Infra-areolar subcutaneous mastectomy in the surgical treatment of adolescent gynecomastia.

BACKGROUND: Despite being a common condition in puberty, only 5-10% of pubertal gynecomastia need surgical treatment. Here the authors present their experiences with infra-areolar subcutaneous mastectomy in the surgical treatment of adolescent gynecomastia. METHODS: The records of patients who underwent infra-areolar subcutaneous mastectomy for adolescent gynecomastia between January 2004 and December 2021 were reviewed retrospectively. The patients' demographic data, complaints and clinical presentation, physical examination, laboratory and radiological findings, surgical management, and postoperative follow-ups were evaluated. The patients were evaluated according to the localization of the gynecomastia (unilateral/bilateral) and according to the patients' body mass index (BMI) (normal/overweight). RESULTS: A total of 21 boys with a mean age of 15 ± 1.4 years were operated by the senior author and infra-areolar subcutaneous mastectomy by a semilunar incision was performed for adolescent gynecomastia. The mean duration of the complaint was 24.2 ± 10.9 months. Gynecomastia was bilateral in 15 (71.5%) and unilateral in 6 (28.5%) of the patients. Sixteen patients (76.2%) were normal weight, 5 (23.8%) were overweight. Chromosomal anomaly and hypogonadism were detected in two patients. Pseudoangiomatous stromal hyperplasia was detected in the pathology of one patient. The mean follow-up time was 2.7 ± 1 years, seroma developed in 2 patients at the early postoperative period. Their long-term follow-up was uneventful without complication. CONCLUSIONS: The results of infra-areolar subcutaneous mastectomy are very promising in pubertal gynecomastia due to good skin elasticity and without obesity in the adolescent age group. We believe that this method provides an almost invisible incision and a natural pectoral appearance for adolescent patients who have experienced serious emotional problems related to their body images.

COVID-19 pandemic and lockdown: what has changed in common home accidents such as foreign bodies and corrosive injuries?

BACKGROUND: COVID-19 pandemic greatly affected our lives in all areas. Due to the social isolation policies implemented during this period, the majority of parents and all school-age children spent their lives at home. This study aims to investigate the effects of pandemic and isolation on home accidents treated in our center. METHODS: Foreign body ingestion (gastric foreign bodies: G.FB), foreign body aspiration (respiratory foreign bodies: R.FB), and corrosive substance (CS) ingestion cases admitted to our hospital between March 11, 2019, and March 10, 2021, were retrospectively analyzed. Demographic data, type and cause of home accidents, the time of the accident and the admission to the hospital, the location of the foreign body, and the follow-up data were recorded. The patients were divided into two groups: the pre-pandemic period (11 March 2019-10 March 2020) and the COVID pandemic period (11 March 2020-10 March 2021), and the data were evaluated between two groups as < 6 years old and 6-18 years old. RESULTS: During the 2 years, a total of 982 patients were admitted to our hospital for G.FB, R.FB, or CS. Four hundred and eighty-three of them (49.2%) were in the pre-pandemic period and 499 (50.8%) were in the pandemic period (p = 0.206). The mean age of the patients was 3.63 ± 3.32 years; 82.4% of the patients in the pre-pandemic group and 85.4% of the patients in the pandemic group were children < 6 years old. While the F/M ratio was 1/1.5 during the pre-pandemic period, it was 1/1.1 during the pandemic period. Of the cases, 73.3% were G.FB, 4.6% were R.FB, and 22.1% were CS. Almost half of the accidents occurred between the hours of 16 and 24. During the pandemic period, the accidents increased to occur between 0 and 8 am in children < 6 years old, and between 8 am and 4 pm in children 6-18 years old (p = 0.003). All of the home accidents in the 6-18 age group between 0 and 8 o'clock were girls (p < 0.0001). During the pandemic period, the frequency of button batteries and food products increased in G.FB. Also, the frequency of R.FB increased significantly (p = 0.006) and the most common R.FB was the food products. The frequency of CS increased in girls during the pandemic period, and CSs were brought to the hospital in a shorter time after the accident during the pandemic period (p = 0.007). CONCLUSIONS: It can be thought that the main reason why home accidents are common in the 0-6 age group is due to the developmental characteristics of the child rather than the longer time spent at home. The pandemic and isolation increase the frequency of foreign body aspirations and home accidents in girls.

