Commentary to Ceresoli M, Tamini N, Gianotti L et al. “Are endoscopic loop ties safe even in complicated acute appendicitis? A systematic review and meta-analysis”
Successful Foley catheter tamponade of an epigastric vessel trocar injury in a toddler – A case report
Highlights • Epigastric vessel injury is a well recognized complication during laparoscopic trocar placement. • Precautionary measures to prevent trocar induced injuries should be implemented to lower the incidence of this complication. • If this complication is encountered, tamponade by Foley catheter placement is an effective measure to provide hemostasis. • Hemorrhage control using a Foley catheter is feasible even in small children and toddlers.
Femoral, Direct, and Rare Inguinal Hernias in Children-An Update.
AbstractPediatric surgeons deal with inguinal hernias on a regular basis. While most of these are straightforward in terms of diagnosis and therapy, occasionally what initially sounds like a routine case turns out to be a perplexing conundrum. This review discusses rare and unusual findings in the groin area that may mimic an indirect inguinal hernia, but are not. To provide good and effective care, pediatric surgeons should be readily familiar with the possible differential diagnosis of these entities, along with their specific management. In general, laparoscopy is one of the most useful interventions to discern unusual groin pathology from standard indirect inguinal hernias and in many c…
Methods for evaluating causality in observational studies.
BACKGROUND: In clinical medical research, causality is demonstrated by randomized controlled trials (RCTs). Often, however, an RCT cannot be conducted for ethical reasons, and sometimes for practical reasons as well. In such cases, knowledge can be derived from an observational study instead. In this article, we present two methods that have not been widely used in medical research to date. METHODS: The methods of assessing causal inferences in observational studies are described on the basis of publications retrieved by a selective literature search. RESULTS: Two relatively new approaches—regression-discontinuity methods and interrupted time series—can be used to demonstrate a causal relat…
Pulmonary Agenesis and Associated Pulmonary Hypertension: A Case Report and Review on Variability, Therapy, and Outcome
Abstract Pulmonary agenesis is a rare congenital disorder with large variability in presentation and prognosis. We describe a full-term infant born with right-sided pulmonary agenesis who underwent thoracoscopic placement of a tissue expander. He ultimately died of pulmonary hypertension. Immunohistology showed intimal hyperplasia without the loss of endothelial caveolin-1 expression. A literature review revealed that while some of these patients have favorable outcome, many succumb despite therapy.
Duodenal Atresia Repair Using a Miniature Stapler Compared to Laparoscopic Hand-Sewn and Open Technique
Abstract Background: Laparoscopic duodenal atresia (DA) repair is a demanding procedure that requires performing a watertight anastomosis in a small working space. Drawbacks of the approach have be...
Using multidimensional scaling in model choice for congenital oesophageal atresia: similarity analysis of human autopsy organ weights with those from a comparative assessment of Aachen Minipig and Pietrain piglets.
Swine models had been popular in paediatric oesophageal surgery in the past. Although being largely replaced by rodent models, swine experienced a revival with the establishment of minipig models. However, none of them has ever been investigated for similarity to humans. We conducted a pilot study to determine whether three-week old Pietrain piglets and three-month old Aachen Minipigs are suitable for experimental paediatric oesophageal atresia surgery. We tested the operation's feasibility, performed a necropsy, weighed organs, measured organ length and calculated relative weights and lengths, and measured laboratory parameters. We used multidimensional scaling to assess the similarity of…
Erratum to “The SCARE guidelines: Consensus-based surgical case report guidelines” [Int. J. Surg. 34 (2016) 180–186]
Thoracoscopic Lung Biopsies and Resections in Children
Pediatric surgeons are frequently faced with a variety of indications regarding the lung. Pulmonary lesions found on imaging studies may be congenital, malignant, infectious, or inflammatory in nature. Often, only a biopsy can make the diagnosis and guide subsequent management. In other cases, resection may be curative.
An experimental study on long term outcomes after magnetic esophageal compression anastomosis in piglets
Abstract Background/Purpose Previous studies have shown that a patent, watertight esophageal anastomosis can be accomplished safely using specially-shaped magnets in piglets. However, it is unclear whether such a magnetic esophageal compression anastomosis (MECA) remains patent in the long-term. The purpose of this study was to evaluate the long-term outcome of MECA in an experimental pig model over an observation period of 2 months. Methods Ten piglets underwent creation of an MECA with custom-made 8 mm magnets and a U-shaped esophageal bypass loop to allow peroral nutrition at eight weeks of life. Two weeks later, the bypass loop was closed surgically, requiring the pigs to swallow via th…
The role of obesity in cancer development
Access to an online video enhances the consent process, increases knowledge, and decreases anxiety of caregivers with children scheduled for inguinal hernia repair: A randomized controlled study.
