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Cruz-Centeno N, Fraser JA, Stewart S, Oyetunji TA, St Peter SD, Hendrickson RJ. Parental Reports on Gastrostomy Tube Feeds: Blenderized Versus Nonblenderized Formula. Clin Pediatr (Phila) 2024; 63:608-612. [PMID: 37548416 DOI: 10.1177/00099228231191937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - James A Fraser
- Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
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Feldman K, Heble DE, Hendrickson RJ, Fischer RT. Hepatic artery thrombosis and use of anticoagulants and antiplatelet agents in pediatric liver transplantation. Pediatr Transplant 2024; 28:e14516. [PMID: 37550273 DOI: 10.1111/petr.14516] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Hepatic artery thrombosis (HAT) is a reported complication of 5%-10% of pediatric liver transplantations, rates 3-4 times that seen in adults. Early HAT (seen within 14 days after transplant) can lead to severe allograft damage and possible urgent re-transplantation. In this report, we present our analysis of HAT in pediatric liver transplant from a national clinical database and examine the association of HAT with anticoagulant or antiplatelet medication administered in the post-operative period. METHODS Data were obtained from the Pediatric Health Information System database maintained by the Children's Hospital Association. For each liver transplant recipient identified in a 10-year period, diagnosis, demographic, and medication data were collected and analyzed. RESULTS Our findings showed an average rate of HAT of 6.3% across 31 centers. Anticoagulant and antiplatelet medication strategies varied distinctly among and even within centers, likely due to the fact there are no consensus guidelines. Notably, in centers with similar medication usage, HAT rates continue to vary. At the patient level, use of aspirin within the first 72 h of transplantation was associated with a decreased risk of HAT, consistent with other reports in the literature. CONCLUSION We suggest that concerted efforts to standardize anticoagulation approaches in pediatric liver transplant may be of benefit in the prevention of HAT. A prospective multi-institutional study of regimen-possibly including aspirin-following transplantation could have significant value.
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Affiliation(s)
- Keith Feldman
- Health Outcomes and Health Services Research, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Daniel E Heble
- Department of Pharmacy, Children's Mercy Kansas City, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Ryan T Fischer
- Division of Gastroenterology, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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Cruz-Centeno N, Stewart S, Marlor DR, Rivard DC, Daniel JM, Oyetunji TA, Hendrickson RJ. Exchange of Extracorporeal Membrane Oxygenation Cannulas for Hemodialysis Catheters in Children Requiring Renal Replacement Therapy. Am Surg 2024; 90:216-219. [PMID: 37609992 DOI: 10.1177/00031348231198119] [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: 08/24/2023]
Abstract
BACKGROUND Pediatric patients requiring extracorporeal membrane oxygenation (ECMO) may require renal replacement therapy even after decannulation. However, data regarding transition from ECMO cannulation to a hemodialysis catheter in pediatric patients is not currently available. METHODS Patients <18 years old who had an ECMO cannula exchanged for a hemodialysis catheter during decannulation at a tertiary care children's center from January 2011 to September 2022 were identified. Data was collected from the electronic medical record. RESULTS A total of 10 patients were included. The cohort was predominantly male (80.0%, n = 8) with a median age of 1 day (IQR 1.0, 24.0). All ECMO cannulations were veno-arterial in the right common carotid artery and internal jugular vein. The median time on ECMO was 8.5 days (IQR 6.0, 15.0). One patient had the venous cannula exchanged for a tunneled hemodialysis catheter during decannulation, two were transitioned to peritoneal dialysis, and seven had the temporary hemodialysis catheter converted to a tunneled catheter by Interventional Radiology (when permanent access was required) at a median time of 10 days (IQR 8.0, 12.5). Of these 7 patients, 28.6% (n = 2) developed catheter-associated infection within 30 days of replacement, with one requiring catheter replacement. Transient bloodstream infection occurred in 10.0% (n = 1) within 30 days of ECMO cannula exchange. CONCLUSION Venous ECMO cannula exchange for a hemodialysis catheter in children requiring renal replacement therapy after decannulation is possible as a bridge to a permanent hemodialysis or peritoneal catheter if renal function does not recover, while supporting vein preservation.
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Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Derek R Marlor
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Douglas C Rivard
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - John M Daniel
- Department of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
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Cruz-Centeno N, Stewart S, Marlor DR, Aguayo P, Rentea RM, Hendrickson RJ, Juang D, Snyder CL, Fraser JD, St Peter SD, Oyetunji TA. Duodenal Atresia Repair: A Single-Center Comparative Study. Am Surg 2023; 89:5911-5914. [PMID: 37257499 DOI: 10.1177/00031348231180910] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The use of laparoscopy in the repair of duodenal atresia has been increasing. However, there is no consensus regarding which surgical approach has better outcomes. We aimed to compare the different surgical approaches and types of anastomoses for duodenal atresia repair. METHODS Patients who underwent duodenal atresia repair at a single pediatric center were identified between January 2006 and June 2022. Those with concomitant gastrointestinal anomalies or who required other simultaneous operations were excluded. The primary outcome was rate of complications, defined as rate of leak, stricture, and re-operation by surgical approach and technique of anastomosis. RESULTS A total of 78 patients were included. The majority were female (51.3%, n = 40), with a median age of 4 days (IQR 3.0,8.0) and a median weight of 2.7 kg (IQR 2.2,3.3) at repair. The re-operation rate was 7.7% (n = 6), of which two were anastomotic leaks, and four were anastomotic strictures. The leak rate was 5.6% (n = 1/18) for the open handsewn and 4.8% (n = 1/21) for the laparoscopic handsewn technique. The stricture rate was 12.5% (n = 1/8) for the laparoscopic-assisted handsewn, 9.1% (n = 2/22) for the laparoscopic U-clip, 4.8% (n = 1/21) for the laparoscopic handsewn, and none with laparoscopic stapled and laparoscopic converted to open handsewn techniques. No differences were found in complication rate when controlling for surgical approach. CONCLUSION The method of surgical approach did not affect the outcomes or complications in the repair of duodenal atresia.
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Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Derek R Marlor
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Charles L Snyder
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
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Cruz-Centeno N, Fraser JA, Stewart S, Marlor DR, Rentea RM, Aguayo P, Juang D, Hendrickson RJ, Snyder CL, St Peter SD, Fraser JD, Oyetunji TA. Hypertrophic Pyloric Stenosis Protocol: A Single Center Study. Am Surg 2023; 89:5697-5701. [PMID: 37132378 DOI: 10.1177/00031348231175126] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Initial treatment of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Our aim was to describe the protocol and subsequent outcomes. METHODS We conducted a single-center retrospective review of patients diagnosed with HPS from 2016 to 2023. All patients were given ad libitum feeds postoperatively and discharged home after tolerating three consecutive feeds. The primary outcome was the postoperative hospital length of stay (LOS). Secondary outcomes included the number of preoperative labs drawn, time from arrival to surgery, time from surgery to initiation of feeds, time from surgery to full feeds, and re-admission rate. RESULTS The study included 333 patients. A total of 142 patients (42.6%) had electrolytic disturbances that required fluid boluses in addition to 1.5x maintenance fluids. The median number of lab draws was 1 (IQR 1,2), with a median time from arrival to surgery of 19.5 hours (IQR 15.3,24.9). The median time from surgery to first and full feed was 1.9 hours (IQR 1.2,2.7) and 11.2 hours (IQR 6.4,18.3), respectively. Patients had a median postoperative LOS of 21.8 hours (IQR 9.7,28.9). Re-admission rate within the first 30 postoperative days was 3.6% (n = 12) with 2.7% of re-admissions occurring within 72 hours of discharge. One patient required re-operation due to an incomplete pyloromyotomy. DISCUSSION This protocol is a valuable tool for perioperative and postoperative management of patients with HPS while minimizing uncomfortable intervention.