The effects of hesperidin on stricture formation in corrosive esophageal burns: an experimental study.

AIM/BACKGROUND: Esophageal strictures in children that develop as a result of accidental ingestion of corrosive substances remain an important health problem. The purpose of this study is to determine the effects of Hesperidin, an effective bioflavonoid in the proliferative and exudative phase of inflammation, on the stricture formation in corrosive esophageal burns. METHODS: Experimental esophageal burns in rats were created using a modified Gehanno and Guedon model with 20% NaOH. Rats were divided into 5 groups. In the Sham group, the distal esophagus was prepared and cannulated according to the model, but no NaOH was administrated. The esophageal burn was created with NaOH in the other groups. The burned groups were divided into two groups as untreated (T14, T21) and treated with 100 mg/kg/day Hesperidin (H14, H21) intraperitoneally, and these groups were divided into two according to their sacrification periods (14 and 21 days). Inflammation, fibrosis, and necrosis were graded by histopathological evaluation in all groups. The efficacy of treatment was evaluated using the weight of rats, stenosis index, and histopathological parameters. RESULTS: Histopathologic damage scores such as inflammation, necrosis, and fibrosis were lower in the H14 and H21 groups and higher in the T14 and T21 groups. And also stenosis index was found higher in T14 and T21 groups (p < 0.05), while it was similar to the Sham group in H14 and H21 groups. No statistically significant difference was found between the H14 and H21 groups in terms of stenosis index. When weights of the rats at the beginning and end of the experiment were compared, weights of the H14 and H21 groups and the Sham group were similar. There was a significant decrease in the weight of the rats in the T14 and T21 groups (p < 0.001). CONCLUSIONS: This study is the first to use Hesperidin in preventing esophageal damage in an esophageal caustic burn model. It was shown that Hesperidin was effective in reducing macroscopic and microscopic histopathologic damage in the corrosive esophageal burn model, preventing the stricture formation, and has positive effects on nutrition in rats with an esophageal burn.

Comparison of Open Repair and Laparoscopic Percutaneous Internal Ring Suturing Method in Repairing Inguinal Hernia in Children.

Introduction An inguinal indirect hernia is one of the most frequent surgical conditions in children. In this study the experience with laparoscopic percutaneous internal ring suturing (PIRS) and open inguinal hernia surgery and their relations evaluated. Methods All children over 90 days of age and without having prior inguinal region surgery with a diagnosis of indirect inguinal hernia underwent surgical repair with open or laparoscopic PIRS technique. Patients' gender, age at surgery, inguinal hernias side, surgery duration, recurrence, complications, and follow-ups were collected. Results A total of 488 inguinal hernias of 405 patients were repaired. The diagnoses were unilateral inguinal hernia in 360 (88.9%) and it was bilateral in 33 (8.1%) patients. The operative technique was laparoscopic PIRS for 227 and open inguinal hernia surgery for 178 patients. In the PIRS group, a contralateral hernia was found in 48 of 205 children (23.4%). The surgery times were 23.3 (PIRS) and 33.7 (open) min for unilateral and 28 (PIRS) and 53.1 (open) min on average for bilateral inguinal hernia surgery. Mean follow-up was 30.4 months for PIRS and 24.4 months for open technique. Recurrence was observed in seven (3%) patients in PIRS and one (0.5%) in the open group and postoperative complications in three (1.3%) in PIRS and four (2.2%) in the open group. Conclusion PIRS method has the advantage to evaluate contralateral hernia at the same session, minimal scar related to surgery, and preserve the spermatic cord from manipulation. PIRS is an alternative feasible method and easy to perform to repair the inguinal hernia with/without communicating hydrocele in children.

Comparison of laparoscopic percutaneous internal ring suturing method and open inguinal hernia repair in children under 3 months of age.

