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Raymond SL, Sharafeddin F, Sacks MA, Srikureja D, Gomez N, Moores D, Radulescu A, Khan FA, Tagge EP. Establishment of a successful robotic pediatric general surgery practice. J Robot Surg 2023; 17:2427-2433. [PMID: 37452975 PMCID: PMC10492704 DOI: 10.1007/s11701-023-01667-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Robotic-assisted surgery (RAS) has a variety of theoretical advantages, including tremor filtration, optimal visualization, and improvement of surgeon ergonomics. Though it has achieved wide application in pediatric urology, the majority of pediatric general surgeons do not employ RAS. This study reports our institution's experience with RAS on a pediatric general surgery team. Following IRB approval, a retrospective review of all pediatric patients at our academic children's hospital who underwent RAS between 2017 and 2022 for pediatric general surgical conditions was performed. Patient demographics, operation performed, operating time, complications, and recovery were evaluated. A total of 159 children underwent RAS, increasing from 10 patients in 2017 to 59 patients in 2022. The median age and weight were 15.3 years and 76.4 kg, and 121 (76.1%) were female. The application of RAS was successful in all cases. There were no intraoperative complications and no conversions to an open approach. Eleven patients (6.9%) had unplanned presentations to the emergency department within 30 days. Five of these patients (3.1%) required admission to the hospital. This study demonstrates that the application of RAS in an academic pediatric general surgery practice is feasible and safe. The application of RAS to pediatric general surgery should continue to increase as operative teams increase their experience and comfort.Level of evidence Level IV.
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Affiliation(s)
- Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA
| | - Fransua Sharafeddin
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA
| | - Daniel Srikureja
- Department of Surgery, Memorial Hospital of South Bend, South Bend, Indiana, USA
| | - Nephtali Gomez
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA
| | - Donald Moores
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite, Loma Linda, CA, 21111, USA.
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Lee JD, Sacks MA, Radulescu A, Moores D. Case report: Duplicated appendicitis with history of cloacal exstrophy causing bowel obstruction. Int J Surg Case Rep 2023; 108:108437. [PMID: 37413759 PMCID: PMC10382772 DOI: 10.1016/j.ijscr.2023.108437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION Cloacal and bladder exstrophy are rare embryological defects that can cause developmental disruption of surrounding organ structures, the pelvis, spinal cord, and small intestines being the most commonly affected. Duplicated appendix is another rare embryological defect that has historically caused confusing clinical presentations. Our case highlights a rare instance of a patient with cloacal exstrophy who presented with a bowel obstruction and an associated inflamed duplicated appendix. CASE PRESENTATION A newborn male is born with omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex. As primary surgical reconstruction was pursued, the patient was found to have a non-inflamed duplicated appendix, which was left unremoved. In the following months, the patient experienced episodes of small bowel obstruction, eventually requiring surgical intervention. During this operation, the duplicated appendix was noted to be inflamed, prompting removal of both appendices. DISCUSSION This case highlights the increased prevalence of duplicated appendix in a patient with cloacal exstrophy, as well as the utility of prophylactic appendectomy for patients incidentally found to have a duplicated appendix intraoperatively. The duplicated appendix may lead to increased rates of complications and atypical presentation of appendicitis, supporting the practice of prophylactic appendectomy in patients with an incidentally found duplicated appendix. CONCLUSION We suggest clinicians be aware of the association and potentially atypical presentation of appendicitis in patients with a duplicated appendix, particularly in the setting of cloacal exstrophy. The decision to prophylactically remove an incidentally found, non-inflamed duplicated appendix may be beneficial in preventing confusing clinical presentations and future complications.
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Affiliation(s)
- Jonathan D Lee
- Loma Linda University Health, Loma Linda, CA, United States of America
| | - Marla A Sacks
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Andrei Radulescu
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Donald Moores
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America.
