Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter?

Background

The aim of this study was to determine if there is any predictive factor indicating the risk of bile leakage before surgery for hepatic hydatid disease in clinically asymptomatic patients.

Methods

The data of 116 patients who underwent surgery for hepatic hydatid disease were reviewed retrospectively. There were 43 men (37%) and 73 women (63%) with a mean age of 45 ± 15 years. Because of high preoperative serum bilirubin and liver function test levels, 12 patients were excluded from the study. These patients underwent preoperative endoscopic retrograde cholangiopancreatography. In addition, 2 medically treated patients were excluded from the study. The following variables were analyzed as potential predictors of biliary-cyst communication: age, sex, physical examination findings, leukocyte count, liver function test results, and ultrasonographic cyst features (type, diameter, number, and localization).

Results

Bile leakage was detected in 24 out of 102 patients. There were no differences in age, sex, cyst type, alkaline phosphatase level, γ-glutamyl transpeptidase level, alanine aminotransferase level, aspartate aminotransferase level, bilirubin level, and number of cysts and cyst locations between the patients with and without bile leakage. The mean cyst size in patients with biliary leakage was 10.2 cm as compared with 6.1 cm in patients with no biliary leakage (P < .05). When the cut-off value of cyst diameter was accepted as 7.5 cm, the specificity and sensitivity for biliary-cyst communication were 73% and 79%, respectively.

Conclusions

These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.     

Natural course and outcome of cystic lesions in the pancreas

Background

The number of patients identified with cysts of the pancreas is increasing. The current study was undertaken to assess the natural course and malignant potential of pancreatic cysts.

Methods

From 1995 to 2008, radiology records were reviewed for the presence of cystic lesions of the pancreas (CLP) characteristics, patient demographics, and follow-up.

Results

Eighty-two patients met the study inclusion criteria, with a mean age at time of diagnosis of 64.4 ± 16.7 years. Mean cyst size was 1.36 ± 1.05 cm, with 75.6% of patients having a solitary cyst. Thirteen patients underwent surgery. Operative intervention was statistically related to symptomatic, loculated cysts with the presence of calcifications (all P <.05). Malignancy was statistically related to symptomatic (P <.05), loculated cysts (P <.01), and male gender (P <.05).

Conclusions

Our data show that most pancreatic cysts found on radiographic imaging are asymptomatic, solitary, and small and can be followed safely radiographically.     

The incidence and surgical management of paratubal cysts in a pediatric and adolescent population

Purpose

The aim of this study is to determine the incidence of paratubal cysts (PTCs) in a pediatric and adolescent population.

Methods

An institutional review board-approved retrospective chart review was performed between the years of 1998 and 2008 at a single children's hospital. Inclusion criteria were met if pathology reports demonstrated diagnosis of PTC, hydrosalpinx, or hydatid of morgagni.

Results

One hundred ten patients had confirmed diagnoses of hydatid of morgagni, hydrosalpinx, or PTC. The incidence of PTCs was 7.3%. Mean age of PTC diagnosis was 13.7 ± 2.82 years, with 12.6% diagnosed premenarchal. Mean age menarche was 11.7 ± 1.34 years among pubertal females. The age of menarche and diagnosis of PTC correlated (Pearson, 0.54) (P < .0001). There was a small correlation between body mass index and size of PTC (r = 0.36; P ≤ .001).

Conclusion

The incidence of PTCs was 7.3% in this pediatric and adolescent population. In addition, this is the first study to confirm presence of PTCs in prepubertal females. Surgeon should be aware of these benign cysts because they are frequently a source of abdominal pain in young girls. As nonphysiologic cysts, these will not resolve spontaneously and may increase in size and/or be at risk for adnexal torsion. Ultimately, surgical management is required for definitive resolution.     

An analysis of clinical features of pulmonary giant hydatid cyst in adult population

Background

We performed an analysis of giant hydatid cysts (GCHs) detected in the adult population by comparison with the features of other simple hydatid cysts (CHs) in the light of the relevant literature.