OBJECTIVES: Laparoscopic inguinal hernia repair in younger infants has not been completely accepted worldwide. The aim of this study was to evaluate the safety and feasiblity of laparoscopic percutaneous internal ring suturing method in children aged younger than 3 months and compare the recurrence and complication rates with open repair; which may still be mentioned as the gold standard procedure. MATERIAL AND METHODS: A total of 387 children underwent inguinal hernia repair in the clinic between 2016 and 2019. One hundred and forty of them were under 3 months old and divided into two groups; children who underwent laparoscopic percutaneous internal ring suturing (Group 1) and open surgery (Group 2). Selection of the surgical method was regardless of weight, sex or any patient characteristics other than surgeon's choice. Operation durations, complications and recurrences were compared between the two groups. RESULTS: A total of 140 patients underwent surgery due to inguinal hernia. Group 1 included 85 and Group 2 included 55 children. There were two recurrences in each group (p> 0.05). Operative durations were shorter in Group 1 for both; unilateral and bilateral repairs (p <0.0001). There were no intraoperative complications in any group. There was one major postoperative complication in Group 2: iatrogenic undescended testis, and none was observed in Group 1. In the laparoscopic group, 47% of the children who were diagnosed to have unilateral hernia were revealed to have bilateral inguinal hernias (n= 31). CONCLUSION: Laparoscopic percutaneous internal ring suturing method seems favourable in terms of operative time. It also has the advantage of detecting contralateral patent processus vaginalis or asymptomatic contralateral inguinal hernia.

Management of perinatal testicular torsion: experience of two tertiary centers.

PURPOSE: Perinatal testicular torsion is a rare condition in which testicular salvage rates are significantly low and management is controversial. We retrospectively evaluated our patients and aimed to go through our management approach. METHODS: The newborn patients who underwent surgery for testicular torsion in two tertiary referral centers between 2000 and 2019 are enrolled. Radiological and clinical findings are retrospectively evaluated. RESULTS: Thirty-two newborns are enrolled in the study. All of the cases were unilateral and 30 ended up with immediate orchidectomy while 2 received orchidopexy but both underwent atrophy on follow-up. No bilateral torsion is demonstrated neither in 16 patients with bilateral exploration nor in the follow up of the rest 16 with unilateral exploration. Intravaginal torsion was encountered in five patients (16%). No morbidity or mortality related to anesthesia is documented. No malignancy is encountered in any of the patients. CONCLUSION: Although ipsilateral testicular salvage rates are low, urgent bilateral exploration in a multidisciplinary center seems reasonable to give a chance to the ipsilateral testis and to avoid the rare but catastrophic bilateral torsion, after discussing with the family.

A Novel Technique for Bladder Wall Fixation in Pneumovesicoscopic Surgery: T-Bar.

Background: As a relatively new approach, popularity of pneumovesicoscopic surgery is increasing, but slower than expected due to complex nature of the procedure with efforts to overcome the difficult steps of the procedure. Bladder fixation is one of the crucial steps of the procedure. In this study, we present a novel and simple T-bar technique to overcome this difficulty. Methods: We retrospectively evaluated 24 consecutive patients (39 ureters) who underwent pneumovesicoscopic surgery with fixation of the bladder wall between December 2017 and September 2019. Results: Fixation by transabdominal suture (TS) was performed in 3 patients, while fixation by thread loops with needle in 3 and T-bar device in 18. Tearing of the bladder wall was encountered in 2 patients in TS, in 2 patients with thread loop groups, but none in the T-bar group. Conversion to open surgery was necessary in 3 patients in the T-bar group, but only 1 was related with the fixation technique. Conclusions: T-bar technique is an inexpensive and simple solution providing stable and reliable bladder wall and working port fixation during pneumovesicoscopy.

Comparison of Biomicroscopy and Light Microscopy Findings in Demodex Diagnosis in Patients With Chronic Blepharitis.

OBJECTIVES: We aimed to compare the results of biomicroscopic examination and light microscopy in the diagnosis of Demodex infestation in chronic blepharitis cases. METHODS: The study was performed with retrospective data and included patients with chronic blepharitis and who were admitted to the Medipol University Ophthalmology Outpatient Clinic. Biomicroscopic evaluation was performed intentionally under 40x magnification to investigate the presence of Demodex ectoparasites. Three or four pieces of eyelashes were obtained from all cases with epilation technique, and Demodex parasites were examined under ×100 and ×400 magnifications with light microscopy. The presence of one or more Demodex parasites in the examined area under light microscopy was considered to be positive for infestation. We calculated sensitivity, specificity, false-positive rate, false-negative rate, and positive and negative predictive values of biomicroscopic examination compared with those of positive light microscopy. RESULTS: Of the 255 subjects included in the study, 134 (52.5%) were men and 121 (47.5%) were women. The mean age was 43.9±11.9 years. Of the 255 chronic blepharitis cases, 130 (51%) presented Demodex infestation on light microscopy. We calculated the sensitivity, specificity, false-positive rate, false-negative rate, positive predictive value, and negative predictive value and were found to be 83.07%, 90.4%, 9.6%, 16.9%, 90%, and 83.7%, respectively, for the biomicroscopic examination. CONCLUSIONS: Careful biomicroscopic examination can be time-efficient and cost-effective, and the need for more advanced and invasive procedures for the identification of Demodex in patients with chronic blepharitis can be reduced.