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Affiliation(s)
- Nelimar Cruz-Centeno
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - James A Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shai Stewart
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Derek R Marlor
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Charles L Snyder
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, Kansas City, University of Missouri-Kansas City, MO, USA
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Stewart S, Fraser JA, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, St Peter SD, Oyetunji TA. Institutional outcomes of blunt liver and splenic injury in the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium era. J Trauma Acute Care Surg 2023; 95:295-299. [PMID: 36649594 DOI: 10.1097/ta.0000000000003870] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium practice management guideline was created to standardize management of blunt liver or spleen injury across pediatric trauma centers. We describe our outcomes since guideline adoption at our institution and hypothesize that blunt liver or spleen injury may be managed more expeditiously than currently reported without compromising safety. METHODS A retrospective cohort study was conducted on patients younger than 18 years presenting with blunt liver and/or splenic injuries from March 2016 to March 2021 at one participating center. RESULTS A total of 199 patients were included. There were no clinically relevant differences for age, body mass index, or sex among the cohort. Isolated splenic injuries (n = 91 [46%]) and motor vehicle collisions (n = 82 [41%]) were the most common injury and mechanism, respectively. The overall median length of stay (LOS) was 1.2 days (interquartile range, 0.45-3.3 days). Intensive care unit utilization was 23% (n = 46). There was no statistically significant difference in median LOS among patients with isolated solid organ injuries, regardless of injury grade. There were no readmissions associated with non-operative management. CONCLUSION The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium guideline fosters high rates of nonoperative management with low intensive care unit utilization and LOS while demonstrating safety in implementation, irrespective of injury grade. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Shai Stewart
- From the Division of Pediatric Surgery, Department of Surgery (S.S., J.A.F., R.M.R., P.A., D.J., J.D.F., C.L.S., R.J.H., S.D.S., T.A.O.), Children's Mercy Kansas City University of Missouri-Kansas City School of Medicine (S.S., R.M.R., P.A., D.J., J.D.F., C.L.S., R.J.H., S.D.S., T.A.O.), Kansas City, Missouri
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Alfares BA, van der Doef HPJ, Wildhaber BE, Casswall T, Nowak G, Delle M, Aldrian D, Berchtold V, Vogel GF, Kaliciński P, Markiewicz-Kijewska M, Kolesnik A, Bernabeu JQ, Hally MM, Larrarte K M, Marra P, Bravi M, Pinelli D, Kasahara M, Sakamoto S, Uchida H, Mali V, Aw M, Franchi-Abella S, Gonzales E, Guérin F, Cervio G, Minetto J, Sierre S, de Santibañes M, Ardiles V, Uno JW, Evans H, Duncan D, McCall J, Hartleif S, Sturm E, Patel J, Mtegha M, Prasad R, Ferreira CT, Nader LS, Farina M, Jaramillo C, Rodriguez-Davalos MI, Feola P, Shah AA, Wood PM, Acord MR, Fischer RT, Mullapudi B, Hendrickson RJ, Khanna R, Pamecha V, Mukund A, Sharif K, Gupte G, McGuirk S, Porta G, Spada M, Alterio T, Maggiore G, Hardikar W, Beretta M, Dierckx R, de Kleine RHJ, Bokkers RPH. Prevalence, management and efficacy of treatment in portal vein obstruction after paediatric liver transplantation: protocol of the retrospective international multicentre PORTAL registry. BMJ Open 2023; 13:e066343. [PMID: 37500271 PMCID: PMC10387733 DOI: 10.1136/bmjopen-2022-066343] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Portal vein obstruction (PVO) consists of anastomotic stenosis and thrombosis, which occurs due to a progression of the former. The aim of this large-scale international study is to assess the prevalence, current management practices and efficacy of treatment in patients with PVO. METHODS AND ANALYSIS The Portal vein Obstruction Revascularisation Therapy After Liver transplantation registry will facilitate an international, retrospective, multicentre, observational study, with 25 centres around the world already actively involved. Paediatric patients (aged <18 years) with a diagnosed PVO between 1 January 2001 and 1 January 2021 after liver transplantation will be eligible for inclusion. The primary endpoints are the prevalence of PVO, primary and secondary patency after PVO intervention and current management practices. Secondary endpoints are patient and graft survival, severe complications of PVO and technical success of revascularisation techniques. ETHICS AND DISSEMINATION Medical Ethics Review Board of the University Medical Center Groningen has approved the study (METc 2021/072). The results of this study will be disseminated via peer-reviewed publications and scientific presentations at national and international conferences. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL9261).
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Affiliation(s)
- Bader A Alfares
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hubert P J van der Doef
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Barbara E Wildhaber
- Swiss Paediatric Liver Centre, Division of Child and Adolescent Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Thomas Casswall
- Department Clinical Interventions and Technology Clintec, Division for Paediatrics, Karolinska Institute, Stockholm, Sweden
| | - Greg Nowak
- Department Clinical Interventions and Technology Clintec, Division for Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Martin Delle
- Department Clinical Science, Intervention and Technology Clintec, Division for Interventional Radiology, Karolinska Institute, Stockholm, Sweden
| | - Denise Aldrian
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Valeria Berchtold
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg F Vogel
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Piotr Kaliciński
- Department of Paediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Adam Kolesnik
- Cardiovascular Interventions Laboratory, The Children's Memorial Health Institute, Warsaw, Poland
| | - Jesús Q Bernabeu
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - María Mercadal Hally
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - Mauricio Larrarte K
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Bravi
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mureo Kasahara
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Vidyadhar Mali
- Department of Paediatric Surgery, National University Hospital, Singapore
| | - Marion Aw
- Department of Paediatrics, National University Hospital, Singapore
| | | | - Emmanuel Gonzales
- Paediatric Hepatology and Paediatric Liver Transplantation Unit, Hôpital Bicêtre, Paris, France
| | - Florent Guérin
- Paediatric Surgery and Paediatric Liver Transplantation Unit, Hôpital Bicêtre, Paris, France
| | - Guillermo Cervio
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Julia Minetto
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Sergio Sierre
- Division of Interventional Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Martin de Santibañes
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimmy Walker Uno
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Helen Evans
- Department of Paediatric Gastroenterology, Starship Children's Health, Auckland, New Zealand
| | - David Duncan
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand
| | - John McCall
- Liver Transplant Unit, Starship Children's Health, Auckland, New Zealand
| | - Steffen Hartleif
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Ekkehard Sturm
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Jai Patel
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marumbo Mtegha
- Department of Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Raj Prasad
- Department of Surgery and Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Luiza S Nader
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Marco Farina
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Catalina Jaramillo
- Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peter Feola
- Paediatric Interventional Radiology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amit A Shah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Phoebe M Wood
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ryan T Fischer
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Bhargava Mullapudi
- Department of Paediatric Surgery, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Richard J Hendrickson
- Department of Paediatric Surgery, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Rajeev Khanna
- Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Viniyendra Pamecha
- Department Hepatobiliary Surgery and Liver transplantation, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Khalid Sharif
- Liver Unit, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Girish Gupte
- Liver Unit, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Simon McGuirk
- Department of Interventional Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Gilda Porta
- Department of Paediatric Hepatology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Ospedale Pediatrico Bambino Gesu, Roma, Italy
| | - Tommaso Alterio
- Gastrointestinal, Liver, Nutrition Disorders Unit, IRCCS Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Giuseppe Maggiore
- Gastrointestinal, Liver, Nutrition Disorders Unit, IRCCS Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Winita Hardikar
- Department of Pediatrics, Royal Children's Hospital Research Institute, Parkville, Victoria, Australia
| | - Marisa Beretta
- Faculty of Health Sciences, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Rudi Dierckx
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ruben H J de Kleine
- Division of Hepatobiliary Surgery & Liver Transplantation, Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
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Stewart S, Fraser JA, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, Oyetunji TA, St Peter SD. Management of primary spontaneous pneumothorax in children: A single institution protocol analysis. J Pediatr Surg 2023:S0022-3468(23)00075-1. [PMID: 36803908 DOI: 10.1016/j.jpedsurg.2022.12.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/13/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol. METHODS A single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management involved aspiration alone with a ≤12 F percutaneous thoracostomy tube followed by clamping of the tube and chest radiograph at 6 h. Success was defined as ≤2 cm distance between chest wall and lung at the apex and no air leak when the clamp was released. VATS followed if aspiration failed. RESULTS Fifty-nine patients were included. Median age was 16.8 years (IQR 15.9, 17.3). Aspiration was successful in 33% (20), while 66% (39) required VATS. The median LOS with successful aspiration was 20.4 h (IQR 16.8, 34.8), while median LOS after VATS was 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, the mean LOS for those managed with a chest tube after failed aspiration was 6.0 days (±5.5). Recurrence after successful aspiration was 45% (n = 9), while recurrence after VATS was 25% (n = 10). Median time to recurrence after successful aspiration was sooner than that of the VATS group [16.6 days (IQR 5.4, 19.2) vs. 389.5 days (IQR 94.1, 907.0) p = 0.01]. CONCLUSION Simple aspiration is safe and effective initial management for children with PSP, although most will require VATS. However, early VATS reduces length of stay and morbidity. LEVEL OF EVIDENCE IV. Retrospective study.
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Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - James A Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Fraser JA, Briggs KB, Svetanoff WJ, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, St Peter SD, Oyetunji TA. Umbilical access in laparoscopic surgery in infants less than 3 months: A single institution retrospective review. J Pediatr Surg 2022; 57:277-281. [PMID: 34872728 DOI: 10.1016/j.jpedsurg.2021.11.010] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Umbilical access in laparoscopic surgery has been cited as a factor for increased complications in low-birth-weight infants and those less than three months old. In a previous series, 10.6% of pediatric surgeons reported complications in this population associated with umbilical access, citing carbon dioxide (CO2) embolism as the most common complication. To further examine the safety of this technique, we report our outcomes with blunt transumbilical laparoscopic access at our institution over four years. METHODS A retrospective review was performed of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016 to 2019. Operative reports, anesthesia records, and postoperative documentation were reviewed for complications related to umbilical access. Complications included bowel injury, vascular injury, umbilical vein cannulation, CO2 embolism, umbilical surgical site infection (SSI), umbilical hernia requiring repair, and death. RESULTS Of 365 patients, 246 underwent laparoscopic pyloromyotomy, and 119 underwent laparoscopic inguinal hernia repairs. Median age at operation was 5.9 weeks [4.3,8.8], and median weight was 3.9 kg [3.4,4.6]. Nine complications (2.5%) occurred: 5 umbilical SSIs (1.4%), 1 bowel injury upon entry requiring laparoscopic repair (0.2%), 1 incisional hernia repair 22 days postoperatively (0.2%), and 2 cases of hypotension and bradycardia upon insufflation that resolved with desufflation (0.5%). There were no intraoperative mortalities or signs/symptoms of CO2 embolism. CONCLUSION In this series, umbilical access for laparoscopic surgery in neonates less than three months of age was safe, with minimal complications. Although concern for umbilical vessel injury, cannulation, and CO2 embolism exists, these complications are not exclusively associated with umbilical access technique.
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Affiliation(s)
- James A Fraser
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA.
