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Pediatric Surgery International
Risk management in pediatric surgery
Mon, 29 Jun 2009 10:06:37 -0000
Abstract Purpose To present the experience documented over 1 year of analysis and quality control on surgical complications and organizational accidents. Methods All children admitted during the study period at our Institution were included in the analysis, which consisted of four phases: (1) definition and standardization of perioperative diagnostic and therapeutic tracks; (2) staff education; (3) documentation and data implementation, and (4) “Morbidity and Mortality” audit. Results Over a 1-year study period, 3,116 children were admitted to our Institution: 2,222 out of 3,116 (71.3%) children underwent a surgical procedure. A total number of 184 complications were recorded in 149 patients. One hundred and seventy-one (92.9%) complications occurred following a surgical procedure. Fifty-six out of 149 complicated patients (37.6%) required a re-operation. Thirty-five out of 184 (19%) complications were classified as organizational. Infection represented the most common complication. All cases of anastomotic dehiscence and perforation, bowel obstruction, and stoma malfunction required reintervention. None of the postoperative bleedings required a second surgical procedure. Conclusion Although a proper statistical comparison with literature complication rates is not feasible, our experience confirms the importance of quality-control audit in health care systems. Prolonged observation, long-term follow up, and comparison with previous results will represent our future goal. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2407-xAuthors Girolamo Mattioli, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyStefano Avanzini, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyAlessio Pini-Prato, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyPiero Buffa, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyEdoardo Guida, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyGiovanni Rapuzzi, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyMichele Torre, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyValentina Rossi, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyGiovanni Montobbio, G. Gaslini Children’s Hospital Anesthesiology and Intensive Care Unit Genoa ItalyUbaldo Rosati, G. Gaslini Children’s Hospital Quality Control Office Genoa ItalyVincenzo Jasonni, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa Italy Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Abdominal posterior rectopexy with an omental pedicle for intractable rectal prolapse: a modified technique
Thu, 25 Jun 2009 06:52:33 -0000
Abstract Introduction Rectal prolapse is a relatively common paediatric surgical condition. It has a number of benign aetiologies. Management is usually centred on regulating bowel habits. Surgery is considered after the failure of medical treatment. Numerous surgical techniques have been described with a spectrum of results. Materials and methods We adopted a limited abdominal approach to achieve a posterior rectopexy using an omental pedicle in intractable cases. This technique has not been performed in children previously. Results From 2005 to 2008 we have applied this technique on five patients with recurrent rectal prolapse which had failed to respond to medical treatment, injection sclerotherapy or perianal cercalage. One patient had solitary rectal ulcer syndrome, and was initially treated with a defunctioning colostomy, had a concomitant sigmoidectomy performed at the time of rectopexy. None of the patients had cystic fibrosis. There were three females and two males, with a mean age of 9.6 years (4.7–14.0). No operative complications were encountered. The mean hospital stay was 5.4 days (3–8). None of the patients experienced recurrence at a mean of 2.1 years (0.2–2.8) follow up. The cosmetic result was regarded as satisfactory by all patients. Conclusion This early experience with abdominal posterior rectopexy using an omental pedicle graft is encouraging. This technique does not involve the use of synthetic material and hence the risk of infection is low. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2404-0Authors K. Elmalik, Sheffield Children’s Hospital Paediatric Surgical Unit Western Bank Sheffield S10 2TH UKH. Dagash, Sheffield Children’s Hospital Paediatric Surgical Unit Western Bank Sheffield S10 2TH UKR. N. Shawis, Sheffield Children’s Hospital Paediatric Surgical Unit Western Bank Sheffield S10 2TH UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Duodenal atresia: associated anomalies, prenatal diagnosis and outcome
Wed, 24 Jun 2009 06:05:37 -0000
