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BACKGROUND: Moorthy checklist (MC) and laparoscopic skill competency assessment tool (LS-CAT) are tools commonly used to evaluate the quality of laparoscopic suturing. The current assessment model is single measurement by multiple raters. Our aim is to examine the reliability of the current assessment model and tools. METHODS: With IRB approval, participants of three different backgrounds, namely medical students, trainees, and surgeons, were enrolled. The participants each accomplished a standardized laparoscopic suturing task. The performances were video-recorded and reviewed with LS-CAT and MC independently by three blinded raters. Intraclass correlation coefficients (ICC) were calculated for inter-rater and intra-rater reliability. RESULTS: 26 participants were enrolled, comprising 10 students, 10 trainees and 6 surgeons. In regard of inter-rater reliability, ICC values (95% CI) were 0.909 (0.768-0.961) and 0.868 (0.608-0.948) in LS-CAP and MC, respectively. For students, ICC values were 0.908 (0.682-0.976) and 0.815 (0.408-0.951) in LS-CAT and MC, respectively. For trainees, ICC values were 0.812 (0.426-0.947) and 0.717 (0.102-0.925), respectively. For surgeons, ICC values were 0.720 (0.064-0.955) and 0.868 (0.608-0.948), respectively. In regard of intra-rater reliability, ICC values of the mean scores from the three raters were 0.956 (0.905-0.980) and 0.925 (0.842-0.966) in LS-CAP and MC, respectively. CONCLUSION: LS-CAT and MC are both qualified assessment tools for laparoscopic suturing. LS-CAT is more reliable particularly for medical students and trainees. The current assessment model of single measurement by multiple raters provides excellent reliability.
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Laparoscopia , Cirurgiões , Lista de Checagem , Humanos , Laparoscopia/educação , Variações Dependentes do Observador , Reprodutibilidade dos Testes , SuturasRESUMO
BACKGROUND: Burnia is a suturless repair for inguinal hernias in girls. It is performed under laparoscopy by grabbing the sac, inverting it into the peritoneal cavity, and cauterizing. The aim of this study is to report our experience with single-site laparoscopic burnia (BURNIA) and compare them with open repair (OPEN). METHODS: With IRB approval, pediatric female patients younger than 18 years of age who underwent inguinal hernia repair between January 2015 and December 2017 were enrolled. Medical records were retrospectively reviewed. The patients were divided into two groups, BURNIA and OPEN. RESULTS: 198 patients were included. In BURNIA, 49 patients underwent bilateral repairs, and 50 patients underwent 51 unilateral repairs (one patient had metachronous contralateral hernia). In OPEN, 27 patients underwent bilateral repairs, and 72 patients underwent 77 unilateral repairs (five patients had metachronous contralateral hernias). The mean age of BURNIA was similar to OPEN for bilateral repairs (49.1 ± 36.6 vs. 43.7 ± 26.4 months, p = 0.46), but significantly older for unilateral repairs (54.6 ± 29.8 vs. 29.0 ± 31.4, p < 0.01). The mean operation time of BUNIA was similar to OPEN for bilateral repairs (24.2 ± 7.6 vs. 22.4 ± 8.6 min, p = 0.35), but significantly longer for unilateral repairs (19.2 ± 7.0 vs, 13.6 ± 8.8 min, p < 0.01). The mean follow-up duration of BURNIA was significantly shorter than OPEN for bilateral and unilateral repairs, respectively (32.5 ± 8.8 vs. 45.4 ± 4.8 months, p < 0.01) (30.2 ± 8.8 vs. 39.1 ± 9.6 months, p < 0.01). No conversion was required in BURNIA. There were no complications and no recurrence in all patients. CONCLUSIONS: Single-site laparoscopic burnia is technically feasible, and as safe and effective as open inguinal hernia repair.
