RESUMEN
OBJECTIVES: About 24% of children with Crohn's Disease (CD) require surgery. In 2003, Kono et al. described a novel anastomosis reported to decrease the rate of anastomotic CD recurrence. Subsequent studies have reproduced these outcomes, but none has demonstrated its effect in pediatric patients. This study evaluates short-term outcomes of pediatric patients following ileocolic resection and Kono-S anastomosis. METHODS: A retrospective review of patients < 18 years old who underwent ileocolic resection followed by Kono-S anastomosis compared with those who underwent a stapled anastomosis. RESULTS: Nine Kono-S patients were matched with nine patients preceding them who received traditional side-to-side and end-to-side anastomoses. All patients underwent minimally invasive surgery. Demographics, pre-operative medication usage, and symptom profiles were not significantly different. Traditional anastomosis (TA) patients had longer lengths of stay (4.6 vs 2.9 days; p = 0.03) but had no statistically significant differences in blood loss, procedure length, and pathologic findings. One Kono-S patient had a superficial surgical site infection, and one TA patient had an anastomotic leak requiring reoperation within 30 days. More TA patients experienced post-operative symptoms at both 30-day and 6-month follow-up (66.7% vs 33.3%; p = 0.16 and 77.8% vs 25%; p = 0.03). CONCLUSION: The Kono-S anastomosis appears to be safe in pediatric CD when compared to traditional stapled anastomoses.
Asunto(s)
Enfermedad de Crohn , Humanos , Niño , Adolescente , Enfermedad de Crohn/cirugía , Colon/cirugía , Íleon/cirugía , Anastomosis Quirúrgica/métodos , Estudios Retrospectivos , Recurrencia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Inflammatory bowel disease encompasses relapsing gastrointestinal disorders commonly presenting in pediatric patients, with 25% of diagnoses made before age 20 and 4% before age 5. Considering the need for life-long surgical follow-up, a collaborative system involving both pediatric and colorectal surgeons could improve overall patient experiences. We hypothesized that cases performed in collaboration with both pediatric and adult colorectal surgeons may lead to better outcomes. METHODS: Data were gathered retrospectively for 116 patients 18 y old or younger who underwent colorectal resections for inflammatory bowel disease between 2010 and 2017 at our institution. Data included patient demographics, type of procedure, surgical approach, specimen extraction site, surgeon involvement (pediatric, colorectal, or collaborative), operative time, and estimated blood loss. We analyzed days until passage of flatus and bowel movement, length of stay, type of surgical procedure, and surgical complications. RESULTS: Our data showed that days until flatus (2.27 ± 0.47, P = 0.049), first bowel movement (2.64 ± 0.67, P = 0.006), and length of stay (4.45 ± 1.51, P = 0.006) were the shortest in the collaborative group. We also found that single-incision laparoscopic surgery was significantly more common in the collaborative group (77.8%, P = 0.002). We did not see a difference in surgical complication rates among any of the groups. CONCLUSIONS: Our study showed short-term beneficial outcomes in a single institution associated with the collaboration of pediatric surgeons and colorectal surgeons on pediatric colorectal cases in comparison to those performed by pediatric surgeons or adult colorectal surgeons alone.
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Colectomía/efectos adversos , Enfermedades Inflamatorias del Intestino/cirugía , Colaboración Intersectorial , Grupo de Atención al Paciente/organización & administración , Complicaciones Posoperatorias/prevención & control , Adolescente , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Niño , Colectomía/métodos , Cirugía Colorrectal/organización & administración , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Tempo Operativo , Pediatría/organización & administración , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Cirujanos/organización & administración , Resultado del TratamientoRESUMEN
BACKGROUND: The Nuss procedure for pectus excavatum has historically been associated with significant postoperative pain, which has been the major factor contributing to hospital length of stay (LOS). METHODS: A single-institution, prospective study of 40 consecutive patients undergoing Nuss bar placement for pectus excavatum between November 2019 and January 2021 was conducted to assess the effectiveness of a multimodality pain management protocol. All patients received T3-T8 intercostal nerve cryoablation (INC), T3-T8 bupivacaine intercostal nerve blocks, Exparel at the skin incisions, and management with a perioperative analgesia regimen that minimized narcotic usage. The primary outcome was LOS. Secondary outcomes included opioid use, pain scores, and time to sensory recovery. RESULTS: 37/40 patients (92.5%) were discharged home on postoperative day (POD) 1, and 3/40 (7.5%) were discharged on POD 2 (mean LOS = 1.1 days). The median average postoperative pain score was 2/10. After eliminating IVPCA from our protocol, total oral morphine equivalent (OME) decreased by 73% (55.5 mg to 15 mg) with no change in pain scores or discharge timing. CONCLUSIONS: INC combined with bupivacaine intercostal nerve blocks and a pre- and post-hospital analgesia protocol facilitated discharge one day after the Nuss procedure, achieved excellent pain control, and eliminated the need for intravenous opioids.
