Surgeons_and_Clinics RSS : Gourt

A review of patch options in the repair of congenital diaphragm defects

Abstract Repair of congenital diaphragmatic hernia (CDH) continues to pose a dilemma for the pediatric surgeon. While the management of CDH has evolved from surgical urgency to delayed repair after medical optimization with substantial improvements in mortality, morbidity continues to perplex clinicians. Significant morbidity occurs with recurrence, re-recurrence and complications such as obstructions, principally with mesh repair. When primary closure is not possible, mesh repair is indicated. While there are several non-absorbable prosthetic, absorbable biosynthetic and composite mesh types available, the ideal mesh remains elusive. In this article, we reviewed the current materials, reported advantages, and animal and clinical studies of non-absorbable prosthetic, absorbable biosynthetic and composite mesh. However, adequate comparative data are lacking, leaving a wide void for future animal models and clinical studies. Content Type Journal ArticleCategory Review ArticlePages 1-7DOI 10.1007/s00383-012-3059-9Authors Alessandra C. Gasior, Department of Pediatric Surgery, The Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USAShawn D. St. Peter, Department of Pediatric Surgery, The Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Pediatric surgical site infection in the developing world: a Kenyan experience

Abstract Background The purpose of the current study was to determine the incidence of pediatric surgical site infections (SSIs) at an academic children’s hospital in rural sub-Saharan Africa and to identify potentially modifiable risk factors. Methods Prospectively collected data from 1,008 surgical admissions to BethanyKids Kijabe Hospital (Kijabe, Kenya) were analyzed retrospectively. Follow-up data were available in 940 subjects. Results SSIs occurred in 6.8% of included subjects (N = 64). Superficial (69%) and deep (29%) infections of the back (38%) and head (25%) were most common. When comparing children who developed SSI to those who did not, we found that wound contamination classification and duration of operation were the only variables with significant differences between groups. Conclusions Our rate of SSI among pediatric patients in sub-Saharan Africa is the lowest reported in the literature to date. More work is needed to identify modifiable risk factors for pediatric SSI in low- and middle-income countries. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00383-012-3058-xAuthors James H. Wood, Department of Surgery, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Box C302, Aurora, CO 80045, USAPeter M. Nthumba, BethanyKids at Kijabe Hospital, Kijabe, KenyaEdita Stepita-Poenaru, BethanyKids at Kijabe Hospital, Kijabe, KenyaDan Poenaru, BethanyKids at Kijabe Hospital, Kijabe, Kenya Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Single trocar retroperitoneoscopic nephrectomy for unilateral multicystic dysplastic kidney in children

Abstract The author presents the first report in performing single trocar nephrectomy for five patients with multicystic dysplastic kidney (MCDK). The mean operative time was 66 min and mean postoperative hospital stay was 36 h. There were no perioperative complications. The one-trocar nephrectomy is a feasible and safe procedure for patients with MCDK. Content Type Journal ArticleCategory Technical InnovationPages 1-3DOI 10.1007/s00383-012-3056-zAuthors N. T. Liem, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, VietnamL. A. Dung, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, VietnamN. D. Viet, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, Vietnam Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Does necrotizing enterocolitis affect growth and neurodevelopmental outcome in very low birth weight infants?