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10
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Fraser JA, Osuchukwu O, Briggs KB, Svetanoff WJ, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, St Peter SD, Oyetunji TA. Evaluation of a fluid resuscitation protocol for patients with hypertrophic pyloric stenosis. J Pediatr Surg 2022; 57:386-389. [PMID: 34839945 DOI: 10.1016/j.jpedsurg.2021.10.052] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We previously developed an institutional, evidence-based fluid resuscitation protocol for neonates with infantile hypertrophic pyloric stenosis (HPS) based on the severity of electrolyte derangement on presentation. We aim to evaluate this protocol to determine its efficacy in reducing the number of preoperative lab draws, time to electrolyte correction, and overall length of stay. METHODS A single center, retrospective review of 319 infants with HPS presenting with electrolyte derangement from 2008 to 2020 was performed; 202 patients managed pre-protocol (2008-2014) and 117 patients managed per our institutional fluid resuscitation algorithm (2016-2020). The number of preoperative lab draws, time to electrolyte correction, and length of stay before and after protocol implementation was recorded. RESULTS Use of a fluid resuscitation algorithm decreased the number of infants who required four or more preoperative lab draws (20% vs. 6%) (p < .01), decreased median time to electrolyte correction between the pre and post protocol cohorts (15.1 h [10.6, 22.3] vs. 11.9 h [8.5, 17.9]) (p < .01), and decreased total length of hospital stay (49.0 h [40.3, 70.7] vs. 45.7 h [34.3, 65.9]) (p < .05). CONCLUSION Implementation of a fluid resuscitation algorithm for patients presenting with hypertrophic pyloric stenosis decreases the frequency of preoperative lab draws, time to electrolyte correction, and total length of hospital stay. Use of a fluid resuscitation protocol may decrease discomfort through fewer preoperative lab draws and shorter length of stay while setting clear expectations and planned intervention for parents. LEVEL OF EVIDENCE III - Retrospective comparative study.
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Affiliation(s)
- James A Fraser
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Obiyo Osuchukwu
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States.
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11
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Stewart S, Briggs KB, Fraser JA, Dekonenko C, Svetanoff WJ, Rentea RM, Aguayo P, Juang D, Hendrickson RJ, Snyder CL, Peter SDS, Oyetunji TA, Fraser JD. Laparoscopic Gastrostomy in Infants During an Open Abdominal Procedure: A Novel Approach. J Laparoendosc Adv Surg Tech A 2022; 32:1005-1009. [PMID: 35666589 DOI: 10.1089/lap.2022.0117] [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: 11/12/2022] Open
Abstract
Introduction: Infants with intra-abdominal pathology necessitating open abdominal surgery may also require placement of a gastrostomy tube (GT). Use of laparoscopy provides better visualization for gastrostomy placement and lowers the risk of complications compared with an open approach. We describe a series of patients who underwent laparoscopic GT placement at the time of an open abdominal procedure. Methods: All patients who underwent an open abdominal procedure with concurrent laparoscopic gastrostomy from January 2010 to June 2020 were reviewed. Descriptive statistics were performed with categorical variables reported as proportions and continuous variables reported as medians with interquartile range [IQR]. Results: Twelve patients were included; 8 (67.5%) were male. The median age at time of surgery was 10 weeks [IQR 6, 14], with a median weight of 4.1 kg [IQR 3.4, 4.8]. Ten patients had the laparoscope placed through the open incision, whereas 2 had the laparoscope placed through a separate incision. Median operative time was 106 minutes [IQR 80, 125]. There were no intraoperative complications. Postoperative complications included surgical site infection in 5 (41.7%), leaking around the GT in 3 (25%), and malfunction of the tube in 1 (8.3%). One patient required reoperation 28 days postoperatively due to malfunction. Conclusion: Laparoscopic GT can be safely performed at the time of an open abdominal procedure, and frequently through the same incision, harnessing the benefits of a laparoscopic approach even when an open incision is needed.
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Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - James A Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Charlene Dekonenko
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | | | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Surgery, Quality Improvement and Surgical Equity Research (QISER) Center, Kansas City, Missouri, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
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12
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Fraser JA, Briggs KB, Svetanoff WJ, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, St. Peter SD, Oyetunji TA. Behind the mask: extended use of surgical masks is not associated with increased risk of surgical site infection. Pediatr Surg Int 2022; 38:325-330. [PMID: 34665318 PMCID: PMC8524207 DOI: 10.1007/s00383-021-05032-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE COVID-19 has prompted significant policy change, with critical attention to the conservation of personal protective equipment (PPE). An extended surgical mask use policy was implemented at our institution, allowing use of one disposable mask per each individual, per day, for all the cases. We investigate the clinical impact of this policy change and its effect on the rate of 30-day surgical site infection (SSI). METHODS A single-institution retrospective review was performed for all the elective pediatric general surgery cases performed pre-COVID from August 2019 to October 2019 and under the extended mask use policy from August 2020 to October 2020. Procedure type, SSI within 30 days, and postoperative interventions were recorded. RESULTS Four hundred and eighty-eight cases were reviewed: 240 in the pre-COVID-19 cohort and 248 in the extended surgical mask use cohort. Three SSIs were identified in the 2019 cohort, and two in the 2020 cohort. All postoperative infections were superficial and resolved within 1 month of diagnosis with oral antibiotics. There were no deep space infections, readmissions, or infections requiring re-operation. CONCLUSION Extended surgical mask use was not associated with increased SSI in this series of pediatric general surgery cases and may be considered an effective and safe strategy for resource conservation with minimal clinical impact.
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Affiliation(s)
- James A. Fraser
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Kayla B. Briggs
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Wendy Jo Svetanoff
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Rebecca M. Rentea
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - David Juang
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Jason D. Fraser
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Charles L. Snyder
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Richard J. Hendrickson
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Shawn D. St. Peter
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Tolulope A. Oyetunji
- Department of Surgery, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA ,University of Missouri-Kansas City School of Medicine, Kansas City, MO USA ,Quality Improvement and Surgical Equity Research (QISER) Center, Kansas City, USA
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13
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Briggs KB, Fraser JA, Svetanoff WJ, Staszak JK, Snyder CL, Aguayo P, Juang D, Rentea RM, Hendrickson RJ, Fraser JD, St Peter SD, Oyetunji TA. Review of Perioperative Prophylactic Antibiotic Use during Laparoscopic Cholecystectomy and Subsequent Surgical Site Infection Development at a Single Children's Hospital. Eur J Pediatr Surg 2022; 32:85-90. [PMID: 34942672 DOI: 10.1055/s-0041-1740461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES With the rise of antibiotic resistance, the use of prophylactic preoperative antibiotics (PPA) has been questioned in cases with low rates of surgical site infection (SSI). We report PPA usage and SSI rates after elective laparoscopic cholecystectomy at our institution. MATERIALS AND METHODS A retrospective review of children younger than 18 years who underwent elective outpatient laparoscopic cholecystectomy between July 2010 and August 2020 was performed. Demographic, preoperative work-up, antibiotic use, intraoperative characteristics, and SSI data were collected via chart review. SSI was defined as clinical signs of infection that required antibiotics within 30 days of surgery. RESULTS A total of 502 patients met the inclusion criteria; 50% were preoperatively diagnosed with symptomatic cholelithiasis, 47% with biliary dyskinesia, 2% with hyperkinetic gallbladder, and 1% with gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). In total, 60% (n = 301) of patients received PPA, while 40% (n = 201) did not; 1.3% (n = 4) of those who received PPA developed SSI, compared with 5.5% (n = 11) of those who did not receive PPA (p = 0.01). Though PPA use was associated with a 77% reduction in the risk of SSI in multivariate analysis (p = 0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics, while the remainder were treated with outpatient antibiotics. Gender, age, body mass index, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA. CONCLUSION Given the relatively low morbidity of the superficial SSI, conservative use of PPA is advised to avoid contributing to antibiotic resistance.
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Affiliation(s)
- Kayla B Briggs
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - James A Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Wendy Jo Svetanoff
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jessica K Staszak
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Charles L Snyder
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
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14
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Svetanoff WJ, Dorman RM, Dekonenko C, Osuchukwu OO, Hendrickson RJ, Fraser JD, Oyetunji TA, St Peter SD. 30 Years of Flipping the Coin-Heads or Tails? Eur J Pediatr Surg 2021; 31:497-503. [PMID: 33142323 DOI: 10.1055/s-0040-1718752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Swallowed coins are a frequent cause of pediatric emergency department visits. Removal typically involves endoscopic retrieval under anesthesia. We describe our 30-year experience retrieving coins using a Foley catheter under fluoroscopy ("coin flip"). MATERIALS AND METHODS Patients younger than 18 years who underwent the coin flip procedure from 1988 to 2018 were identified. Failure of fluoroscopic retrieval was followed by rigid endoscopic retrieval in the operating room. Detailed subanalysis of patients between 2011 and 2018 was also performed. RESULTS A total of 809 patients underwent the coin flip procedure between 1988 and 2018. Median age was 3.3 years; 51% were male. The mean duration from ingestion to presentation was 19.8 hours. Overall success of removal from the esophagus was 85.5%, with 76.5% of coins retrieved and 9% pushed into the stomach. All remaining coins were retrieved by endoscopy. Complication rate was 1.2% with nine minor and one major complications, a tracheal tear that required repair. In our recent cohort, successful fluoroscopic removal led to shorter hospital lengths of stay (3.2 vs. 18.1 hours, p < 0.001). CONCLUSION Patients who present with a coin in the esophagus can be successfully managed with a coin flip, which can be performed without hospital admission, with rare complications.
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Affiliation(s)
- Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Robert M Dorman
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Charlene Dekonenko
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Obiyo O Osuchukwu
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Shawn D St Peter
- Department of Surgery, Center for Prospective Trials, Children's Mercy Hospital, Kansas City, Missouri, United States
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15
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Svetanoff WJ, Lopez J, Aguayo P, Hendrickson RJ, Oyetunji TA, Rentea RM. The impact of botulinum injection for hospitalized children with Hirschsprung-associated enterocolitis. Pediatr Surg Int 2021; 37:1467-1472. [PMID: 34309717 DOI: 10.1007/s00383-021-04966-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Stasis from obstruction at the level of the internal anal sphincter (IAS) can lead to Hirschsprung-associated enterocolitis (HAEC) and may be improved by botulinum toxin (BT) injections. Our aim was to determine if BT injection during HAEC episodes decreased the number of recurrent HAEC episodes and/or increased the interval between readmissions. METHODS A retrospective review was performed of patients admitted for HAEC from January 2010 to December 2019. Demographics and outcomes of patients who received BT were compared to patients who did not receive BT during their hospital stay. RESULTS A total of 120 episodes of HAEC occurred in 40 patients; 30 patients (75%) were male, 7 (18%) had Trisomy 21 and 10 (25%) had long-segment disease. On multivariate analysis, patients who received BT during their inpatient HAEC episode had a longer median time between readmissions (p = 0.04) and trending toward an association with fewer readmissions prior to a follow-up clinic visit (p = 0.08). CONCLUSION The use of BT in HD patients hospitalized for HAEC is associated with an increased time between recurrent HAEC episodes and trended toward fewer recurrent episodes. The use of BT should be considered in the management of patients admitted with HAEC.