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Analgesia Epidural , Criocirugía , Tórax en Embudo , Analgésicos Opioides , Tórax en Embudo/cirugía , Humanos , Nervios Intercostales , Tiempo de Internación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/cirugía , Alta del Paciente , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
BACKGROUND: APSA's Right Child/Right Surgeon Initiative addresses issues concerning patient access to appropriate pediatric surgical care and workforce distribution. The APSA Workforce Committee sought to understand the experiences and motivations of recent graduates of Pediatric Surgery Training Programs entering the workforce. METHODS: Using APSA membership databases, we identified members who completed fellowship training from 2010 to 2019. An online survey was created using Survey Monkey, and invitations to participate were sent via email. RESULTS: 144 of 447 invited participants responded (32% response rate). 91% of respondents participated in dedicated research prior to fellowship, but only 64% perform research during their employment. 23% completed an additional clinical fellowship, but only 54% currently practice within the second field. When asked to identify the top three factors used to choose a position, the most common responses were "location or geography" (71%), "available mentorship" (53%), and "compensation and benefits" (37%). Describing their first position, 77% reported working in an academic institution, 78% reported working in a metropolitan/urban area, and 55% reported working in a free-standing children's hospital. 94% participate in General Surgery resident education, and 49% are faculty within a Pediatric Surgery fellowship. Overall, 92% of respondents were able to find the type of employment position that they had wanted. CONCLUSION: In our survey the overwhelming majority of young pediatric surgeons found the type of job they desired. Most report beginning their practice in more populated, urban areas within academic institutions. Geographic location and work environment played heavily into their employment decisions. These preferences could contribute to continued disparity in access to pediatric surgeons between urban and rural America and to dilution of experience for urban surgeons. Possible solutions include alternative incentive programs for employment in less populated areas or new training models for general surgeons in rural areas to train in fundamentals of Pediatric Surgery.
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Especialidades Quirúrgicas , Cirujanos , Selección de Profesión , Empleo , Becas , Humanos , Encuestas y CuestionariosRESUMEN
The development of pediatric surgery as a specialty has its roots in disaster medicine. In recent years, the medical community and population at large have begun to acknowledge injury prevention as a public health priority. Domestic terrorist attacks and natural catastrophes over the last decade have highlighted the need for disaster preparedness. Recognition of the unique problems that the pediatric-age population can encounter in a natural or manmade disaster situation has exposed a new facet of injury prevention. Recounting the history of pediatric trauma care and identifying current efforts for injury prevention are essential toward achieving an injury-free America.
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Prevención de Accidentes/historia , Servicios Médicos de Urgencia/historia , Política de Salud/historia , Pediatría/historia , Traumatología/historia , Heridas y Lesiones/historia , Adulto , Niño , Historia del Siglo XX , Humanos , Estados Unidos/epidemiología , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & controlRESUMEN
Oesophageal pseudodiverticula rarely occur after excision of benign oesophageal neoplasms. While management and outcomes have been reported in the adult leiomyoma literature, sparse data exist on the occurrence and management of pseudodiverticula after foregut duplication cyst excision. We discuss our experience with a paediatric patient and review relevant literature regarding operative techniques and surgical outcomes.
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Anomalías del Sistema Digestivo/cirugía , Divertículo Esofágico/cirugía , Quiste Esofágico/cirugía , Esófago/cirugía , Quiste Mediastínico/cirugía , Preescolar , Anomalías del Sistema Digestivo/diagnóstico por imagen , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Divertículo Esofágico/diagnóstico por imagen , Divertículo Esofágico/etiología , Quiste Esofágico/congénito , Quiste Esofágico/diagnóstico por imagen , Esófago/anomalías , Esófago/diagnóstico por imagen , Femenino , Humanos , Quiste Mediastínico/diagnóstico por imagenRESUMEN
Trauma is the leading case of death for children in the United States. Effective initial resuscitation of pediatric trauma patients can reduce mortality. Guidelines have been developed to facilitate patient care in a systematic and productive manner. Advances have been made in both diagnostic and therapeutic methods. The evaluation and treatment of trauma patients will continue to engage pediatric surgeons as efforts in trauma prevention become more successful.