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Raymond SL, Sacks MA, Hashmi A, Robertson JO, Moores D, Tagge EP, Radulescu A, Islam S, Khan FA. Short-term outcomes of thoracoscopic versus open lobectomy for congenital lung malformations. Pediatr Surg Int 2023; 39:155. [PMID: 36944730 PMCID: PMC10030530 DOI: 10.1007/s00383-023-05445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Thoracoscopic and open approaches for the management of congenital lung malformations (CLM) has been debated. The aim of this study is to compare 30-day outcomes for non-emergent lobectomies in children. METHODS The National Surgical Quality Improvement Program-Pediatric database was queried for patients undergoing CLM resection from 2013 to 2020. Outcomes were compared by operative technique in an intention-to-treat model and then propensity matched. RESULTS 2157 patients met inclusion criteria and underwent non-emergent pulmonary lobectomy for CLM. The intended operative approach was thoracoscopic in 57.7% of patients. Patients in the open group compared to the thoracoscopic were more likely to be born premature, have chronic lung disease, require preoperative oxygen support, and be ventilator dependent. After propensity matching, there was no statistically significant difference in 30-day mortality, unplanned readmission, and other complications between the thoracoscopic and open groups. Thoracoscopic approach was associated with a shorter length of stay. The proportion of cases approached via thoracoscopy increased over time from 48.8% in 2013 to 69.9% in 2020. CONCLUSIONS This large multicenter retrospective matched analysis demonstrates thoracoscopic lobectomy in children has similar favorable 30-day outcomes and shorter length of stay for the non-emergent management of CLM, compared to open thoracotomy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Asra Hashmi
- Division of Plastic Surgery, Department of Surgery, Kaiser Permanente, San Jose, CA, USA
| | - Jason O Robertson
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Donald Moores
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA.
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Sacks MA, Neal D, Pairawan S, Tagge EP, Hashmi A, Islam S, Khan FA. Optimal Timing of Inguinal Hernia Repair in Premature Infants: A NSQIP-P Study. J Surg Res 2023; 283:690-698. [PMID: 36459862 DOI: 10.1016/j.jss.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/19/2022] [Accepted: 11/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Among premature infants, the incidence of inguinal hernias is reported to be as high as 30%. Despite being one of the most commonly performed procedures, the optimal setting of inguinal hernia repair (IHR) that is inpatient versus outpatient remains debatable. We sought to compare the 30-day outcomes of each approach by querying the National Surgical Quality Improvement Program-Pediatric database. MATERIALS AND METHODS A retrospective cohort study comparing inpatient versus outpatient IHR using the National Surgical Quality Improvement Program-Pediatric database from 2013 to 2019 was performed. Demographic and clinical data were initially compared using univariate analysis. Continuous variables are presented as median and interquartile range and categorical variables are presented as n (%). Subsequently, cohorts were propensity matched using clinically and statistically significant patient characteristics. RESULTS 928 patients underwent IHR, 634 (68.3%) while inpatient, 294 (31.7%) following hospital discharge. Inpatient IHR was associated with lower age at the time of surgery (120 versus 147 d; P < 0.0001), younger gestational age (27 versus 33 wk; P < 0.0001), decreased probability of repair in elective setting (87.2% versus 97.3%; P < 0.0001), and increased preoperative supplemental oxygen need (42% versus 4.4%; P < 0.0001). Comparison of propensity matched cohorts revealed that inpatient IHR was associated with increased procedure time (82 versus 51 min; P < 0.0001) and anesthetic duration (146 versus 102 min; P < 0.0001), wound infection rates (3.8% versus 0%; P = 0.007), blood transfusions (4.2% versus 0.5%; P = 0.036), unplanned intubations (2.8% versus 0%; P = 0.03), ventilator days (0 versus 0; range [0,30 versus 0,2]; P = 0.002), reoperation rate (5.6% versus 0%; P < 0.001), postoperative hospital length of stay (4 versus 1 d; P < 0.0001), and unplanned readmissions (8.9% versus 0.9%; P = 0.002). CONCLUSIONS Inpatient IHR in premature neonates were associated with different postoperative outcomes than outpatient IHR. At least in the elective setting among premature infants, outpatient IHR can be considered safe in select patients while we await higher quality prospective data.