Abstract Background The diagnosis of duodenal atresia is commonly made prenatally, either as an isolated lesion or due to its association with other chromosomal abnormalities (Robertson et al. in Semin Perinatol 18:182–195, 1994; Hemming and Rankin in J Prenat Diagn 27:1205–1211, 2007). The aim of this study was to describe the prevalence of associated anomalies, prenatal diagnostic accuracy and survival of cases of congenital duodenal atresia in our institution. Methods All cases of duodenal atresia registered with our local congenital anomaly register over a 10-year period, 1995–2004 inclusive, were studied, including those resulting in termination of pregnancies, stillbirths, intrauterine deaths and neonatal deaths. To ensure high-case ascertainment, data were cross checked with prenatal ultrasound, cytogenetic laboratory, pathology department and neonatal surgical data base. Data were analysed for associated anomalies, accuracy of prenatal diagnosis and neonatal outcomes. Results A total of 65 patients were initially diagnosed as having duodenal atresia, of these 4 were subsequently excluded (1 postnatal normal bowel and 3 high jejunal atresias). In the remaining 61 cases, 35 (57%) had an association with other congenital abnormalities and 26 (43%) were isolated anomalies. Thirty-five were male and 26 female (M:F = 1.4:1). Twenty-one out of 29 (72%) patients prenatally diagnosed, compared with 14 out of 32 (44%) patients diagnosed postnatally had associated anomalies. Duodenal atresia was suspected on routine prenatal ultrasonography at 20-week gestation in 33 cases and confirmed in 29 (48%) cases with 4 false-positive diagnoses (1 normal bowel and 3 high jejunal atresias). No prenatal diagnosis was made in 32 (52%) babies. Of the 61 cases, 53 were live births with 2 early neonatal deaths (1 cardiac and 1 VACTERL), 5 terminations, 2 intrauterine deaths and 1 stillbirth (Fig. 3). Overall neonatal survival was 96% (51 cases). Mortality in the group diagnosed prenatally was 34 % (10 cases). Conclusion This study shows an overall increased association of duodenal atresia with Down’s syndrome. In the group diagnosed prenatally, mortality as well as the association with other congenital anomalies was found to be higher. We have demonstrated a greater prenatal diagnostic accuracy, but confirm postnatal outcomes similar to previous studies. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2406-yAuthors M. S. Choudhry, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UKN. Rahman, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UKP. Boyd, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UKK. Lakhoo, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
The role of basic fibroblast growth factor to enhance fetal intestinal mucosal cell regeneration in vivo
Tue, 23 Jun 2009 06:02:35 -0000
Abstract Background/Purpose The limited application of small bowel transplantation for short bowel syndrome, mainly on the account of the morbidity and long-term implications of the procedure, has led to a search for alternative therapies. The purpose of this study was to evaluate whether basic fibroblast growth factor (bFGF) could facilitate regeneration of fetal small intestinal mucosa in vivo. Methods Intestinal epithelial organoid units harvested from fetal Lewis rats were injected into adult male Lewis rats whose colon was denuded of mucosa, as syngeneic recipients. One experimental group transplanted with the addition of 50 ng/ml bFGF, was compared with a control group that were transplanted without bFGF. The grafts were harvested and analyzed using histology and immunohistochemistry 3 weeks after operation. Results There were 4 anesthetic deaths, two in each group, and 11 deaths due to adhesive ileus. In no rat did neomucosa fully cover the denuded colonic muscle throughout the whole length of lumen. Histologically, the structure of the neomucosa, when present, was normal small intestinal mucosa. The small intestinal mucosa was partially restored in 100% (6 of 6) of bFGF, and in 28.6% (2 of 7) of those not given bFGF (P = 0.0021). Conclusions These data demonstrate that bFGF can facilitate the restoration of intestinal epithelial cells, at least to some degree. Potentially, refinements of this technique could be used to facilitate the physiologic tissue engineering of small intestine in a way that allows it to move peristaltically, and have an application in the management of patients with short bowel syndrome. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2405-zAuthors Atsushi Yoshida, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanTakuo Noda, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanMorimichi Tani, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanTakanori Oyama, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanYasuhiro Watanabe, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanHideyasu Kiyomoto, Kagawa University Division of Nephrology and Dialysis, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanAkira Nishiyama, Kagawa University Department of Pharmacology, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Colon replacement of vagina to restore menstrual function in 11 adolescent girls with vaginal or cervicovaginal agenesis