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Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Cauterização , Criança , Pré-Escolar , Feminino , Humanos , Duração da Cirurgia , Cavidade Peritoneal/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: This study aims to compare the results of laparoscopy and open surgery for idiopathic intussusception in children as well as evaluate the efficacy of ileopexy. METHODS AND MATERIALS: Between January 2007 and July 2013, children aged <18 years who were operated for intussusception in our institution were reviewed. Patients were classified into two groups, laparoscopy (LAP) and open (OPEN). Both groups were further divided into two subgroups, ileopexy (IP) and non-ileopexy (NIP). Parameters investigated included age, gender, operative indication, surgical procedure, type of intussusception, level of intussusceptum, presence of spontaneously reduced intussusception and pathologic lead points, operative time (OP time), time to oral intake (PO time), length of postoperative hospital stay (LOS), and surgical recurrence. RESULTS: There were 23 and 35 patients in LAP and OPEN group, respectively. No significant difference was found on age, operative indication, surgical procedure, type of intussusception, level of intussusceptum, and presence of spontaneously reduced intussusception between both groups. In LAP group, mean OP time was significantly longer; mean PO time and LOS were significantly shorter. One surgical recurrence occurred in each group (p = 0.76). In comparison of LAP-IP (n = 15) and LAP-NIP (n = 8), OP time, PO time, and LOS were similar in both subgroups. One recurrence was noted in LAP-IP (p = 0.46). The overall conversion rate was 13.0 % (6.8 vs. 25 %, p = 0.21). Compared to patients with intussusceptum to ascending colon, the conversion rate was significantly higher in patients with intussusceptum to transverse and descending colon. With the exclusion of conversion, OP time was significantly shorter in LAP-NIP (p = 0.01). CONCLUSION: Laparoscopy should be considered the primary modality for radiologically irreducible or recurrent idiopathic intussusception in children. Ileopexy provides no benefit on recurrence prevention but contributes to longer OP time.
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Doenças do Íleo/cirurgia , Íleo/cirurgia , Intussuscepção/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Estudos RetrospectivosAssuntos
Fístula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Úlcera Péptica/complicações , Adolescente , Fístula Biliar/etiologia , Colangiopancreatografia por Ressonância Magnética , Endoscopia do Sistema Digestório , Doenças da Vesícula Biliar/etiologia , Humanos , Masculino , Úlcera Péptica/diagnóstico por imagemRESUMO
Purpose: We establish stepwise training program in which laparoscopic suturing is broken down to discrete steps. The purpose is to evaluate the learning outcomes of stepwise training program. Materials and methods: Volunteer participants were enrolled from medical students and surgical trainees. Students took two courses of 2-h stepwise training, and a post-course (1st & 2nd) test was taken after each course; trainees took one course of stepwise training with a pre-course (1st) and a post-course (2nd) test. Attending surgeons took the test as control. Learning outcomes were assessed with laparoscopic suturing competency assessment tool (LS-CAT) and suturing time. Results: There were 10 students, 8 trainees and 6 surgeon controls. Suturing time and LS-CAT scores significantly improved between the 1st and 2nd test (p < 0.01). In the both tests, suturing time and LS-CAT scores of students and trainees were similar. In the 1st test, surgeons had significantly better performance in suturing time and LS-CAT score than students and trainees; in the 2nd test, the LS-CAT scores of students and trainees were similar to the surgeon controls. Conclusions: Stepwise program effectively enhances laparoscopic suturing skill for medical students and surgical trainees. Catch-up effect was demonstrated in medical students with stepwise training.
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[This corrects the article DOI: 10.3389/fped.2021.732524.].
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BACKGROUND: Transumbilical laparoscopy-assisted Malone procedure (TULAM) is a single-incision laparoscopic procedure in which the appendicostomy is made at umbilicus. The aim of this study is to evaluate the outcomes of TULAM. METHODS: With IRB approval, the medical records of the patients who underwent TULAM were retrospectively reviewed between July 2013 and December 2018. The data collected included ages, gender, underlying diseases, operative techniques, complications, stoma continence, parental satisfaction and follow-up duration. RESULTS: Fifteen patients underwent TULAM at the median age of 5.0 years (2.9-10.7 years). There were 4 girls and 11 boys. Thirteen patients had anorectal malformations or cloaca; the other two patients had spina bifida. All patients presented with fecal incontinence; 9 of them had concomitant constipation. TULAM was successfully accomplished in 14 patients; one patient required conversion to the three-port procedure. The median follow-up period was 1.7 years (0.5-3.2 years). One patient required tube replacement under endoscopy guidance in the operation room. One patient required surgical revision because the appendix was disrupted after an episode of enterocolitis. All patients were socially continent with antegrade enemas. 12 patients were stoma continent, and 3 patients had minor leaking less than once a month. The stoma cosmesis was satisfactory. All parents expressed satisfaction with TULAM. CONCLUSION: TULAM is effective in the management of fecal incontinence and constipation, and provides a continent stoma with excellent cosmesis.
