Who seeks bariatric surgery? Psychosocial functioning among adolescent candidates, other treatment-seeking adolescents with obesity and healthy controls.

Limited data are available on the characteristics of adolescents with obesity who seek bariatric surgery. Existing data suggest that adolescent surgery candidates have a higher body mass index (BMI) than comparison adolescents with obesity, but the limited findings regarding psychosocial functioning are mixed. This study aimed to compare BMI and psychosocial functioning among adolescent bariatric surgery candidates, outpatient medical-treatment-seeking adolescents with obesity (receiving lifestyle modification), and adolescents in the normal-weight range. All adolescents completed self-report measures of impulsivity, delay discounting, depression, anxiety, stress, eating pathology, family functioning and quality of life, and had their height and weight measured. Adolescent surgical candidates had higher BMIs than both comparison groups. Surgical candidates did not differ from medical-treatment-seeking adolescents with obesity on any measure of psychosocial functioning, but both groups of adolescents with obesity reported greater anxiety and eating pathology and poorer quality of life than normal-weight adolescents. Quality of life no longer differed across groups after controlling for BMI, suggesting that it is highly related to weight status. Adolescents with obesity may experience greater anxiety, eating pathology, and quality of life impairments than their peers in the normal-weight range regardless of whether they are seeking surgery or outpatient medical treatment. Clinical implications and directions for future research are discussed.

Vaginal bleeding in an infant secondary to sliding inguinal hernia.

BACKGROUND: Vaginal bleeding in infancy is rare and, to our knowledge, has not been reported in association with an inguinal hernia. CASE: A premature infant with a known reducible inguinal hernia developed vaginal bleeding at 8 months. Work-up revealed no coagulopathy and no endocrine abnormality. Physical examination and ultrasound found no anatomic lesion responsible for her bleeding. At surgery, she was found to have an indirect hernia in which the uterus, fallopian tube, and ovary were sliding components. Her vaginal bleeding ceased after herniorrhaphy. CONCLUSION: Vaginal bleeding in a child with an inguinal hernia may occur when the uterus is a sliding component of the hernia.

Pseudoaneurysm after penetrating trauma in children and adolescents.

BACKGROUND: Although skin lacerations are common in children and adolescents, the complication of pseudoaneurysm (PA) has rarely been reported. METHODS: The author reports a series of four cases of patients in whom PA developed after lacerations. The diagnosis was made on the basis of the history and clinical findings in all cases. Doppler ultrasound confirmed the diagnosis in two cases. Resection of the aneurysm was the treatment in each. RESULTS: Each of the patients had successful removal of his lesion. One patient with a radial artery PA underwent resection without reconstruction; he remains free of claudication and has symmetrical upper extremities. CONCLUSIONS: Pseudoaneurysms are uncommon sequella of lacerations. In children, resection is satisfactory treatment when adequate collateral flow can be demonstrated.

Inflammatory esophagogastric polyps: resolution following antireflux surgery.

Inflammatory gastroesophageal polyps are a rare manifestation of reflux esophagitis. In this report, an inflammatory gastroesophageal polyp resolved following antireflux surgery. The literature of inflammatory polyps is reviewed.

Laparoscopy in complicated pediatric appendicitis.

BACKGROUND: Complicated appendicitis (gangrenous or perforated) has been associated with increased risk for postoperative complications, especially intraabdominal abscess. Caution has been advised when attempting laparoscopic appendectomy for complicated appendicitis in children. The objective of our study was to assess the incidence of intraabdominal abscess formation after laparoscopic appendectomy in pediatric patients presenting with complicated appendicitis. METHODS: This is a retrospective review of 52 pediatric patients presenting with acute appendicitis at a single teaching institution who underwent laparoscopic appendectomy by a single surgeon. All laparoscopic procedures were completed without conversion. Treatment complications and outcomes were recorded for all cases. RESULTS: Five of the 52 patients (10%) had complicated appendicitis. One of the 5 patients (20%) developed intraabdominal abscess postoperatively and underwent laparoscopic drainage during the same admission. No other complications were noted. None of these patients was readmitted for wound infections or intraabdominal abscesses. The single postoperative abscess occurred early during our initial experience with laparoscopic appendectomy. CONCLUSION: Laparoscopic appendectomy seems to be a safe alternative for the treatment of complicated appendicitis in children. Caution is recommended during the initial experience of surgeons with this procedure, because the complication rate seems to be higher during the learning curve. Close postoperative follow-up and a high index of suspicion for development of complications is recommended. As surgeons' experience accumulates, the safety of the procedure seems to increase. A prospective, randomized trial is recommended to establish the role of laparoscopy in complicated appendicitis in the pediatric population.