Abstract Aim To evaluate the effect of necrotizing enterocolitis (NEC) on growth and neurodevelopmental outcome. Patients and methods Neurodevelopmental outcome of 20 of 39 surviving very low birthweight infants (VLBW) diagnosed with NEC between 2007 and 2009 was compared with 40 control infants matched for gestational age and year of admission. Follow-up studies were performed at 18 and 24 months of corrected age. Bayley Scales of Infant Development-Second Edition scale was used for neurodevelopmental assessment. Results At 18–24 months corrected age, body weight, body length, and head circumference did not differ significantly between the NEC and without NEC groups. The median mental developmental index (62 vs. 75, p = 0.008) and psychomotor developmental index points (72 vs. 91.5, p = 0.002) were lower in infants with NEC compared to without NEC, respectively. Although the rate of neurodevelopmental impairment was slightly higher in infants with NEC, there were no differences between the groups according to the frequency of minimal impairment and cerebral palsy. Growth or neurodevelopmental outcome did not differ between the NEC survivors with and without surgery. Conclusion Necrotizing enterocolitis has affected neurodevelopmental outcome but not growth in VLBW infants at 18–24 months of corrected age. Both those treated medically or requiring surgery need close neurodevelopmental follow-up for the first years of life. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-012-3051-4Authors Dilek Dilli, Department of Neonatology, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyZeynep Eras, Department of Developmental Pediatrics, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyHülya Özkan Ulu, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyUğur Dilmen, Department of Neonatology, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyEvrim Durgut Şakrucu, Department of Developmental Pediatrics, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Therapeutic outcome and prognosis in young patients with papillary and follicular thyroid cancer

Abstract Background Papillary and follicular thyroid cancer is a common malignancy in young patients, and the incidence of this cancer has been increasing. The aims of this study are to assess the clinical characteristics of papillary and follicular thyroid cancer in young patients and evaluate the long-term therapeutic outcomes and prognostic factors for cancer mortality and recurrence. Methods We performed a retrospective analysis of 116 patients aged ≤20 years who underwent thyroidectomy and a mean follow-up of 11.1 ± 0.6 years. Results There were 28 (24.1%) patients classified into the residual cancer or relapse groups. The progression-free survival rate for the young patients was lower than that of the patients between 20 and 45 years of age; however, the difference between the thyroid cancer survival rates was not statistically different. Two of the 28 patients died of thyroid cancer. Thirteen patients who showed relapsed underwent 131I whole-body scan; 6 of the 13 patients were diagnosed with distant metastases to the lung and 1 was diagnosed with distant metastases to the bones. Among the young patients, the 5- and 10-year progression-free survival rates were 79.1 and 73.4%, respectively, and the corresponding cancer survival rates were 99.1, and 96.5%, respectively. Conclusion The progression-free survival in young patients with papillary and follicular thyroid cancer was lower than the patients of age 20–45 years; otherwise, cancer survival was higher than age group over or equal to 45 years. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-012-3054-1Authors Chung-Huei Huang, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROCTzu-Chieh Chao, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCChuen Hseuh, Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCKun-Ju Lin, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCTsung-Ying Ho, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCShu-Fu Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROCJen-Der Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROC Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

The use of Onyx for embolization of peripheral vascular malformations in pediatric patients

Abstract Purpose The management of congenital peripheral vascular malformations (VMs) can present a difficult therapeutic challenge. Endovascular transcatheter embolization of peripheral VMs is widely accepted as a first therapeutic option for many VMs. However, data describing the use of Onyx are limited in children with peripheral VMs. Our aim is to retrospectively evaluate the results of transcatheter arterial embolization with Onyx for peripheral VMs in children. Materials and methods We analyzed clinical and imaging records of 16 patients who underwent 25 embolization procedures by using Onyx for peripheral VMs. In eight cases, embolization procedures were performed once; in seven cases, twice; and in one case, thrice. Results Embolization was technically complete in 4 patients and incomplete in 12 patients. Clinically, complete success was achieved in nine patients, and partial success was achieved in six patients. In one patient, reflux to the anterior and posterior tibial arteries caused peripheral ischemia, and the patient was referred to undergo plastic surgery. There were no complications in the other 15 patients. Conclusion With future studies to better characterize the safety profile of this agent in peripheral vasculature, embolization with Onyx may become a valuable treatment option for peripheral VMs in pediatric patients. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s00383-012-3052-3Authors Murat Cantasdemir, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFatih Gulsen, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeySerdar Solak, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyGokce Yalcin Gulsen, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFatih Kantarci, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFuruzan Numan, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Magnetic compression gastrostomy in the rat