Investigation of Demodex Parasite Existence in Treatment-Resistant Chronic Blepharitis Cases.

OBJECTIVE: Demodex acari is an obligate ectoparasite, and it is usually located in the human hair follicles, eyelash roots, and sebaceous glands. The aim of this study was to investigate the presence of Demodex infestation in chronic blepharitis cases that are resistant to therapy. METHODS: Patients who were admitted at the Istanbul Medipol University School of Medicine Hospital with a diagnosis of chronic blepharitis were included. All cases received conventional therapy at least three times. Three or four eyelash samples from patients with blepharitis were collected and examined under light microscopy. For the diagnosis, the presence of one or more Demodex parasites at 10× and 40× magnification by a light microscope was considered as positive for infestation. RESULTS: Overall, 153 cases were included in the study. Of the cases, 79 (51.6%) were males and 74 (48.4%) were females. The mean age was 43.1±9.7 years. The presence of D. acari in the follicles of the eyelashes in patients with chronic blepharitis was found in 69 (45.1%) cases. CONCLUSION: D. acari should be considered in patients with chronic blepharitis, especially in treatment-resistant cases. We believe that it would be useful to search for the parasite in patients with blepharitis prior to treatment on a routine basis.

Assessment of efficacy of topical azithromycin 1.5 per cent ophthalmic solution for the treatment of meibomian gland dysfunction.

BACKGROUND: The aim was to evaluate the clinical efficacy of topical azithromycin 1.5 per cent ophthalmic solution in treatment of the clinical signs and symptoms associated with meibomian gland dysfunction (MGD). METHODS: In this retrospective study, 35 patients with MGD were treated with topical azithromycin 1.5 per cent ophthalmic solution for 30 days. Topical azithromycin 1.5 per cent ophthalmic solution was prescribed twice daily for two days and then once daily for a total of 30 days. Daily lid hygiene with dilute baby shampoo was instructed for all patients. Patient total symptom score, meibomian gland grading score, Schirmer score with anaesthetic, tear film break-up time (TFBUT) and corneal fluorescein staining score were evaluated at baseline and after one and three months. RESULTS: Patient total symptom score, meibomian gland grading score, Schirmer score with anaesthetic, TFBUT and corneal staining score reduced significantly from the baseline to the first month (p < 0.05, for each); however, at the third month, there was no significant difference from baseline in the meibomian gland grading score, Schirmer score with anaesthetic, TFBUT and corneal fluorescein staining score (p > 0.05, for each). CONCLUSION: These results demonstrate that topical azithromycin 1.5 per cent ophthalmic solution appears effective in the short-term treatment of the clinical signs and symptoms associated with MGD.

Longitudinal assessment of intraocular pressure in premature infants.

PURPOSE: To investigate the longitudinal change in intraocular pressure (IOP) in premature infants and to establish a normative IOP value. METHODS: Forty premature infants with a gestational age (GA) of 26 weeks were enrolled in this longitudinal study. Measurements were taken initially at 28 weeks postconceptional age (PCA) and at 2-week intervals up to 40 weeks PCA. Intraocular pressure was measured with a hand-held tonometer (Tono-Pen XL; Reichert Inc.). RESULTS: From 40 (22 male, 18 female) premature Caucasian infants, seven (for each eye) IOP measurements were obtained. Mean GA was 26 weeks and mean birthweight was 820 ± 112 grams. The mean IOP was 15.1 ± 1.2 mm Hg and 14.9 ± 1.1 mm Hg for the right and left eyes, respectively. The mean IOP in both eyes for all measurements was 15.0 ± 1.1 mm Hg. At 28 weeks PCA, 9 (22.5%) preterm infants had IOP values greater than 20 mm Hg. The mean IOPs at 28 weeks, 30 weeks, 32 weeks, 34 weeks, 36 weeks, 38 weeks, and 40 weeks PCA were 18.7 ± 1.1 mm Hg, 16.9 ± 0.9 mm Hg, 15.3 ± 0.9 mm Hg, 14.1 ± 1.3 mm Hg, 13.7 ± 1.3 mm Hg, 13.4 ± 1.4 mm Hg, and 13.1 ± 1.3 mm Hg, respectively. A significant decrease in IOP measurements was found up to 34 weeks PCA, with no significant decline in IOP measurements after that point (F = 109.7, p<0.01). There was a negative correlation between IOP and PCA (r = -0.712, p<0.01). CONCLUSIONS: The mean IOP of premature infants was 15.0 ± 1.1 mm Hg and IOP values decreased significantly up to 34 weeks PCA, indicating a decline trend approaching the term period.