Abstract Background There is limited time within the clinical workflow of most pediatric surgeons to obtain a comprehensive, well informed consent. This study evaluates whether ad-lib access to an online video on the consent dialogue enhances the consent process for inguinal hernia repair (IHR) in children. Methods The study was approved by the state ethics board. A 6-min video of a consent speech on IHR was produced and uploaded to a nonpublic online channel, explaining the condition, procedure, complications, and postoperative expectations. A total of 50 families were randomized to conventional, face-to-face consenting in clinic either with (intervention) or without (control) access to th…
A Continuous Suture Anastomosis Outperforms a Simple Interrupted Suture Anastomosis in Esophageal Elongation.
Abstract Introduction Long-gap esophageal atresia represents a distinct entity among the esophageal atresia spectrum. In many patients, achieving a reasonable anastomosis depends on some millimeters of tissue. We aimed to determine what effect the suturing technique would have on esophageal ex vivo elongation as it may determine the strength of a primary anastomosis. Materials and Methods In an analysis of porcine esophagi from animals for slaughter (100–120 days old with a weight of 100–120 kg), we determined esophageal length gain of simple continuous and simple interrupted suture anastomoses subjected to linear traction until linear breaking strength was reached. Statistical power of 80%…
Laparoscopy for Abdominal Testes: Nationwide Analysis of German Routine Data
Introduction: Laparoscopy has been used for the evaluation of impalpable testes for more than 30 years. However, its use for intra-abdominal testes has never been evaluated in a population-based ap...
Bodyweight, not age, determines oesophageal length and breaking strength in rats
Delayed primary repair is still the method of choice in the management of long-gap oesophageal atresia in many centres, but the timing of anastomoses varies. Some assume the infant's bodyweight to be an important factor, whereas others prefer age. We therefore aimed to clarify whether age or bodyweight determined oesophageal length in a rodent model.We explanted the oesophagi of 20 Sprague-Dawley rats, aged 15 to 444 days (n = two per time point), measured bodyweight, oesophageal length, weight, and linear breaking strength to measure tissue resilience. Univariate and multivariate regression analyses were conducted to determine the influence of age and bodyweight on oesophageal length and l…
The timeout procedure in pediatric surgery - effective tool or lip service? A randomized prospective observational study
ABSTRACTBackgroundFor over a decade, the preoperative timeout procedure has been implemented in most pediatric surgery units. In our hospital, a standardized team-timeout is performed before every operation. However, the impact of this intervention has not been systematically studied.PurposeThis study evaluates whether purposefully-introduced errors during the timeout routine are picked up by the operating team members.MethodsAfter ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a pediatric surgery attending. Errors were randomly selected among wrong name, site, side, allerg…
Behandlung der Ösophagusatresie mit unterer tracheoösophagealer Fistel – Zusammenfassung der aktuellen S2K-Leitlinie der DGKCH
ZusammenfassungDie Ösophagusatresie (ÖA) ist eine angeborene Kontinuitätsunterbrechung der Speiseröhre mit oder ohne Fistel zur Trachea (Tracheoösophageale Fistel, TÖF). Je nach Abstand zwischen den beiden Ösophagusenden unterscheidet man eine „kurzstreckige“ von einer „langstreckigen“ Form. Bis zu 50% der Neugeborenen weisen weitere Anomalien auf. Eine pränatale Diagnose der ÖA gelingt in 32–63% der Fälle. Die interdisziplinäre Betreuung dieser Kinder hat sich in den letzten Jahren gewandelt. In der folgenden Arbeit wird die aktuelle S2K-Leitlinie der Deutschen Gesellschaft für Kinderchirurgie zur Behandlung der ÖA mit unterer TÖF, die etwa 90% aller Fälle ausmacht, zusammengefasst. Hierzu…
How to Become a Pediatric Surgeon?
As the title of this chapter already suggests, in this chapter the path of how become a pediatric surgeon is described and important question on this issue are answered. These questions are all dealing with the process and the structure of pediatric surgery training and the requirements which are necessary to become a pediatric surgeon. In preparation of this book chapter, we performed an online survey about the organization and structure of pediatric surgery training around the world. The survey was sent to all official national admissions departments and organizations of pediatric surgery. Thus, data from 28 different countries were compiled. They serve as the basis of some of the questio…
Laparoscopic Epigastric Hernia Repair
Epigastric hernias are midline abdominal wall defects located between the umbilicus and the xiphoid process that do not resolve spontaneously. Symptomatic hernias require surgical repair.