Abstract Purpose Magnetic compression anastomosis is used for gastrointestinal, biliary, and urinary anastomoses. We have developed a simple magnetic compression gastrostomy technique in rats. Methods Animals were randomized into two groups (n = 12 each): magnetic gastrostomy (MG) and surgical gastrostomy (SG) (control). In the MG group, a magnetic insertion catheter was coupled with the first magnetic ball and introduced transorally into the stomach. A second magnetic ball was placed subcutaneously into the left upper quadrant. The two magnetic balls (4 mm) were strongly coupled together. On postoperative day (PD) 20 (MG group) and PD10 (SG group), rats were killed, gastrostomies were evaluated macroscopically and histopathologically, and mechanical burst testing was performed. Results Two animals died due to suspected leaks. Macroscopic evaluation indicated no gastrostomy canal in one rat in each group. Mild adhesion was observed in two rats in the MG group. Moderate adhesion was observed in all rats in the SG group. No significant differences were observed in burst pressure between the two groups (means: MG group, 143 mmHg, n = 9; SG group, 159 mmHg, n = 8). Conclusions Magnetic compression gastrostomy can be performed easily in rats, and may be developed in future as a simple alternative to some gastrostomy procedures in humans. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-012-3053-2Authors Ibrahim Uygun, Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, TurkeyMehmet Hanifi Okur, Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, TurkeyHasan Cimen, Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, TurkeyAysenur Keles, Department of Pathology, Medical Faculty of Dicle University, 21280 Diyarbakir, TurkeyOzben Yalcin, Department of Pathology, Hospital of Children, 21280 Diyarbakir, TurkeyHayrettin Ozturk, Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Abant Izzet Baysal University, 14280 Bolu, TurkeySelcuk Otcu, Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Urinary incontinence in children: botulinum toxin is a safe and effective treatment option

Abstract Purpose This study’s aim was to assess the use of intravesical injection of botulinum neurotoxin type A (BoNT-A) as a treatment of overactive bladder (OAB) in children. Methods A 6-year retrospective study of children who received BoNT-A for OAB was performed. Treatment outcome was classified as complete success (CS), partial success (PS) or treatment failure (TF). Results Of the 57 patients who received BoNT-A treatment for OAB, 35 were males. CS occurred in 74.2% of males and 54.5% of females. PS was achieved in 20% of males and 18.2% of females. TF occurred in 2.9% of males and 22.7% of females. Anticholinergics had previously been used and had been effective in 58.6% and 83.3% of males and females. Significant side effects to medications were experienced in 12 (41.4%) males and 4 (22.2%) females. Of these, BoNT-A achieved CS in seven (53.3%) males and two (50%) females and PS in three (25%) males and one (25%) female. BoNT-A was successful in seven (58.3%) males and two (66.7%) females where anticholinergics were ineffective. Conclusions BoNT-A has a role in a carefully selected subgroup of children with overactive bladder symptoms including those with medication side effects and treatment compliance issues. It may have a role in patients who do not respond to conventional therapy. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3039-5Authors Dermot Thomas McDowell, Department of Paediatric Urology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, IrelandDamien Noone, Department of Paediatric Nephrology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, IrelandFarhan Tareen, Department of Paediatric Urology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, IrelandMary Waldron, Department of Paediatric Nephrology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, IrelandFeargal Quinn, Department of Paediatric Urology, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, Ireland Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Near-miss events are really missed! Reflections on incident reporting in a department of pediatric surgery