Sat, 20 Jun 2009 06:00:50 -0000
Abstract Aim Cervicovaginal or vaginal agenesis with functioning endometrial tissue is rare. We report the construction of a colon conduit which is anastomosed to posterior uterine wall or upper vaginal pouch to allow menstruation. Materials and methods We report seven girls with cervicovaginal agenesis and four with lower vaginal agenesis (aged 12–20 years) who presented with painful cryptomenorrheoa. All the girls wanted to conserve their uterus and menstruate normally. A colon conduit was constructed for the egress of menstrual blood. The colon conduit was anastomosed to the posterior uterine wall in the seven girls with cervicovaginal agenesis and to the distended upper vaginal pouch in the four girls with vaginal agenesis. Utero-colonic neovaginal anastomosis was performed only after excising a circular portion of the posterior myometrium to prevent stenosis. Results The colon conduit functioned effectively, providing an egress for regular painless menstruation. One patient had stenosis of the perineal neovaginal orifice for which dilations were done. One girl has married and reports satisfactory intercourse. The mean follow up is 2.2 years. Conclusions This group of patients forms a separate subgroup needing a conduit not only for sexual function but also for menstruation. However, if treated by the method described herein, they should be cautioned against pregnancy if they have cervicovaginal agenesis and against vaginal delivery if they have vaginal agenesis. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2391-1Authors Lavanya Kannaiyan, Christian Medical College and Hospital Vellore IndiaJacob Chacko, Christian Medical College and Hospital Vellore IndiaAlice George, Christian Medical College and Hospital Vellore IndiaSudipta Sen, Christian Medical College and Hospital Vellore India Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
The impact of iatrogenic gastroschisis on pulmonary maturation in the fetal rabbit models of congenital diaphragmatic hernia
Sat, 13 Jun 2009 08:38:14 -0000
Abstract Purpose The aim of this study was to analyze the effect of iatrogenic gastroschisis on pulmonary hypoplasia in fetal rabbits with congenital diaphragmatic hernia (CDH). Materials and methods A total of 30 pregnant rabbits received fetal surgery on gestational day 23. A left diaphragmatic hernia was created in one end fetus (DH group) of each rabbit, and the other end fetus of the same rabbit received sham thoracotomy as control (CR group). Another 19 pregnant rabbits underwent partial resection of the diaphragm in both end fetuses on gestational day 23, and then artificial gastroschisis was performed on one end fetus (GS group) on gestational day 26, while the other end remained as control (CGS group). The fetuses were harvested on gestational day 30. The histological and morphometric evaluation of lungs and livers of the end fetuses in each group was conducted. Results In the DH group, the lungs were hypoplastic with a decrease in the total lung weight to body weight ratio, and remarkable thickening in alveolar septa. The lung vessels showed significantly thicker arterial walls when compared with those from control fetuses. The pathological finding in the CGS group was similar to that of the DH group. The thickness of the alveolar septa and of the pulmonary arterial walls showed no significant difference among the GS group, DH group and the CGS group. The ratio of liver weight to body weight increased notably in the GS group, DH group and CGS group compared with that in the CR group. Conclusions In the fetal rabbit models of CDH, pulmonary hypoplasia is the most significant pathological feature. Iatrogenic gastroschisis does not improve pulmonary maturation due to the active growth of the liver that herniates into the thoracic cavity. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2384-0Authors Gong Chen, FUDAN University Shanghai ChinaShan Zheng, FUDAN University Shanghai ChinaXian Min Xiao, FUDAN University Shanghai ChinaYi Luo, FUDAN University Shanghai China Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358 Journal Volume Volume 25 Journal Issue Volume 25, Number 7 / July, 2009
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Risk management in pediatric surgery
Mon, 29 Jun 2009 10:06:37 -0000
