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1.
David M Notrica Lois W Sayrs Nidhi Krishna Daniel J Ostlie Robert W Letton Adam C Alder Shawn D St. Peter Todd A Ponsky James W Eubanks David W Tuggle Nilda M Garcia Charles M Leys R Todd Maxson Amina M Bhatia 《Journal of pediatric surgery》2019,54(2):335-339
Background
After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury + 2 in weeks. This study evaluates activity restriction adherence and 60?day outcomes.Methods
Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤ 18?years).Results
Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60?day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60?days. No patient bled after discharge. There was no statistical difference between adherent patients (n?=?279) and non-adherent (n?=?49) for return to ED (χ2?=?0.8 [p?<?0.4]) or readmission (χ2?=?3.0 [p?<?0.09]); for 216 high injury grade patients, there was no difference between adherent (n?=?164) and non-adherent (n?=?30) patients for return to ED (χ2?=?0.6 [p?<?0.4]) or readmission (χ2?=?1.7 [p?<?0.2]).Conclusion
For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline.Level of evidence
Level II, Prognosis. 相似文献2.
Katie W. Russell Micah G. Katz Scott S. Short Eric R. Scaife Stephen J. Fenton 《Journal of pediatric surgery》2019,54(3):569-571
Introduction
Recreation on longboards is gaining in popularity. The purpose of this study is to detail the injury patterns, treatment and management of children with longboarding injuries seen at a level 1 pediatric trauma center.Methods
A retrospective review using our trauma registry from 2006 to 2016 of pediatric patients who sustained injuries while riding a longboard.Results
Of 12,920 injured children, 64 (0.5%) were treated for injuries that occurred while riding a longboard. Median age was 14.5 years (IQR 13.6, 15.4) and 84% were male. Fifty-one (80%) suffered a traumatic brain injury (TBI) including 32 intracranial hemorrhages (ICH), 17 concussions, and 31 skull fractures. Seven (11%) were wearing helmets. Three patients required neurosurgical intervention. Extremity fractures were the most common reason for surgery. Ninety-six percent of patients were admitted to the hospital with a median length of stay of 1 day (IQR 1, 3). All children survived to discharge. Compared with skateboard injuries during the same period, TBI, ICH, concussion, and skull fractures were all greater.Conclusions
TBI ranging from concussion to ICH requiring craniotomy is common in children injured while riding a longboard, and greater than rates after skateboarding injuries. Extremity fracture was the most common reason for operative intervention.Level of evidence
III. 相似文献3.
Micah G. Katz Zachary J. Kastenberg Mark A. Taylor Carol D. Bolinger Eric R. Scaife Stephen J. Fenton Katie W. Russell 《Journal of pediatric surgery》2019,54(2):354-357
Background/purpose
Nonoperative management of blunt solid organ injuries continues to progress and improve cost-effective utilization of resources while maximizing patient safety. The purpose of this study is to compare resource utilization and patient outcomes after changing admission criteria from a grade-based protocol to one based on hemodynamic stability.Methods
A retrospective review of isolated liver and spleen injuries was done using prospectively collected trauma registry data from 2013 to 2017. The 2?years preceding the change were compared to the 2?years after protocol change. All analyses were performed using SAS 9.4.Results
There were 121 patients in the preprotocol cohort and 125 patients in the postprotocol cohort. Baseline demographics were similar along with injury mechanisms and severity. The ICU admission rate decreased from 40% to 22% (p?=?0.002). There were no adverse events on the floor and no patient needed to be transferred to the ICU.Conclusions
A protocol for ICU admission based on physiologic derangement versus solely on radiologic grade significantly reduced admission rates to the ICU in children with solid organ injury. The protocol was safe and effectively reduced resource utilization.Level of evidence
Level II, prospective comparison study. 相似文献4.