Methods

The records of 74 adult patients who were operated on in our clinic for pulmonary CHs between 2001 and 2005 were retrospectively evaluated. Cysts that were 10 cm or larger in diameter on any plane were considered GCHs. The cysts were classified into 2 groups as GCHs (group A) and other (group B). The groups were then compared for age, sex, symptom, cyst location, preoperative complications, surgical procedure performed, operative morbidity, and mortality.

Results

Of 74 patients, 10 (13.5%) were in group A and 64 were in group B. No differences were detected between the clinical presentation, gender distribution, surgical procedure performed, and postoperative morbidity and mortality rates of GCHs and other cysts in adults. In both groups, there were no significant differences between the rates of involvement of 2 lungs (P = .527). However, both groups had lower lobe involvement, more markedly in group A (81.8% and 45.5% respectively; P = .023). Two patients in group A (20%) and 18 patients in group B (28.1%) had complicated cysts.

Conclusions

The tendency of GCH to involve the lower lobe of the lung compared to smaller cysts suggests underlying mechanisms other than lung elasticity in the late onset of the symptoms parallel to cyst growth.     

Colonic manometry via appendicostomy shows reduced frequency, amplitude, and length of propagating sequences in children with slow-transit constipation

Background/Purpose

We wish to define colonic motor function in children with slow-transit constipation (STC) using manometry catheters introduced through appendiceal stomas, previously sited for controlling fecal retention by colonic irrigation.

Methods

We undertook 24-hour pancolonic manometry of 6 children (5 boys; mean, 11.5 years; SD, 3.0) using a multilumen silastic catheter. Results were compared to nasocolonic motility studies obtained in healthy young adults.

Results

Antegrade propagating sequences (APSs) originated less frequently in the cecum compared to controls. There were fewer APS (mean ± SEM: STC, 13 ± 6 per 24 hours; controls, 52 ± 6 per 24 hours; P < .01) and high-amplitude propagating contractions (HAPCs: STC, 5 ± 2 per 24 hours; controls, 9.9 ± 1.4 per 24 hours; P < .05). The amplitude of APS and HAPC was less in STC (APS, 39 ± 9 mm Hg; controls, 54 ± 3 per 24 hours; P < .05) (HAPC: STC, 94 ± 10 mm Hg; control, 117 ± 3 mm Hg; P < .01), whereas the amplitude of retrograde propagating sequences was greater in STC (43 ± 6 mm Hg; control, 27 ± 1 mm Hg; P < .01). The distances propagated by HAPC were significantly less in STC (36 ± 4.5 vs 47 ± 2.3 cm, controls; P < .05), and there was no evidence of a region-specific difference in propagation velocity of APS. Neither meal ingestion nor waking significantly increased colonic motor activity in patients with STC.

Conclusions

Despite the small numbers available to be studied, we found that children with STC in whom an appendicostomy had been placed show significant abnormalities in pancolonic motor function.     

Laparoscopic treatment of hydatid cyst of the liver in children. A report on 34 cases

Purpose

This study evaluated the safety and efficiency of laparoscopically treated liver cysts in children.

Methods

From September 2001 to July 2004, 34 patients underwent laparoscopic treatment of hydatid cysts of the liver. All patients had chest x-ray, abdominal sonography, and hydatid serology. The different stages of the procedure were the same as in open surgery: puncture, aspiration, injection of scolicidal agent, reaspiration, removal of proligerous membrane, and resection of the dome.

Results

The patients' mean average age was 7 years and 7 months (range, 3-14 years). The number of cysts ranged from 1 to 10 with a diameter of 40 to 150 mm (mean diameter, 65.5 mm). One case had a mesenteric associated hydatid cyst, another splenic hydatid cyst. The average length of hospital stay was 5 days (range, 4-14 days). No per- or postoperative complications were reported. At 12 to 45 months follow-up, no recurrence has been reported.

