15.
Silvia Yukari Togoro Miguel Lia Tedde Robert S Eisinger Erica Mie Okumura Jose Ribas Milanez de Campos Paulo Manuel Pêgo-Fernandes 《Journal of pediatric surgery》2018,53(3):406-410
Background
To minimize cardiac perforation during the minimally invasive repair of pectus excavatum (MIRPE), several surgeons have suggested using a suction device to intraoperatively lift the sternum. Whether or not this technique is effective for all PE patients is not yet known. As such, our aim was to quantify the extent to which a suction device is capable of lifting the sternum with a short duration of use.Methods
30 PE patients received a low-dose CT scan as part of standard PE evaluation. A Vacuum Bell suction was then applied for only two minutes, and a repeat CT scan was obtained only at the deepest point of the chest wall deformity. We compared chest dimensions before and after Vacuum Bell suction.Results
The Vacuum Bell lifted the sternum in all 29 patients included in the analysis. The absolute change in depth ranged from 0.29 to 23.67 mm (M = 11.02, SD = 6.05). The average improvement in Haller index was 0.76. The suction was most effective for individuals with low BMI and smaller chest depths. Efficacy was not associated with gender, age, or chest morphology.Conclusions
The Vacuum Bell device effectively lifted the sternum in PE patients with different demographics and chest morphologies. Future research is needed to address whether or not the device reduces risk of cardiac perforation during MIRPE.Levels of evidence
Prognosis Study Level IV. 相似文献16.
Anastasia Mentessidou Ioanna Loukou Georgios Kampouroglou Anastasia Livani Ioannis Georgopoulos Petros Mirilas 《Journal of pediatric surgery》2018,53(8):1504-1508
Background/purpose
In the few studies on intestinal complications and growth of cystic fibrosis (CF) patients with a history of meconium ileus (MI), operated MI has not been investigated separately. We aimed to investigate the incidence of long-term intestinal obstruction sequelae [constipation, distal intestinal obstruction syndrome (DIOS)] and growth in CF patients operated for MI.Methods
Retrospective study (1989–2016) including operative diagnoses and procedures, constipation and DIOS events, yearly Body Mass Index (BMI) measurements. Outcomes were examined in subgroups operated for MI only and for MI with atresia and/or volvulus.Results
Of 49 patients followed-up for 15 (mean) years, 5 (10.2%) developed constipation and 14 (28.6%) DIOS. BMI was within normal percentiles in 53 patients over a 10-year follow-up. MI only and MI with atresia and/or volvulus did not differ in constipation and/or DIOS incidence (11/34 vs. 7/15, p = 0.39) or in BMI (p = 0.47). Cases with ileocecal valve resection (ICV-R) showed lower constipation and/or DIOS incidence than those without ICV-R (0/6 vs. 11/28, p = 0.02) and no different BMI (p > 0.05).Conclusions
CF patients operated for MI were in long-term risk for constipation/DIOS; their growth was normal. Interestingly, underlying atresia/volvulus neither increased constipation/DIOS risk nor affected growth. Strikingly, ICV-R showed no constipation/DIOS risk and no impact on growth.Type of study
Retrospective comparative study.Level of evidence
III. 相似文献17.
Background/purpose
The role of serum gamma-glutamyl transpeptidase (GGT) levels in predicting clinical outcomes after Kasai portoenterostomy (KPE) is unknown. This study analyzed whether postoperative GGT along with the aspartate aminotransferase-to-platelet ratio index (APRi) predicted prognosis of biliary atresia (BA).Methods
Data were retrospectively reviewed for 169 BA patients categorized into jaundice-free (JF) (total bilirubin < 2.0 mg/dL ≤ 6 months post-KPE) and persistent jaundice (PJ) groups (total bilirubin ≥ 2.0 mg/dL ≤ 6 months post-KPE). Serum biochemical markers, including GGT levels, were measured monthly after KPE, and mean GGT levels and APRi were compared between groups. Factors predicting native liver survival (NLS) were determined using a Cox regression analysis.Results
GGT concentrations > 550 IU/L at month 5 (hazard ratio: 1.74, P < 0.05), an APRi > 0.605 at month 4 (hazard ratio: 3.78, P = 0.001), and being jaundice-free at 6 months (hazard ratio: 5.49, P < 0.001) were independent risk factors for decreased NLS.Conclusions
Serum GGT concentrations > 550 IU/L at month 5 and an APRi > 0.605 at month 4 post-KPE were associated with significantly lower NLS rates. Among JF patients, those with GGT concentrations > 550 IU/L at month 5 and APRi > 0.605 at month 4 showed poorer outcomes.Type of study
Retrospective comparative studyLevel of evidence
Level III. 相似文献18.
Colin Muncie Michael Morris Barry Berch David Sawaya Christopher Blewett 《Journal of pediatric surgery》2018,53(1):126-129
Purpose
The safety and effectiveness of a stapled intestinal anastomosis in adults, children, and infants is well documented. However, in neonates it is not well validated. We hypothesized that premature infants who received a stapled bowel anastomosis utilizing endoscopic staplers had similar outcomes compared to patients with a handsewn anastomosis.Methods
A retrospective study was performed reviewing premature infants who underwent an intestinal anastomosis over a 4-year period. Patients greater than 36 weeks gestational age at birth or a weight greater than 5 kg at surgery were excluded. Patient demographics, type of intestinal anastomosis, and anastomotic related complications within 3 months were collected and analyzed.Results
Sixty-five patients underwent 71 operations involving an intestinal anastomosis: 33 cases were handsewn, and 38 cases were stapled. Groups were noted to have differences in age, weight, and diagnosis. Complications including leak and anastomotic stricture did not differ between groups. Reports of blood per rectum after surgery were more common in the stapled group (24% versus 6%, p = 0.0522), but this did not reach statistical significance.Conclusion
There were no significant differences in anastomotic complications when comparing the handsewn and stapled intestinal anastomosis techniques in premature infants weighting less than 5 kg.Type of study
Treatment Study.Level of evidence
III. 相似文献19.
Huseyin Murat Mutus Burhan Aksu Ersan Uzun Neslihan Gulcin Gonca Gercel Erdem Ozatman Cigdem Ulukaya Durakbasa Hamit Okur 《Journal of pediatric surgery》2018,53(2):293-294
Background/purpose
Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic.Methods
PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6 months ago were done for the long-term results, including coherence to regional hair care.Results
There were 268 patients with a median age of 16 years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3 months (7 days–49 months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6–63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences.Conclusions
Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences.Type of study
Treatment study.Level of evidence
Level IV (Retrospective case series with no comparison group). 相似文献20.
Cristen N. Litz Jessica B. Asuncion Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(3):449-451