Alexander Becker Kobi Peleg Joseph Dubose Yaakov Daskal Adi Givon Boris Kessel 《Journal of pediatric surgery》2019,54(4):780-782
Background
Penetrating stab wounds in children are relatively rare and no clear recommendations for the optimal evaluation have been devised. An acceptable traditional approach to the patient with an abdominal stab wound who does not require urgent surgery is selective nonoperative management and serial exams. The use of routine computed tomography remains an actively utilized investigation for these patients at many institutions.Purpose
We hypothesize that the approach to pediatric stab wound victims should be distinctly different than that of adult counterparts in order to minimize radiation exposure.Methods
A retrospective cohort study involving abdominal stab wounds among pediatric trauma patients (age < 14) compared with adults between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry.Results
A total of 92 children and 4444 adults were identified from the registry for inclusion. Among the children 20 (21.7%) patients had intraabdominal injury compared to 1730 (38.9%) among adult counterparts. Four children were hemodynamically unstable, two of them were referred directly to operating room and two others were treated without surgery. Among the remaining 88 children there was no observed mortality.Conclusions
The majority of pediatric stab wounds trauma victims have minor abdominal injuries. We do not recommend the routine utilization of abdominal CT scan in the evaluation of abdominal stab wounds. Observation with serial exams and minimization of radiation exposure from CT are warranted in this unique population.Type of study
Retrospective comparative study.Level of evidence
3. 相似文献5.
Wesley E. Barry Erica Barin Cory M. McLaughlin Aaron Strumwasser Shant Shekherdimian Helen Arbogast Jeffrey S. Upperman Aaron R. Jensen 《Journal of pediatric surgery》2019,54(2):350-353
Background
Firearm injuries are now the third leading cause of death in children. Understanding the circumstances surrounding pediatric firearm injuries will allow for targeted injury prevention efforts. We hypothesized that younger children are more likely to be victims of unintentional firearm injury.Methods
A multicenter, retrospective review of patients < 18?years old who sustained firearm injuries in Los Angeles County from 2006 to 2015 was performed. Unintentional injuries were defined as accidental firearm discharge without violent intent. Intentional injuries were defined as firearm discharge with intent to injure (including suicide).Results
After review of 304 pediatric firearm injuries, 206 had sufficient narrative to determine intent with 10% of injuries classified as unintentional. Unintentional injuries were more common in younger children, more frequently caused by a firearm from within the home, and more likely to involve friend/family (all p?<?0.05). Intentional injuries were associated with more injuries and accounted for all deaths in our study cohort.Conclusions
In pediatric firearm injury, younger children are more susceptible to unintentional injuries, but intentional injuries are more common overall. Future interventions need to target both intentional violence in older children and unintentional firearm injury in young children if the frequency is to be reduced.Type of study
Epidemiologic study.Level of evidence
Level III. 相似文献6.
Benjamin R. White Chong Zhang Angela P. Presson Kim Friddle Robert DiGeronimo 《Journal of pediatric surgery》2019,54(3):465-470
Objective
To describe the prevalence and outcome of assisted home feeding (AHF) in medically complex neonatal intensive care unit (NICU) patients, and to identify variables associated with AHF in this population.Study Design
1223 infants who survived to discharge from 2013 to 2015 were identified in our single-center, retrospective cohort study at a large tertiary referral NICU. Demographic and selected disease-specific variables were compared between infants discharged on full oral feeding (PO) versus AHF.Result
404 (33%) infants were discharged on AHF (NG?=?201, GT?=?186, NJ?=?17). AHF neonates were born at an earlier gestational age, lower birth weight, had longer hospital admission, greater post-menstrual age at discharge, and had more associated co-morbidities compared to the PO group.Conclusion
AHF was a frequently used and safe intervention in our large cohort of infants.Level of Evidence
Treatment Study Level III. 相似文献7.
Matthew T. Harting Austin Wheeler Todd Ponsky Benedict Nwomeh Chuck L. Snyder Nicholas E. Bruns Aaron Lesher Samir Pandya Belinda Dickie Sohail R. Shah 《Journal of pediatric surgery》2019,54(3):587-594
Importance
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction.Objective
To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery.Design
Review and opinion design.Setting
n/a.Participants
n/a.Main outcomes and measures
n/a.Results
n/a.Conclusions and relevance
Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services.Brief Abstract
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program.Type of Study
Review.Level of Evidence
Level V. 相似文献8.