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Affiliation(s)
- Wendy Jo Svetanoff
- Department of Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Joseph Lopez
- Department of Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Pablo Aguayo
- Department of Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. .,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Svetanoff WJ, Briggs K, Fraser JA, Lopez J, Fraser JD, Juang D, Aguayo P, Hendrickson RJ, Snyder CL, Oyetunji TA, St Peter SD, Rentea RM. Outpatient Botulinum Injections for Early Obstructive Symptoms in Patients with Hirschsprung Disease. J Surg Res 2021; 269:201-206. [PMID: 34587522 DOI: 10.1016/j.jss.2021.07.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Botulinum toxin (BT) injections may play a role in preventing Hirschsprung associated enterocolitis (HAEC) episodes related to internal anal sphincter (IAS dysfunction). Our aim was to determine the association of outpatient BT injections for early obstructive symptoms on the development of HAEC. METHODS A retrospective review of children who underwent definitive surgery for Hirschsprung disease (HSCR) from July 2010 - July 2020 was performed. The timing from pull-through to first HAEC episode and to first BT injection was recorded. Primary analysis focused on the rate of HAEC episodes and timing between episodes in patients who did and did not receive BT injections. RESULTS Eighty patients were included. Sixty patients (75%) were male, 15 (19%) were diagnosed with trisomy 21, and 58 (72.5%) had short-segment disease. The median time to pull-through was 150 days (IQR 16, 132). Eight patients (10%) had neither an episode of HAEC or BT injections and were not included in further analysis. Forty-six patients (64%) experienced at least one episode of HAEC, while 64 patients (89%) had at least one outpatient BT injection. Compared to patients who never received BT injections (n = 9) and those who developed HAEC prior to BT injections (n = 35), significantly fewer patients who received BT injections first (n = 28) developed enterocolitis (P < 0.001), with no patient developing more than one HAEC episode. CONCLUSION Outpatient BT is associated with decreased episodes of HAEC and increased interval between HAEC episodes requiring inpatient treatment. Scheduling outpatient BT injections to manage obstructive symptoms may be beneficial after pull-through for HSCR.
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Affiliation(s)
| | - Kayla Briggs
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri
| | - James A Fraser
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri
| | - Joseph Lopez
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri
| | - David Juang
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital; Kansas City, Missouri; University of Missouri-Kansas City School of Medicine; Kansas City, Missouri.
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Lopez JJ, Hendrickson RJ. Re-tubularization of highly-ischemic anti-mesenteric border (ReHAB). Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.101882] [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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Svetanoff WJ, Fraser JA, Briggs KB, Staszak JK, Dekonenko C, Rentea RM, Juang D, Aguayo P, Fraser JD, Snyder CL, Hendrickson RJ, St Peter SD, Oyetunji T. A single institution experience with Laparoscopic Hernia repair in 791 children. J Pediatr Surg 2021; 56:1185-1189. [PMID: 33741178 DOI: 10.1016/j.jpedsurg.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are many described technique to performing laparoscopic inguinal hernia repair in children. We describe our outcomes using a percutaneous internal ring suturing technique. METHODS A retrospective review of patients under 18 years old who underwent repair between January 2014 - March 2019 was performed. A percutaneous internal ring suturing technique, involving hydro-dissection of the peritoneum, percutaneous suture passage, and cauterization of the peritoneum in the sac prior to high ligation, was used. p < 0.05 was considered significant during the analysis. RESULTS 791 patients were included. The median age at operation was 1.9 years (IQR 0.37, 5.82). The median operative time for a unilateral repair was 21 min (IQR 16, 28), while the median time for a bilateral repair was 30.5 min (IQR 23, 41). In total, 3 patients required conversion to an open procedure (0.4%), 4 (0.6%) experienced post-operative bleeding, 9 (1.2%) developed a wound infection, and iatrogenic ascent of testis occurred in 10 (1.3%) patients. Twenty patients (2.5%) developed a recurrent hernia. All but two were re-repaired laparoscopically. CONCLUSIONS The use of percutaneous internal ring suturing for laparoscopic repair of inguinal hernias in the pediatric population is safe and effective with a low rate of complications and recurrence.
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Affiliation(s)
| | - James A Fraser
- Department of Surgery, Children's Mercy, Kansas City, USA
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy, Kansas City, USA
| | | | | | - Rebecca M Rentea
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - David Juang
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Tolulope Oyetunji
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA.
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Svetanoff WJ, Ahmed A, Hendrickson RJ, Rentea RM. Neonatal Renal Failure in the Setting of Anorectal Malformation: A Case Report and Literature Review. Cureus 2021; 13:e14984. [PMID: 34123676 PMCID: PMC8194500 DOI: 10.7759/cureus.14984] [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] [Indexed: 11/05/2022] Open
Abstract
Anorectal malformations (ARMs) can occur in isolation or in association with other anomalies, most commonly those of the genitourinary systems. Morbidity and mortality are highest among patients who develop end-stage renal disease (ESRD) either from severe congenital anomalies (dysplastic kidneys) or from repeated infections in those who have vesicoureteral reflux or persistent recto-urinary fistulas. We describe our management strategy for a patient born with an ARM and bilateral dysplastic kidneys to highlight the nuances and complex decision-making considerations required in taking care of this complex patient population. Our patient is a male twin born at 32 weeks' gestational age who was found to have bilateral dysplastic kidneys on prenatal ultrasound. On initial examination, an imperforate anus was identified along with a severe urethral stricture. Full workup also revealed sacral dysgenesis and confirmation of the dysplastic kidneys. On day of life 3, a laparoscopic diverting sigmoid colostomy was performed; urologic evaluation confirmed the severe urethral stricture, which required dilation to place an 8F council tip catheter. Due to his small size, peritoneal dialysis could not be initiated until five weeks of age. As full volumes could not be reached with peritoneal dialysis, he was soon transitioned to continuous renal replacement therapy. At five months of age, a laparoscopic-assisted posterior sagittal anorectoplasty (PSARP) was performed. As his urethral stricture had worsened, a suprapubic catheter had been placed for bladder decompression. Reversal of his colostomy was performed 15 days after PSARP. Unfortunately, the patient required three further surgical interventions due to abdominal wall and inguinal hernias contributing to filling and emptying dysfunction when utilizing peritoneal dialysis. He is currently 16 months of age and remains inpatient due to intermittent hemodialysis requirements along with autocycling of his peritoneal dialysis. He is working on developmental milestones, can pull to a stand, and is currently being evaluated for kidney transplantation. The development of ESRD in a neonate or infant with an ARM is rare and can be due to congenital dysplasia or agenesis of bilateral kidneys. While peritoneal dialysis is the preferred approach, catheter dysfunction can result from intra-abdominal adhesions or inadequate fluid removal from inguinal or abdominal wall hernias that form in the setting of increased intra-abdominal pressure required for peritoneal dialysis. Close collaboration is required between pediatric surgeons, nephrologists, and urologists to facilitate colonic and urologic reconstruction and manage catheter-related complications.
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Affiliation(s)
| | - Asma Ahmed
- General Surgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Richard J Hendrickson
- Pediatric Surgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Rebecca M Rentea
- Pediatric Surgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
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20
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Hall EM, Yin DE, Goyal RK, Ahmed AA, Mitchell GS, St Peter SD, Flatt TG, Ahmed IA, Li W, Hendrickson RJ, August KJ, Myers GD. Tisagenlecleucel infusion in patients with relapsed/refractory ALL and concurrent serious infection. J Immunother Cancer 2021; 9:jitc-2020-001225. [PMID: 33472856 PMCID: PMC7818837 DOI: 10.1136/jitc-2020-001225] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Tisagenlecleucel, an anti-CD19 chimeric antigen receptor T (CAR-T) cell therapy, has demonstrated durable efficacy and a manageable safety profile in pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) in the ELIANA pivotal trial and real-world experience. Experience from investigator-led studies prior to ELIANA suggests that infections and inflammatory conditions may exacerbate the severity of cytokine release syndrome (CRS) associated with CAR-T cell therapy, leading to extreme caution and strong restrictions for on-study and commercial infusion of tisagenlecleucel in patients with active infection. CRS intervention with interleukin (IL)-6 blockade and/or steroid therapy was introduced late in the course during clinical trials due to concern for potential negative effect on efficacy and persistence. However, earlier CRS intervention is now viewed more favorably. Earlier intervention and consistency in management between providers may promote broader use of tisagenlecleucel, including potential curative therapy in patients who require remission and recovery of hematopoiesis for management of severe infection. MAIN BODY Patient 1 was diagnosed with B-ALL at 23 years old. Fourteen days before tisagenlecleucel infusion, the patient developed fever and neutropenia and was diagnosed with invasive Mucorales infection and BK virus hemorrhagic cystitis. Aggressive measures were instituted to control infection and to manage prolonged cytopenias during CAR-T cell manufacturing. Adverse events, including CRS, were manageable despite elevated inflammatory markers and active infection. The patient attained remission and recovered hematopoiesis, and infections resolved. The patient remains in remission ≥1 year postinfusion.Patient 2 was diagnosed with pre-B-ALL at preschool age. She developed severe septic shock 3 days postinitiation of lymphodepleting chemotherapy. After receiving tisagenlecleucel, she experienced CRS with cardiac dysfunction and extensive lymphadenopathy leading to renovascular compromise. The patient attained remission and was discharged in good condition to her country of origin. She remained in remission but expired on day 208 postinfusion due to cardiac arrest of unclear etiology. CONCLUSIONS Infusion was feasible, and toxicity related to tisagenlecleucel was manageable despite active infections and concurrent inflammation, allowing attainment of remission in otherwise refractory pediatric/young adult ALL. This may lead to consideration of tisagenlecleucel as a potential curative therapy in patients with managed active infections.