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Affiliation(s)
- Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - Dan Neal
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Seyed Pairawan
- Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Saleem Islam
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California.
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Sacks MA, Do Jeong Y, Mendez YS, Hashmi A, Radulescu A, Tagge EP, Robertson JO, Khan FA. Are pediatric surgery fellowship websites ready for the changing paradigms in the virtual interview era? Global Surg Educ 2023; 2:27. [PMID: 38013871 PMCID: PMC9874179 DOI: 10.1007/s44186-023-00104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/26/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
Purpose With the COVID-19 pandemic, in-person fellowship interviews were curtailed, leading candidates to seek information from other resources. Our main purposes were (1) to determine what information recent participants in the match needed to evaluate programs and (2) to assess which of these were available online. Methods A focus group of ten recent graduates/applicants identified information that was important in choosing a fellowship program. In August 2020 and December 2021, websites belonging to the American Pediatric Surgical Association (APSA) and individual programs were assessed. Results Recent applicants identified 55 pieces of information considered important to their decision making. Of 57 pediatric surgery fellowships, 98% were listed on APSA's website. Program descriptions on APSA's website listed on average 60% of program information desired by applicants. All listed fellowship director, accreditation status, faculty list, and current fellow(s). Other descriptors frequently noted were alumni (95%), graduate's board performance (83%), ECMO exposure (77%), and curriculum (70%). Information desired but less frequently available were fellow case logs (63%), trauma center designation (53%), burn center designation (40%), research opportunities (30%), candidate interview assistance (25%), and supplemental fellowships (12%). There were 7% of program descriptions that were not updated for at least a year. Conclusions APSA and individual program websites were complimentary. Websites often lacked data that applicants sought to inform their rank list. To best adapt to the evolving virtual interview paradigm, we suggest reporting key information on a central APSA website with more nuanced information available via links to program specific websites. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-023-00104-w.
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Affiliation(s)
- Marla A. Sacks
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Young Do Jeong
- School of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Yomara S. Mendez
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Edward P. Tagge
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Jason O. Robertson
- Department of Pediatric Surgery, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Faraz A. Khan
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
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Maidan A, Sacks MA, Raymond SL, Mladenov GD, Khan FA, Radulescu A. Trisomy 18 and necrotizing enterocolitis. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Won MM, Sacks MA, Leigh R, Mendez YS, Goodman LF, Tagge E, Radulescu A. An Unusual Case of Primary Ileal Trichobezoar Causing Intussusception. Am J Case Rep 2022; 23:e935460. [PMID: 35900939 PMCID: PMC9344775 DOI: 10.12659/ajcr.935460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patient: Male, 8-year-old
Final Diagnosis: Intussusception
Symptoms: Abdominal pain • nausea • vomiting
Medication: —
Clinical Procedure: —
Specialty: Surgery
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Affiliation(s)
- Mitchell M. Won
- School of Medicine, Loma Linda University, Loma Linda, USA, CA
| | - Marla A. Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
| | - Rebekah Leigh
- School of Medicine, Loma Linda University, Loma Linda, USA, CA
| | - Yomara S. Mendez
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
| | - Laura F. Goodman
- Department of Pediatric Surgery, Children’s Hospital Orange County, Orange, USA, CA
| | - Edward Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, USA, CA
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Sacks MA, Khan FA, Hazboun R, Radulescu A, Tagge EP. Objective Personality Determination: A Useful Addition to the Traditional Process of Pediatric Surgical Fellow Selection. Am Surg 2022; 88:2531-2537. [PMID: 35619551 DOI: 10.1177/00031348221103646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Selection of pediatric surgical trainees is a multifaceted process heavily influenced by in-person interviews to determine personality makeup and institutional compatibility. We present our experience in utilizing a validated personality inventory in the selection of our candidates. METHODS All applicants selected for an in-person interview for the 2020 Pediatric Surgery Match were offered the Big Five Inventory (BFI) questionnaire. An initial rank order list (ROL) was formulated employing application information and in-person interview score. A reformulated ROL was created after incorporating BFI data. Correlation of specific personality characteristics vs position on the ROL was assessed for both the initial ROL and the reformulated ROL. RESULTS Thirty-four applicants were interviewed and 24 (70.6%) were ranked. Linear regression analysis identified a lower neuroticism score directly related to a higher position on the initial ROL {R = .4626, P = .023}. The reformulated ROL identified a higher conscientiousness score {R = .5331; P = .007} and a lower neuroticism score {R = -.4383; P = .032} correlated with ascending the final ROL. CONCLUSIONS The self-administered BFI adds objectivity to personality determination gleamed from the standard face-to-face interview. Conscientiousness and neuroticism had a significant impact on the final ROL position. Adding objective personality data appears to provide additional aid in this difficult process.