9.
Stephanie F. Polites Miho Watanabe Thomas Crafton Todd M. Jenkins Carlos R. Alvarez-Allende Adrienne M. Hammill Roshni Dasgupta 《Journal of pediatric surgery》2019,54(4):740-743
Purpose
There has been a paradigm shift from corticosteroid to propranolol treatment for infantile hemangiomas (IHs), with surgical resection reserved for complicated or persistent IHs. The purpose of this study was to determine if propranolol treatment was associated with decreased utilization of surgical resection compared to corticosteroids.Methods
A single center retrospective chart review of all corticosteroid or propranolol treated IHs between 2005 and 2014 was performed. Demographic and clinical data were collected. Both univariate and multivariate analyses were performed with the primary outcome of requiring surgical intervention.Results
Of 652 patients with IH, 52 were treated with oral corticosteroids and 195 with propranolol only. Surgical intervention was required in 14 (27%) of steroid patients vs 18 (9%) of propranolol patients (p?<?.001). On multivariable analysis patients treated with steroids had 3.3 the odds of requiring surgery when compared to propranolol patients (p?=?.001). Prematurity (< 37?weeks) was also associated with increased odds of surgery (OR?=?2.8, p?=?.003).Conclusion
Patients treated with propranolol required significantly fewer surgical interventions than those treated with corticosteroids suggesting a more efficacious treatment paradigm. Prematurity increases the need for surgical intervention regardless of the modality of medical treatment.Level of evidence
Level III, treatment study. 相似文献10.
John Jayman Ali Tourchi Zhaoyong Feng Bruce J. Trock Mahir Maruf Karl Benz Matthew Kasprenski Timothy Baumgartner Daniel Friedlander Paul Sponseller John Gearhart 《Journal of pediatric surgery》2019,54(3):491-494
Purpose
To investigate the factors affecting primary bladder closure in cloacal exstrophy (CE). A successful primary closure is important for optimizing reconstructive outcomes, and it is a critical first-step in the reconstruction of CE. The authors' hypothesize that a smaller diastasis and use of an osteotomy are independent predictors of a successful closure.Methods
A prospectively maintained database of 1332 exstrophy-epispadias complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. Univariate and multivariable analyses were performed to identify significant factors associated with CE primary bladder closure.Results
Of 143?CE patients identified, 99 patients met inclusion criteria. Median follow-up time was 8.82 [IQR 5.43–14.26] years. In the multivariable model, the odds of having a successful closure are about 4 times greater for the staged cloacal approach compared to the 1-stage approach (OR, 3.7; 95% CI 1.2–11.5; p-value?=?0.023). Also, having an osteotomy increases the chance of a successful closure by almost six-fold (OR, 5.8; 95% CI 1.7–19.6; p-value?=?0.004).Conclusions
Using the staged approach with a pelvic osteotomy is paramount to a successful primary closure in CE. The authors strongly recommend using the staged approach and osteotomy as these factors independently increase the chance for a successful primary bladder closure.Study Type
Therapeutic study.Level of Evidence
Level III, Retrospective comparative study. 相似文献11.