Comparing Aachen Minipigs and Pietrain Piglets as Models of Experimental Pediatric Urology to Human Reference Data
<b><i>Introduction:</i></b> Swine had special roles in the development of minimally invasive procedures to treat vesicoureteral reflux, and minipigs have been gaining ground in recent years in experimental pediatric urology as they combine small size with less vulnerable adult physiology, but their suitability as a model has never been assessed. We therefore compared a landrace piglet with a juvenile minipig to elucidate comparability. <b><i>Methods:</i></b> We evaluated five 3-week old Pietrain piglets and five 3-month old Aachen Minipigs as representatives of landrace and minipig models based on their expected bodyweight being similar to a n…
Timeout procedure in paediatric surgery: effective tool or lip service? A randomised prospective observational study.
BackgroundFor over a decade, the preoperative timeout procedure has been implemented in most paediatric surgery units. However, the impact of this intervention has not been systematically studied. This study evaluates whether purposefully introduced errors during the timeout routine are detected and reported by the operating team members.MethodsAfter ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a paediatric surgery attending. Errors were randomly selected among wrong name, site, side, allergy, intervention, birthdate and gender items. The main outcome measure was how freq…
Multivariate analysis on complications of central venous access devices in children with cancer and severe disease influenced by catheter tip position and vessel insertion site (A STROBE-compliant study)
Abstract Context Reliable long-term central venous access device (CVAD) is essential for the management of pediatric patients with cancer or chronic diseases. However, there is no general consensus for optimal catheter tip location and vessel insertion site in children. Objective This single center study analyzes the risk of complications associated with long-term upper body CVAD and evaluates them with respect to catheter tip location as well as vessel insertion site. Design Pediatric patients who received long-term upper body CVAD from January 2008 through April 2017 and underwent radiographic documentation of the tip location were retrospectively included in the study. Data on demographi…
Telemedicine for pediatric surgical outpatient follow-up: A prospective, randomized single-center trial
Telemedicine is gaining popularity for a variety of indications. We performed a randomized controlled trial comparing telemedical versus conventional clinic follow-up in terms of feasibility and quality.Patients discharged from pediatric surgery were randomized to telemedical or onsite follow-up. In the telemedical group, video telephony was used to obtain interim history and physical findings. Onsite patients were personally seen in the outpatient clinic. Caregivers completed a postvisit survey on satisfaction and efficiency. Providers scored data transmission quality and clinical interpretability.From March 2015 until January 2017, 224 patients were randomized equally to the study groups.…
Contralateral processus closure to prevent metachronous inguinal hernia: A systematic review.
Inguinal hernia repair is one of the most frequent operations in pediatric surgery and is increasingly performed laparoscopically. The latter introduced new momentum in the debate on the necessity of contralateral exploration, as the rates of contralateral patent processus vaginales and metachronous inguinal hernias determine whether a routine closure would be overtreatment or useful prevention.We searched MEDLINE via PubMed, Web of Science and Scopus at the 6th of September 2017; reference lists and CrossRef were snowballed for reports citing identified studies. Eligibility criteria were age18 years, preoperative diagnosis of unilateral hernia, laparoscopic evaluation, and publication sinc…
Pterygium axillae as a rare manifestation of Poland syndrome
Abstract Poland syndrome is characterized by a combination of absent pectoralis muscle, abnormalities of the rib cage, the breast, as well as brachy-syndactyly. We report a case of a 3 month old girl who was born with right sided axillary pterygium combined with flattening of the right anterior chest wall. Resection of a sclerotic band with reconstruction by Z-plasty was performed. Intraoperative and histopathological findings confirmed that the axillary pterygium developed on the basis of a scarred, hypoplastic pectoralis major muscle. Our case adds to the body of evidence that Poland syndrome may present in a heterogeneous fashion, including the rare finding of axillary pterygium with ass…
Novel Device for Endoluminal Esophageal Atresia Repair: First-in-Human Experience
Thoracoscopic esophageal atresia (EA) repair affords many benefits to the patient; however, intracorporeal suturing of the anastomosis is technically challenging. Esophageal magnetic compression anastomosis (EMCA) is a compelling option for endoluminal EA repair, but available EMCA devices have prohibitive rates of recalcitrant stricture. Connect-EA is a new endoluminal EMCA device system that employs 2 magnetic anchors with a unique mating geometry designed to reliably create a robust anastomosis and decrease rates of leak and stricture. We describe our first-in-human experience with this novel endoluminal device for staged EA repair in 3 patients (Gross type A, B, and C) at high risk for …
Thoracoscopic Tracheoesophageal N-fistula Repair using a 5.8-mm Miniature Stapler for Fistula Division
Using simple interrupted suture anastomoses may impair translatability of experimental rodent oesophageal surgery
Background/purpose: Irreproducibility and missing translatability are major drawbacks in experimental animal studies. Hand-sewn anastomoses in oesophageal surgery are usually continuous, whereas th...
