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Sun C, Sun H, Lei J. Laparoscopic versus laparotomy for resolving intestinal adhesions in pediatric bowel obstruction: A retrospective comparative study. Asian J Surg 2024:S1015-9584(24)00488-3. [PMID: 38604841 DOI: 10.1016/j.asjsur.2024.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Chuanwei Sun
- Department of Pediatric Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Hong Sun
- Department of Pediatric Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China
| | - Jie Lei
- Department of Pediatric Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China.
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Patwardhan UM, Floan GM, Calvo RY, Acker SN, Choi PM, Prieto JM, Bansal V, Sise MJ, Thangarajah H, Fairbanks TJ, Lazar DA, Ignacio RC. A Comparative Study of Laparoscopic versus Open Management of Index Small Bowel Obstruction in Children. J Pediatr Surg 2024; 59:416-420. [PMID: 37978001 DOI: 10.1016/j.jpedsurg.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There is limited literature on the optimal approach to treat adhesive small bowel obstruction (ASBO) in children. We sought to compare rates and outcomes of laparoscopic (LAP) and open (OPEN) surgery for pediatric ASBO. METHODS A California statewide database was used to identify children (<18 years old) with an index ASBO from 2007 to 2020. The primary outcome was the type of operative management: LAP or OPEN. Secondary outcomes were hospital characteristics, patient demographics, and postoperative complications. We excluded patients treated non-operatively. RESULTS Our study group had 545 patients. 381 (70%) underwent OPEN and 164 (30%) LAP during the index admission. Over the study period, there was increasing use of laparoscopic surgery, with higher use in older children (p < 0.001). LAP was associated with fewer overall complications (65.2% vs. 81.6%, p < 0.001), with a decreasing trend in complications over time (p < 0.001). The LAP group had significantly lower rates of bowel resection (4.9% vs. 17.1%, p < 0.001), length of stay (LOS) (17 vs. 23 days, p < 0.001), and TPN use (12.2% vs. 29.1%, p < 0.001). Mortality rates were equivalent. Although the LAP group had lower readmission rates (22.6% vs. 37.3%, p < 0.001), the length of time between discharge and readmission was similar (171 vs. 165 days, p = 0.190). DISCUSSION The use of laparoscopic surgery for index ASBO increased over the study period. However, it was less commonly utilized in younger children. LAP had fewer overall complications as well as shorter LOS, decreased TPN use, and fewer readmissions. The benefits and risks of each approach must be weighed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Utsav M Patwardhan
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Gretchen M Floan
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Richard Y Calvo
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Shannon N Acker
- Colorado Children's Hospital, 13123 E 16th Ave, Aurora, CO 80045, USA
| | - Pamela M Choi
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - James M Prieto
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Vishal Bansal
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Michael J Sise
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Hari Thangarajah
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Timothy J Fairbanks
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - David A Lazar
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Romeo C Ignacio
- Rady Children's Hospital San Diego, 3020 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, Department of Surgery, 9500 Gilman Dr, La Jolla, CA 92093, USA.
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Patwardhan UM, Floan GM, Calvo RY, Acker SN, Prieto JM, Thangarajah H, Bansal V, Sise MJ, Fairbanks TJ, Lazar DA, Ignacio RC. Trends in Management of Index Adhesive Small Bowel Obstruction in Children. J Surg Res 2023; 292:258-263. [PMID: 37660549 DOI: 10.1016/j.jss.2023.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 07/02/2023] [Accepted: 07/23/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION To examine practice patterns and surgical outcomes of nonoperative versus operative management (OPM) of children presenting with an index adhesive small bowel obstruction (ASBO). METHODS A California statewide health discharge database was used to identify children (<18 y old) with an index ASBO from 2007 to 2020. The primary study outcome was evaluating initial management patterns (nonoperative versus OPM and early [≤3 d] versus late surgery [>3 d]) of ASBO. Secondary outcomes were hospital characteristics, patient demographics, and postoperative complications. RESULTS Of the 2297 patients identified, 1948 (85%) underwent OPM for ASBO during the index admission. Of these, 14.7% underwent early surgery within 3 d. Teaching hospitals had higher operative intervention than nonteaching centers (87.1% versus 83.7%, P = 0.034). OPM was the highest in 0-5-year-olds compared to other ages (89% versus 82%, P < 0.001). In comparison to early surgery, late surgery was associated with longer length of stay (early 7[interquartile range 5-10], late 9[interquartile range 6-17], P < 0.001), increased infectious complications (16.4% versus 9.8%, P = 0.004), and greater use of total parenteral nutrition (28.0% versus 14.3%, P = 0.001); there was no difference in bowel resection (21% versus 18%, P = 0.102) or mortality (P = 0.423). CONCLUSIONS Our pediatric study demonstrated a high rate of OPM for index ASBO, especially in newborns and toddlers. Although operative intervention, especially late surgery, was associated with increased length of stay, increased infectious complications, and increased total parenteral nutrition use, the rates of bowel resection and mortality did not differ by management strategy. These trends need to be further evaluated to optimize outcomes.