Maadrika M.N.P. Kanglie Nanko de Graaf Femke Beije Elise M.J. Brouwers Sabine D.M. Theuns-Valks Frits H. Jansen Diederick B.W. de Roy van Zuidewijn Bas Verhoeven Rick R. van Rijn Roel Bakx 《Journal of pediatric surgery》2019,54(3):500-506
Background
There is a lack of studies addressing the occurrence of negative intraoperative findings (that is the absence of intussusception) after an unsuccessful hydrostatic reduction of an ileocolic intussusception. The aim of this study is to determine the incidence of negative intraoperative findings after unsuccessful hydrostatic reduction of ileocolic intussusception.Methods
We conducted a multicentre retrospective study of all children aged 0–18?years treated for ileocolic intussusception from January 1, 2010 to December 31, 2015 in 9 Dutch hospitals. Primary outcome measure was the percentage of children without an intussusception during surgical exploration after unsuccessful hydrostatic reduction.Results
In the study period 436 patients were diagnosed with an ileocolic intussusception. Of these, 408 patients underwent hydrostatic reduction of an ileocolic intussusception. 112 patients (27.5%) underwent surgery after an unsuccessful hydrostatic reduction. In 13 (11.6%) patients no intraoperative evidence of intussusception was found. Patients who underwent surgical intervention after unsuccessful hydrostatic reduction were significantly younger than patients who had a successful hydrostatic reduction; there was no gender difference.Conclusion
A substantial number of children (11.6%) underwent a laparotomy after unsuccessful hydrostatic reduction in whom no intussusception was found intraoperatively. We suggest initiating laparoscopy instead of laparotomy when surgery is necessary.Level of evidence
Level II. 相似文献12.
Amir H. Taghinia Joseph Upton Cameron C. Trenor Ahmad I. Alomari Anna P. Lillis Raja Shaikh Patricia E. Burrows Steven J. Fishman 《Journal of pediatric surgery》2019,54(3):562-568
Background
Central conducting lymphatic anomalies (CCLA) may cause chylous leaks and protein-losing enteropathy (PLE) owing to dysfunction of the central lymphatic channels. Most of the treatment strategies for these conditions are palliative and provide transient improvement.Methods
We treated 14 patients with intractable chylous leak and/or PLE using a novel technique of lymphaticovenous bypass of the terminal portion of the thoracic duct. Chylous leaks occurred in multiple different anatomic sites. All patients had CCLA and failure of thoracic duct emptying demonstrated by preoperative intranodal lymphangiography.Results
Five patients had complete resolution of symptoms, and two patients had partial improvement. There were no major complications. Of 5 patients with PLE, only one improved after lymphaticovenous bypass. Repeat traditional lymphangiography was performed in 4 patients who did not improve, demonstrating patency of the bypass in all cases with persistent sluggish drainage. One patient had repeat MR lymphangiography that did not show the thoracic duct well.Conclusions
Bypass of the terminal thoracic duct is a novel procedure that offers improvement and a chance of cure for some patients with devastating manifestations of CCLA who lack other effective therapeutic options.Level of evidence
IV. 相似文献13.
Andrew Wang James M Prieto Erin Ward Stephen Bickler Marion Henry Karen Kling Hariharan Thangarajah Romeo Ignacio 《Journal of pediatric surgery》2019,54(3):495-499
Background/objectives
An incidental appendectomy is performed by some surgeons during operative treatment for intussusception to eliminate future appendicitis as a diagnostic consideration. However, an appendectomy can increase the risk of infection and other noninfectious complications making an incidental appendectomy controversial. We examined outcomes for surgical intervention for intussusception with appendectomy (SWA) compared to surgical reduction alone (SRA).Methods
The Pediatric Health Information System database, 8/2008–9/2015, was retrospectively analyzed for patients under the age of five who required an operative intervention for intussusception without bowel resection. Demographic data and postoperative outcomes were analyzed. Available data included need for postoperative enema, subsequent small bowel obstruction, recurrent intussusception, length of stay (LOS), and adjusted total cost (ATC).Results
Fifty-seven percent (748/1312) of patients had appendectomy performed during surgical reduction, 564 (43%) did not. ATC ($10,594 vs. $8939, p?<?0.001) and LOS (3.0 vs. 2.48, p?<?0.001) are higher in the SWA group. Rates of readmission are similar, but post-operative small bowel obstruction may be higher in the SWA group (1.3% vs. 0.35%, p?=?0.06).Conclusion
There is a higher mean LOS and ATC in the SWA group. This study suggests that appendectomy during surgery for uncomplicated intussusception should be reconsidered and requires further investigation.Type of Study