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Affiliation(s)
- Erin M Hall
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Dwight E Yin
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Rakesh K Goyal
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Atif A Ahmed
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Grace S Mitchell
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Shawn D St Peter
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Terrie G Flatt
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Ibrahim A Ahmed
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Weijie Li
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Richard J Hendrickson
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Keith J August
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - G Doug Myers
- School of Medicine, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, Missouri, USA
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21
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Dekonenko C, Svetanoff WJ, Osuchukwu OO, Pierce AL, Orrick BA, Sayers KL, Rentea RM, Aguayo P, Fraser JD, Juang D, Hendrickson RJ, Snyder CL, Andrews WS, St Peter SD, Oyetunji TA. Same-day discharge for pediatric laparoscopic gastrostomy. J Pediatr Surg 2021; 56:26-29. [PMID: 33109344 DOI: 10.1016/j.jpedsurg.2020.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Laparoscopic gastrostomy is a common procedure in children. We developed a same-day discharge (SDD) protocol for laparoscopic button gastrostomy. METHODS We performed a prospective observational study of children undergoing laparoscopic button gastrostomy and were eligible for SDD from August 2017-September 2019. Patients were eligible if: 1) the family was comfortable with eliminating overnight admission and were suitable candidates for outpatient surgery (absence of major co-morbidities), 2) they were not undergoing additional procedures requiring admission, and 3) they received pre-operative education. RESULTS Sixty-two patients who underwent laparoscopic button gastrostomy were eligible for SDD. The median age was 2.1 years [IQR 0.9-4.1], and the median weight was 10.5 kg [IQR 7.6-15.5]. Forty-one (66%) were previously nasogastric fed. The median operative time was 22 min [IQR 16-29]. The median time to initiation of feeds was 4.4 h [IQR 3.4-5.5]. Fifty-one (82%) were discharged the same day with a median length of stay of 9 h [IQR 7-10]. Eleven were admitted, most commonly for further teaching. Eleven SDD patients were seen in the emergency room <30 days at a median 5 days [IQR 3-12] post-operatively, primarily for mechanical complications. CONCLUSION Same-day discharge following laparoscopic gastrostomy is safe and feasible for select pediatric patients who undergo pre-operative education. The SDD pathway results in a low admission rate and relatively low ER visits. TYPE OF STUDY Prospective Observational Study. LEVEL OF EVIDENCE Level II.
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22
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Fischer RT, Day JC, Wasserkrug H, Faseler M, Kats A, Daniel JF, Slowik V, Andrews W, Hendrickson RJ. Complications of Cryptosporidium infection after pediatric liver transplantation: Diarrhea, rejection, and biliary disease. Pediatr Transplant 2020; 24:e13807. [PMID: 32777150 DOI: 10.1111/petr.13807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 10/16/2019] [Revised: 01/22/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cryptosporidium enteritis can be devastating in the immunocompromised host. In pediatric liver transplant recipients, infection may be complicated by prolonged carriage of the parasite, rejection, and biliary tree damage and fibrosis. Herein, we report on six patients and their long-term outcomes following cryptosporidiosis. METHODS We reviewed all cases of cryptosporidiosis in a pediatric liver transplant population over a 17-year period at a single center. Six patients with infection were identified, and their outcomes were analyzed. RESULTS Infection was associated with significant diarrhea and dehydration in all cases, and led to hospitalization in one-half of patients. Four of the six patients developed biopsy-proven rejection following infection, with three of those patients developing rejection that was recalcitrant to intravenous steroid treatment. Additionally, three patients developed biliary tree abnormalities with similarity to sclerosing cholangitis. In one patient, those biliary changes led to repeated need for biliary drain placement and advancing fibrotic liver allograft changes. CONCLUSIONS Cryptosporidiosis in pediatric liver transplant recipients may lead to significant complications, including recalcitrant episodes of rejection and detrimental biliary tree changes. We advocate for increased awareness of this cause of diarrheal disease and the allograft injuries that may accompany infection.
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Affiliation(s)
- Ryan T Fischer
- Division of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - J Christopher Day
- Division of Infectious Disease, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Heather Wasserkrug
- Division of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Megan Faseler
- Division of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Alexander Kats
- Division of Pathology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - James F Daniel
- Division of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Voytek Slowik
- Division of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Walter Andrews
- Division of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Richard J Hendrickson
- Division of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
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23
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Ryan JL, Dandridge LM, Andrews WS, Daniel JF, Fischer RT, Rivard DC, Wieser AB, Kane BJ, Hendrickson RJ. Conservative Management of Pneumatosis Intestinalis and Portal Venous Gas After Pediatric Liver Transplantation. Transplant Proc 2020; 52:938-942. [PMID: 32122661 DOI: 10.1016/j.transproceed.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/10/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pneumatosis intestinalis (PI) is a rare pathologic finding in pediatric liver transplant (PLT) recipients. The presentation and course of PI can range from asymptomatic and clinically benign to life threatening, with no consensus regarding management of PI in children. We aim to review the clinical presentation and radiologic features of PLT recipients with PI and to report the results of conservative management. METHODS A retrospective medical chart review was conducted on PLT recipients between November 1995 and May 2016. Parameters evaluated at PI diagnosis included pneumatosis location, presence of free air or portal venous gas (PVG), symptoms, laboratory findings, and medication regimen. RESULTS PI developed in 10 of 130 PLT patients (7.7%) between 8 days and 7 years (median: 113 days) posttransplant. Five of the patients were male, and the median age was 2 years (range, 1-17 years). PI was located in 1 to 2 abdominal quadrants in 6 patients, and 3 patients had PVG. At diagnosis, all patients were on steroids and immunosuppressant medication and 6 patients had a concurrent infection. Laboratory findings were unremarkable. Symptoms were present in 7 patients. Nine patients were managed conservatively, and 1 patient received observation only. All patients had resolution of PI at a median of 7 days (range, 2-14 days). CONCLUSIONS PI can occur at any time after PLT and appears to be associated with steroid use and infectious agents. If PI/PVG is identified and the patient is clinically stable, initiation of a standard management algorithm may help treat these patients conservatively, thus avoiding surgical intervention.
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Affiliation(s)
- Jamie L Ryan
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA; Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Laura M Dandridge
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA; Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Walter S Andrews
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - James F Daniel
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Ryan T Fischer
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Douglas C Rivard
- Department of Radiology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Andrea B Wieser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Bartholomew J Kane
- Department of Transplantation, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
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Williams K, Baumann L, Abdullah F, Hendrickson RJ, Oyetunji TA. Elective laparoscopic gastrostomy in children: potential for an enhanced recovery protocol. Pediatr Surg Int 2019; 35:643-647. [PMID: 30915530 DOI: 10.1007/s00383-019-04472-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastrostomy tube placement is one of the most commonly performed pediatric surgical procedures and discharge is possible as early as the first postoperative day with early initiation of feeds postoperatively. We examined a national database to determine hospital length of stay (LOS) after elective laparoscopic gastrostomy in children. METHODS We queried the 2012-2013 National Surgical Quality Improvement Program Pediatric (NSQIP-P) database, including all patients who underwent elective laparoscopic gastrostomy tube placement for failure to thrive or feeding difficulties. Demographic data, admission status, disposition at discharge, surgical subspecialty data and hospital LOS were extracted. RESULTS A total of 599 patients underwent gastrostomy tube placement for failure to thrive or feeding intolerance. The majority, 52%, was male and 69.3% were White. The median age was 2.2 years (IQR 0.9-6.3). Of the total, 28.7% were infants. The median total hospital LOS was 2 days (IQR 1-2), with only 39% discharged in a day or less. CONCLUSION Pediatric patients undergoing elective laparoscopic gastrostomy have a median hospital length of stay of 2 days, despite evidence that early feeding and discharge within 24 h is both feasible and safe. There is potential for the implementation of an enhanced recovery protocol as a quality metric for this procedure.
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Affiliation(s)
- Kibileri Williams
- Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Lauren Baumann
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Fizan Abdullah
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611, USA
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Hendrickson RJ, Sujka J, Fischer R, Manalang M, Daniel J, Andrews WS. Indications and efficacy of conversion from tacrolimus- to sirolimus-based immunosuppression in pediatric patients who underwent liver transplantation for unresectable hepatoblastoma. Pediatr Transplant 2019; 23:e13369. [PMID: 30719825 DOI: 10.1111/petr.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 01/12/2018] [Revised: 05/19/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022]
Abstract
SRL-based immunosuppressive strategies in pediatric liver transplantation are not clearly defined, especially within the first year after liver transplant. TAC is the more common, traditional immunosuppressant used. However, SRL may modulate TAC-associated kidney injury and may also have antiproliferative properties that are valuable in the management of patients following liver transplantation for HB. We sought to determine whether early conversion from TAC to SRL was safe, effective, and beneficial in a subset of liver transplant recipients with unresectable HB exposed to CDDP-based chemotherapy. Between 2008 and 2013, six patients were transplanted for unresectable HB. All patients received at least one cycle of CDDP-based chemotherapy prior to transplant. All patients were switched from TAC- to SRL-based immunosuppression within 1 year of transplant. Five patients had improvement in their mGFR, while one patient had a slight decline. The improvement in mGFR was statistically significant. No adverse events were identified. Three patients had BPAR that responded to pulsed steroids. Historical controls showed similar rates of BPAR within the first year after transplant. There were no identified HB recurrences in the follow-up time period. Conversion from TAC to SRL appears to be safe and effective in this selected group of pediatric liver transplant recipients without adverse reaction or HB recurrences.