Conclusion

Laparoscopy represents an excellent approach for the treatment of hydatid cyst of the liver in children.     

Increasing national burden of hospitalizations for skin and soft tissue infections in children

Background

The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus.

Methods

The 2000, 2003, and 2006 Kids' Inpatient Databases were queried for patients with a primary diagnosis of SSTI. Weighted data were analyzed to estimate temporal changes in incidence, incision and drainage (I&D) rate, and economic burden. Factors associated with I&D were analyzed by multivariable logistic regression.

Results

Pediatric SSTI admissions increased (1) in number, (2) as a fraction of all hospital admissions, and (3) in incidence per 100,000 children from the years 2000 (17,525 ± 838; 0.65%; 23.2) to 2003 (27,463 ± 1652; 0.99%; 36.2) and 2006 (48,228 ± 2223; 1.77%; 62.7). Children younger than 3 years accounted for 49.6% of SSTI admissions in 2006, up from 32.5% in 2000. Utilization of I&D increased during the study period from 26.0% to 43.8%. Factors most associated with requiring I&D were age less than 3 years and calendar year 2006 (both P < .001). Hospital costs per patient increased over time and were higher in the group of patients who required I&D ($4296 ± $84 vs $3521 ± $81; P < .001; year 2006). Aggregate national costs reached $184.0 ± $9.4 million in 2006.

Conclusion

The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial.     

Surgery in children with hydatid disease of the spleen

Background/Purpose

Hydatid disease of the spleen is a rare disease, and it occurs in 1% to 8% of all children with hydatid disease. That difference in frequency depends on the social and economic status of the patients and the country. The aim of our study is to reveal its diagnosis and treatment.

Methods

From 1985 to 2004, 152 children with hydatid disease have been operated on at the Surgical Department of General and Pediatric surgery at the Medical University in Stara Zagora and Medical University in Plovdiv, Bulgaria. Of the 152 children, 15 (9.87%) had spleen localization: 6 males and 9 females, aged 10 to 18 years. A solitary cyst in the spleen was found in 10 patients, 8 children had an isolated cyst only in the spleen, 7 with involvement of other organs (5 in the liver, 2 in liver and lungs). All spleen cysts were “silent.” Abdominal sonography, computed tomography, and enzyme-linked immunosorbent assay tests proved the diagnosis. All children were operated on.

Results

A splenectomy was performed in 14 cases, and a cystectomy was possible in only 1 case. Patients with combined forms successfully underwent different variations of cystectomy: 6 omentoplasty, 5 capitonnages, and 4 invaginations.

Conclusions

Splenic involvement of hydatid disease has no specific clinical manifestation, the diagnosis is late and often leads to splenectomy. Organ-preserving procedures are possible only in cases with early diagnosis. It has to be suspected in a patient with a splenic cyst and has to be confirmed by ultrasonography and/or computed tomography, magnetic resonance imaging, and immunologic tests. The early diagnosis is a good precondition for better results.     

Unsafe at any speed--kids riding all-terrain vehicles

Background

All-terrain vehicle (ATV) sales have climbed 89% in the last 5 years. We sought to determine if pediatric ATV accidents have increased in frequency and morbidity.

Methods

Medical records of children treated in our emergency unit for ATV accidents from 1993 to 2003 were reviewed. The 11 years were divided into 2 periods, January 1993 to June 1998 and July 1998 to December 2003, to allow comparisons and analysis of trends over time.

Results

We treated 184 children, with 90% requiring admission. Comparing the first and second halves of the study, patients treated increased from 8.7 ± 4.8 (mean ± SD) to 24.5 ± 11.1 per year (P < .01), patients requiring immediate operation increased from 4 (9%) of 44 to 24 (17%) of 140, and patients with serious injuries (resulting in direct intensive care unit admission, immediate operation, or death) rose from 12 (27%) of 44 to 51 (36%) of 140. Patient age was 11.5 ± 3.9 years. Sixty-eight percent of the children sustained multiple injuries and 50% required surgery. Only 35% of the children wore helmets.