Contribution of dual fluorescein and indocyanine green angiography to the appraisal of posterior involvement in birdshot retinochoroiditis and Vogt-Koyanagi-Harada disease.

PURPOSE: To assess the levels of retinal and choroidal involvement in initial-onset birdshot retinochoroiditis (BRC) and Vogt-Koyanagi-Harada (VKH) disease, two stromal choroiditis entities. METHODS: This retrospective study included patients diagnosed with BRC and VKH, seen during initial-onset disease at the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiographic signs were quantified, using an established dual fluorescein angiography (FA) and indocyanine green angiography (ICGA) scoring system for uveitis, and the FA/ICGA score ratios were compared between diseases. RESULTS: Among 1793 patients with uveitis seen from 1995 to 2015, 7 newly diagnosed BRC patients and 4 patients with newly diagnosed VKH disease had sufficient data for study inclusion. Patients with BRC and VKH at initial onset had mean FA angiographic scores of 16.91 ± 3.42 and 4.06 ± 1.87; mean ICGA angiographic scores of 21.34 ± 3.49 and 25.75 ± 3.88; and mean FA/ICGA ratios of 0.79 ± 0.21 and 0.16 ± 0.09, respectively. CONCLUSION: This study showed the differential involvements of the retina and choroid in BRC and VKH. The choroid was preponderantly involved in both diseases; thus, ICGA is essential for disease assessment and follow-up. However, these diseases also differed substantially. The origin of inflammation was primarily in the choroid in VKH and in both the choroid and retina in BRC. We recommend dual FA and ICGA for evaluating posterior uveitis, when choroiditis is suspected.

Enhanced depth imaging is less suited than indocyanine green angiography for close monitoring of primary stromal choroiditis: a pilot report.

The purpose of this study is to investigate the performance, utility, and precision of enhanced depth imaging optical coherence tomography (EDI-OCT) versus indocyanine green angiography (ICGA) in tracking any fluctuation in the activity of stromal choroiditis in response to therapeutic interventions during long-term follow-up. Patients with a diagnosis of Vogt-Koyanagi-Harada (VKH) disease or birdshot retinochoroiditis (BRC), with untreated initial disease, and having had long-term follow-up, including both ICGA and EDI-OCT, were recruited at the Centre for Ophthalmic Specialised care, Lausanne, Switzerland. Angiography signs were quantified according to established dual fluorescein angiography (FA) and ICGA scoring systems for uveitis. Changes in ICGA score and EDI choroidal thickness, in response to therapeutic intervention, were assessed. In the four eyes analysed (2 BRC and 2 VKH), mean EDI-OCT choroidal thickness decreased from 672 ± 101 µm at presentation to 358.5 ± 44.5 µm in a mean of 26.5 months, i.e. the time taken to stabilize the disease. Mean ICGA scores decreased from 28 ± 4.2 at presentation to 5 ± 7 at stabilization. Only ICGA was sufficiently sensitive and reactive having the ability to detect disease recurrences and efficacy or the absence of effect of successive treatment changes, detected in seven instances during follow-up, not recorded by EDI-OCT. This pilot study showed that ICGA was a more sensitive methodology, which promptly identifies evolving subclinical and occult choroidal disease, and flag occult recurrence and/or therapeutic responses that were otherwise missed by EDI-OCT. Although choroidal thickness was proportional to treatment course, demonstrating a linear decrease, these changes were too sluggish to be relied upon for close follow-up and timely adjustment of therapy.

Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy.