Laparoscopic appendectomy in children.

BACKGROUND AND OBJECTIVES: The advantages of laparoscopic appendectomy over open appendectomy have not yet been clearly demonstrated. The present study evaluated our early experience with laparoscopic appendectomy in children, in terms of its safety, effectiveness, technical difficulties, and economics. METHODS: We reviewed the records of 50 cases involving laparoscopic appendectomy performed at our affiliated institutions between September, 1994, and September, 1996. Patient age ranged from 6 to 18 years (mean, 14 years). Thirty-two patients had acute nonperforated appendicitis, six had perforated appendicitis, two had fibrosis of the appendix, and ten had a histologically normal appendix. RESULTS: In five patients the laparoscopic procedures were converted to open appendectomies because of technical difficulties. There were postoperative complications in four patients: one incomplete appendectomy which subsequently required an open appendectomy for completion, one pelvic abscess, one bowel obstruction, and one minor wound infection. CONCLUSIONS: Laparoscopic appendectomy is a safe and effective procedure. It takes longer operative time than open appendectomy. Length of hospitalization and incidence of postoperative complications are equivalent to those of open appendectomy. Economic benefits are difficult to assess at present. In sum, we believe that with better training, surgical techniques and equipment, laparoscopic appendectomy will eventually become the surgical procedure of choice in appendicitis.

Intussusception in childhood.

We present our experiences with 41 consecutive cases of intussusception. Most cases had a preliminary barium enema performed that successfully reduced the intussusception in 12 cases. Twenty-nine patients were explored surgically; bowel resection was carried out in 6 patients, and surgical reduction was carried out in 23 cases.

Transinguinal diagnostic laparoscopy in pediatric inguinal hernia.

The decision of the surgeon whether to explore the opposite groin in a child with an inguinal hernia remains controversial. Numerous techniques have been used to determine the need for contralateral repair. Two groups of patients underwent transinguinal diagnostic laparoscopy at the time of herniorrhaphy to assess the contralateral groin. Of 20 patients older than 24 months, only 1 (5%) was found to have a patent processus vaginalis. In a group of 21 patients ranging from 2 to 24 months, 9 (42.9%) were found to have a contralateral patent processus vaginalis. Twelve patients had a closed or slit-like peritoneum at the internal ring. Transinguinal diagnostic laparoscopy can be used to identify which children may benefit from contralateral exploration, as well as those in whom surgery can be avoided.

Nonfluoroscopic reduction of intussusception by air enema.

Intussusception is a common pediatric condition in China. Hydrostatic reduction with barium sulfate or pneumatic reduction using air and fluoroscopy has become the standard method in most centers throughout the world. To avoid radiation exposure, reduction without fluoroscopic confirmation was studied. Between 1981 and 1985 a total of 224 children were diagnosed and treated for intussusception. The diagnosis was made correctly on clinical grounds in 184 cases; in 40 cases ultrasonography confirmed the clinical diagnosis. Pressurized air reduction was successful in 217 patients (96.9%); seven patients required operative reduction. Ultrasonograms of the abdomen supported the diagnosis in 40 patients and confirmed subsequent reduction. This experience demonstrates that childhood intussusception can be reduced using pneumatic pressure without exposing the patient to ionizing radiation.

Combined cervical and intraoral approach to lingual thyroid: a case report.

BACKGROUND: Lingual thyroid is a rare anomaly that may require surgical intervention. Lesions have been approached either via the neck or transorally. Advantages and limitations exist with each technique. METHODS: A 10-year-old female on long-term suppression therapy for lingual thyroid developed progressive dysphagia; surgical excision was performed. Suprahyoid pharyngotomy was used to dissect the posterior limits of the tumor. Resection was completed via a transoral approach. RESULTS: Cervical exposure allowed safe access to the posterior tumor margins. Transoral exposure permitted direct dissection of the anterior margin of the lesion, rendering complete excision simple. CONCLUSION: A combined surgical approach to lingual thyroid is a safe technique that affords excellent visualization and facilitates resection.