retrospective comparative study.Level of Evidence
III. 相似文献14.
Marc G Schlatter Long V Nguyen Maria Tecos Elle L Kalbfell Omar Gonzalez-Vega Tedi Vlahu 《Journal of pediatric surgery》2019,54(4):663-669
Purpose
Management of postoperative pain is a significant challenge following the Nuss procedure. Epidurals, PCAs, and newer analgesia modalities have been used elsewhere without demonstrating consistent improvement in the reported length of hospital stays (LOS). We reviewed a large single surgeon experience identifying three different methods of analgesia used over time to highlight marked improvement in patient LOS.Methods
IRB approval was obtained and patient clinical information was retrospectively reviewed from 2001 to 2017. The primary outcome variable was length of hospital stay. An expanded preoperative consultation reviews the issue of pain, the negative impact of anxiety on recovery, and our current success of shortened hospital stays with our patients.Results
One hundred and seventy-three patients representing three different analgesia approaches had a LOS of 4.4 days (epidural); 2.2 days (PCA/intercostal nerve block); and 1.6 days (scheduled oral pain meds/intercostal nerve blocks). The current LOS for patients is 1.0 day. Patients successfully stop using narcotics by the end of the first week postoperatively.Conclusions
Intraoperative intercostal nerve blocks, scheduled postoperative pain medications, and enhanced preoperative consultation aimed to educate patients about anxiety and reframe patient pain expectations have collectively decreased LOS, and reduced postoperative narcotic usage.Type of study
Clinical researchLevel of evidence
Level III 相似文献15.
Benjamin D. Carr Christa N. Grant Richard E. Overman Samir K. Gadepalli James D. Geiger 《Journal of pediatric surgery》2019,54(3):604-607
Background
Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases.Methods
Patients aged 0 to 12?months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum.Results
All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29?days postoperatively and were discharged from hospital at a median of 42?days postoperatively.Conclusions
Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches.Study type
Therapeutic.Level of evidence
IV 相似文献16.
Ghazi M. Al Edwan Hammam H. Mansi Omar Nabeeh M. Atta Mohammad M. Shaath Rawand Al Adwan Waleed Mahafza Kameel M. Afram Omar Ababneh Deema Al Adwan Muheilan M. Muheilan 《Journal of pediatric surgery》2019,54(3):595-599
Objective
The purpose of this study is to evaluate the effect of Intravesical Botulinum toxin injection on the symptoms and urodynamic parameters in pediatric patients with idiopathic overactive bladder (iOAB) refractory to medical treatment.Materials and methods
The study was designed as an open-label uncontrolled therapeutic clinical trial. The eligible patients who underwent Intravesical botulinum toxin injection were evaluated before treatment. The evaluation included a 7-day paper bladder diary to assess OAB symptoms (frequency, urgency urinary incontinence (UUI) and nocturnal enuresis (NE)), filling the Arabic International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI short form), and conducting urodynamic study. The Urodynamic parameters obtained were the maximum filling detrusor pressure, cystometric bladder capacity, and compliance. After 12?weeks of the intravesical injection, the patients were revaluated and the results were compared using paired samples t-test.Results
The study enrolled 75 patients. And of those, statistical analysis was done on 46 patients who did follow the study protocols. The mean age was 8.9?years and male to female ratio was 1:4. There was a statistically significant improvement in overactive bladder symptoms and urodynamic parameters in the patient injected with botulinum toxin with minimal side effects.Conclusion
The evidence in this study would support the safety and efficacy of Intravesical botulinum toxin injection in children with refractory idiopathic OAB with significant improvement of symptoms, quality of life, as well as urodynamic parameters.Type of Study
Open-label uncontrolled therapeutic clinical trial.Level of Evidence
III 相似文献17.
