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Othman MY, Teh KH, Zahari Z. Biliary complications post liver resection for pediatric liver tumors. World J Pediatr Surg 2023; 6:e000589. [PMID: 37441088 PMCID: PMC10335567 DOI: 10.1136/wjps-2023-000589] [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: 03/07/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Objective To review biliary complications following liver resection for liver tumors in children and their associated risk factors. Methods Retrospectively, we reviewed children who underwent liver resection for liver tumors from 2010 to 2019. Demographic data, operative details, types of complications, interventions and outcomes were studied. Results Eighty-six out of 108 liver resections were included in this study. The median age of patients was 1.8 years old, and 55% were male. The majority (95%) were malignant tumors, of which 87% were hepatoblastoma (n=71). The most common procedure performed was extended right hepatectomy (37%, n=32). Twelve (14%) patients had primary biliary complications: nine bile leakages and three biliary obstructions. Six cases of bile leakage were treated non-operatively with drainage only; however, one developed bilothorax. Three bile leakages underwent early operative intervention. Four patients underwent biliary reconstruction. Biliary complications were not significantly associated with age, sex, ethnicity or pathology of the tumor. Ten of them (83%) developed following extended hepatectomies (five right, five left), in which the left side had a higher rate of complications (63% vs 16%). None of the central hepatectomies had biliary complications. Biliary complication rates were significantly higher among those who had segmentectomy 1 (p=0.023). Conclusions Biliary complication is a significant morbidity following liver resection in children. Surgery is eventually required for complicated bile leakage and primary biliary strictures. Follow-up is mandatory since secondary biliary complications may occur after the initial resolution of bile leakage. The groups at high risk of developing biliary complications are extended left hepatectomies and segmentectomy 1.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Paediatric Surgery, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
| | - Kok Hoi Teh
- Department of Paediatrics, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
| | - Zakaria Zahari
- Department of Paediatric Surgery, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital, Ministry of Health Malaysia), Kuala Lumpur, Malaysia
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Chan EEH, Merchant K, Othman MY, Laksmi NK. Diagnostic dilemma and challenges in management: Hirschsprung's disease, anal stenosis and reduced interstitial cells of Cajal enteric mesenchymopathy. BMJ Case Rep 2023; 16:16/4/e252484. [PMID: 37185243 PMCID: PMC10151910 DOI: 10.1136/bcr-2022-252484] [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: 05/17/2023] Open
Abstract
Hirschsprung's disease (HD) is one of the most well-known gastrointestinal motility disorders. Diagnosis and management of other lesser-known motility disorders are often challenging and tedious. We describe a teenager who was severely constipated from birth and needed intensive care admissions for life-threatening enterocolitis. She also had concomitant anal stenosis. Several rectal biopsies were unable to yield a conclusive diagnosis. Surgical level of resection had to be identified based on the motility of the bowel as determined by transit studies using oral ingestion of a milk feed labelled with Technetium-99m colloid. After completion of all operative stages, histopathological examination of the excised specimens concluded that she had short-segment HD associated with reduced interstitial cells of Cajal in the large bowel. She is currently continent, evacuating voluntarily approximately four times a day and is relieved of all her symptoms.