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Affiliation(s)
- Marla A Sacks
- Division of Pediatric Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Faraz A Khan
- Division of Pediatric Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Rajaie Hazboun
- Division of Plastic Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Edward P Tagge
- Division of Pediatric Surgery, 23333Loma Linda University Children's Hospital, Loma Linda, CA, USA
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Thornhill R, Sacks MA, Goodman LF, Khan FA, Radulescu A. Newborn with annular pancreas and H-Type tracheoesophageal fistula. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.102068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sacks MA, Goodman LF, Mendez YS, Khan FA, Radulescu A. Pain versus Gain: Multiport versus single-port thoracoscopic surgery for pediatric pneumothorax a case series. International Journal of Surgery Open 2021. [DOI: 10.1016/j.ijso.2021.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Leigh R, Sacks MA, Won MM, Mikael A, Moores D, Radulescu A. Large mesenteric cyst mimicking an ovarian cyst in an 8-year-old: A case report. Int J Surg Case Rep 2021; 89:106566. [PMID: 34773912 PMCID: PMC8593222 DOI: 10.1016/j.ijscr.2021.106566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Pediatric mesenteric cysts, rare and usually benign intra-abdominal tumors, are a difficult preoperative diagnosis due to ambiguous clinical characteristics. The final diagnosis is typically established only during surgery or histological analysis. CASE PRESENTATION An 8-year-old female presented with five days of worsening abdominal pain, associated with nausea, vomiting, and fever, as well as vague tenderness in the right quadrants on examination. Computed tomography imaging showed a 10.5 × 8.7 × 7 cm abdominal mass, most suspicious for a cystic mass of ovarian origin. Upon diagnostic laparoscopy, a mesenteric cyst extending to the root of the mesentery was visualized and entirely resected after conversion to an exploratory laparotomy. Histopathological examination of both the cystic fluid and specimen suggest a benign mesenteric cyst. CLINICAL DISCUSSION Although mesenteric cysts are noticeably rare, it is important differential to consider in pediatric patients with non-specific symptoms like abdominal pain and distention, intestinal obstruction, or a palpable abdominal mass. Notably, these cysts can be managed successfully by complete surgical resection with an excellent outcome. CONCLUSION This report recounts an interesting case of a large mesenteric cyst that mimicked an ovarian cyst in a pre-pubertal girl.
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Affiliation(s)
- Rebekah Leigh
- Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | - Marla A Sacks
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Mitchell M Won
- Loma Linda University School of Medicine, Loma Linda, CA, United States of America
| | - Amarseen Mikael
- Department of Surgery, University of California at Riverside School of Medicine, CA, United States of America
| | - Donald Moores
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Andrei Radulescu
- Loma Linda University School of Medicine, Loma Linda, CA, United States of America; Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America.