Management and Outcome of Mucosal Injury During Pyloromyotomy--An Analytical Survey Study.
Different approaches of dealing with mucosal injury during pyloromyotomy for hypertrophic pyloric stenosis have been described. There is, however, no consensus on the best technique to use. We conducted a survey among International Pediatric Endosurgery Group (IPEG) members on their experience of mucosal injuries during pyloromyotomy, the way in which these were handled, any modification in subsequent postoperative care, and impact on outcome.A confidential survey was sent to IPEG members querying demographic data, number of pyloromyotomies performed, operative approach, incidence of mucosal injury, intraoperative management, and postoperative consequences. Statistical analysis was performe…
Pediatric oncologic endosurgery.
Despite increasing popularity of minimal-invasive techniques in the pediatric population, their use in diagnosis and management of pediatric malignancy is still debated. Moreover, there is limited evidence to clarify this controversy due to low incidence of each individual type of pediatric tumor, huge diversity of the disease entity, heterogeneity of surgical technique, and lack of well-designed studies on pediatric oncologic minimal-invasive surgery. However, a rapid development of medical instruments and technologies accelerated the current trend toward less invasive surgery, including oncologic endosurgery. The aim of this article is to review current literatures about the application o…
Tracheostomy in Infants
High-Voltage Injuries by Contact With Overhead Lines: Case Reports of Two Young Girls
Abstract High-voltage burn injuries are rare in the pediatric age group, but can lead to devastating, severe sequelae. We present the cases of two young girls who suffered high-voltage burn injuries due to direct contact with overhead power lines. Both patients came from difficult psychosocial backgrounds. The injuries resulted in severe long-term consequences and functional deficits.
Fertility in males after childhood, adolescent, and adult inguinal operations
Abstract Background/purpose Inguinal hernia repair and orchidopexy are among the most common operations in boys. The impact on future fertility has not been conclusively defined. This study evaluates sperm quality after previous inguinal surgery. Methods Spermiograms of men with a desire to conceive children were analyzed. History of previous inguinal surgery (hernia repair, orchidopexy, varicocele ligation) was correlated with sperm quality. Other influential factors (age, BMI, chronic medication, tobacco use) were also tested. Results A total of 333 patients were included. Overall, 12.6% of the subjects had undergone previous inguinal surgery. Of these, 17 (43%) were inguinal hernia repai…
The Association of Appendectomy, Adhesions, Tubal Pathology, and Female Infertility.
Background and Objectives: The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility. Methods: We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation. Results: In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general pop…
The STROCSS statement: Strengthening the Reporting of Cohort Studies in Surgery
Abstract Introduction The development of reporting guidelines over the past 20 years represents a major advance in scholarly publishing with recent evidence showing positive impacts. Whilst over 350 reporting guidelines exist, there are few that are specific to surgery. Here we describe the development of the STROCSS guideline ( St rengthening the R eporting o f C ohort S tudies in S urgery). Methods and analysis We published our protocol apriori . Current guidelines for case series (PROCESS), cohort studies (STROBE) and randomised controlled trials (CONSORT) were analysed to compile a list of items which were used as baseline material for developing a suitable checklist for surgical cohort…
An experimental study on magnetic esophageal compression anastomosis in piglets.