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Affiliation(s)
| | - Khurshid Merchant
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Mohd Yusran Othman
- Department of Paediatric Surgery, Hospital Tunku Azizah (Kuala Lumpur Women's and Children's Hospital), Kuala Lumpur, Malaysia
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Othman MY, Halepota HF, Le Linn Y, Lee YT, Chang KTE, Ahamed SH, Lam JCM, Bhattacharyya R, Tan AM, Loh AHP. Gastrointestinal and oncologic outcomes of pediatric gastrointestinal lymphoma following upfront resection or biopsy of bowel masses. Pediatr Surg Int 2021; 37:1049-1059. [PMID: 33963920 DOI: 10.1007/s00383-021-04915-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass. METHODS We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups. RESULTS Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery-10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p < 0.001). Three resection patients were surgically down-staged. Second surgeries were required in 30% and 40% of resected and biopsied patients, respectively, at median 4.6 months. Survival was similar in both groups, but better in patients on LMB96 protocol and stage II/III disease. CONCLUSIONS Children with upfront attempted resection had low rates of surgical down-staging, greater delay in chemotherapy initiation, but fewer gastrointestinal complications and subsequent surgeries than biopsies. Survival was similar regardless of upfront surgery, likely reflecting beneficial effects of newer protocols.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pediatric Surgery, Hospital Tunku Azizah (Women's and Children's Hospital), Jalan Raja Muda Abdul Aziz, Kampung Baru, 50300, Kuala Lumpur, Malaysia
| | - Huma Faiz Halepota
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pediatric General Surgery, Indus Hospital, Plot C-76, Sector 31/5, Karachi, Pakistan
| | - Yun Le Linn
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Kenneth T E Chang
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Summaiyya Hanum Ahamed
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Joyce C M Lam
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Rajat Bhattacharyya
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Ah Moy Tan
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Amos H P Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore. .,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
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Othman MY, Blair S, Nah SA, Ariffin H, Assanasen C, Soh SY, Jacobsen AS, Lam C, Loh AHP. Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia. JCO Glob Oncol 2020; 6:1328-1345. [PMID: 32886560 PMCID: PMC7529532 DOI: 10.1200/go.20.00284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor boards (MDTBs) are lacking in low- and middle-income countries (LMICs). We aimed to profile the landscape of pediatric solid tumor care and practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMICs. METHODS Using online surveys, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, one pediatric surgeon and one pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. RESULTS In 37 (80.4%) of 46 identified PSTUs, availability of pediatric-trained specialists was as follows: oncologists, 94.6%; surgeons, 91.9%; radiologists, 54.1%; pathologists, 40.5%; radiation oncologists, 29.7%; nuclear medicine physicians, 13.5%; and nurses, 81.1%. Availability of pediatric-trained surgeons, radiologists, and pathologists was significantly associated with the existence of MDTBs (P = .037, .005, and .022, respectively). Among 43 (89.6%) of 48 respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported > 50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between oncologists and surgeons. The majority agreed that MDTBs helped to improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations were the top barriers. CONCLUSION This first known profile of pediatric solid tumor care in Southeast Asia found that availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs in this region. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathologic diagnoses were the most common limitations for MDTBs. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- Department of Pediatric Surgery, Hospital Tunku Azizah (Women’s and Children’s Hospital), Kuala Lumpur, Malaysia
| | - Sally Blair
- Vietnam Pediatric Hematology Oncology Programme, Ho Chi Minh City, Vietnam
- Division of Pediatric Haematology and Oncology, Department of Pediatrics, National University of Singapore, Singapore
| | - Shireen A. Nah
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hany Ariffin
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chatchawin Assanasen
- Vietnam Pediatric Hematology Oncology Programme, Ho Chi Minh City, Vietnam
- Southeast Asia Pediatric Hematology Oncology, Division of Hematology/Oncology Department of Pediatrics, UT Health San Antonio, San Antonio, TX
| | - Shui Yen Soh
- Haematology/Oncology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
| | - Anette S. Jacobsen
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- SingHealth-Duke NUS Global Health Institute, Duke NUS Medical School, Singapore
| | - Catherine Lam
- St Jude Global, St Jude Children’s Research Hospital, Memphis, TN
| | - Amos H. P. Loh
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- SingHealth-Duke NUS Global Health Institute, Duke NUS Medical School, Singapore
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Othman MY, Srihari S. Multiple magnet ingestion: The attractive hazardst. Med J Malaysia 2016; 71:211-212. [PMID: 27770124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Foreign body ingestion among children is common and most usually pass through the gastrointestinal tract without requiring any intervention. Magnets, however, pose a greater threat especially when more than one are ingested. We report a case of multiple bowel perforation secondary to ingestion of magnetic beads in a 3-year-old.
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Affiliation(s)
- M Y Othman
- Hospital Kuala Lumpur, Paediatric Surgery, Paediatric Istitute, Jalan Pahang, Kuala Lumpur, Kuala Lumpur 50586, Malaysia.
| | - S Srihari
- University Malaya Medical Center, Department of Surgery, Division of Paediatric Surgery, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
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