Conclusion

Over the 2 periods, there was a significant increase in number of patients treated, and considerable increases in serious injuries, and need for immediate operation. Despite inherent risks with riding ATVs, helmet use and patient age were remarkably low.     

Selection of live-related liver transplantation candidates

Purpose

Living donor liver transplantation (LR) is an important alternative for children. We compared our outcomes of LR and cadaveric (CAD) graft recipients, with attention to the pediatric end-stage liver disease (PELD) score and perioperative morbidity and mortality to identify appropriate candidates for LR.

Methods

Our transplant database and electronic medical records were searched for demographics and outcome measures.

Results

From 2000 to 2008, 81 children underwent liver transplantation from 37 LR and 44 CAD donors. There were no significant differences in graft or overall survival at 3 months or 1 year. The LR group was significantly younger (4.46 ± 5.2 years vs 7.41 ± 6.6 years; P = .03) and had a significantly lower PELD score (12.7 ± 13 vs 22 ± 12; P = .001) at the time of transplantation. Ten patients were transplanted for unresectable tumor in the LR group vs 4 CAD (P = .03). Significantly fewer LR recipients required return to the operating room in the first 30 days posttransplant (13.9% vs 34.1%; P = .03). The LR recipients had a higher rate of biliary stricture requiring reoperation (22.2% vs 2.3%; P = .005).

Conclusions

The LR liver transplantation is highly selected for patients with a parent donor who will need transplant but do not yet have a high PELD score. A lower PELD score at operation may have contributed to the lower incidence of postoperative complications requiring reoperation.     

Comparison of short- and long-term functional outcome of nonoperatively managed renal injuries in children

Purpose

The purpose of this study was to better determine the long-term functional outcome of nonoperatively managed renal injuries in children.

Methods

After Institutional Review Board approval, all children with blunt renal injuries were retrospectively reviewed. Renal function, after complete healing had been documented radiographically (3 months postinjury), was evaluated through measurements of blood urea nitrogen, serum creatinine, blood pressure, and split percentage of renal function using technetium-99m-dimercaptosuccinic acid nuclear scanning. Repeated data at 1 year postinjury were compared with the early follow-up results.

Results

Sixteen consecutive children (mean age, 10 years; range, 3-16 years) had complete follow-up over the study period. All children were managed without laparotomy. Injury grades were as follows: grades I to III, 4; grade IV, 9; and grade V, 3. No child had an abnormal blood urea nitrogen, serum creatinine, or blood pressure measurement at follow-up. Consistent with previous results, percentage of renal function by technetium-99m-dimercaptosuccinic acid scanning was influenced by injury grade at the early 3-month follow-up (46.5% ± 4.5%, 42% ± 7.1%, and 32.7% ± 5.9% [mean ± SD] for grades I-III, grade IV, and grade V, respectively). One-year functional results for the high-grade injuries also correlated to initial injury grade and were not significantly different from the results at early follow-up (43.8% ± 4.8%, 41.9% ± 6.6%, and 31.35 ± 5.7% [mean ± SD] for grades I-III, grade IV, and grade V, respectively; P = not significant). No child required delayed surgery.

Conclusions

Long-term (1 year) functional outcome in nonoperatively managed renal injuries in children appears preserved and is influenced by injury grade.     

Pediatric vs adult vascular trauma: a National Trauma Databank review

Introduction

The purpose of this study was to examine nationwide data on vascular injuries in children and to compare pediatric and adult patients with respect to the incidence, injury mechanisms, and outcomes.

Methods

This is a National Trauma Databank analysis based on dataset version 7.0 (spanning a 5-year period ending December 2006). Pediatric patients under the age of 16 with at least one reported diagnosis of a vascular injury were compared to the adult cohort aged 16 and greater with a vascular injury.

