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European Journal of Pediatric Surgery

Annie Hsiao, Ashwin Pimpalwar
INTRODUCTION:  External angular dermoid cysts, or epidermoid inclusion cysts, are a common subcutaneous tumor of the head and neck. For the majority of these lesions, excision is relatively simple and performed through an incision immediately overlying the mass. Facial lesions in pediatric patients present a unique challenge in that a direct approach carries the potential for visible scar formation. OBJECTIVE:  This article aims to detail our experience with subcutaneoscopic excision of external angular dermoid cysts in pediatric patients using endoscopic instrumentation...
March 13, 2018: European Journal of Pediatric Surgery
Annika Mutanen, Agostino Pierro, Augusto Zani
Necrotizing enterocolitis (NEC) is a devastating condition that mainly affects premature infants. Advanced cases of NEC require surgical treatment, which in up to 70% of infants is associated with significant perioperative morbidity including anastomosis- or enterostomy-related complications, sepsis, peritonitis, and wound infections. Moreover, the perioperative complications may compromise the long-term gastrointestinal and neurodevelopmental outcome of patients requiring surgery for NEC.
March 13, 2018: European Journal of Pediatric Surgery
Francesco Morini, Andrea Conforti, Pietro Bagolan
Current survival rate of infants with esophageal atresia with/without tracheoesophageal fistula (EA/TEF) exceeds 90% and great interest is dedicated to the long-term outcomes and complications. However, perioperative complications represent a significant burden to the EA/TEF infants and a technical challenge for the surgeon. In this review, we will focus on the most frequent perioperative complications specific of EA/TEF to describe their predisposing factors, possible preventive measures, and treatment options...
March 13, 2018: European Journal of Pediatric Surgery
Christoph Zoeller, Benno M Ure, Jens Dingemann
INTRODUCTION:  Video-assisted thoracoscopic surgery (VATS) has gained broad acceptance among pediatric surgeons. Today, VATS can be regarded as a routine approach for various conditions in neonates and infants. However, there is a lack of information concerning the complications of thoracoscopic pulmonary surgery in neonates and infants. We aimed to review the available data. PATIENTS AND METHODS:  A systematic review of the literature was performed using PubMed...
March 6, 2018: European Journal of Pediatric Surgery
Jim C H Wilde, Ana M Calinescu, Barbara E Wildhaber
Biliary atresia (BA) and congenital choledochal malformations (CCM) are rare. Both pathologies must (BA) or may (CCM) be operated during the neonatal period or early infancy. We briefly describe the classical operative techniques for both pathologies, followed by the most common and severe perioperative complications encountered during and up to 30 days after surgery in children operated for BA and CCM early in life. For patients with BA, intestinal complications represent the most common and hazardous perioperative surgical complications...
March 6, 2018: European Journal of Pediatric Surgery
Arun Kelay, Nigel J Hall
Pyloromyotomy is the tried and tested surgical procedure for successful operative treatment of pyloric stenosis. Over time, the operative approach has evolved to take advantage of cosmetically superior incisions and more recently minimally invasive surgery. During and following surgery, complications are uncommon. The specific complications of an inadequate pyloromyotomy requiring repeated procedure and mucosal perforation during an overzealous pyloromyotomy represent the ends of a spectrum within which sits the perfect procedure...
March 6, 2018: European Journal of Pediatric Surgery
Antti Stenroos, Jenni Jalkanen, Juha-Jaakko Sinikumpu, Sauli Palmu, Eeva Koskimies-Virta, Topi Laaksonen, Yrjänä Nietosvaara
BACKGROUND:  Surgical treatment of pediatric tibia shaft fractures has gained popularity despite closed reduction and cast-immobilization providing good long-term results. There is no consensus about optimal methods and satisfactory quality of treatment. MATERIALS AND METHODS:  During 2010 to 2014, 226 pediatric patients were treated under anesthesia for tibia shaft fractures in Finland's five university hospitals. A total of 164 (73%) patients had closed fractures of the tibia or both tibia and fibula without other injuries (62 tibia only and 102 both tibia and fibula)...
February 28, 2018: European Journal of Pediatric Surgery
Dhanya Mullassery, Sumita Chhabra, Ashik Muhamed Babu, Roberta Iacona, Simon Blackburn, Kate M Cross, Paolo Decoppi, Colin Tennant Baillie, Simon Kenny, Joe I Curry
AIM:  Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers. METHODS:  This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years...