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Affiliation(s)
| | - Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Ryan Fischer
- Department of Gastroenterology and Hepatology, Children's Mercy Hospital, Kansas City, Missouri
| | - Michelle Manalang
- Department of Hematology and Oncology, Children's Mercy Hospital, Kansas City, Missouri
| | - James Daniel
- Department of Gastroenterology and Hepatology, Children's Mercy Hospital, Kansas City, Missouri
| | - Walter S Andrews
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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26
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Poola AS, Aguayo P, Fraser JD, Hendrickson RJ, Weaver KL, Gonzalez KW, St Peter SD. Primary Closure versus Bedside Silo and Delayed Closure for Gastroschisis: A Truncated Prospective Randomized Trial. Eur J Pediatr Surg 2019; 29:203-208. [PMID: 29458229 DOI: 10.1055/s-0038-1627459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND We report a prospective randomized trial comparing primary closure (PC) to bedside silo and delayed closure (DC) for babies with gastroschisis. MATERIALS AND METHODS Patients were randomized to PC versus DC. We excluded those with atresia/necrosis, <34 weeks' gestation, or congenital anomalies. The primary outcome was length of stay (LOS). RESULTS A total of 38 patients were included from August 2011 to August 2016; 18 patients underwent DC and 20 PC. There were no differences in gestational age or birth weight. Fifty percent of PC patients were successfully closed with the rest closed at a median of 4 days (interquartile range [IQR]: 2-4 days). DC patients were closed at a median of 4 days after silo placement (IQR: 2-5.8 days). None of the patients in this series developed abdominal compartment syndrome after closure. Median LOS, median time to enteral tolerance, and median time on ventilation were not statistically different. Two patients (one DC and one PC) had bowel ischemia and necrosis following silo placement requiring reoperation. Four patients (two DC and two PC) were noted to have small umbilical defects; none have yet required operative correction. CONCLUSION There were no differences seen between PC and DC in LOS, time to enteral feeds, or ventilator times.
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Affiliation(s)
- Ashwini S Poola
- Department of Surgery, Center for Prospective Trials, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Katrina L Weaver
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Katherine W Gonzalez
- Department of Surgery, Center for Prospective Trials, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Shawn D St Peter
- Department of Surgery, Center for Prospective Trials, Children's Mercy Hospital, Kansas City, Missouri, United States
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Sola R, Poola AS, Memon R, Singh V, Hendrickson RJ, St Peter SD, Fraser JD. The relationship of eosinophilia with outcomes of Hirschsprung disease in children. Pediatr Surg Int 2019; 35:425-429. [PMID: 30666416 DOI: 10.1007/s00383-018-04430-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE It has been postulated that children with Hirschsprung disease (HD) and mucosal eosinophilia have been thought to have poorer outcome, but supporting evidence is lacking. The objective of our study was to review the outcomes of children with HD and mucosal eosinophilia. METHODS A single center, retrospective review was conducted on all patients diagnosed with HD between 1999 and 2016. Pathology specimens were evaluated for mucosal eosinophilia. Demographics, complications, and outcomes were analyzed. RESULTS A total of 100 patients were diagnosed with HD and 27 had mucosal eosinophilia. Median age at the time of surgery was 12 days (8, 30) and 82 were males. Comparing patients with HD with and without mucosal eosinophilia, there was no statistically significant difference in time to bowel function (2 days vs. 2 days; p = 0.85), time to start feeds (3 days vs. 3 days; p = 0.78) and time to goal feeds (5 days vs. 5 days; p = 0.47). There was no statistically significant difference in feeding issues (13% vs. 9%; p = 1.0) and stooling issues (60% vs. 50%; p = 0.38). There was no statistically significant difference in postoperative complications and readmissions rates (63% vs. 56%; p = 0.53). CONCLUSION Hirschsprung-associated mucosal eosinophilia may not increase postoperative complications, and may not change feeding and bowel management. Further prospective studies are in process to evaluate long term follow-up outcomes for this patient population.
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Affiliation(s)
- Richard Sola
- Department of General Surgery, The Children's Mercy Hospital and Clinics, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Ashwini S Poola
- Department of General Surgery, The Children's Mercy Hospital and Clinics, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Rmaah Memon
- Department of General Surgery, The Children's Mercy Hospital and Clinics, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Vivekanand Singh
- Department of Pathology, The Children's Mercy Hospital, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of General Surgery, The Children's Mercy Hospital and Clinics, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Shawn D St Peter
- Department of General Surgery, The Children's Mercy Hospital and Clinics, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Jason D Fraser
- Department of General Surgery, The Children's Mercy Hospital and Clinics, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
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Hendrickson RJ, Poola AS, Sujka JA, Weaver KL, Rentea RM, St Peter SD, Oyetunji TA. Feeding Advancement and Simultaneous Transition to Discharge (FASTDischarge) after laparoscopic gastrostomy. J Pediatr Surg 2018; 53:2326-2330. [PMID: 29848452 DOI: 10.1016/j.jpedsurg.2018.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 11/11/2017] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Laparoscopic gastrostomy (LG) is a common surgical procedure. However, there is little consensus on a postoperative feeding regimen. With prior nasogastric feed tolerance, there should be no delay in resumption of feeds and subsequent discharge to home. This is a report on a Feeding Advancement and Simultaneous Transition-Discharge (FAST-Discharge) pathway, which to date has not been reported in the literature. METHODS A retrospective review of patients who underwent LG was performed from May 2010 to May 2015. All were outpatients who were on prior nasogastric feeds. The postoperative order set initiates feeds in 4 h to advance to goal as tolerated. Time to initial feed and goal nutrition, and overall length of stay (LOS) were evaluated. RESULTS 122 patients were identified with 55% percent being male and with a median operative age of 15 months (IQR 8-27). 53% were started on bolus feeds. Initial feeds were started at a median of 2.8 h (IQR: 1.8-4.7). The median duration to goal nutrition was 6 h (IQR: 0-14). 97% reached full feeds within 24 h with no complications related to feed advancement. Median LOS was 26 h (IQR: 24-30). CONCLUSION An expedited pathway with early feeding and discharge is possible after laparoscopic gastrostomy tube placement with a low risk for adverse events. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Joseph A Sujka
- Department of Pediatric Surgery, Children's Mercy Hospital
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Sujka J, Weaver KL, Poola AS, Rivard DC, Hendrickson RJ. Percutaneous transhepatic cholecysto-cholangiography (PTCC): An alternative to intraoperative cholangiography in high risk infants suspect for biliary atresia. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.05.003] [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: 10/16/2022] Open
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Sujka JA, Weaver KL, Lim JD, Gonzalez KW, Biondo DJ, Juang D, Aguayo P, Hendrickson RJ. A safe and efficacious preventive strategy in the high-risk surgical neonate: cycled total parenteral nutrition. Pediatr Surg Int 2018; 34:1177-1181. [PMID: 30267193 DOI: 10.1007/s00383-018-4351-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hepatic dysfunction in patients reliant on total parenteral nutrition (TPN) may benefit from cycled TPN. A concern for neonatal hypoglycemia has limited the use of cycled TPN in neonates less than 1 week of age. We sought to determine both the safety and efficacy of cycled TPN in surgical neonates less than 1 week of age. METHODS A retrospective chart review was conducted on surgical neonates placed on prophylactic and therapeutic cycled TPN from January 2013 to March 2016. Specific emphasis was placed on identifying incidence of direct hyperbilirubinemia and hypoglycemic episodes. RESULTS Fourteen neonates were placed on cycled TPN; 8 were prophylactically cycled and 6 were therapeutically cycled. Median gestational age was 36 weeks (34, 37). Sixty-four percent (n = 9) had gastroschisis. There was no difference between the prophylactic and therapeutic groups in incidence of hyperbilirubinemia > 2 mg/dL (3 (37%) vs 5 (83%), p = 0.08) or the length of time to development of hyperbilirubinemia [24 days (4, 26) vs 27 days (25, 67), p = 0.17]. Time on cycling was similar though patients who were prophylactically cycled had a shorter overall time on TPN. Three (21%) infants had documented hypoglycemia, but only one infant became clinically symptomatic. CONCLUSION Prophylactic TPN cycling is a safe and efficacious nutritional management strategy in surgical neonates less than 1 week of age with low rates of hypoglycemia and a shorter total course of TPN; however, hepatic dysfunction did not appear to be improved compared to therapeutic cycling.
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Affiliation(s)
- Joseph A Sujka
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Katrina L Weaver
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Joel D Lim
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | | | - Deborah J Biondo
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - David Juang
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Williams K, Lautz TB, Hendrickson RJ, Oyetunji TA. Postoperative Antibiotic Administration in Children with Non-Perforated Appendicitis. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.337] [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: 10/28/2022]
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Poola AS, Weaver KL, Sola R, Reddy S, Mundakkal A, Fallahian F, Bawa H, Rentea RM, Hendrickson RJ, St. Peter SD. Transabdominal Versus Subcuticular Sutures to Secure a Laparoscopic Gastrostomy. J Laparoendosc Adv Surg Tech A 2018; 28:884-887. [DOI: 10.1089/lap.2017.0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ashwini S. Poola
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Katrina L. Weaver
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Richard Sola
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shiva Reddy
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Angela Mundakkal
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Fedra Fallahian
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Harmeet Bawa
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Rebecca M. Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Shawn D. St. Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Sujka J, Gonzalez KW, Curiel KL, Daniel J, Fischer RT, Andrews WS, Wicklund BM, Hendrickson RJ. The impact of thromboelastography on resuscitation in pediatric liver transplantation. Pediatr Transplant 2018; 22:e13176. [PMID: 29577520 DOI: 10.1111/petr.13176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/07/2018] [Indexed: 12/01/2022]
Abstract
Although TEG directs effective resuscitation in adult surgical patients, pediatric data are lacking. We performed a retrospective comparative review of the effect of TEG on blood product utilization and outcomes following pediatric liver transplantation in 38 patients between 2008 and 2014. Diagnoses, laboratory values, fluid and blood product use, and outcomes were examined. Nineteen patients underwent liver transplantation prior to the implementation of TEG, and 19 had perioperative TEG. The most common indications for transplant were BA (n = 14), HB (n = 7), and metabolic disorders (n = 7). Intraoperative blood loss, urine output, fluid and blood product use were similar between groups. However, the use of fresh frozen plasma decreased significantly in TEG patients within the first 24 hours (29 vs 0 mL/kg, P < .01), and between 24 and 48 hours (12 vs 0 mL/kg, P = .01) post-operatively. The total use of fresh frozen plasma during hospitalization was markedly reduced (111 vs 17 mL/kg, P < .01). Four patients in the TEG group had thromboembolic graft complications, including portal vein or hepatic artery thrombosis, and underwent retransplantation. The decreased use of fresh frozen plasma since implementation of TEG is an important finding for resource utilization and patient safety. However, the increased incidence of thromboembolic complications requires further investigation.