Results

During the study period, of 251,787 injured patients younger than 16 years, 1138 (0.6%) had a vascular injury. The incidence in patients 16 years or older was significantly higher, at 1.6% (P < .01). Compared to the adult vascular patients, pediatric patients had a significantly lower Injury Severity Score (16.8 ± 14.9 vs 26.3 ± 16.7, P < .001) and encountered less frequently penetrating injuries (41.8% vs 51.2%, P < .001). The most commonly injured vessels in the pediatric population were vessels of the upper extremity (424 patients or 37.9%). The overall incidence of thoracic aortic injuries in children was seven-fold lower compared to the incidence in adults (0.03% vs 0.21%). After adjusting for confounding factors, pediatric patients demonstrated improved survival following vascular injuries (adjusted odds ratio, 0.60; 95% CI, 0.45-0.79; P < .001). No significant difference was identified in the rate of amputation between pediatric and adult patients who had sustained upper or lower extremity vascular injuries.

Conclusion

Vascular trauma in the pediatric population is uncommon, occurring in only 0.6% of all pediatric trauma patients. Although less frequent than adults, a significant proportion was due to penetrating injury. Vessels of the upper extremity were the most commonly injured and were associated with low mortality. Injuries of the thoracic aorta are rare. Overall, pediatric patients had an improved adjusted mortality when compared to adults.     

An audit on pediatric hydatid disease of uncommon localization: incidence, diagnosis, surgical approach, and outcome

Background/Purpose

Infestation of sites other than the liver and lungs by the parasite Echinococcusgranulosus is rarely encountered in clinical practice. The present study aims to determine the incidence of hydatid disease of uncommon localization in children and to document the clinical and radiologic findings, the types of the operations performed, and the postoperative course of the disease.

Methods

A retrospective review of the demographical data as well as preoperative and postoperative clinical findings of children who underwent surgical treatment of hydatid disease was done.

Results

Hydatid disease of uncommon localization was encountered in 15 (7%) of 207 children reviewed. The sites in which the cysts were located were as follows: spleen (n = 4, 1.9%), kidney (n = 4, 1.9%), retroperitoneum (n = 3, 1.4%), omentum (n = 2, 1%), anterior abdominal wall (n = 1, 0.5%), and anterior thigh (n = 1, 0.5%). Radiodiagnostic tools such as ultrasonography were used in all. Partial pericystectomy was the surgical procedure of choice in most cases. There was 1 recurrence in a patient with splenic disease, with no mortality.

Conclusions

Pediatric hydatid disease can involve any body part. Radiologic imaging techniques are helpful in diagnosis. Surgery should aim to preserve as much tissue as possible while precautions to prevent recurrences are undertaken.     

Briefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program

Background

The purpose of this study was to examine the outcomes of checklist-driven preoperative briefings and postoperative debriefings during the Veterans Health Administration (VHA) medical team training program.

Methods

A briefing score (1, never started; 2, started then discontinued; 3, maintained on original targeted cases; 4, expanded to other services; 5, briefing all cases, all services) was established at 10.1 ± .3 months after introduction of the checklist. Outcomes included antibiotic and deep venous thrombosis prophylaxis compliance rates before and after use of the checklist.

Results

Antibiotic (97.0% ± .1% vs 92.1% ± 1.5%; P = .01) and deep venous thrombosis (95.7% ± .8% vs 85.1% ± 4.6%; P = .05) prophylaxis compliance rates were higher after initiation of a surgical checklist.

Conclusions

Checklist-driven preoperative briefings and postoperative debriefings are associated with improvements in patient safety for surgical patients.     

Partial splenectomy for hereditary spherocytosis: a multi-institutional review

Background/Purpose

Partial splenectomy has emerged as a surgical option for selected children with hereditary spherocytosis, with the goal of reducing anemia while preserving splenic function. This multi-institutional study is the largest series to date examining outcomes data for partial splenectomy in patients with hereditary spherocytosis.

Methods

Data were collected retrospectively from 5 North American pediatric hospitals. Sixty-two children underwent partial splenectomy for hereditary spherocytosis between 1990 and 2008.