The objective of the study was to compare the success rate of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with or without the use of adjunctive mitomycin C (MMC) in cases with primary nasolacrimal duct obstruction (NLDO). This retrospective study was comprised of 68 patients with uncomplicated primary NLDO. There were two groups in the study: the Group 1 (n = 35) patients underwent TCL-DCR surgery with MMC and the Group 2 (n = 33) patients underwent TCL-DCR surgery without MMC. All patients had bicanalicular silicone tube intubation. The main outcome measures were patent osteotomy as visualized endoscopically and patent nasolacrimal irrigation. The follow-up period was 12 months. All patients had unilateral TCL-DCR with silicone tube intubation. Six months following surgery, the silicone tubes were removed. At the final evaluation, success rates were 80 % in Group 1 and 78.8 % in Group 2. There was no statistically significant difference between the two groups (p = 0.52). No complications related to MMC usage were recorded during the study period. Intraoperative use of MMC has no beneficial effect on the success rate in TCL-DCR.

Evaluation of Retinal and Choroidal Thickness in Fuchs' Uveitis Syndrome.

Purpose. We aimed to investigate retinal and choroidal thickness in the eyes of patients with Fuchs' uveitis syndrome (FUS). Methods. Fifteen patients with unilateral FUS and 20 healthy control subjects were enrolled. Spectral domain optical coherence tomography (Spectralis HRA+OCT, 870 nm; Heidelberg Engineering, Heidelberg, Germany) was used to obtain retinal and choroidal thickness measurements. The retinal nerve fiber layer (RNFL) thickness, macular thickness, and choroidal thickness of the eyes with FUS were compared with the unaffected eye and the eyes of healthy control subjects. Results. The mean choroidal thickness at fovea and at each point within the horizontal nasal and temporal quadrants at 500 µm intervals to a distance of 1500 µm from the foveal center was significantly thinner in the affected eye of FUS patients compared with the unaffected eye of FUS patients or the eyes of healthy control subjects. However, there were no significant differences in RNFL or macular thickness between groups. Conclusions. Affected eyes in patients with FUS tend to have thinner choroids as compared to eyes of unaffected fellow eyes and healthy individuals, which might be a result of the chronic inflammation associated with the disease.

Intravitreal Lower-Dose (20 µg) Melphalan for Persistent or Recurrent Retinoblastoma Vitreous Seeds.

BACKGROUND AND OBJECTIVE: The major cause of failure in the management of retinoblastoma is the persistence/recurrence of vitreous seeds (VS). This study reports the efficacy and complications of standard lower-dose (20 µg) intravitreal melphalan for VS. PATIENTS AND METHODS: Retrospective review of all patients with active VS treated with lower-dose intravitreal melphalan (20 µg/0.1 mL) on a monthly basis until complete VS regression was achieved. RESULTS: A total of 14 injections were delivered to seven eyes of seven patients (range: 1-4; median: 2). At a median follow-up of 20 months (range: 12-32 months), complete regression of VS was achieved in all cases (100%), and globe salvage was achieved in six cases (86%). One eye required enucleation for solid tumor recurrence. Side effects of retinal pigment epithelium mottling at the site of injection was noted in two eyes (29%). CONCLUSION: The 2-year results of this study suggest that standard lower-dose (20 µg) intravitreal melphalan is safe and highly effective for the management of viable VS from retinoblastoma.

Single-Incision Total Proctocolectomy and Ileal Pouch Anal Anastomosis in Pediatric Patients: Lessons Learned.

BACKGROUND: Total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) have become the standard of care for patients with ulcerative colitis refractory to medical management. The purpose of our study is to show our single-site approach and to identify maneuvers that improve efficiency. MATERIALS AND METHODS: We retrospectively reviewed patients who underwent single-site three-stage TPC-IPAA for ulcerative colitis at our institution. Primary outcomes included operative time, conversion from single site to standard laparoscopy, time to oral intake and stoma function, postoperative complications, and length of stay. The GelPOINT(™) Advanced Access Platform (Applied Medical, Santa Margarita, CA) was used. RESULTS: Eight patients were identified who had undergone single-site surgery with the GelPOINT platform. Six of the 8 patients underwent the first stage, total abdominal colectomy (TAC), and all 8 underwent the second stage (proctectomy/IPAA). The mean operating time for TAC was 242 ± 32 minutes. The mean time until tolerance of clear diet was 1.2 ± 0.4 days, and time until tolerance of regular diet was 3.3 ± 1.2 days. The mean time to stoma function was 1.5 ± 0.55 days, and that for postoperative opioid use was 4.0 ± 1.3 days. The median length of stay was 5 days (range, 3-10 days). There was one postoperative complication. The mean operating time for the proctectomy/IPAA was 283 ± 50 minutes. The mean time until tolerance of clear diet was 1.0 ± 0.5 days, and time until tolerance of regular diet was 3.3 ± 1.1 days. The mean time to stoma function was 1.6 days ± 0.52 days, and that for postoperative opioid use was 3.3 ± 1.4 days. Median length of stay was 4 days (range, 3-9 days). There was one postoperative complication. Technical adaptations that included extracorporeal mesenteric division, rectal eversion, and rotation of the GelPOINT device served to improve the ease and efficiency of the procedure. CONCLUSIONS: Single-site TPC-IPAA is both feasible and safe. Incorporation of adapted technical maneuvers can increase efficiency.