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Affiliation(s)
- Utsav M Patwardhan
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California
| | - Gretchen M Floan
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California
| | - Richard Y Calvo
- Department of Trauma Surgery, Scripps Mercy Hospital San Diego, San Diego, California
| | - Shannon N Acker
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - James M Prieto
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California
| | - Hari Thangarajah
- Divison of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, California
| | - Vishal Bansal
- Department of Trauma Surgery, Scripps Mercy Hospital San Diego, San Diego, California
| | - Michael J Sise
- Department of Trauma Surgery, Scripps Mercy Hospital San Diego, San Diego, California
| | - Timothy J Fairbanks
- Divison of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, California
| | - David A Lazar
- Divison of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, California
| | - Romeo C Ignacio
- Divison of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, California.
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Norsa L, Goulet O, Alberti D, DeKooning B, Domellöf M, Haiden N, Hill S, Indrio F, Kӧglmeier J, Lapillonne A, Luque V, Moltu SJ, Saenz De Pipaon M, Savino F, Verduci E, Bronsky J. Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr 2023; 77:298-314. [PMID: 37256821 DOI: 10.1097/mpg.0000000000003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The preferred treatment for IF is parenteral nutrition which may be required until adulthood. The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their expertise. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. This second part of the position paper is dedicated to the long-term management of children with SBS-IF. The paper mainly focuses on how to achieve intestinal rehabilitation, treatment of complications, and on possible surgical and medical management to increase intestinal absorption.
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Affiliation(s)
- Lorenzo Norsa
- From the Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Olivier Goulet
- the Department of Pediatric Gastroenterology-Hepatology-Nutrition, APHP Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Daniele Alberti
- the Department of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
- the Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara DeKooning
- From the Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Susan Hill
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Flavia Indrio
- the Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Jutta Kӧglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Alexandre Lapillonne
- the Neonatal Intensive Care Unit, APHP Necker-Enfants Malades Hospital, Paris Cité University, Paris, France
- the CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Veronica Luque
- Serra Hunter, Universitat Rovira I Virgili, IISPV, Tarragona, Spain
| | - Sissel J Moltu
- the Department of Neonatology, Oslo University Hospital, Oslo, Norway
| | - Miguel Saenz De Pipaon
- the Department of Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain
| | - Francesco Savino
- the Dipartimento di Patologia e cura del bambino "Regina Margherita", A.U.O. Città delle Salute e della Scienza di Torino, Torino, Italy
| | - Elvira Verduci
- the Department of Pediatrics, Ospedale dei Bambini Vittore Buzzi University of Milan, Milan, Italy
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
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GÜLER AG, KARAKAYA AE, DOĞAN AB, BAHAR AY, YURTTUTAN S. The effect of natural surfactants on the development of postoperative intraabdominal adhesion. Turk J Med Sci 2023; 53:1112-1119. [PMID: 38813040 PMCID: PMC10763776 DOI: 10.55730/1300-0144.5676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/26/2023] [Accepted: 04/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The development of postoperative adhesion after abdominal surgery is sometimes a severe problem. Our study investigates the effectiveness of exogenous surfactant application in preventing adhesion development in the experimental adhesion model. Materials and methods This randomized-controlled interventional study was carried out in the animal laboratory of Kahramanmaraş Sütçü İmam University between March 1 and March 31, 2020. An experimental intra-abdominal adhesion model was established in 24 adult female rats by cecal abrasion. Rats were randomly divided into four groups. Groups I, II, and III were taken intraperitoneally as beractant, poractant, and calfactant applied groups, respectively. Group IV was the control group. Relaparotomy was performed in all groups on the 15th postoperative day, and intra-abdominal adhesions were scored macroscopically according to the Canbaz scoring system. In addition, the cecal regions were evaluated microscopically and scored according to the Zühlke microscopic classification system. The scores of the groups were compared statistically. Results The Zühlke adhesion development score was significantly lower in the exogenous surfactant applied groups. In addition, when the surfactant-applied groups were compared among themselves, it was seen that the adhesion score in the beractant group was significantly better than the other surfactant types (p < 0.01). Conclusion Our study results showed that prophylactic intraperitoneal surfactant application significantly reduced postoperative adhesion development, particularly beractant.
