Surgical drainage procedures for paediatric chronic pancreatitis: a scoping review.

Paediatric chronic pancreatitis (CP) is a relatively rare entity, but it can be accompanied by debilitating complications such as pseudocysts, chronic pain and pancreatic duct obstruction. Surgical drainage procedures, such as pancreaticojejunostomy or cystogastrostomy/jejunostomy to address these complications may be required; however, there is a paucity of evidence as to the efficacy and long-term outcomes of these operations in the paediatric population. A scoping review of contemporary (post-2000) studies detailing surgical pancreatic drainage procedures performed in children (< 18 years) was undertaken. After screening, 24 case series detailing a total of 248 patients met the inclusion criteria. Longitudinal pancreaticojejunostomy and cystogastrostomy were the most common surgical procedures performed in children with CP and pseudocysts, respectively. Overall generally favourable outcomes were reported, but all studies were considered to have a high risk of bias. Operative management for paediatric CP is infrequently required; therefore, large prospective studies or trials focusing on this population are infeasible, limiting the best available evidence on the topic to case series, level IV. Recommendations to improve the quality of surgical care in the paediatric CP population could include centralisation and the formation of registries to allow accurate long-term follow-up.

Surgical Experience and Learning Points in the Management of Foregut Duplication Cysts.

BACKGROUND: Foregut duplication cysts (FDC) have unpredictable natural course and rarely remain asymptomatic. We present our large cohort of FDC to highlight surgical learning points and outcome. MATERIALS AND METHODS: Review of 41 children with FDC (April 1997-April 2015) included demographics, clinical presentation, preoperative investigations, surgical management, post-operative complications, and overall outcome. RESULTS: Forty-one children (26 girls/15 boys; male/female [M/F] ratio 1:1.7) had 43 FDC (two cases >1 cyst) consisting of antenatally diagnosed 16 (39%), late with symptoms 21 (51.2%), and incidental 4(9.8%) cases. FDC locations were cervical (3), mediastinal (35), and subdiaphragmatic (5). During all cervical FDC resection, recurrent laryngeal nerve was required to be dissected off the cyst wall. Thoracoscopic resection was feasible in 27 cases, with 4 conversions related to infections and adhesions or accidental injury to trachea/esophagus. Complete resection was achieved in all cases with no recurrence. There was no mortality and morbidity included, chylothorax (1) esophageal injury (1), phrenic nerve injury (1), and tracheal injury (2). The minimally invasive surgery and surgery on asymptomatic lesions significantly affect the outcome by reducing need for chest drain (p = 0.01) and length of hospital stay (p = 0.04). CONCLUSION: This retrospective study confirms the efficacy and safety of thoracoscopic surgery; important learning points were association of common wall with trachea in some superior mediastinal cysts and association of recurrent laryngeal nerve in cervical FDC.

Laparoscopic Duhamel Procedure for Hirschsprung's Disease: Systematic Review and Meta-analysis.

INTRODUCTION: Since its introduction in 1956, the Duhamel procedure has been and remains one of the most widely performed for Hirschsprung's disease (HD). The most significant modification to this procedure has been the incorporation of laparoscopy, while the original principles of the method have been retained. This study compared long-term outcomes for open Duhamel (OD) and laparoscopic Duhamel (LD) procedures for HD, to identify any added advantage of the laparoscopic technique. MATERIALS AND METHODS: We undertook a systematic review of all studies published over a period of 20 years (1994-2014) that assessed functional outcomes for OD and/or LD procedures. Odds ratios were calculated for dichotomous variables, and mean difference values were calculated for continuous variables. RESULTS: From 11 articles 456 patients were included (253 OD, 203 LD), with no significant difference in age at surgery and length of follow-up (P > .05). The open group had a significantly greater incidence of soiling/incontinence (11% versus 4%; P = .02) and further surgery (25% versus 14%; P = .005), longer hospital stay (9.79 versus 7.3 days; P < .00001), and time to oral feed (4.05 versus 3.27 days; P < .00001). Operative time was significantly longer in the laparoscopic group (3.83 versus 4.09 hours; P = .004). There was no significant difference in incidence of enterocolitis (15% versus 10%; P = .14) and constipation (23% versus 30%; P = .12). CONCLUSIONS: Our meta-analysis convincingly demonstrates the superiority of LD over OD pull-through for HD. Prospective, randomized control trials are required to overcome limitations in the current literature.

A new operative technique - extra renal ureterocalycostomy for correction of PUJ obstruction in a horseshoe kidney.

The authors describe a novel operative technique in a child with PUJ obstruction in a horseshoe kidney, where a pyeloplasty was clinically indicated but unsafe because of insufficient length of ureter and predicted technical difficulty in transposing large renal vessels coursing to the renal hilum. During the operation, there was a favourably positioned extra renal lower pole calyceal infundibulum identified, of similar dimensions to the spatulated ureter and this was chosen for an end to side tension free anastomosis. As far as the authors are aware this technique of extra renal ureterocalycostomy has not been described before.

C-reactive protein (CRP) levels in babies with gastroschisis managed with preformed silos.

BACKGROUND/PURPOSE: The purpose of this study was to assess the degree of elevation of serum C-reactive protein (CRP) levels in infants with gastroschisis managed by placement of a preformed silo and subsequent nonoperative closure. METHODS: CRP measurements were collected prospectively in infants with gastroschisis undergoing preformed silo placement until defect closure. Infants requiring operative closure or surgical silo placement were excluded as were any infants with confirmed sepsis during the closure period. RESULTS: Data were available for 43 infants. Median CRP at birth was 8 mg/L (range 6 to 55) rising to 42 mg/L (range 35 to 68) at the time of closure. CONCLUSIONS: Elevation of serum CRP levels is to be expected in infants with gastroschisis managed with a preformed silo in the absence of infection. This data may be used to prevent unnecessary use of antibiotics in this group of patients.

An unusual complication of ischemic injury to upper pole ureter during lower pole heminephroureterectomy.

Lower pole heminephroureterectomy is a common paediatric urology procedure with few reported complications. We report a case of possible vascular ischemic injury to the normal remaining ureter following a lower pole heminephroureterectomy, probably due to both ureters sharing a common blood supply. Extra caution in such procedures is therefore warranted.

The role of cystovaginoscopy and hygienic advice in girls referred for symptoms of vulvovaginitis.

Vulvovaginitis is a common presenting symptom referred to a paediatric urology clinic. Some of these patients undergo diagnostic cystovaginoscopy to determine whether there is any underlying anatomical cause for the persistent infection. However, in the majority of the patients, no underlying abnormality is found and they are given hygienic advice and prescribed bio yoghurt postoperatively. This study examines the outcome in these patients after hygienic advice is given: determining whether cystovaginoscopy was really necessary and whether it changed the management of vulvovaginitis.

A new operative technique for a rare case of pyelic fusion.

This case report presents the first documented case of pyelic fusion with two sites of obstruction. The patient was diagnosed following antenatal presentation and the operative technique described in this case report is the only way by which the obstructions could be treated with a single procedure. The left pelvicalyceal system was grossly dilated and was draining into the common pelvis via an obstructed calyx in the isthmus of the horse shoe. The common ureter also had a pelviureteric junction stenosis. Incisions were made in the left dilated pelvis and in the obstructed part of the pelviureteric junction and ureter. The two openings were sutured as a culp pyeloplasty using interrupted 6/0 PDS sutures over a 4F JJ stent.