Abstract Purpose The aim of this study was to evaluate the frequency of surgical and organizational events that occurred in the whole Department of Paediatric Surgery at Gaslini Children’s Hospital through an incident-reporting system in order to identify the vulnerabilities of this system and improve it. Materials and methods This is a 6-month prospective observational study (1st January–1st July 2010) of all events (including surgical and organizational events, and near misses) that occurred in our department of surgery (pediatric surgery, orthopedics and neurosurgery units). Results Over a 6-month study period, 3,635 children were admitted: 1,904 out of 3,635 (52.4%) children underwent a surgical procedure. A total number of 111 adverse events and 4 near misses were recorded in 100 patients. A total of 108 (97.3%) adverse events occurred following a surgical procedure. Of 111 adverse events, 34 (30.6%) required re-intervention. Eighteen of 100 patients (18%) required a re-admission, and 18 of 111 adverse events (16.2%) were classified as organizational. Infection represented the most common event. Conclusions An electronic physician-reported event tracking system should be incorporated into all surgery departments to report more accurately adverse events and near misses. In this system, all definitions must be standardized and near misses should be considered as important as the other events, being a rich source of learning. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3047-5Authors Girolamo Mattioli, Pediatric Surgery Department, Giannina Gaslini Institute, University of Genoa, Genoa, ItalyEdoardo Guida, Pediatric Surgery Department, Giannina Gaslini Institute, University of Genoa, Genoa, ItalyGiovanni Montobbio, Anaesthesia and Intensive Care Department, Giannina Gaslini Institute, Genoa, ItalyAlessio Pini Prato, Pediatric Surgery Department, Giannina Gaslini Institute, University of Genoa, Genoa, ItalyMarcello Carlucci, Pediatric Surgery Department, Giannina Gaslini Institute, University of Genoa, Genoa, ItalyArmando Cama, Neurosurgery Department, Giannina Gaslini Institute, Genoa, ItalySilvio Boero, Orthopedic Surgery Department, Giannina Gaslini Institute, Genoa, ItalyMaria Beatrice Michelis, Orthopedic Surgery Department, Giannina Gaslini Institute, Genoa, ItalyElio Castagnola, Infectious Disease Department, Giannina Gaslini Institute, Genoa, ItalyUbaldo Rosati, Quality Control Office, Giannina Gaslini Institute, Genoa, ItalyVincenzo Jasonni, Pediatric Surgery Department, Giannina Gaslini Institute, University of Genoa, Genoa, Italy Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Colonic venous malformation and portal hypertension: association, management, and review of the literature

Abstract We present a case of an adolescent with lower gastrointestinal bleeding caused by a colorectal venous malformation (VM) with concomitant portal hypertension. After an episode of massive gastrointestinal bleeding, we performed an extended right hemicolectomy and resection of the VM and selective portosystemic shunt. Here, we present the case and review the literature regarding portal hypertension and gastrointestinal vascular malformations. Additionally, we discuss the physiologic and hemodynamic effects of gastrointestinal vascular malformations on the portal system. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00383-011-3041-yAuthors James R. Pierce, Department of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd #100, Los Angeles, CA 90027, USACatherine J. Hunter, Department of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd #100, Los Angeles, CA 90027, USABindi Naik-Mathuria, Department of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd #100, Los Angeles, CA 90027, USAPhilip Stanley, Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, USAHenri R. Ford, Department of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd #100, Los Angeles, CA 90027, USAYuri Genyk, Department of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd #100, Los Angeles, CA 90027, USADonald B. Shaul, Department of Surgery, Kaiser Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, USAAndre Panossian, Vascular Anomalies Center, Children’s Hospital Los Angeles, Los Angeles, USADean M. Anselmo, Department of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd #100, Los Angeles, CA 90027, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

A prospective, randomized, double-blind study comparing the efficacy of diltiazem, glyceryl trinitrate, and lidocaine for the treatment of anal fissure in children