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Sacks MA, Goodman LF, Mendez YS, Khan FA, Moores DC, Radulescu A. Pediatric Perforated Appendicitis Rate Increased During the Covid-19 Pandemic. J Am Coll Surg 2021. [PMCID: PMC8531609 DOI: 10.1016/j.jamcollsurg.2021.08.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pairawan SS, Tagge EP, Sacks MA, Hashmi A, Radulescu A, Khan FA. Thoracoscopic segmentectomy for a large previously undiagnosed CPAM presenting as a spontaneous pneumothorax: A case report. Int J Surg Case Rep 2021; 87:106412. [PMID: 34560589 PMCID: PMC8473762 DOI: 10.1016/j.ijscr.2021.106412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Incidentally found congenital pulmonary airway malformations (CPAM) in older children are extremely rare and have traditionally been managed with minimally invasive versus open lobectomy of the affected lobe. Presentation of case In this report, we present a 11-year-old male who presented with a recurrent spontaneous pneumothorax and was found to have a large symptomatic CPAM confined to a single segment of the right lower lobe. The patient was successfully treated with thoracoscopic segmentectomy without any residual disease seen on follow up imaging. Discussion Minimally invasive thoracoscopic approach has many advantages over open approach including better pain control, reduced hospital length of stay, and decreased intraoperative blood loss. With increasing use of minimally invasive approaches, lung-sparing surgery has demonstrated to be a viable and an attractive option for definitive resection of CPAM, without compromising resection margins and/or future lung function. Conclusion This report demonstrates that minimally invasive lung-sparing surgical treatment of a large CPAM is feasible in older children. Older children with CPAM can present with a spontaneous pneumothorax. CPAM confined to a segment of a single lobe should be managed with segmentectomy. VATS segmentectomy for CPAM in older children can be successful.
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Affiliation(s)
- Seyed S Pairawan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States of America
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America.
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Sacks MA, Goodman LF, Khan FA, Radulescu A. Unusual cause of appendicitis: Orthodontic wire. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Goodman LF, Lin AC, Sacks MA, McRae JJLH, Radulescu A, Khan FA. Single site versus conventional laparoscopic appendectomy: some pain for no gain? J Surg Res 2021; 264:321-326. [PMID: 33848830 DOI: 10.1016/j.jss.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The optimal laparoscopic appendectomy approach is not clear, comparing single site laparoscopic appendectomy (SILA) to conventional 3-port appendectomy (CLA). We investigated outcomes in pediatric patients comparing SILA to CLA: length of operation, length of stay, time to resumption of regular diet, follow up, rehospitalization, and cost. METHODS Data was collected from children 1 to 18 years with appendectomy at Loma Linda University from 2018 to 2020, operated by two surgeons. Analysis utilized two-sample T, chi-squared, and Fisher's exact tests. RESULTS Of 173 patients, 77 underwent SILA and 96 had CLA. There was no gender, age, or race difference between groups. Mean WBC was 17.5 × 103/mL in SILA group, compared to 15.3 × 103/mL in CLA group (P = 0.004). Operative time was 47.0 SILA compared to 49.5 minutes CLA (P = 0.269). Of SILA cases, 55.8% were simple appendicitis, while 53.3% of the CLA cases were simple (P = 0.857). Regular diet was resumed after 1.7 days in the SILA group, 1.1 days in CLA (P = 0.018). Length of stay was 2.9 days for SILA, 2.4 days for CLA (P = 0.144). Seven children required hospital readmission, 5 SILA and 2 CLA (P = 0.244). Five of the children who returned had intra-abdominal abscesses, of whom 4 had SILA. There was no difference in cost. CONCLUSIONS The operative techniques had similar outcomes and operative times. There was a trend toward more intra-abdominal abscesses in the SILA group. Further study and longer follow up is needed to determine if there is an advantage to one laparoscopic approach over another.
