Pediatric Surgery interesting papers

PURPOSE: The aim of this study was to describe our experience in the management of patients with ventriculoperitoneal shunt-related complications (abdominal pseudocyst, bowel-related complications, and ascites) and to propose treatment recommendations. MATERIAL AND METHODS: A retrospective descriptive study was conducted in patients with ventriculoperitoneal shunt-related abdominal complications seen between 2009 and 2019 at a tertiary-care pediatric center. Patients were classified according to their diagnosis into the following: group A (abdominal pseudocyst), group B (bowel-related complications), and group C (ascites)...

BACKGROUND: The safety of the laparoscopic treatment of intestinal malrotation remains controversial. This study compared the outcomes of laparoscopic and open surgical treatment of intestinal malrotation. METHODS: A multicentric retrospective study included pediatric cases of intestinal malrotation operated on between 2005 and 2016. RESULTS: This study included 227 children with a median age of 17 days (0-17.2 years), including 161 with a midgut volvulus...

BACKGROUND: Sutureless gastroschisis repair involves covering the abdominal wall defect with the umbilical cord or a synthetic dressing to allow closure by secondary intention. No randomized studies have described the outcomes of this technique. Our objective was to prospectively compare short-term outcomes of sutureless vs sutured closure in a randomized fashion. STUDY DESIGN: We recruited patients who presented with gastroschisis between 2009 and 2014 and were randomized into either sutureless or sutured treatment groups...

OBJECTIVES: To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged <1 year presenting to general practitioners (GPs). DESIGN, SETTING AND PARTICIPANTS: A nationally representative, prospective, cross-sectional survey of GP activity in Australia, 2006-2016 (Bettering the Evaluation And Care of Health Study). Annually, a random sample of around 1000 GPs recorded details for 100 consecutive visits with consenting, unidentified patients...

No abstract text is available yet for this article.

PURPOSE: Despite the numerous methods of closure for giant omphaloceles, uncertainty persists regarding the most effective option. Our purpose was to review the literature to clarify the current methods being used and to determine superiority of either staged surgical procedures or nonoperative delayed closure in order to recommend a standard of care for the management of the giant omphalocele. METHODS: Our initial database search resulted in 378 articles. After de-duplification and review, we requested 32 articles relevant to our topic that partially met our inclusion criteria...

Gastroesophageal reflux (GER) occurs frequently in infants, generally at its worst at 4 months of age, with approximately two-thirds of infants spitting up daily. GER typically improves after 7 months of age, with only ∼5% of infants continuing to have reflux at 1 year of age. The diagnosis can often be made based on clinical symptoms. Upper GI (UGI) study has low sensitivity and specificity and should not be ordered as a diagnostic test for reflux. UGI study is best for evaluating other anatomic causes of vomiting...

PURPOSE: Peritoneal drainage (PD) constitutes a definitive therapy for a subset of extremely low birth weight (ELBW) infants with spontaneous intestinal perforation (SIP). We investigated the factors which may differentiate these patients from those who require a laparotomy (LAP) after initial PD. METHODS: A retrospective chart review of all ELBW infants (<1000 grams) who underwent PD at two tertiary neonatal intensive care units over a 42-month period was performed...

Gastroesophageal reflux (GER) and pulmonary aspiration are encountered in children of all ages. Signs, symptoms, and complications vary from mild and transient to severe life-threatening conditions. This review will present relevant clinical information on these conditions as well as common diagnostic procedures. The role of scintigraphic techniques used in the evaluation of these conditions will be discussed in detail including protocols and performance in comparison to other diagnostic methods.

IMPORTANCE: Gastrostomy tube (GT) placement is the most common gastrointestinal operation performed on neonates. Concomitant fundoplication is used variably to prevent complications of gastroesophageal reflux, but its effectiveness is unproven. OBJECTIVE: To compare the effect of fundoplication at the time of GT placement vs GT placement alone on subsequent reflux-related hospitalizations in infants with neurological impairment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, observational cohort study, defined by birth between January 1, 2005, and December 31, 2010, at 42 children's hospitals in the United States, with a 1-year follow-up period among 4163 infants with neurological impairment who underwent GT placement with or without fundoplication during their neonatal intensive care unit stay...