Results

At 1 year following partial splenectomy, mean hemoglobin significantly increased by 3.0 ± 1.4 g/dL (n = 52), reticulocyte count decreased by 6.6% ± 6.6% (n = 41), and bilirubin level decreased by 1.3 ± 0.9 mg/dL (n = 25). Patients with poor or transient hematologic response were found to have significantly more splenic regeneration postoperatively compared with patients with a durable clinical response (maximal spleen dimension, 9.0 ± 3.4 vs 6.3 ± 2.2 cm). Clinically significant recurrence of anemia or abdominal pain led to completion splenectomy in 4.84% of patients. No patients developed postsplenectomy sepsis.

Conclusions

Our multi-institutional review indicates that partial splenectomy for hereditary spherocytosis leads to sustained and clinically significant improvement in hematologic profiles and clinical symptoms in most patients. Our data support partial splenectomy as an alternative for selected children with hereditary spherocytosis.     

Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996-2006

Objective

Determine changes in rates for pediatric adenotonsillar procedures over time with attention to infectious indications.

Study Design

Historical cohort study.

Setting

Academic medical center.

Subjects and Methods

The National Survey of Ambulatory Surgery and the National Hospital Discharge Survey 1996 and 2006 releases were examined, extracting all cases of pediatric tonsillectomy, adenotonsillectomy, and adenoidectomy. The aggregate numbers and rates of adenotonsillar procedures performed overall and specifically for chronic infectious etiologies were determined. These procedure rates were then compared to determine differences in performance rates between 1996 and 2006.

Results

In 1996, an estimated 441,870 ± 23,315 children underwent some form of adenotonsillar surgery in the ambulatory and inpatient settings (60,034 ± 6994 tonsillectomies, 255,217 ± 18,960 adenotonsillectomies, and 126,619 ± 11,627 adenoidectomies), while in 2006, the total rose to 695,029 ± 36,979 children (58,111 ± 9645 tonsillectomies, 506,778 ± 32,054 adenotonsillectomies, and 129,540 ± 15,714 adenoidectomies). However, when examined according to infectious indications, a notable decline in the population rate of tonsillectomy from 0.62 per 1000 children in 1996 to 0.53 per 1000 in 2006 was found (P = 0.252). Moreover, the larger decline in the rate of adenotonsillectomy for infectious indications from 2.20 per 1000 to 1.46 per 1000 was significant (P = 0.003). There was no significant change adenoidectomy rates for chronic infectious etiologies (0.25 versus 0.21 per 1000, P = 0.326).

Conclusion

Although there was an overall increase in the rate of performance of adenotonsillar surgery, population adjusted performance rates of these procedures specifically for infectious indications declined from 1996 to 2006.     

Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation?

Purpose

The aim of this study was to assess benefit of surgery in the treatment of childhood constipation in children without aganglionosis or anorectal malformations.

Methods

Retrospective chart review and follow-up questionnaire of 19 children (10 girls, age 7.6 ± 3.9 years) who underwent surgery after colonic and anorectal manometry had documented abnormal motility. Children at the time of manometric evaluation had symptoms of intractable constipation a mean of 5.1 ± 2.5 years. Follow-up questionnaires were administered to caregivers a mean of 11.4 ± 9.3 months after surgical intervention.

Results

Proximal colonic abnormalities were seen in 2 patients, abnormalities involving the distal colon and rectosigmoid region in 13 patients, pancolonic abnormalities in 2 patients, and incomplete relaxation of the internal anal sphincter in 2 patients. Surgery led to increase in frequency of bowel movements per week (8.1 v 1.9; P < .005), decrease in soiling episodes per week (2.20 v 4.7; P < .01), and decrease in daily use of medications for constipation (0.8 v 2.3; P < .05). Adverse events included skin breakdown at site of ostomy (9%), fecal incontinence after pull-through procedure (13%), and persistent constipation (4.5%). Parents felt that the symptoms after surgery were completely resolved in 89% of patients.