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Affiliation(s)
- Laura F Goodman
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California
| | - Ann C Lin
- Department of Surgery, Loma Linda University, Loma Linda, California
| | - Marla A Sacks
- Department of Surgery, Loma Linda University, Loma Linda, California; Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California
| | | | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California; School of Medicine, Loma Linda University, Loma Linda, California
| | - Faraz A Khan
- Department of Surgery, Loma Linda University, Loma Linda, California; Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California; School of Medicine, Loma Linda University, Loma Linda, California.
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Pace S, Sacks MA, Goodman LF, Tagge EP, Radulescu A. Antenatal Diagnosis of Retroperitoneal Cystic Mass: Fetiform Teratoma or Fetus in Fetu? A Case Report. Am J Case Rep 2021; 22:e929247. [PMID: 33568621 PMCID: PMC7885532 DOI: 10.12659/ajcr.929247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Teratoma, a tumor containing a variety of tissues, is a broad diagnosis containing mature teratoma, immature teratoma, and teratomas with malignant transformation. The tumor forms during embryological development secondary to unsuccessful migration of primordial germ cells. A specific type of mature teratoma, containing human-like features, is called a fetiform teratoma. The fetiform teratoma is often compared and confused with fetus in fetu, a reabsorbed twin. While these tumors have commonly been described in the gonads, the retroperitoneal location finding on antenatal imaging is rare. The distinction between the aforementioned subtypes is not well established, proving a challenging diagnosis prior to resection. CASE REPORT We present a case of a newborn male with a prenatal diagnosis of retroperitoneal cystic mass. Although prenatal imaging was obtained, the diagnosis remained unclear. After birth, planned surgical excision on day of life 7 showed the suprarenal mass contained contiguous intestinal elements. Histopathology examination revealed a mature cystic teratoma with multiple tissue types, including colonic, brain, respiratory, lymphatics, and nerves, reminiscent of fetiform teratoma. This case report presents an interesting example of differentiating elements straddling the diagnoses mentioned above. CONCLUSIONS This is the first reported case of fetiform teratoma diagnosed in a newborn and is especially unique for having the element of intestinal duplication within the retroperitoneal mass. The differentiating features of fetus in fetu and fetiform teratoma depend on subjective distinctions. The case provides an opportunity to discuss the differentials and management strategies.
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Affiliation(s)
- Spencer Pace
- School of Medicine, Touro University California, Vallejo, CA, USA
| | - Marla A Sacks
- Department of Surgery, Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Laura F Goodman
- Department of Surgery, Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Edward P Tagge
- Department of Surgery, Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Andrei Radulescu
- Department of Surgery, Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
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Pace S, Sacks MA, Minasian T, Hashmi A, Khan FA. Paraspinal plexiform schwannoma of unknown nerve origin: A case report. Int J Surg Case Rep 2021; 79:267-270. [PMID: 33486308 PMCID: PMC7829105 DOI: 10.1016/j.ijscr.2021.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 11/05/2022] Open
Abstract
Plexiform schwannomas are exceedingly rare in paediatric populations. This is a unique case located outside the spinal canal without a nerve of origin. Preoperative planning is imperative for complete resection and cosmesis.
Introduction and importance Schwannomas are benign, slow-growing nerve sheath tumors of neoplastic Schwann cells. They are the most common peripheral nerve tumors in adults and are typically discovered incidentally due to their asymptomatic presentation. Despite the fact that most schwannomas are unassociated with a syndrome, their etiology is thought to be related to alterations or loss of the neurofibromatosis type two tumor suppressor gene. Case presentation We present the case of a fifteen-year-old female who presented with a recurrent lower back/upper buttocks 9 cm mass with imaging suspicious for schwannoma. Needle biopsy revealed an S100 positive cellular schwannoma with patchy Ki-67. During surgical dissection down to the sacrum, no nerve of origin was identified. Clinical discussion Schwannomas have no pathognomonic findings on MRI and may occur at any location that Schwann cells are present; therefore, confirming a diagnosis relies on histopathology. Plexiform schwannomas are defined by a “network-like” intraneural growth pattern and are exceedingly rare in paediatric populations. A location distinct from the spinal canal is also very rare as schwannomas typically originate from the head and neck region. Conclusion Paediatric plexiform schwannomas have been rarely reported. Surgical planning relies on multiple factors such as tumor size, tumor location, pathologic features and symptomatic burden. The distinctive features of this case including an unknown nerve origin and a location outside the spinal canal provide a unique opportunity to discuss the diagnosis and management of paraspinal schwannomas and the impact on operative planning when a nerve of origin is not identified.