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Incontinência Fecal , Laparoscopia , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Constipação Intestinal/cirurgia , Enema/métodos , Enterostomia/efeitos adversos , Enterostomia/métodos , Incontinência Fecal/etiologia , Incontinência Fecal/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
De Barsy syndrome (DBS) is characterized by progeroid features, ophthalmological abnormalities, intrauterine growth retardation, and cutis laxa. Recently, PYCR1 mutations were identified in cutis laxa with progeroid features. Herein, we report on a DBS patient born to a nonconsanguineous Chinese family. The exceptional observation of congenital glaucoma, aortic root dilatation, and idiopathic hypertrophic pyloric stenosis in this patient widened the range of symptoms that have been noted in DBS. Mutation analysis of PYCR1 revealed compound heterozygous PYCR1 mutations, including a p.P115fsX7 null mutation allele and a second allele with two missense mutations in cis: p.G248E and p.G297R. The effect of mutation results in a reduction of PYCR1 mRNA expression and PYCR1 protein expression in skin fibroblasts from the patient. The findings presented here suggest a mutation screening of PYCR1 and cardiovascular survey in patients with DBS.
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Opacidade da Córnea/genética , Cútis Laxa/genética , Heterozigoto , Deficiência Intelectual/genética , Mutação , Fenótipo , Pirrolina Carboxilato Redutases/genética , Anormalidades Múltiplas/genética , Sequência de Bases , Criança , Pré-Escolar , Opacidade da Córnea/diagnóstico , Cútis Laxa/diagnóstico , Éxons , Expressão Gênica , Humanos , Deficiência Intelectual/diagnóstico , Masculino , Pirrolina Carboxilato Redutases/metabolismo , delta-1-Pirrolina-5-Carboxilato RedutaseRESUMO
Introduction: Sacral ratio (SR) is currently the only measurement to quantitatively evaluate sacral development in patients with anorectal malformations (ARM). This study proposes sacral curvature (SC) as a new indicator to qualitatively assess the sacrum and hypothesizes that sacral development, both quantitatively and qualitatively, can be an indicator to predict the type of ARM. The study aims to investigate the difference of SR and SC between ARM types and the association with the type of ARM. Methods and Materials: This study was retrospectively conducted between August 2008 and April 2019. Male patients with ARMs were enrolled and divided into three groups based on the types of ARM: (1) rectoperineal fistulae, (2) rectourethral-bulbar fistulae, and (3) rectourethral-prostatic or rectobladder-neck fistulae. SC was measured in the sagittal views of an MRI or a lateral radiograph of the sacrum. Results: Included in the study were 316 male patients with ARMs. SRs were 0.73 ± 0.12, 0.65 ± 0.12, and 0.57 ± 0.12 in perineal, bulbar, and prostatic/bladderneck fistula, respectively (p < 0.01). The SCs in perineal fistulae and bulbar fistulae were significantly higher than that in prostatic/bladderneck fistulae (0.25 ± 0.04, 0.22 ± 0.14, and 0.14 ± 0.18, p < 0.01). When SR ≥ 0.779, there was an 89.9% of possibility that the child has a perineal fistula. When SR ≤ 0.490 and SC ≤ 0, the possibilities of the child having prostatic/bladderneck fistulae were 91.6 and 89.5%, respectively. SC < 0 was also noted in 27 (27.8%), 19 (10.5%), and no (0%) patients of prostatic/bladderneck, bulbar, and perineal fistulae (p < 0.01), respectively. Sacral defect was noted in 63% of patients with SC ≤ 0, compared to none with SC > 0 (p < 0.01). Conclusions: The higher the rectal level is in an ARM, the lower are the objective measurements of the sacrum. SC ≤ 0 is associated with sacral defects and implies a high likelihood of prostatic/bladderneck fistulae.