Early versus delayed surgical correction of malrotation in children with critical congenital heart disease.

PURPOSE: The purpose of this study was to compare outcomes between early and delayed surgical correction of malrotation in children with critical congenital heart disease (CHD). METHODS: Patients with CHD who underwent cardiac surgery by 1 year of age and had malrotation diagnosed during their initial admission at 34 hospitals contributing to the Pediatric Health Information System in 2004-2009 were included. Ladd's procedures performed during the first admission were considered early correction, and those at a subsequent admission were considered delayed. Interhospital variability in the proportion of patients undergoing delayed correction was assessed, and outcomes were compared between the groups. RESULTS: Of the 324 patients identified, 85.2% underwent early correction. Significant variability existed in the proportion of patients undergoing delayed correction across hospitals (p<0.0001). Baseline characteristics, including severity of CHD, were similar between the groups. In the delayed group, 27% of patients underwent a Ladd's procedure during an urgent or emergent admission, but none had volvulus or underwent intestinal resection. Rates of mortality and readmission within 1 year of malrotation diagnosis were similar in both groups. Chart validation confirmed 100% accuracy of diagnosis and treatment group assignment. CONCLUSIONS: In patients with critical CHD, delayed operative intervention for malrotation without volvulus may be a reasonable alternative.

Does timing of neonatal inguinal hernia repair affect outcomes?

PURPOSE: The purpose of this study was to examine practice variability and compare outcomes between early and delayed neonatal inguinal hernia repair (IHR). METHODS: Patients admitted to neonatal intensive care units with a diagnosis of IH who underwent IHR by age 1 year in the Pediatric Health Information System from 1999 to 2011 were included. IHR after the index hospitalization was considered delayed. Inter-hospital variability in the proportion of delayed repairs and differences in outcomes for each group were compared. A propensity score matched analysis was performed to account for baseline differences between treatment groups. RESULTS: Of the 2030 patients identified, 32.9% underwent delayed IHR with significant variability in the proportion of patients having delayed repair across hospitals (p<0.0001). More patients in the delayed group had a congenital anomaly or received life supportive measures prior to IHR (all p<0.01), and 8.2% of patients undergoing delayed repair had a diagnosis of incarceration at repair. More patients in the early group underwent reoperation for hernia within 1 year (5.9% vs. 3.7%, p=0.02). Results were similar after performing a propensity score matched analysis. CONCLUSIONS: Significant variability in practice exists between children's hospitals in the timing of IHR, with delayed repair associated with incarceration and early repair with a higher rate of reoperation.

Evaluation of 968 children with corrosive substance ingestion.

BACKGROUND AND AIMS: The aim of the study was to evaluate the etiology, treatment, and prognosis in children who had presented at our clinic with corrosive substance ingestion and comparison of our results with the literature. MATERIALS AND METHODS: The patients were put on nil by mouth and broad-spectrum antibiotics were administered. Oral fluids were started for patients whose intraoral lesions resolved and who could swallow their saliva. Steroids were not given, a nasogastric catheter was not placed, and early endoscopy was not used. RESULTS: A total of 968 children presented at our clinic for corrosive substance ingestion during the 22-year period. The stricture development rate was 13.5%. Alkali substance ingestion caused a stricture development rate of 23%. A total of 54 patients required 1-52 sessions (mean 15 ±12) of dilatation. CONCLUSION: We do not perform early endoscopy, administer steroids, or place a nasogastric catheter at our clinic for patients who had ingested a corrosive substance. This approach has provided results similar to other series. We feel that determining the burn with early esophagoscopy when factors that prevent or decrease the development of corrosive strictures will be very important.