February 28, 2018: European Journal of Pediatric Surgery
Pablo Stringa, Nidia Monserrat Arreola, Ane M Andres Moreno, Carlota Largo, Martín Rumbo, Francisco Hernandez
BACKGROUND:  Modified multivisceral transplantation (MMVTx) refers to the use of a graft that includes all abdominal organs except the liver. The use of this type of transplant in children and adults expanded over the last years with good results. However, long-term survival in experimental models has not been reported. Our aim is to describe in detail some technical modifications of MMVTx to obtain long-term survival. MATERIALS AND METHODS:  Syngeneic (Lewis-Lewis) heterotopic MMVTx was performed in 16 male rats (180-250 g)...
February 23, 2018: European Journal of Pediatric Surgery
Mikko Pakarinen
Transanal pull-through is currently one of the most commonly used operation to treat Hirschsprung's disease (HD) worldwide. It has undergone some technical modifications during the last decades and still contains variable surgical practices. As high quality comparative studies between different surgical approaches are missing, debate over the optimal operation for HD still continues. Transanal pull-through is associated with multiple potential complications, which may result in permanently impaired functional outcome, life-long morbidity, and significant social restrictions...
February 19, 2018: European Journal of Pediatric Surgery
Catarina Barroso, Jorge Correia-Pinto
Although improvements have been made, the management of congenital diaphragmatic hernia (CDH) remains a major challenge for perinatologists and neonatal surgeons. Many aspects of the disease remain unknown and, being a rare entity, evidence-based data are hard to find. Surgical morbidity is considerable and affects long-term quality of life. Perioperative complications have been reviewed focusing on thoracoscopic repair. Intraoperative acidosis was more severe during thoracoscopy when compared with open surgery (OS), though it is possible that later neurodevelopment was not affected...
February 19, 2018: European Journal of Pediatric Surgery
Ashwini S Poola, Pablo Aguayo, Jason D Fraser, Richard J Hendrickson, Katrina L Weaver, Katherine W Gonzalez, Shawn D St Peter
BACKGROUND:  We report a prospective randomized trial comparing primary closure (PC) to bedside silo and delayed closure (DC) for babies with gastroschisis. METHODS:  Patients were randomized to PC versus DC. We excluded those with atresia/necrosis, <34 weeks' gestation, or congenital anomalies. The primary outcome was length of stay (LOS). RESULTS:  A total of 38 patients were included from August 2011 to August 2016; 18 patients underwent DC and 20 PC...
February 19, 2018: European Journal of Pediatric Surgery
Klarieke Bravenboer-Monster, Claudia Keyzer-Dekker, Monique van Dijk, Lonneke Staals, Tom de Leeuw, Rene Wijnen
BACKGROUND: Epidural analgesia (EDA) is used as postoperative pain treatment in children, but little is known about its efficacy after laparotomy in children. This retrospective study investigated the efficacy of postoperative EDA after laparotomy in children and the frequencies of adverse effects and complications. MATERIALS AND METHODS: Data of all children aged 0 to 18 years undergoing laparotomy and treated with EDA in our hospital from January 2014 to December 2015 were collected...
February 19, 2018: European Journal of Pediatric Surgery
Federica Pederiva, Basem Khalil, Antonino Morabito, Sarah J Wood
BACKGROUND:  Short bowel syndrome (SBS) has an impact on children and their families not only physically, but also emotionally, mentally, and socially. This study aimed to evaluate quality of life and family impact in patients with SBS, using the Pediatric Quality of Life Inventory (PedsQL) measurement model. MATERIALS AND METHODS:  PedsQL questionnaires were administered to patients with SBS followed at the Pediatric Surgery of Royal Manchester Children's Hospital...
January 30, 2018: European Journal of Pediatric Surgery
Igor Sukhotnik, Yoav Ben Shahar, Salim Halabi, Nir Bitterman, Tatiana Dorfman, Yulia Pollak, Arnold Coran, Arie Bitterman
BACKGROUND:  Accumulating evidence indicates that changes in intestinal toll-like receptors (TLRs) precede histological injury in a rodent model of necrotizing enterocolitis. N-acetylserotonin (NAS) is a naturally occurring chemical intermediate in the biosynthesis of melatonin. A recent study has shown that treatment with NAS prevents gut mucosal damage and inhibits programmed cell death following intestinal ischemia-reperfusion (IR). The objective of this study was to determine the effects of NAS on TLR-4, myeloid differentiation factor 88 (Myd88), and TNF-α receptor-associated factor 6 (TRAF6) expression in intestinal mucosa following intestinal IR in a rat...
