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Zahradnikova P, Pechanova R, Fedorova L, Jager R, Nedomova B, Babala J. Laparoscopic management of the congenital chylous ascites in a newborn: Case report. J Minim Access Surg 2023; 19:548-551. [PMID: 37282439 PMCID: PMC10695317 DOI: 10.4103/jmas.jmas_304_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/27/2023] [Indexed: 06/08/2023] Open
Abstract
Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising.
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Affiliation(s)
- Petra Zahradnikova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Rebeka Pechanova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Lenka Fedorova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Rene Jager
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Barbora Nedomova
- Department of Paediatric Anaesthesiology and Intensive Medicine, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Jozef Babala
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
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Fideler F, Mustafi M, Kirschner HJ, Gerbig I, Fuchs J, Hofbeck M, Kumpf M, Kagan O, Michel J, Jost W, Neunhoeffer F. Successful on-ECLS Repair of CDH and Omphalocele in a Newborn. European J Pediatr Surg Rep 2023; 11:e15-e19. [PMID: 37051184 PMCID: PMC10085641 DOI: 10.1055/s-0043-1767734] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/08/2023] [Indexed: 04/14/2023] Open
Abstract
Both congenital diaphragmatic hernias (CDHs) and omphaloceles show relevant overall mortality rates as individual findings. The combination of the two has been described only sparsely in the literature and almost always with a fatal course. Here, we describe a term neonate with a rare high-risk constellation of left-sided CDH and a large omphalocele who was successfully treated on extracorporeal life support (ECLS). Prenatally, the patient was diagnosed with a large omphalocele and a left CDH with a lung volume of ∼27% and an observed to expected lung-to-head ratio of 30%. Due to respiratory insufficiency, an ECLS device was implanted. As weaning from ECLS was not foreseeable, the female infant underwent successful surgery on ECLS on the ninth day of life. Perioperative high-frequency oscillatory ventilation and circulatory and coagulation management under point-of-care monitoring were the main anesthesiological challenges. Over the following 3 days, ECLS weaning was successful, and the patient was extubated after another 43 days. Surgical treatment on ECLS can expand the spectrum of therapy in high-risk constellations if potential risks are minimized and there is close interdisciplinary cooperation.
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Affiliation(s)
- Frank Fideler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
- Address for correspondence Frank Fideler, MD Department of Anesthesiology and Intensive Care Medicine, University Hospital,Tübingen,Germany
| | - Migdad Mustafi
- Department of Thoracic, Heart and Vascular Surgery, University Hospital, Tübingen, Germany
| | - Hans-Joachim Kirschner
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany
| | - Ines Gerbig
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital, Tübingen, Germany
| | - Matthias Kumpf
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital, Tübingen, Germany
| | - Oliver Kagan
- Department of Women's Health, University Women's Hospital, Tübingen, Germany
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital, Tübingen, Germany
| | - Walter Jost
- Cardiovascular Engineering, University Hospital, Tübingen, Germany
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital, Tübingen, Germany
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Galazka P, Skinder D, Styczynski J. Short-term and mid-term effects of thoracoscopic repair of esophageal atresia: No anastomotic leaks or conversions to open technique. Front Surg 2022; 9:1009448. [PMID: 36504576 PMCID: PMC9727094 DOI: 10.3389/fsurg.2022.1009448] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
The frequency rate of esophageal anastomosis leaks after thoracoscopic correction of esophageal atresia (EA) in the current literature is reported as 5.6%-24.7% and a conversion rate of 2%-53%. The objective of this retrospective study was to examine the characteristics of EA and analysis of the safety and efficacy of EA repair with the use of the thoracoscopic approach in a single academic center, as well as risk factors analysis in the context of short-term and mid-term follow-up status. A retrospective analysis of the management of all consecutive newborns affected by EA hospitalized in our department over a period between 2013 and 2022, including preoperative, perioperative, and postoperative management, together with the outcome, complications and long-term follow-up status was performed. A total of 38 patients with a median birth weight of 2,570 g (range; 1,020-3,880) were treated over the study period, including 30/38 (78.9%) with additional congenital anomalies. Overall, 30 patients underwent primary anastomosis of the esophagus and eight underwent a multistaged procedure, with or without an initial ligation of the tracheoesophageal fistula and delayed primary anastomosis. Overall survival for all patients was 0.894 ± 0.050, with a median follow-up of 4.5 years. We noted neither anastomotic leaks nor conversions to open technique in our cohort. Implementation of vancomycin prophylaxis was successful in preventing postoperative central venous access-related infectious complications. At the end of the follow-up, 85% of patients have a Lansky performance score ≥80. Risk factors analysis for length of hospitalization, overall survival, Lansky performance status, and neurological impairment were analyzed. In conclusion, we have found that the outcome of thoracoscopic repair of EA in terms of surgery-dependent morbidity (anastomosis leakage, conversion rate to open surgery), provides benefit to those previously reported in the literature, regardless of the prognostic criteria of the classification system.
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Affiliation(s)
- Przemyslaw Galazka
- Department of General and Oncologic Surgery for Children and Adolescents, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland,Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland,Correspondence: Przemysław Galazka
| | - Dominika Skinder
- Department of General and Oncologic Surgery for Children and Adolescents, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
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Apfeld JC, Kastenberg ZJ, Sylvester KG, Lee HC. The Effect of Level of Care on Gastroschisis Outcomes. J Pediatr 2017; 190:79-84.e1. [PMID: 29144275 DOI: 10.1016/j.jpeds.2017.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/29/2017] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the relationship between level of care in neonatal intensive care units (NICUs) and outcomes for newborns with gastroschisis. STUDY DESIGN A retrospective cohort study was conducted at 130 California Perinatal Quality Care Collaborative NICUs from 2008 to 2014. All gastroschisis births were examined according to American Academy of Pediatrics NICU level of care at the birth hospital. Multivariate analyses examined odds of mortality, duration of mechanical ventilation, and duration of stay. RESULTS For 1588 newborns with gastroschisis, the adjusted odds of death were higher for those born into a center with a level IIA/B NICU (OR, 6.66; P = .004), a level IIIA NICU (OR, 5.95; P = .008), or a level IIIB NICU (OR, 5.85; P = .002), when compared with level IIIC centers. The odds of having more days on ventilation were significantly higher for births at IIA/B and IIIB centers (OR, 2.05 [P < .001] and OR, 1.91 [P < .001], respectively). The odds of having longer duration of stay were significantly higher at IIA/B and IIIB centers (OR, 1.71 [P < .004]; OR, 1.77 [P < .001]). CONCLUSIONS NICU level of care was associated with significant disparities in odds of mortality for newborns with gastroschisis.
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Affiliation(s)
- Jordan C Apfeld
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
| | - Zachary J Kastenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA
| | - Karl G Sylvester
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA; Center for Fetal and Maternal Health, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford University, Palo Alto, CA
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