Abstract Purpose To present the experience documented over 1 year of analysis and quality control on surgical complications and organizational accidents. Methods All children admitted during the study period at our Institution were included in the analysis, which consisted of four phases: (1) definition and standardization of perioperative diagnostic and therapeutic tracks; (2) staff education; (3) documentation and data implementation, and (4) “Morbidity and Mortality” audit. Results Over a 1-year study period, 3,116 children were admitted to our Institution: 2,222 out of 3,116 (71.3%) children underwent a surgical procedure. A total number of 184 complications were recorded in 149 patients. One hundred and seventy-one (92.9%) complications occurred following a surgical procedure. Fifty-six out of 149 complicated patients (37.6%) required a re-operation. Thirty-five out of 184 (19%) complications were classified as organizational. Infection represented the most common complication. All cases of anastomotic dehiscence and perforation, bowel obstruction, and stoma malfunction required reintervention. None of the postoperative bleedings required a second surgical procedure. Conclusion Although a proper statistical comparison with literature complication rates is not feasible, our experience confirms the importance of quality-control audit in health care systems. Prolonged observation, long-term follow up, and comparison with previous results will represent our future goal. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2407-xAuthors Girolamo Mattioli, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyStefano Avanzini, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyAlessio Pini-Prato, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyPiero Buffa, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyEdoardo Guida, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyGiovanni Rapuzzi, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyMichele Torre, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyValentina Rossi, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa ItalyGiovanni Montobbio, G. Gaslini Children’s Hospital Anesthesiology and Intensive Care Unit Genoa ItalyUbaldo Rosati, G. Gaslini Children’s Hospital Quality Control Office Genoa ItalyVincenzo Jasonni, G. Gaslini Children’s Hospital Pediatric Surgery Department Largo G. Gaslini, 5 16147 Genoa Italy Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Abdominal posterior rectopexy with an omental pedicle for intractable rectal prolapse: a modified technique
Thu, 25 Jun 2009 06:52:33 -0000
Abstract Introduction Rectal prolapse is a relatively common paediatric surgical condition. It has a number of benign aetiologies. Management is usually centred on regulating bowel habits. Surgery is considered after the failure of medical treatment. Numerous surgical techniques have been described with a spectrum of results. Materials and methods We adopted a limited abdominal approach to achieve a posterior rectopexy using an omental pedicle in intractable cases. This technique has not been performed in children previously. Results From 2005 to 2008 we have applied this technique on five patients with recurrent rectal prolapse which had failed to respond to medical treatment, injection sclerotherapy or perianal cercalage. One patient had solitary rectal ulcer syndrome, and was initially treated with a defunctioning colostomy, had a concomitant sigmoidectomy performed at the time of rectopexy. None of the patients had cystic fibrosis. There were three females and two males, with a mean age of 9.6 years (4.7–14.0). No operative complications were encountered. The mean hospital stay was 5.4 days (3–8). None of the patients experienced recurrence at a mean of 2.1 years (0.2–2.8) follow up. The cosmetic result was regarded as satisfactory by all patients. Conclusion This early experience with abdominal posterior rectopexy using an omental pedicle graft is encouraging. This technique does not involve the use of synthetic material and hence the risk of infection is low. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2404-0Authors K. Elmalik, Sheffield Children’s Hospital Paediatric Surgical Unit Western Bank Sheffield S10 2TH UKH. Dagash, Sheffield Children’s Hospital Paediatric Surgical Unit Western Bank Sheffield S10 2TH UKR. N. Shawis, Sheffield Children’s Hospital Paediatric Surgical Unit Western Bank Sheffield S10 2TH UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Duodenal atresia: associated anomalies, prenatal diagnosis and outcome
Wed, 24 Jun 2009 06:05:37 -0000