Abstract Introduction Fashioning a patent, watertight anastomosis in patients with esophageal atresia is a challenging task in pediatric surgery, particularly when performed under tension. A reproducible suture-less alternative would decrease operative time. We evaluated magnetic esophageal compression anastomoses in a novel bypass-loop swine model. Methods Eight-week-old piglets underwent thoracotomy to mobilize the esophagus at the carina to create a U-shaped loop. Custom-made 8 mm diameter Neodymium Magnets were inserted into the esophagus proximal and distal to the loop, then mated side-to-side at the future anastomosis site. Pigs were observed for 8 (n = 4), 10 (n = 6), and 12 (n = 2) …
Esophageal Biomechanics Revisited: A Tale of Tenacity, Anastomoses, and Suture Bite Lengths in Swine
Background Anastomotic tension has repeatedly been associated with anastomotic leakages after esophagectomy for cancer or esophageal atresia repair. We therefore aimed to determine which anastomotic technique would come as close as possible to the native esophagus in sustaining traction forces. Constant traction for several minutes at esophageal remnants and large suture bites are also considered relevant in long-gap esophageal atresia repair. Methods Porcine esophagi were subjected to linear traction using a motorized horizontal test stand. We compared breaking strengths of native esophagi to simple continuous, simple interrupted, stapled, and barbed suture anastomoses. We also investigate…
Beyond Magnamosis: A Method to Test Sutureless Esophageal Anastomotic Devices in Living Swine by Creating an Esophageal Bypass Loop for Natural Oral Nutrition.
Abstract Introduction: Thoracoscopic esophageal atresia repair has become increasingly popular, but is still limited to a few expert centers and has some challenges and shortcomings. One of them ha...
Intralesional Endoscopy and Septectomy as a Diagnostic Tool and Treatment Method for Lymphatic Malformations
A Novel Technique of Posterolateral Suturing in Thoracoscopic Diaphragmatic Hernia Repair
Background Closure of the posterolateral defect in some cases of congenital diaphragmatic hernia (CDH) can be difficult. Percutaneous transcostal suturing is often helpful to create a complete, watertight closure of the diaphragm. A challenge with the technique is passing the needle out the same tract that it entered so that no skin is caught when the knots are laid down into the subcutaneous tissue. This report describes a novel technique using a Tuohy needle to percutaneously suture the posterolateral defect during thoracoscopic repair of CDH. Case We report a case of a 6-week-old infant who presented with a CDH and ipsilateral intrathoracic kidney that was repaired using thoracoscopic a…
Measuring Intraoperative Oesophageal Anastomotic Tension With a Knot-Pusher–Mounted Dynamometer Is Not Quite Ready for Take-Off
Diaphragmatic Hernia following Pediatric Liver Transplantation: An Underappreciated Complication Prone to Recur.
Abstract Introduction Postoperative diaphragmatic hernia (DH) is a rare but potentially life-threatening complication following pediatric liver transplantation (LT). In the current literature, a total of 49 such hernias have been reported in 17 case series. We present eight additional cases, three of which reoccurred after surgical correction, and review the current literature with a focus on recurrence. Materials and Methods The study sample included children (<18 years of age) who underwent LT between June 2013 and June 2020 at five large transplant centers and who subsequently presented with DH. During the study period, a total of 907 LT was performed. Eight DH were recognized, and ri…
Sex represents a relevant interaction in Sprague–Dawley rats: the example of oesophageal length*
Background: 8-week old Sprague Dawley rats represent the standard rodent model of oesophageal surgery, which is challenging and might be eased by larger oesophageal lengths. Therefore, we aimed to ...
Extrathoracic Lengthening (Kimura Technique)
Treatment of congenital long gap esophageal atresia is extremely challenging. Cases are rare, variable, and oftentimes complex. Possible treatment options include delayed primary repair after initial gastrostomy, gastric transposition, intestinal interpositions, traction procedures, myotomy, and gastric tube techniques. Treatment strategies often consist of variations and combinations of different approaches.
Laparoscopic Treatment of Intussusception
Most cases of ileocolic intussusception are reduced by imaging-guided air or fluid enema. If unsuccessful, operative intervention is necessary. The laparoscopic approach allows inspection of the bowel, identification of intraabdominal pathology, and achieves reduction of the intussuscepted bowel in most cases. The procedure requires the combination of slow and gradual traction as well as “rolling” the cecum distally. If unsuccessful, the bowel can be delivered through an extended umbilical incision for extracorporeal manipulation, or resection if this should be necessary.
Rationing and triage of scarce, lifesaving therapy in the context of the COVID-19 pandemic: a cross-sectional, social media-driven, scenario-based online query of societal attitudes
ABSTRACTBackgroundThe recent COVID-19 pandemic made us aware that medical resources are limited. When demand for essential resources surpasses availability, difficult triaging decisions are necessary. While algorithms exist, almost nothing is known on societal attitudes regarding triage criteria.MethodsA cross-sectional survey was conducted via social media channels to query a broad sample of society. Participants were asked to make triage decisions in case-based vignettes, exploring a variety of factors. They also were asked to assess how sure they were about their decisions, and how such decisions should be reached.ResultsThe survey was completed in full by 1626 participants in April 2020…