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BACKGROUND: To compare single-incision laparoscopic appendectomy (SILA) with conventional (CLA) and transumbilical laparoscopic appendectomy (TULA). METHODS: This is a retrospective cohort study. Patients were divided into three groups, SILA, CLA, and TULA. SILA was defined as performing appendectomy extracorporeally or intracorporeally by using a glove-port incorporated with 3 trocars. TULA was defined as exteriorizing appendix and performing extracorporeal appendectomy by using an operative telescope. Statistical analysis was conducted in patients with simple (SA) and complicated appendicitis (CA), respectively. RESULTS: A total of 315 patients were enrolled, including 161 in SILA, 105 in CLA, and 49 in TULA. Demographic data were similar. In patients with simple appendicitis, operation time of SILA was shorter than CLA but longer than TULA (62.8 ± 22.5 vs. 82.2 ± 24.3 and 51.6 ± 22.3 min, p < 0.01). SILA had shorter hospital stay than CLA, and similar to TULA (56.1 ± 20.4 vs. 71.5 ± 37.8 and 56.9 ± 19.0 h, p < 0.01). In patients with complicated appendicitis, SILA had shorter operation time than CLA, but a similar time to TULA (80.9 ± 22.4 vs. 105.7 ± 28.8 and 82.5 ± 31.2 min, p < 0.01). Conversion to open surgery was not required in all groups. The rates of complications, such as wound infection, intraabdominal abscess and adhesion ileus, were similar. SILA required fewer additional ports than TULA in both simple and complicated appendicitis (1.1% vs. 13.5%, and 9.6% vs. 41.7%, p < 0.01). CONCLUSION: SILA has the advantages of shorter operation time and hospital stay over CLA as well as a lower rate of additional ports than TULA.
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Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia , Criança , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
BACKGROUND: To evaluate the occurrence of constipation after anorectal malformations (ARM) repair and the results of laxative treatment. METHODS: Between August 2012 and July 2017, the clinical data of patients with ARMs was prospectively collected. The patients were divided into two groups, good types and poor types. Good types included rectoperineal, rectovestibular, rectourethral bulbar, and no fistula. Risk factors were defined as spinal cord anomalies, sacral ratio <0.4, or cognitive impairment. Success was defined as that laxative could be tapered. RESULTS: Eighty-four patients were enrolled with mean age of 6.3 ± 7.8 (0.6-59.9) years. The mean age of onset of constipation was 12.8 ± 8.3 months and the mean interval was 5.9 ± 5.1 months after reconstructions. The interval was not significantly different between patients with good types and poor types. In 23 patients with severe constipation being treated for >6 months, 14 of 18 (77.8%) patients with good types were classified as success, whereas only 1 of 5 (20%) patients with poor types was (p = 0.02). In patients with good types, 9 of 9 (100%) patients with no risk factors were successful; however, only 5 out of 9 (55.6%) patients with risk factors were successful (p = 0.02). CONCLUSION: Constipation occurs shortly after operations. Patients with good types and no risk factors are susceptible to weaning laxatives.
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Malformações Anorretais/cirurgia , Constipação Intestinal/etiologia , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Malformações Anorretais/complicações , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: The aim of this study is to evaluate the feasibility of single-incision laparoscopic surgery (SILS) for idiopathic intussusception in children and compare the outcomes with conventional laparoscopy (CLS). METHODS: Between January 2011 and December 2012, patients who underwent CLS for idiopathic intussusception were assigned into the group of CLS. Between January 2013 and March 2017, patients who underwent SILS were assigned to the group of SILS. For patients who failed to reduce by SILS, bimanual transabdominal approach was conducted. RESULTS: A total of 23 patients were enrolled, including 7 and 16 patients in SILS and CLS, respectively. The mean age was similar in both group (22.4⯱â¯18.7 vs. 24.6⯱â¯18.6â¯months, pâ¯=â¯0.80). There is no difference in gender distribution. The main indication was radiological reduction failure in both groups (85.7% vs. 75%, pâ¯=â¯0.58). Ileocolic intussusception was found in 6 (85.7%) and 15 (93.8%) patients of SILS and CLS, respectively (pâ¯=â¯0.25). The level of intussusception was at ascending colon in 3 (42.9%) and 12 (75.0%) patients, respectively (pâ¯=â¯0.11). The operation time was similar in both groups (64.9⯱â¯53.7 and 70.9⯱â¯26.1â¯min, pâ¯=â¯0.79). There were 2 (28.6%) and 1 (6.2%) conversions, respectively (pâ¯=â¯0.15). For the two patients in SILS, the intussusception was successfully reduced by bimanual transabdominal approach. There was no significant difference in time to feeding (1.9⯱â¯1.1 vs. 1.4⯱â¯0.7â¯days, pâ¯=â¯0.21). The mean length of postoperative hospital stay was 3.9⯱â¯1.6 and 3.1⯱â¯1.1â¯days, respectively (pâ¯=â¯0.17). CONCLUSIONS: SILS for pediatric intussusception is technically feasible and has comparable results to CLS. Transabdominal bimanual reduction is applicable in cases of failed laparoscopic reduction. LEVEL OF EVIDENCE: III.