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Affiliation(s)
- Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - Kayla L Curiel
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - James Daniel
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Ryan T Fischer
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Walter S Andrews
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Brian M Wicklund
- Department of Hematology, Children's Mercy Hospital, Kansas City, MO, USA
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Abstract
Please see fulltext
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Williams K, Oyetunji TA, Hsuing G, Hendrickson RJ, Lautz TB. Spontaneous Pneumothorax in Children: National Management Strategies and Outcomes. J Laparoendosc Adv Surg Tech A 2017; 28:218-222. [PMID: 29237135 DOI: 10.1089/lap.2017.0467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/13/2022] Open
Abstract
INTRODUCTION The timing of surgical intervention in the management of spontaneous pneumothorax remains controversial. The aim of this multicenter review was to compare management strategies and outcomes in children with spontaneous pneumothorax. METHODS We retrospectively reviewed patients 10-19 years old in the Pediatric Health Information System admitted for spontaneous pneumothorax from 2010 to 2014. Three treatment groups were identified based on initial hospital management-no intervention, initial chest tube placement, and operation; and outcomes were compared. RESULTS A total of 1040 patients were included. The majority were male (82.1%) and White (71.1%). The mean age at first encounter was 15.7 ± 1.7 years. Initial treatment included no intervention in 336 (32.3%), chest tube in 497 (47.8%), and video-assisted thoracoscopic surgery (VATS) in 207 (19.9%). Ultimately, 417 (40.1%) patients underwent VATS during the initial admission and 559 (53.8%) during the initial admission or a subsequent encounter. Aggregate length of stay (LOS) was highest for those treated initially with chest tube alone (P < .001). For patients managed initially with chest tube, the probability of requiring surgery increased with each day of hospitalization. Initial operation was associated with a decreased risk of readmission (OR 0.67, 95% CI 0.50-0.90). Estimated adjusted hospital costs, aggregated across all encounters, were highest for chest tube alone (P < .001). CONCLUSION Early VATS is associated with decreased hospital LOS, charges, and readmissions. For those managed initially with chest tube alone, the likelihood of requiring operation increases with each day hospitalized, and early conversion to operative management should be considered in patients with persistent pneumothorax or air leak.
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Affiliation(s)
- Kibileri Williams
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Tolulope A Oyetunji
- 3 Department of Surgery, Children's Mercy Kansas City , Kansas City, Missouri
| | - Grace Hsuing
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | | | - Timothy B Lautz
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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Abstract
Pediatric transplant candidates include heart, lung, liver, pancreas, small intestine, and kidney. The purpose of this article is to review the history and current methods for determining priority of the above-mentioned transplantable organs. The methods used by the authors involved the review of historical and current manuscripts and UNOS policy documents. We summarized the findings in order to create a concise review of the current policies and wait times for transplantation in pediatric transplant patients.
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Affiliation(s)
- Walter S Andrews
- Department of Pediatric & Transplant Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MI 64108
| | - Bartholomew J Kane
- Department of Pediatric & Transplant Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MI 64108; Department of Surgery, Transplant, Kansas University Medical Center, Kansas City, Missouri, MO
| | - Richard J Hendrickson
- Department of Pediatric & Transplant Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MI 64108.
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Rentea RM, Oyetunji TA, Erkmann J, Knowlton JQ, Hendrickson RJ. Review of surgical and anesthetic management for esophageal atresia with tracheoesophageal fistula, unilateral pulmonary agenesis and dextrocardia. Pediatr Surg Int 2017; 33:817-821. [PMID: 28417152 DOI: 10.1007/s00383-017-4090-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/26/2022]
Abstract
Association of unilateral severe pulmonary atresia or agenesis and esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) and dextrocardia is a rare and highly lethal combination. We report a case of a full-term female infant who had EA with TEF, right lung agenesis, and dextrocardia. Repair of the fistula took place on day of life 3. We describe anesthetic and surgical concerns of this patient's case which are keys to a good operative outcome as well as follow-up for the patient.
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Affiliation(s)
- Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - John Erkmann
- Department of Anesthesiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Joshua Q Knowlton
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
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Dalton BG, Gonzalez KW, Reddy SR, Hendrickson RJ, Iqbal CW. Improved outcomes for inborn babies with uncomplicated gastroschisis. J Pediatr Surg 2017; 52:1132-1134. [PMID: 28017414 DOI: 10.1016/j.jpedsurg.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 07/14/2016] [Revised: 11/16/2016] [Accepted: 12/09/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Gastroschisis (GS) is a common abdominal wall defect necessitating neonatal surgery and intensive care. We hypothesized that inborn patients had improved outcomes compared to patients born at an outside hospital (outborn) and transferred for definitive treatment. METHODS A single center, retrospective chart review at a pediatric tertiary care center was performed from 2010 to 2015. All patients whose primary surgical treatment of GS was performed at this center were included. We compared patients delivered within our center (inborn) to patients delivered outside of our center and transferred for surgical care (outborn). Babies with complicated gastroschisis were excluded. RESULTS During the study period 79 patients with GS were identified. Of these, 53 were inborn and 26 were outborn. Sixteen patients were excluded for complicated GS. The rate of complicated GS was higher in the outborn group (32%) compared to the inborn population (11%) (p=0.03). Duration of stay, readmission rate and time on TPN were all significantly decreased for inborn patients, while time to definitive closure was similar. Mortality was 0% for both inborn and outborn patients. CONCLUSION Patients with uncomplicated GS seem to benefit from delivery with immediate pediatric surgical care available eliminating the need for transfer. LEVEL OF EVIDENCE III.
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Affiliation(s)
- B G Dalton
- Children's Mercy Hospital Kansas City, MO
| | | | - S R Reddy
- Children's Mercy Hospital Kansas City, MO
| | | | - C W Iqbal
- Children's Mercy Hospital Kansas City, MO.
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Hendrickson RJ, Poola AS, Gonzalez KW, Lim J, Oyetunji TA. Re-Tubularization of Highly-Ischemic Anti-Mesenteric Border (ReHAB): A Novel Bowel Preservation Technique in Complex Gastroschisis. J Neonatal Surg 2017; 6:63. [PMID: 28920023 PMCID: PMC5593482 DOI: 10.21699/jns.v6i3.602] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/11/2017] [Indexed: 11/11/2022] Open
Abstract
Complex gastroschisis with bowel necrosis poses an operative challenge. Surgeons must weigh the decision between resection versus preservation of ischemic bowel. As one of the leading causes of short bowel syndrome, aggressive resection in complicated gastroschisis subjects children to prolonged dependence on parenteral nutrition and its attendant complications. Herein, we describe a novel technique aimed towards bowel preservation in complex gastroschisis patients with severe bowel ischemia with the ultimate goal for enteral autonomy.
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Affiliation(s)
| | | | | | - Joel Lim
- Department of Pediatric Gastroenterology, Children’s Mercy Hospital
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Rentea RM, Varghese A, Ahmed A, Kats A, Manalang M, Dowlut-McElroy T, Hendrickson RJ. Pediatric Ovarian Growing Teratoma Syndrome. Case Rep Surg 2017; 2017:3074240. [PMID: 28656118 PMCID: PMC5471592 DOI: 10.1155/2017/3074240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 12/06/2016] [Revised: 04/03/2017] [Accepted: 05/03/2017] [Indexed: 12/31/2022] Open
Abstract
Ovarian immature teratoma is a germ cell tumor that comprises less than 1% of ovarian cancers and is treated with surgical debulking and chemotherapy depending on stage. Growing teratoma syndrome (GTS) is the phenomenon of the growth of mature teratoma elements with normal tumor markers during or following chemotherapy for treatment of a malignant germ cell tumor. These tumors are associated with significant morbidity and mortality due to invasive and compressive growth as well as potential for malignant transformation. Current treatment modality is surgical resection. We discuss a 12-year-old female who presented following resection of a pure ovarian immature teratoma (grade 3, FIGO stage IIIC). Following chemotherapy and resection of a pelvic/liver recurrence demonstrating mature teratoma, she underwent molecular genetics based chemotherapeutic treatment. No standardized management protocol has been established for the treatment of GTS. The effect of chemotherapeutic agents for decreasing the volume of and prevention of expansion is unknown. We review in detail the history, diagnostic algorithm, and previous reported pediatric cases as well as treatment options for pediatric patients with GTS.