Conclusions

Surgery may be beneficial in the management children with chronic intractable constipation and documented abnormalities in motility.     

Early adult outcome of the Duhamel procedure for left-sided Hirschsprung disease--a prospective serial assessment study

Purpose

To assess both early adult functional outcome and change in long-term functional outcome over time after the Duhamel procedure (DP) for left-sided Hirschsprung disease (HSCR).

Methods

The study population consisted of 78 children (aged 19.9 ± 3.6 years) who previously underwent objective outcome assessment after DP was performed for HSCR during the period of 1980 to 1991. Inclusion criteria were previous evaluation of functional outcome and either rectosigmoid or left-sided HSCR. Outcome measures were assessed twice within the cohort, in 1997 and in 2005. The primary outcome measure was the Rintala (J Ped Surg. 1995;30:491-494) functional outcome score (FOS; maximum, 20). Controls consisted of 20 age-matched healthy children. Satisfactory functional score was defined as an FOS at or above the 10th percentile of controls (FOS, ≥17). Secondary outcome measures were the operation failure rate (defined by requirement for a stoma or major reoperative surgery), and enterocolitis rates (defined by intention to treat). Consecutive outcome scores were compared by paired t test. Data were expressed as mean ± SD, and P < .05 was considered significant.

Results

Operation failure occurred in 9 (11.5%) of 78. Consecutive FOSs were obtained in 40 (57%) of 69. A satisfactory functional score was observed in 23 (58%) of 40 adults as opposed to 33 (47%) of 70 children 8 years previously (P = .02). Satisfactory outcome (defined by satisfactory functional score and lack of enterostomy or major revision pull-through procedure) was observed in 23 (47%) of 49. Previously, this figure was 34 (44%) of 78. Individual paired FOSs showed a significant improvement with time (1997: 14.9 ± 4.1; 2005: 16.4 ± 2.8; P = .02).

Conclusions

At early adult follow-up, the operation failure rate has not changed from that of the same cohort 8 years earlier. However, a significant improvement in individual FOSs was demonstrated.     

Orthotopic liver transplantation in biliary atresia: a single-center experience

Introduction

Biliary atresia (BA) is the leading indication for orthotopic liver transplantation (OLT) among children. However, there are technical difficulties, including the limited dimensions of anatomical structures, hypoplasia and/or thrombosis of the portal vein and previous portoenterostomy procedures.

Objective

The objective of this study was to present our experience of 239 children with BA who underwent OLT between September 1989 and June 2010 compared with OLT performed for other causes.

Methods

We performed a retrospective analysis of patient charts and analysis of complications and survival.

Results

BA was the most common indication for OLT (207/409; 50.6%). The median age of subjects was 26 months (range, 7-192). Their median weight was 11 kg (range, 5-63) with 110 children (53.1%) weighing ≤10 kg. We performed 126 transplantations from cadaveric donors (60.8%) and 81 from living-related donors (LRD) (39.2%). Retransplantation was required for 31 recipients (14.9%), primarily due to hepatic artery thrombosis (HAT; 64.5%). Other complications included the following: portal vein thrombosis (PVT; 13.0%), biliary stenosis and/or fistula (22.2%), bowel perforation (7.0%), and posttransplantation lymphoproliferative disorder (PTLD; 5.3%). Among the cases of OLT for other causes, the median age of recipients was 81 months (range, 11-17 years), which was higher than that for children with BA. Retransplantation was required in 3.5% of these patients (P < .05), mostly due to HAT. The incidences of PVT, bowel perforation, and PTLD were significantly lower (P < .05). There was no significant difference between biliary complications in the 2 groups. The overall survival rates at 1 versus 5 years were 79.7% versus 68.1% for BA, and 81.2% versus 75.7% for other causes, respectively.

Conclusions

Children who undergo OLT for BA are younger than those engrafted for other causes, displaying a higher risk of complications and retransplantations.