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Doenças do Íleo/cirurgia , Intussuscepção/cirurgia , Laparoscopia , Pré-Escolar , Humanos , Lactente , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Duração da CirurgiaRESUMO
BACKGROUND: The purpose of this study is to examine the outcome of transumbilical minilaparotomy for infants and compare the results between normal birthweight (NBW) and low birthweight (LBW). METHODS: Between July 2010 and March 2017, infants who underwent abdominal surgery through transumbilical minilaparotomy were enrolled. Medical records were retrospectively reviewed. Patients were divided into two groups, NBW and LBW. Complexity was defined as complicated conditions other than intestinal atresia and malrotation. RESULTS: Totally, 16 patients were included. The diagnosis included intestinal atresia (n = 3), meconium peritonitis (n = 4), bowel infarction/necrosis (n = 4), spontaneous intestinal perforation (n = 2), segmental volvulus and necrosis (n = 1), necrotizing enterocolitis (n = 1), and malrotation (n = 1). The median gestational age and body weight were 32 (24-40) weeks and 1731 (560-4200) grams respectively. The median age at operation was 3 (1-41) days. The surgical procedure included primary repair of the intestine (n = 14), ileostomy (n = 1) and Ladd's procedure (n = 1). Postoperative complications included anastomotic leakage (n = 2), adhesion ileus (n = 1), and missed rectal atresia (n = 1). There was one mortality due to extremely low birthweight and poor lung maturation. Re-operation was required in 3 patients for anastomotic leakage (n = 2) and missed rectal atresia (n = 1). Mean birthweight was 2932 ± 97 and 1263 ± 667 g in NBW (n = 5) and LBW (n = 11), respectively (p < 0.01). Complexity rate was 40% and 90.9%, respectively (p = 0.034). The mean operation time was 139.4 ± 65.8 and 124.3 ± 46.1 min, respectively (p = 0.60). The complicated rate and reoperation rate were similar. CONCLUSIONS: Transumbilical minilaparotomy is technically feasible and an alternative option of minimally invasive surgery for LBW infants and complex conditions.
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Recém-Nascido de Baixo Peso , Laparotomia/métodos , Peso ao Nascer , Enterocolite Necrosante/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Atresia Intestinal/cirurgia , Volvo Intestinal/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Umbigo/cirurgiaRESUMO
Objective. This study reports the age and gender characteristics of children with inguinal hernia repairs (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] Operation Codes 530-533). Methods. We used a retrospective cohort study design based on 2 data sources from 2007 to 2011 (the Bureau of National Health Insurance, Department of Health, Taiwan, and a local teaching children's hospital database) and descriptive statistics to analyze the group's age and gender differences as independent variables. Results. The gender ratio was 7 males to 1 female in the general population, whereas the gender ratio in children was 3.5 males to 1 female. Gender difference was found statistically significant in the age subgroup difference: boys (49.1%) were more than girls (39.3%) in ages 1 to 4, while girls (37.8%) were more than boys (23.7%) in ages 5 to 9. Based on the local hospital's data, of those 611 (15%) children born and who received herniorrhaphy, 204 (33.4%) were born as preterm infants and 407 (66.6%) as term infants. The gender ratio among 204 children born prematurely and received herniorrhaphy was 3 males to 1 female. Of those 353 infants under 6 months who received herniorrhaphy, 155 (76%) were preterm infants while 198 (48.6%) were term infants. Conclusion. Early screening of inguinal hernia for children is important and should focus on those born prematurely, particularly those aged <6 months and boys.