Abstract Background The diagnosis of duodenal atresia is commonly made prenatally, either as an isolated lesion or due to its association with other chromosomal abnormalities (Robertson et al. in Semin Perinatol 18:182–195, 1994; Hemming and Rankin in J Prenat Diagn 27:1205–1211, 2007). The aim of this study was to describe the prevalence of associated anomalies, prenatal diagnostic accuracy and survival of cases of congenital duodenal atresia in our institution. Methods All cases of duodenal atresia registered with our local congenital anomaly register over a 10-year period, 1995–2004 inclusive, were studied, including those resulting in termination of pregnancies, stillbirths, intrauterine deaths and neonatal deaths. To ensure high-case ascertainment, data were cross checked with prenatal ultrasound, cytogenetic laboratory, pathology department and neonatal surgical data base. Data were analysed for associated anomalies, accuracy of prenatal diagnosis and neonatal outcomes. Results A total of 65 patients were initially diagnosed as having duodenal atresia, of these 4 were subsequently excluded (1 postnatal normal bowel and 3 high jejunal atresias). In the remaining 61 cases, 35 (57%) had an association with other congenital abnormalities and 26 (43%) were isolated anomalies. Thirty-five were male and 26 female (M:F = 1.4:1). Twenty-one out of 29 (72%) patients prenatally diagnosed, compared with 14 out of 32 (44%) patients diagnosed postnatally had associated anomalies. Duodenal atresia was suspected on routine prenatal ultrasonography at 20-week gestation in 33 cases and confirmed in 29 (48%) cases with 4 false-positive diagnoses (1 normal bowel and 3 high jejunal atresias). No prenatal diagnosis was made in 32 (52%) babies. Of the 61 cases, 53 were live births with 2 early neonatal deaths (1 cardiac and 1 VACTERL), 5 terminations, 2 intrauterine deaths and 1 stillbirth (Fig. 3). Overall neonatal survival was 96% (51 cases). Mortality in the group diagnosed prenatally was 34 % (10 cases). Conclusion This study shows an overall increased association of duodenal atresia with Down’s syndrome. In the group diagnosed prenatally, mortality as well as the association with other congenital anomalies was found to be higher. We have demonstrated a greater prenatal diagnostic accuracy, but confirm postnatal outcomes similar to previous studies. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2406-yAuthors M. S. Choudhry, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UKN. Rahman, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UKP. Boyd, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UKK. Lakhoo, Children’s hospital Oxford and University of Oxford Department of paediatric surgery Headley Way Oxford OX39DU UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
The role of basic fibroblast growth factor to enhance fetal intestinal mucosal cell regeneration in vivo
Tue, 23 Jun 2009 06:02:35 -0000
Abstract Background/Purpose The limited application of small bowel transplantation for short bowel syndrome, mainly on the account of the morbidity and long-term implications of the procedure, has led to a search for alternative therapies. The purpose of this study was to evaluate whether basic fibroblast growth factor (bFGF) could facilitate regeneration of fetal small intestinal mucosa in vivo. Methods Intestinal epithelial organoid units harvested from fetal Lewis rats were injected into adult male Lewis rats whose colon was denuded of mucosa, as syngeneic recipients. One experimental group transplanted with the addition of 50 ng/ml bFGF, was compared with a control group that were transplanted without bFGF. The grafts were harvested and analyzed using histology and immunohistochemistry 3 weeks after operation. Results There were 4 anesthetic deaths, two in each group, and 11 deaths due to adhesive ileus. In no rat did neomucosa fully cover the denuded colonic muscle throughout the whole length of lumen. Histologically, the structure of the neomucosa, when present, was normal small intestinal mucosa. The small intestinal mucosa was partially restored in 100% (6 of 6) of bFGF, and in 28.6% (2 of 7) of those not given bFGF (P = 0.0021). Conclusions These data demonstrate that bFGF can facilitate the restoration of intestinal epithelial cells, at least to some degree. Potentially, refinements of this technique could be used to facilitate the physiologic tissue engineering of small intestine in a way that allows it to move peristaltically, and have an application in the management of patients with short bowel syndrome. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2405-zAuthors Atsushi Yoshida, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanTakuo Noda, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanMorimichi Tani, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanTakanori Oyama, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanYasuhiro Watanabe, Kagawa University Department of Pediatric Surgery, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanHideyasu Kiyomoto, Kagawa University Division of Nephrology and Dialysis, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 JapanAkira Nishiyama, Kagawa University Department of Pharmacology, Faculty of Medicine Miki-cho, Kida-gun Kagawa 761-0793 Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Colon replacement of vagina to restore menstrual function in 11 adolescent girls with vaginal or cervicovaginal agenesis
Sat, 20 Jun 2009 06:00:50 -0000
