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European Journal of Pediatric Surgery

Andre Hebra
The technique for minimally invasive repair of pectus excavatum (MIRPE) has been adopted by most surgeons as the preferred method for treatment of this condition. However, there is limited awareness about the complications related to the procedure. Most importantly, the prevalence and potential for life-threatening complications have frequently been underestimated. The purpose of this communication is to increase awareness of the risk of minor and major (life-threatening) complications, as well as the operative steps and modifications which have been developed to prevent them...
September 18, 2018: European Journal of Pediatric Surgery
Aodhnait S Fahy, Agostino Pierro
INTRODUCTION:  With improvements in prenatal ultrasound, more abdominal enteric duplication cysts (EDCs) are diagnosed prenatally. The optimal time for operative intervention is unclear. We aimed to review the evidence supporting the indication and timing of surgery for prenatally diagnosed EDCs. MATERIALS AND METHODS:  A systematic review was performed using a defined search strategy identifying articles with inclusion criteria of prenatal diagnosis of histologically confirmed EDCs...
September 18, 2018: European Journal of Pediatric Surgery
Robert Edward Kelly
The procedure introduced by Donald Nuss in 1997 for the treatment of pectus excavatum at the American Pediatric Surgical Association meeting has now been adopted by pediatric, thoracic, and plastic surgeons around the world. Rather than resection of the costal cartilages and sternal fracture, which had been standard practice for decades, he advocated using a metal bar to push the sternum into position. Reasoning that the chest wall of children is very flexible, he felt that resection was unnecessary. Since that time, medical centers from around the world have reported their experience with the procedure...
September 13, 2018: European Journal of Pediatric Surgery
Caroline Fortmann, Claus Petersen
In most cases, correction of a pectus deformity is performed for cosmetic reasons. The main indication for corrective therapy is impaired body image and self-esteem due to the deformity. In these instances, patients suffer from a lower quality of life that is not correlated with the severity of the chest wall deformity. After correction of a pectus excavatum (PE) or pectus carinatum (PC) patients experience a significant improvement in body image and self-esteem. For many, corrective surgery is life changing as it leaves patients feeling satisfied with the appearance of their chest, and this in turn increases their engagement in social activities...
August 21, 2018: European Journal of Pediatric Surgery
Elke Zani-Ruttenstock, Augusto Zani, Simon Eaton, Annie Fecteau
AIM:  The American College of Surgeons has developed a registry, the National Quality Improvement Program Pediatric (NSQIP-P), that provides participating centers with high-quality surgical outcome data for children. Herein, we aimed to analyze for the first time the short-term outcomes of live-born infants with congenital diaphragmatic hernia (CDH) registered on this large North American database. METHODS:  During 2015 to 2016, up to 101 participating centers uploaded 95 perioperative data points on the NSQIP-P database for patients that underwent surgical repair of CDH...
August 21, 2018: European Journal of Pediatric Surgery
Zeng Hao Wong, Mark Davenport
AIM:  Biliary atresia (BA) remains a rare disease in Europe with an estimated incidence of 1 in 15-20,000 livebirths. While the Kasai portoenterostomy (KPE) is regarded as the standard operation for BA, there is no consensus on optimum adjuvant therapy. We sought to determine the variation in therapy and opinion in centers known to have an interest in pediatric hepatobiliary surgery across Europe. METHODS:  A survey of current pre- and postoperative practice was circulated to surgeons and centers known to have an interest in BA...
August 21, 2018: European Journal of Pediatric Surgery
Akhilesh Pradhan, Radhika Patel, A J Said, Manasvi Upadhyaya
INTRODUCTION:  Balanitis xerotica obliterans (BXO) is uncommon in children. Diagnosis of the condition is almost always clinical and supported by histology. Our aim was to evaluate the outcomes of children undergoing circumcision for BXO and explore the correlation between surgical and histological findings. MATERIALS AND METHODS:  A 10-year retrospective review (2007-2017) of all children, aged 16 and less, undergoing circumcision at a tertiary teaching hospital was conducted...