January 5, 2018: European Journal of Pediatric Surgery
Saleh Najjar, Sangtae Ahn, Israel Kasago, Chunlai Zuo, Kavita Umrau, Sanaz Ainechi, Christine Whyte, Christine E Sheehan, Suzanne M Homan, Hwajeong Lee
PURPOSE:  Quantification of calretinin-stained mucosal nerve fibers by image processing and analysis (IPA) may objectively define the transition zone (TZ) of Hirschsprung disease (HD). We tested the utility of IPA as an adjunctive tool in HD. MATERIALS AND METHODS:  Calretinin immunostain was performed on 15 HD pull-through specimens, and multiple images were captured from the proximal aganglionic zone, TZ, and probable normal zone (NZ). Pixel count (PC), defined as the percentage of brown-stained pixels in the mucosa, was quantified and plotted against distance from the rectal distal end...
January 5, 2018: European Journal of Pediatric Surgery
Richard Sola, Amita A Desai, Katherine W Gonzalez, Nichole M Doyle, Katrina L Weaver, Ashwini S Poola, Jason D Fraser, Shawn D St Peter, Daniel L Millspaugh
INTRODUCTION:  The recent increased awareness of the dangers of opioids in the United States has highlighted the need to minimize narcotics and identify nonopioid options for pain control after surgery. With evidence suggesting that intravenous acetaminophen (IVA) can be an opioid sparing option, we conducted a prospective, randomized trial that evaluated the effect of IVA on the postoperative pain course of children with perforated appendicitis. MATERIALS AND METHODS:  After IRB approval, children with perforated appendicitis were randomized to receive postoperative IVA with the standard patient/nurse-controlled analgesia (PCA) or to receive the PCA alone...
January 2, 2018: European Journal of Pediatric Surgery
Martha Isabel Romo Muñoz, Alba Sánchez Galán, Miriam Miguel, Vanesa Nuñez Cerezo, Bryant Noriega Rebolledo, Mariela Dore, Paloma Triana Junco, Saturnino Barrena, Mercedes Diaz, Juan Carlos Lopez-Gutierrez
OBJECTIVE: One of the principal objectives in treatment of facial nevus is to minimize psychological damage and encourage the child's schooling by the best possible cosmetic result. There are several therapeutic techniques: grafts, flaps, dermal regenerator, and tissue expanders. MATERIALS AND METHODS: We reviewed 10 patients with facial nevus higher than 10 cm treated in the past 8 years. Our treatment protocol includes serial expander implant to remove everything that does not involve the eyelid and nasal pyramid...
February 2018: European Journal of Pediatric Surgery
Mariela Dore, Paloma Triana Junco, Alba Sánchez Galán, Gerardo Prieto, Esther Ramos, Martha Muñoz Romo, Manuel Gómez Cervantes, Francisco Hernández, Leopoldo Martínez, Manuel López Santamaría
AIM:  The onset of inflammatory bowel disease (IBD) in patients younger than the age of 5 years is rare. Moreover, when there is exclusive colonic inflammation, diagnosis can be challenging. Our aim was to describe the difficulties and pitfalls in the diagnosis of early-onset IBD (eoIBD) and their repercussions in treatment decisions. PATIENTS AND METHODS:  Patients with eoIBD (Crohn's disease [CD], ulcerative, and unclassified colitis) treated at our center between 1990 and 2016 were studied retrospectively...
February 2018: European Journal of Pediatric Surgery
Omid Madadi-Sanjani, Julia Zimmer, Jan-Hendrik Gosemann, Benno M Ure, Martin Lacher, Roland Boehm
OBJECTIVE:  Recurrent esophageal strictures (ESs) following esophageal atresia repair or caustic ingestion represent a common clinical problem. Recently, Mitomycin C was reported to improve the outcome of patients by reducing the number of endoscopic dilatations. However, other groups failed to exhibit a beneficial effect. We report on our experience with topic Mitomycin C application following endoscopic dilatation for recurrent ES. METHODS:  Retrospective chart review of patients with ES treated at the Hannover Medical School (Location A) and the University of Leipzig (Location B) between 2009 and 2015...
December 21, 2017: European Journal of Pediatric Surgery
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