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Affiliation(s)
- Ahmet Gökhan GÜLER
- Department of Pediatric Surgery, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş,
Turkiye
| | - Ali Erdal KARAKAYA
- Department of Pediatric Surgery, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş,
Turkiye
| | - Ahmet Burak DOĞAN
- Department of Pediatric Surgery, Faculty of Medicine, Erciyes University, Kayseri,
Turkiye
| | - Abdülkadir Yasir BAHAR
- Department of Pathology, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş
Turkiye
| | - Sadık YURTTUTAN
- Department of Neonatology, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş
Turkiye
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Vitamin B 12 deficiency presenting as intestinal pseudo-obstruction in short bowel syndrome: A case report. Nutrition 2023; 106:111895. [PMID: 36435090 DOI: 10.1016/j.nut.2022.111895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022]
Abstract
Bowel obstruction and nutrient deficiencies are commonly encountered complications seen during follow-up of patients with short bowel syndrome. It is rare to see vitamin B12 deficiency among micronutrient deficits. The onset of B12 deficiency can be insidious, with autonomic features preceding other symptoms. In this study, we report a case in which vitamin B12 deficiency presented with intestinal dysmotility mimicking mechanical bowel obstruction.
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Boybeyi-Turer O, Soyer T. Percutaneous Gastrostomy in Colon Interposition: Is It Always in the Right Place? Indian J Surg 2022. [DOI: 10.1007/s12262-022-03393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Parolini F, Boroni G, Betalli P, Cheli M, Pinelli D, Colledan M, Alberti D. Extended Adhesion-Sparing Liver Eversion during Kasai Portoenterostomy for Infants with Biliary Atresia. CHILDREN-BASEL 2021; 8:children8090820. [PMID: 34572252 PMCID: PMC8470555 DOI: 10.3390/children8090820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
Background: Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients. Their true survival rate with the native liver reflects the original KPE and the burden of post-operative complications. We report an original modification of the adhesion-sparing liver eversion (ASLE) technique during KPE that facilitates the total native hepatectomy at time of transplantation. Methods: All consecutive patients with BA who underwent KPE at our department and subsequent LT at Paediatric Liver Transplant Centre at Papa Giovanni XXIII Hospital between 2010–2018 were retrospectively enrolled. All patients underwent ASLE during KPE. Patients’ demographic data, type of KPE, total transplant time (TTT), hepatectomy time (HT), intra-operative packed red blood cells and plasma transfusions, intra- and post-operative complications were noted. Results: 44 patients were enrolled. Median TTT and HT were 337 and 57 min, respectively. The median volume of packed red blood cell transfusion was 95 mL. No patients presented bowel perforation during the procedure or in the short post-operative course. No mortality after LT was recorded. Conclusions: In addition to the well-known advantages of the standard liver eversion technique, ASLE reduces the formation of intra-abdominal adhesions, lowering significantly the risk of bowel perforation and bleeding when liver transplantation is performed for failure of KPE.
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Affiliation(s)
- Filippo Parolini
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
- Correspondence: ; Tel.: +39-0303996201; Fax: +39-0303996154
| | - Giovanni Boroni
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
| | - Pietro Betalli
- Department of Paediatric Surgery, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.B.); (M.C.)
| | - Maurizio Cheli
- Department of Paediatric Surgery, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.B.); (M.C.)
| | - Domenico Pinelli
- Department of Surgery III, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Michele Colledan
- Department of Surgery III, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Daniele Alberti
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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