Toshio Harumatsu Goki Uchida Takumi Fujimura Mototoshi Kato Hirofumi Tomita Shigeki Ishioka Akihiro Shimotakahara Naoki Shimojima Satoshi Ieiri Seiichi Hirobe 《Journal of pediatric surgery》2019,54(4):766-770
Purpose
Lingual thyroglossal duct cysts (L-TGDCs) are rare and sometimes lethal owing to their association with asphyxia. We aimed to analyze our single institutional experience with L-TGDCs.Methods
Twelve L-TGDC cases treated at our institution between January 2010 and December 2017 were investigated.Results
The male/female ratio was 6/6. The age at the diagnosis was 2?±?1.4?months (7?days to 6?months), and 3 patients were diagnosed in the neonatal period. The patients presented with stridor (n?=?12; 100%), growth retardation (n?=?5; 42%), apnea (n?=?3; 25%), and vomiting (n?=?1; 8.3%). Lateral X-rays were obtained in 8 cases (66.7%); a lingual mass was suspected in 7 (87.5%). Transoral marsupialization of the cyst was performed under direct vision in all cases. All cases were nasally and orally intubated using a laryngoscope, bronchoscope, or airway scope. The mean operative time was 18?±?2.9?min. The mean cyst size was 10.5?±?1.8?mm. No recurrence was observed during the follow-up period (37.5?±?18?months).Conclusion
L-TGDC requires a precise diagnosis and rapid intervention because of the risk of asphyxia resulting in sudden death. Transoral marsupialization under direct vision is an effective and secure approach. L-TGDC should be considered when patients younger than six months of age present with respiratory distress.Type of study
Retrospective Study.Level of evidence
Level IV. 相似文献18.
Elizabeth J. Renaud Stig Sømme Saleem Islam Danielle B. Cameron Robert L. Gates Regan F Williams Tim Jancelewicz Tolulope A Oyetunji Julia Grabowski Karen A. Diefenbach Robert Baird Meghan A. Arnold Dave R. Lal Julia Shelton Yigit S. Guner Ankush Gosain Akemi L Kawaguchi Robert L. Ricca Roshni Dasgupta 《Journal of pediatric surgery》2019,54(3):369-377
Background
The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy.Methods
The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review.Results
Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence.Conclusions
Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature.Type of study
Systematic review of level 1–4 studies.Level of evidence
Level 1–4 (mainly 3–4). 相似文献19.
Christopher D. Graham Leonel Rodriguez Alejandro Flores Samuel Nurko Terry L. Buchmiller 《Journal of pediatric surgery》2019,54(3):486-490
Purpose
Children failing medical management for severe constipation and/or fecal incontinence may undergo surgical intervention for antegrade enema administration. We present a modification of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure that allows primary placement of a skin-level device.Methods
A single-institution retrospective review was performed from 2009 to 2015. In the modified technique the colonoscope is advanced to the cecum, cecal suspension sutures are placed under laparoscopic visualization, and percutaneous needle puncture of the cecum is performed under direct laparoscopic and endoscopic visualization. A skin-level cecostomy tube is then placed over a guide wire. Patient characteristics and 30-day results were analyzed by Fisher's exact test.Results
Fifty-two patients underwent attempted LAPEC. Successful LAPEC using both laparoscopic and endoscopic guidance was achieved in 46 (88.5%). A MIC-KEY device was placed in 38. Corflo PEG tube placement was necessary in 14 due to high BMI (mean 28.4). Colonoscopy failed to reach the cecum in 6 and laparoscopy alone was utilized to achieve successful tube placement. Cecostomy site infections occurred in 3 (5.8%), only in those undergoing PEG placement using a pull technique (p?<?0.05).Conclusion
Primary placement of a skin-level device was successful in the majority of patients undergoing cecostomy tube placement for bowel management utilizing antegrade colonic enemas. This technique avoids a second anesthesia for tube conversion. Visualization via colonoscopy with the use of cecal suspension sutures is recommended. High BMI necessitates initial placement of a PEG tube and complications exclusively occurred in this group.Type of Study
Clinical.Level of Evidence
IV Case series study. 相似文献20.
Jin-Hu Wang Min-Ju Li Da-Xing Tang Shan Xu Jun-Qing Mao Jia-Bin Cai Min He Qiang Shu Can Lai 《Journal of pediatric surgery》2019,54(3):550-556