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Servicios Médicos de Urgencia , Resucitación/métodos , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapia , Niño , Preescolar , Diagnóstico por Imagen/métodos , Humanos , Lactante , Intubación Intratraqueal , Guías de Práctica Clínica como Asunto , Choque/diagnóstico , Choque/terapia , Traumatismos del Sistema Nervioso/diagnósticoRESUMEN
Duodenal atresia (DA) is a well-described congenital anomaly that usually responds well to surgical correction. Associated defects are common, and these confounding variables often influence outcome. The authors present a case of a newborn female with an unusual constellation of problems including DA with annular pancreas, trisomy 21, and coarctation of the aorta. She developed protracted complications postoperatively and was treated with an innovative surgical strategy.
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Anomalías Múltiples , Fuga Anastomótica/cirugía , Obstrucción Duodenal/cirugía , Duodenostomía/efectos adversos , Píloro/cirugía , Grapado Quirúrgico , Fuga Anastomótica/etiología , Coartación Aórtica/complicaciones , Coartación Aórtica/terapia , Síndrome de Down/complicaciones , Obstrucción Duodenal/complicaciones , Obstrucción Duodenal/diagnóstico , Duodenostomía/métodos , Femenino , Gastrostomía , Humanos , Recién Nacido , Atresia Intestinal , Yeyunostomía , Páncreas/anomalías , Enfermedades Pancreáticas/complicaciones , Reoperación , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
BACKGROUND: Evidence suggests that mild head injuries in humans can result in cumulative damage. No investigation to date has considered the effects of multiple subacute mild head injuries in an animal model. METHODS: Forty-one male Long-Evans hooded rats were trained in a Morris water maze. All animals were fitted with a hollow intracranial screw. Concussions were generated using a fluid percussion device. Animals were then evaluated in the water maze until performance returned to baseline. Control animals received no concussions. The remaining animals were randomized to receive one, two, or three concussions. Animals were allowed to return to baseline after each concussion and were then killed. Motor performance was evaluated on a balance beam both before and after concussions. RESULTS: After one concussion, 85% of animals showed performance deviation from baseline as measured by time to reach the platform, returning to baseline within a mean of 14.0 trials. After two concussions, 48% of animals showed deviation, with a mean return to baseline of 6.8 trials. After three concussions, 25% of animals showed deviation, with a mean return to baseline of 2.3 trials. Of postconcussive animals, 42% developed new inconsistent baseline levels of performance. Balance beam performance was unaffected. CONCLUSION: Multiple concussions cause immediate transient impairment in spatial recognition and have extended effects on baseline performance in rats. Motor performance is not affected.
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Conmoción Encefálica/psicología , Actividad Motora/fisiología , Traumatismo Múltiple/psicología , Conducta Espacial/fisiología , Animales , Masculino , Modelos Animales , Distribución Aleatoria , Ratas , Ratas Long-Evans , NataciónRESUMEN
PURPOSE: We validated a male rat model of bladder outflow obstruction and compared the expression of bladder neurotrophic factor mRNA in male and female rats 6 weeks after bladder outlet obstruction. MATERIALS AND METHODS: We examined the proximal urethra in male Wistar rats. Urethral lumen reducing ligatures were placed in 15 females and 19 males, while 10 male and 10 female controls underwent sham surgery. Awake cystometry was performed 6 weeks after surgery. Ribonuclease protection assay was used to measure changes in bladder neurotrophic factor mRNA expression in the 2 sexes. RESULTS: Average bladder capacity in rats with bladder outlet obstruction increased 3-fold in males and 4.4-fold in females compared with controls, while bladder weight increased 2.2 and 4.3-fold, respectively. Filling and threshold pressure increased significantly and nonvoiding bladder contractions were recorded in 100% of female and 80% of male rats with bladder outlet obstruction. An 8-fold increase in bladder brain derived neurotrophic factor mRNA was noted in each sex after obstruction. A 2-fold increase in bladder nerve growth factor mRNA after obstruction was only observed in females. CONCLUSIONS: This male rat model of bladder outlet obstruction was created by placing lumen reducing ligatures at the urethrovesical junction. The dramatic increase in bladder brain derived neurotrophic factor mRNA expression and differential expression of nerve growth factor mRNA in male and female rats with bladder outlet obstruction suggest that additional neurotrophic factors may contribute to the lower urinary tract neuroplasticity associated with bladder outlet obstruction and this contribution may be gender dependent.