Abstract Aim Cervicovaginal or vaginal agenesis with functioning endometrial tissue is rare. We report the construction of a colon conduit which is anastomosed to posterior uterine wall or upper vaginal pouch to allow menstruation. Materials and methods We report seven girls with cervicovaginal agenesis and four with lower vaginal agenesis (aged 12–20 years) who presented with painful cryptomenorrheoa. All the girls wanted to conserve their uterus and menstruate normally. A colon conduit was constructed for the egress of menstrual blood. The colon conduit was anastomosed to the posterior uterine wall in the seven girls with cervicovaginal agenesis and to the distended upper vaginal pouch in the four girls with vaginal agenesis. Utero-colonic neovaginal anastomosis was performed only after excising a circular portion of the posterior myometrium to prevent stenosis. Results The colon conduit functioned effectively, providing an egress for regular painless menstruation. One patient had stenosis of the perineal neovaginal orifice for which dilations were done. One girl has married and reports satisfactory intercourse. The mean follow up is 2.2 years. Conclusions This group of patients forms a separate subgroup needing a conduit not only for sexual function but also for menstruation. However, if treated by the method described herein, they should be cautioned against pregnancy if they have cervicovaginal agenesis and against vaginal delivery if they have vaginal agenesis. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2391-1Authors Lavanya Kannaiyan, Christian Medical College and Hospital Vellore IndiaJacob Chacko, Christian Medical College and Hospital Vellore IndiaAlice George, Christian Medical College and Hospital Vellore IndiaSudipta Sen, Christian Medical College and Hospital Vellore India Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
The impact of iatrogenic gastroschisis on pulmonary maturation in the fetal rabbit models of congenital diaphragmatic hernia
Sat, 13 Jun 2009 08:38:14 -0000
Abstract Purpose The aim of this study was to analyze the effect of iatrogenic gastroschisis on pulmonary hypoplasia in fetal rabbits with congenital diaphragmatic hernia (CDH). Materials and methods A total of 30 pregnant rabbits received fetal surgery on gestational day 23. A left diaphragmatic hernia was created in one end fetus (DH group) of each rabbit, and the other end fetus of the same rabbit received sham thoracotomy as control (CR group). Another 19 pregnant rabbits underwent partial resection of the diaphragm in both end fetuses on gestational day 23, and then artificial gastroschisis was performed on one end fetus (GS group) on gestational day 26, while the other end remained as control (CGS group). The fetuses were harvested on gestational day 30. The histological and morphometric evaluation of lungs and livers of the end fetuses in each group was conducted. Results In the DH group, the lungs were hypoplastic with a decrease in the total lung weight to body weight ratio, and remarkable thickening in alveolar septa. The lung vessels showed significantly thicker arterial walls when compared with those from control fetuses. The pathological finding in the CGS group was similar to that of the DH group. The thickness of the alveolar septa and of the pulmonary arterial walls showed no significant difference among the GS group, DH group and the CGS group. The ratio of liver weight to body weight increased notably in the GS group, DH group and CGS group compared with that in the CR group. Conclusions In the fetal rabbit models of CDH, pulmonary hypoplasia is the most significant pathological feature. Iatrogenic gastroschisis does not improve pulmonary maturation due to the active growth of the liver that herniates into the thoracic cavity. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2384-0Authors Gong Chen, FUDAN University Shanghai ChinaShan Zheng, FUDAN University Shanghai ChinaXian Min Xiao, FUDAN University Shanghai ChinaYi Luo, FUDAN University Shanghai China Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358 Journal Volume Volume 25 Journal Issue Volume 25, Number 7 / July, 2009
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Meta Description: [ Craniofacial Group Paris-France: Management of anomalies of skull and face: craniostenosis, craniosynostosis, facial clefts, hypertelorism, Crouzon, Apert, tumors and trauma ]
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Meta Description: [ Rocky Mountain Pediatric Surgery provides pediatric surgery for sick children as well as minimally invasive surgery. Rocky Mountain Pediatric Surgery is located in Denver, Colorado and serves the Denver metro area. ]
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Yale University Pediatric Surgery - Offers full range of general and specialized pediatric surgical services, as well as support to parents of chronically ill children. Affiliated with Yale-New Haven's Children's Hospital.
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