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Affiliation(s)
- Spencer Pace
- School of Medicine, Touro University California, Vallejo, CA, United States
| | - Marla A Sacks
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - Tanya Minasian
- Department of Neurosurgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - Asra Hashmi
- Department of Plastic and Reconstructive Surgery, Loma Linda University Hospital, Loma Linda, CA, United States
| | - Faraz A Khan
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States.
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Abstract
Background: Biliary Atresia (BA) is congenital condition, where infant intra- and extrahepatic bile ducts become obliterated, leading to cholestasis, and cirrhosis if untreated. This study aims to assess the predictive measure of absent gallbladder on ultrasounds (US) performed in infants with cholestasis for diagnosing BA. Method: After Institutional Review Board approval, retrospective chart reviews of 61 infants with cholestasis found 43 (70.5%) were diagnosed with BA. A pediatric radiologist provided interpretations of all ultrasounds in a blinded fashion. Statistical analysis was used to assess the utility of absence of gallbladder on US in predicting BA, confirmed intraoperatively. Results: Absent gallbladder on US predicts absent gallbladder with 77% accuracy, 92% sensitivity, 73% specificity, PPV 43%, and NPV 97% (P < 0.001, Fisher exact test). To diagnose BA, absent gallbladder on US has 66% accuracy, 53% sensitivity, 94% specificity, 96% PPV, and 46% NPV (P < 0.001, Fisher exact test). Conclusion: Sonographic gallbladder absence has high specificity and PPV, indicating utility for BA diagnosis; however, it is not useful for ruling out BA given its low sensitivity.
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Affiliation(s)
- Andrea Ho
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, United States
| | - Amita Sapra
- Division of Pediatric Radiology, Department of Radiology, Loma Linda University, Loma Linda, CA, United States
| | - Faraz A Khan
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, United States.,Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, United States
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Won TM, Muñoz A, Sacks MA, Mendez YS, Goodman L, Khan FA, Radulescu A. Single site video assisted thoracoscopic wedge resection for spontaneous pneumothorax in a pediatric patient. Journal of Pediatric Surgery Case Reports 2020. [DOI: 10.1016/j.epsc.2020.101614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Three urinary lysosomal enzymes, beta-glucuronidase (beta-Gluc), beta-galactosidase (beta-Gal) and N-acetyl-beta-D-glucosaminidase (NAG), were measured in twenty-one renal allograft recipients to evaluate their role in the diagnosis and prediction of rejection episodes, and in the prediction of eventual graft outcome. A fluorometric assay using methylumbelliferone substrates was used to measure the three enzymes in morning urine samples and enzyme activity was defined in terms of urine creatinine concentration. Urinary NAG levels increased significantly in 13/16 first rejection episodes and 4/4 instances of acute tubular necrosis and graft infarction. In 5 of the 16 first rejection episodes the NAG was predictive of the rejection. NAG was not useful in diagnosing second or subsequent rejections and beta-Gluc and beta-Gal were of little value in assessing any component of renal transplant pathology. As a prognostic index of eventual graft outcome, the peak urinary NAG was particularly encouraging. It correlated strongly with deterioration in graft function as time passed such that only 2/10 patients with peak NAG greater than 1400 Units had normal serum creatinines at 6 months post transplantation. Conversely 4/4 patients with peak NAG levels less than 700 Units had normal serum creatinine at that time. In our series the measurement of urinary NAG was a useful adjunct to the diagnosis of first rejections but appears to be more valuable in predicting graft outcome.
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