August 21, 2018: European Journal of Pediatric Surgery
Sanjena Kumar Amuddhu, Yong Chen, Shireen Anne Nah
INTRODUCTION:  Recent literature advocates outpatient emergency department (ED) management of intussusception citing low recurrence rates and postreduction events after uncomplicated ileocolic reduction. However, few studies include both inpatient and outpatient cohorts. We performed a systematic review and meta-analysis to compare recurrence rates and length of hospital stay between the groups. METHODS:  Studies published in English up to January 2018 were searched from Medline, Embase, Google Scholar, and Cochrane databases, using a combination of the terms 'intussusception,' 'reduction,' and 'management'...
August 21, 2018: European Journal of Pediatric Surgery
Julia Zimmer, Simon Eaton, Louise E Murchison, Benno M Ure, Carmen Dingemann
AIM:  Surgical expertise and advances in technical equipment and perioperative management have led to enormous progress in survival and morbidity of patients with esophageal atresia (EA) in the last decades. We aimed to analyze the available literature on surgical outcome of EA for the past 80 years. MATERIALS AND METHODS:  A PubMed literature search was conducted for the years 1944 to 2017 using the keywords "esophageal/oesophageal atresia," "outcome," "experience," "management," and "follow-up/follow up...
August 15, 2018: European Journal of Pediatric Surgery
Anton Herbert Schwabegger
Surgical procedures for pectus excavatum (PE) repair, such as minimally invasive repair of pectus excavatum or similar interventions (modified open videoendoscopically assisted repair of pectus excavatum, for remodeling the anterior thoracic wall may finally not always achieve sufficiently pleasing aesthetic results. Particularly in the asymmetric and polymorphic cases, remnant deformities may still be present after any sophisticated remodeling attempt. On the other hand, some cases despite optimal surgical management develop mild recurrences with partial concavity or rib cartilage distortion shortly after pectus-bar removal...
August 15, 2018: European Journal of Pediatric Surgery
Sherif Emil
Pectus carinatum has traditionally been described as a rare chest wall anomaly in comparison to pectus excavatum. However, recent data from chest wall anomaly clinics demonstrate that this deformity is probably much more frequent than once believed. In the past, invasive surgical correction by the Ravitch technique was essentially the only option for treatment of pectus carinatum. Major advances over the past two decades have provided additional options, including noninvasive chest wall bracing and minimally invasive surgical correction...
August 15, 2018: European Journal of Pediatric Surgery
Augusto Zani, Nigel J Hall, Abidur Rahman, Francesco Morini, Alessio Pini Prato, Florian Friedmacher, Antti Koivusalo, Ernest van Heurn, Agostino Pierro
AIM:  To define patterns in the management of pediatric appendicitis. METHODS:  A total of 169 delegates from 42 (24 European) countries completed a validated survey administered at the EUPSA 2017 annual congress. RESULTS:  In the work-up of children with suspected acute appendicitis, most surgeons rely on full blood count (92%), C-reactive protein (82%), and abdominal ultrasonography (76%), but rarely on computed tomography scans or magnetic resonance imaging...
August 15, 2018: European Journal of Pediatric Surgery
Elisa Siano, Giuseppe Lauriti, Silvia Ceccanti, Augusto Zani
AIM:  The main purpose of this study was to investigate if necrotizing enterocolitis (NEC) has a different presentation and outcome in patients with congenital heart defect (CHD) (cardiogenic NEC) from those without (classical NEC). MATERIALS AND METHODS:  A systematic review of the literature on the characteristics of infants with NEC and CHD was performed by three independent investigators using a defined strategy (PubMed, Cochrane, Embase, and Web of Science)...
August 15, 2018: European Journal of Pediatric Surgery
G Goetz, M Klora, J Zeidler, S Eberhard, S Bassler, S Mayer, J-H Gosemann, M Lacher
INTRODUCTION:  Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany. MATERIAL AND METHODS:  Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline...
August 15, 2018: European Journal of Pediatric Surgery
Dawn E Jaroszewski, Cristine S Velazco, Venkata Siva Krishna Kumar Pulivarthi, Reza Arsanjani, Robert J Obermeyer
Patients with pectus excavatum (PE) frequently present with complaints of exercise intolerance and cardiopulmonary symptoms. There continues to be controversy regarding the physiologic benefits of repair. The aim of this review is to summarize and discuss recent data regarding the cardiopulmonary effects of PE deformity and the evidence for improvement obtained after surgical repair including (1) a greater efficiency of breathing (chest wall mechanics), (2) improvement in pulmonary restrictive deficits, (3) an increase in cardiac chamber size and output, with improved cardiac strain and strain rate, and (4) improvement in exercise capacity...