BACKGROUND: Previously, concomitant antireflux surgery was performed in all neurologically impaired children undergoing gastrostomy tube placement in our department. This fundoplication procedure, not necessarily performed for symptomatic gastroesophageal reflux, increased the postoperative complications. This practice was changed and fundoplication was offered to only those children who had clear surgical indications for an antireflux procedure on follow-up after a feeding gastrostomy...

Insulin is a powerful hormone produced by the beta-cells in the pancreas. Its major function is to regulate blood glucose levels, facilitating the transport of glucose into the body's cells. Congenital hyperinsulinism is characterized by the presence of insulin that is inappropriately high for the concentration of blood glucose. Because high levels of insulin also switch off all alternative fuels for the brain to use, this condition can cause brain injury if not detected quickly. Nurses are in a unique position by the bedside to identify the symptoms and treat the hypoglycaemia through very simple nursing interventions, such as safe administration of glucose and frequent blood glucose monitoring...

PURPOSE: Sclerotherapy is well described as a treatment for lymphatic malformations (LMs) in the head, neck, and other soft tissue areas. This study aims to evaluate the effectiveness of intralesional sclerotherapy as primary treatment for intra-abdominal LMs in children. METHODS: We conducted a retrospective review from 2008 to 2012 of all children with intra-abdominal LMs treated with sclerotherapy at our tertiary children's hospital. RESULTS: In this study, five patients underwent sclerotherapy as a primary intervention for intra-abdominal LMs...

Generalized lymphatic malformation (GLM) often causes chylothorax, which can be a highly morbid condition. Chylothorax in a pediatric patient with a lymphangiogenic disorder may be especially resistant to therapy, requiring more aggressive measures. We discuss the complex ongoing long-term management of a pediatric patient with GLM who presented with massive, persistent left chylothorax, which resolved by surgical ligation of the thoracic duct and medical management.

Lymphatic malformations are slow-flow vascular anomalies composed of dilated lymphatic channels and cysts of varying sizes. Percutaneous treatments, particularly sclerotherapy, play an important role in the treatment of these lesions, often obviating the need for surgical intervention. Owing to the complex nature of these lesions, a multidisciplinary approach should be used to guide diagnosis and management. This submission focuses on the workup and treatment of pediatric lymphatic malformations at our institution, with a focus on sclerotherapy...

OBJECTIVE: This is a systematic review of the literature describing doxycycline sclerotherapy (DS) to treat pediatric head and neck lymphatic malformations and examine patient factors associated with treatment success. DATA SOURCES: PubMed, EMBASE, and Ovid. REVIEW METHODS: A query of PubMed, EMBASE, and Ovid search engines (1995-2014) for studies examining outcomes for doxycycline sclerotherapy (DS) as primary treatment strategy for children with head and neck lymphatic malformations was undertaken...

OBJECTIVE: The purpose of this article is to review the practical imaging workup and characteristic imaging appearances of intraabdominal lymphatic malformations (LMs) in the pediatric population with a brief discussion of some common differential diagnoses found in a vascular anomaly clinic. CONCLUSION: LMs are uncommon pediatric lesions. Because of their rarity among LMs overall, a tendency to present later in life than superficial LMs, and often incidental identification, intraabdominal LMs pose a particular diagnostic challenge, and pathologic entities that are more prevalent must be carefully excluded first...

Multimodal treatment of lymphatic malformations continues to expand as new information about the biology and genetics of these lesions is discovered, along with knowledge gained from clinical practice. A patient-centered approach, ideally provided by a multidisciplinary medical and surgical team, should guide timing and modality of treatment. Current treatment options include observation, surgery, sclerotherapy, radiofrequency ablation, and laser therapy. New medical and surgical therapies are emerging, and include sildenafil, propranolol, sirolimus, and vascularized lymph node transfer...