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Affiliation(s)
- Rebecca M. Rentea
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Aaron Varghese
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Kansas City, MO, USA
| | - Atif Ahmed
- Department of Pathology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Alexander Kats
- Department of Pathology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michelle Manalang
- Department of Hematology, Oncology, and Bone Marrow Transplantation, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tazim Dowlut-McElroy
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Kansas City, MO, USA
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Baumann LM, Williams K, Abdullah F, Hendrickson RJ, Oyetunji TA. Do-not-resuscitate orders and high-risk pediatric surgery: professional nuisance or medical necessity? J Surg Res 2017; 217:213-216. [PMID: 28595818 DOI: 10.1016/j.jss.2017.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/10/2017] [Revised: 03/23/2017] [Accepted: 05/05/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a paucity of data in the literature regarding end-of-life care and do-not-resuscitate (DNR) status of the pediatric surgical patient, although invasive procedures are frequently performed in very high risk and critically ill children. Despite significant efforts in adult medicine to enhance discussions around end-of-life care, little is known about similar endeavors in the pediatric population. METHODS A retrospective review of the National Surgical Quality Improvement Program Pediatric database was performed. Patients aged <18 y with American Society of Anesthesiologists class 3 or greater who underwent elective surgical procedure in 2012-2013 were included. Demographic factors, principal diagnosis, associated conditions, DNR status, and mortality were extracted. Descriptive analysis was performed. RESULTS A total of 20,164 patients met the inclusion criteria. Only 36 (0.2%) patients had a signed DNR order before surgical procedure. Of severely ill American Society of Anesthesiologists four patients, only 1% had DNR status. There were no differences in gender, race, ethnicity, or surgical specialty by the presence of a DNR order. Notably, 17.1% of children who died within this period had multiple surgical procedures performed before expiring. CONCLUSIONS The rate of documented DNR status is extremely low in the high-risk pediatric surgical population undergoing elective surgery, even among severely ill children. Well-informed end-of-life care discussions in a patient-focused approach are essential in the surgical care of children with complex medical conditions and critical illness. Better documentation of DNR discussion will also allow better tracking and benchmarking.
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Affiliation(s)
- Lauren M Baumann
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kibileri Williams
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fizan Abdullah
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Gonzalez KW, Weaver KL, Biondo DJ, Lim JD, Hendrickson RJ. Cycling parenteral nutrition in a neonatal surgical patient: An argument for increased utilization. Journal of Pediatric Surgery Case Reports 2017. [DOI: 10.1016/j.epsc.2016.10.002] [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: 11/27/2022] Open
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Oyetunji TA, Rentea RM, Weaver KL, Hendrickson RJ. Preoperative Imaging Does Not Predict Rupture in Acute Appendicitis. J Emerg Med 2016; 52:366. [PMID: 27979640 DOI: 10.1016/j.jemermed.2016.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/03/2016] [Indexed: 11/15/2022]
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Weaver KL, Poola AS, Fioravanti V, Sherman AK, Hendrickson RJ, Andrews WS. Implication of Alloantibodies on Graft Histology after Pediatric Liver Transplantation. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.150] [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: 11/26/2022]
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Dalton BG, Gonzalez KW, Dehmer JJ, Andrews WS, Hendrickson RJ. Transition of Techniques to Treat Choledochal Cysts in Children. J Laparoendosc Adv Surg Tech A 2016; 26:62-5. [DOI: 10.1089/lap.2015.0123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Brian G.A. Dalton
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Jeffrey J. Dehmer
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Walter S. Andrews
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Gonzalez KW, Dalton BGA, Boda S, Aguayo P, Hendrickson RJ, St Peter SD, Juang D. Utility of Preoperative Upper Gastrointestinal Series in Laparoscopic Gastrostomy Tube Placement. J Laparoendosc Adv Surg Tech A 2015; 25:1040-3. [PMID: 26258954 DOI: 10.1089/lap.2015.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION An upper gastrointestinal (UGI) series is a standard preoperative test for patients being evaluated for gastrostomy tube placement. We have recently begun to question the value of the radiation-exposing series in patients who tolerate gastric feeds. MATERIALS AND METHODS A retrospective review was conducted in patients who underwent laparoscopic gastrostomy tube placement between 2000 and 2012. Demographics, indication for gastrostomy tube, comorbidities, preoperative imaging, and nutrition were analyzed. Patients with foregut pathology and those who underwent prior gastrointestinal surgery were excluded. RESULTS Among 695 patients who underwent laparoscopic gastrostomy tube placement, the most common indications were failure to thrive (53%), neurologic disorder (25%), and dysphagia (12%). A UGI series was obtained for 420 patients (60%). Of these, 96 were found to have abnormalities (reflux, aspiration, anatomic). However, only 2 of these patients (0.3%) had a change in management, with 1 patient undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy for suspected malrotation. In the subset analysis of 256 patients tolerating goal gastric feeds, 161 (63%) had a preoperative UGI series with only 2 patients (1.2%) having a resultant change in operative management: 1 undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy. Of the 275 patients who did not have a preoperative UGI series, 1 patient (0.4%) was found to have malrotation postoperatively after two coins became lodged in the duodenum. This patient subsequently underwent an elective Ladd procedure. CONCLUSIONS We found minimal impact of an UGI series during evaluation for gastrostomy alone. These studies may be able to be reserved for those with clear clinical indications.
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Affiliation(s)
- Katherine W Gonzalez
- Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | - Brian G A Dalton
- Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | - Sushanth Boda
- Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | | | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital , Kansas City, Missouri
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Iqbal CW, St Peter SD, Hendrickson RJ. Repair of a traumatic lateral abdominal wall hernia in an 11-year-old boy, using a minimally invasive approach. Trauma 2012. [DOI: 10.1177/1460408612440926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the case of an 11-year-old boy who sustained blunt abdominal trauma while bicycling. An abdominal computed tomography scan obtained during his trauma evaluation was suspicious of a right-sided abdominal wall hernia with acute inflammatory changes although there was no palpable mass on physical examination. In follow-up, he was found to have a palpable mass in his right lateral abdominal wall, which enlarged with valsalva. The hernia was repaired primarily using a minimally invasive approach with a 5-mm umbilical cannula and a stab incision over the defect. He was discharged home on the first post-operative day. At 1 year follow-up, he is symptom-free without evidence of recurrence. Lateral abdominal wall hernias in the pediatric patient are uncommon but can result from trauma. Primary repair using a minimally invasive approach is safe and effective in achieving adequate closure.
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Affiliation(s)
- Corey W Iqbal
- Children’s Mercy Hospital and Clinics, Kansas City, MO, USA
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Abstract
Preoperative ultrasound measurement of pyloric length to determine laparoscopic pyloromyotomy appears to minimize the risk of incomplete pyloromyotomy. Background: Laparoscopic pyloromyotomy is associated with an increased risk of incomplete myotomy compared with open myotomy. We hypothesized that utilizing ultrasound measured length to direct laparoscopic pyloromyotomy would reduce the risk of incomplete pyloromyotomy without a concomitant increase in the risk of mucosal perforation. Methods: Infants (n=43) with hypertrophic pyloric stenosis diagnosed by ultrasound and subsequent laparoscopic pyloromyotomy over a 2-year period (December 2006 through December 2008) were studied. Pyloromyotomy length was guided by preoperative ultrasound measurements. Pyloromyotomy was considered complete if the measured length was ≥ the ultrasound measurement. Infants were followed prospectively for time to full feeding, time to discharge, and complications. Results: The cohort included 38 male and 5 female infants (age, 37±13 days; range, 17 to 72 days) who underwent ultrasound (length 1.9±0.2cm; thickness 4.4±0.9mm) and laparoscopic pyloromyotomy. Infants achieved full feeding 28±16 hours postoperatively and were discharged 34±18 hours postoperatively. No infant required reoperation for incomplete myotomy. One infant sustained mucosal perforation (2%). No patient suffered other complications. Conclusion: Preoperative ultrasound measurement of pyloric length to determine the length of laparoscopic pyloromyotomy, rather than visual cues alone, appears to minimize the risk of incomplete pyloromyotomy.
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Affiliation(s)
- Denis D Bensard
- Department of Pediatric Surgery, The Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana, USA.
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Bensard DD, Hendrickson RJ, Fyffe CJ, Careskey JM, Azizkhan RG. Early discharge following laparoscopic appendectomy in children utilizing an evidence-based clinical pathway. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S81-6. [PMID: 19025474 DOI: 10.1089/lap.2008.0165.supp] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The utility of laparoscopic appendectomy (LA) in children remains controversial. The determination of the efficacy of LA in children is complicated by variable postoperative management, duration of antibiotics,and criteria for discharge. The aim of this study was to examine the results of a commitment to LA and the concurrent implementation of an evidence-based clinical pathway (CP) for management appendicitis in a children's hospital. METHODS With institutional review board approval, all children presenting with appendicitis (n = 72; age =10.6 +/- 0.1 years) were offered LA and management directed by CP. Data were accrued prospectively for 12 consecutive months (May 2006 to April 2007) and analysis performed at 15 months. Data are reported as the mean +/- standard error of the mean. RESULTS Children were stratified based on the operative findings: group one - acute 41; group two-suppurative=11; and group 3-gangrenous or perforated 20. Duration of hospital stay differed between the groups:group one= 26 +/- 0.3 hours; group 2 =48 +/- 3 hours; group 3= 127 +/- 6 hours (P <0.05). No patients in groups one or two suffered a complication or were readmitted following discharge. Two patients in group 3 (10%)were readmitted and treated with antibiotic therapy alone. Overall, 66% of the children with acute appendicitis(27/41) and 27% with suppurative appendicitis (3/11) were discharged within 24 hours of admission. Discharge by 24 hours in groups 1 and 2 was not influenced by age, gender, or time of operation (before or after 7 PM). CONCLUSIONS The commitment to LA and use of CP resulted in discharge within 24 hours in 2 of 3 of children with acute appendicitis without readmission or complications being observed. Early discharge was not influenced by age, gender, or time of admission. For advanced appendicitis, length of hospital stay, determined by clinical parameters, resulted in a low rate of complication or readmission.
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Affiliation(s)
- Denis D Bensard
- Department of Pediatric Surgery, The Peyton Manning Children's Hospital at St. Vincent, Indianapolis, Indiana, USA.
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