August 13, 2018: European Journal of Pediatric Surgery
Frank-Martin Häcker
For decades, open surgical repair was the only available method to treat congenital and acquired chest wall deformities (CWDs). In 1998, D. Nuss described a minimally invasive procedure for surgical repair of pectus excavatum (PE), and a few years later H. Abramson reported on his experience with the "reversed Nuss technique" for surgical repair of pectus carinatum (PC). Both procedures are performed with increasing frequency worldwide.However, nonsurgical measures such as vacuum bell (VB) therapy for conservative treatment of PE and more differentiated bracing systems for conservative treatment of PC were established 15 to 20 years ago...
August 13, 2018: European Journal of Pediatric Surgery
Julie Monteagudo, Catherine M Dickinson, Michelle Wakeley, Shamlal Mangray, Hale E Wills, Francois I Luks
INTRODUCTION:  Rhabdomyomatous dysplasia (RD) is a pathologic finding in CPAMs that was incorrectly attributed to their malignant potential. The increasing recognition of extrathoracic (intradiaphragmatic and intraabdominal) congenital pulmonary airway malformations (CPAMs) offers a clue to the origin of RD. We hypothesize that the presence of RD is related to the CPAM's anatomic location. MATERIALS AND METHODS:  Retrospective review was performed of all children who underwent resection of a CPAM during a 10-year period...
August 13, 2018: European Journal of Pediatric Surgery
Paloma Triana Junco, Esther María Cano, Mariela Dore, Javier Jimenez Gomez, Alba Sánchez Galán, Alejandra Vilanova-Sánchez, Ane Andres, Jose Luis Encinas, Leopoldo Martinez, Francisco Hernandez, Manuel Lopez Santamaria
AIM:  Hepatoblastoma is the most frequent hepatic tumor in children, and its initial presentation will affect treatment and prognosis. The aim of this study is to evaluate long-term results of liver transplantation in children with unresectable hepatoblastoma. PATIENTS AND METHODS:  This is a retrospective review of patients with hepatoblastoma who underwent liver transplantation, analyzing risk factors, tumor presentation, treatment, and long-term survival to identify prognostic factors...
August 7, 2018: European Journal of Pediatric Surgery
Paloma Triana Junco, Ana Alvarez, Mariela Dore, Javier Jimenez Gomez, Alba Sánchez Galán, Alejandra Vilanova-Sánchez, Ane Andres, Jose Luis Encinas, Leopoldo Martinez, Francisco Hernandez, Manuel Lopez Santamaria
AIM:  Extrahepatic portal vein obstruction (EHPVO) is a frequent cause of noncirrhotic portal hypertension in children. The aim of this study is to analyze long-term results after diversion surgery. PATIENTS AND METHODS:  Retrospective review of EHPVO patients who underwent diversion surgery analyzing number of platelets, leukocytes, prothrombin activity, splenomegaly, and gastrointestinal bleeding 10 years after surgery. RESULTS:  Thirty-three patients were evaluated, mostly males (64%) and presenting with gastrointestinal bleeding (46%)...
August 7, 2018: European Journal of Pediatric Surgery
Mirjam Ploeg, Claudia M G Keyzer-Dekker, Cornelius E J Sloots, Cornelis P van de Ven, Conny Meeussen, Rene M H Wijnen, John Vlot
BACKGROUND:  In 2011, we implemented a new video-based system for quality control of laparoscopic pyloromyotomy. More than 3 years later, we evaluated how the implementation had gone and assessed its usability in predicting postoperative outcomes. METHODS:  Four key point images or short video-segments were to be recorded perioperatively: prepyloromyotomy, parallel-mobility testing, perforation testing, and postpyloromyotomy. Data of all 134 patients undergoing laparoscopic pyloromyotomy from September 2011 to December 2014 were analyzed retrospectively...
August 7, 2018: European Journal of Pediatric Surgery
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