Abstract Purpose Anal fissure (AF) is a common perianal condition in children. Although adult patients with AF have been treated successfully using diltiazem, it has not been studied in children. The present randomized, prospective, double-blind study assessed the response, side effects, and recurrence of diltiazem. Methods Ninety-three children with AF were randomly divided into three groups. Each group received topical ointment. Group GTN received 0.2% glyceryl trinitrate, group L received 10% lidocaine, and group D received 2% diltiazem ointment. Results Eighty-two patients completed the 12-month study. At the end of the first 8-week course, the healing rate in group D was significantly higher than that of the other groups (p < 0.0001, χ 2 = 19.82). Nonresponders received a second course of the same treatment. Group D showed significantly higher healing rates than the other groups (p < 0.05, χ 2 = 7.227) at the end of the second 8-week course. The group D recurrence rate was significantly different than that of the other groups (p < 0. 002, χ 2 = 12.79). Conclusion Diltiazem application is effective and safe for the treatment of AF in children, and has a low recurrence rate. The smooth dose–concentration curve causes minimal side effects. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3048-4Authors Muazez Cevik, Çocuk Cerrahisi Anabilim Dali, Harran Universitesi Tip Fakultesi, Morfoloji Binasi, Yenisehir Kampusu, 63300 Sanliurfa, TurkeyMehmet Emin Boleken, Çocuk Cerrahisi Anabilim Dali, Harran Universitesi Tip Fakultesi, Morfoloji Binasi, Yenisehir Kampusu, 63300 Sanliurfa, TurkeyIbrahim Koruk, Halk Sagligi Anabilim Dali, Harran Universitesi Tip Fakultesi, Morfoloji Binasi, Yenisehir Kampusu, 63300 Sanliurfa, TurkeyServet Ocal, Çocuk Cerrahisi Anabilim Dali, Harran Universitesi Tip Fakultesi, Morfoloji Binasi, Yenisehir Kampusu, 63300 Sanliurfa, TurkeyMehmet Emin Balcioglu, Çocuk Cerrahisi Anabilim Dali, Harran Universitesi Tip Fakultesi, Morfoloji Binasi, Yenisehir Kampusu, 63300 Sanliurfa, TurkeyAsim Aydinoglu, Çocuk Cerrahisi Anabilim Dali, Harran Universitesi Tip Fakultesi, Morfoloji Binasi, Yenisehir Kampusu, 63300 Sanliurfa, TurkeyCetin Ali Karadag, Çocuk Cerrahisi Anabilim Dali, Sisli Etfal Egitim ve Arastitma Hastanesi, SEAH Cocuk Cerrahisi ABD, Istanbul, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Small bowel skip segment Hirschprung’s disease presenting with perforated Meckel’s diverticulum

Abstract Skip segment Hirschprung’s disease (SSHD) is an uncommon variant of Hirschprung’s disease where normal intestine is interspersed proximally and distally by abnormal, aganglionated intestine. These segmental changes have no well-defined embryological explanation. We present a case of SSHD in the small bowel and concomitant perforated Meckel’s diverticulum, with review of the literature relevant to SSHD. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00383-011-3050-xAuthors B. L. Skelly, Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, 274 Grovesnor Road, Belfast, BT12 6BA Northern Ireland, UKE. Ervine, Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, 274 Grovesnor Road, Belfast, BT12 6BA Northern Ireland, UKM. Bisharat, Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, 274 Grovesnor Road, Belfast, BT12 6BA Northern Ireland, UKC. Gannon, Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, 274 Grovesnor Road, Belfast, BT12 6BA Northern Ireland, UKA. C. Dick, Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, 274 Grovesnor Road, Belfast, BT12 6BA Northern Ireland, UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Single scrotal incision for repair of bilateral inguinal hernias in boys

Abstract Purpose Single scrotal incision for repair of bilateral inguinal hernias in boys is a new and attractive approach. However, the advantages and drawbacks of this approach have not been fully discussed in the literature and it has not been widely accepted as a standard procedure for repair of bilateral inguinal hernias. We develop the median raphe approach and this study is aimed to clarify the outcomes of this new technique. Methods From January 2006 to December 2010, we studied 114 boys with bilateral inguinal hernias who underwent trans-scrotal repairs using median raphe incisions. The follow-up durations ranged from 12 to 36 months. The operation time and morbidity of this approach were compared to those of 91 boys who underwent conventional bilateral inguinal incision herniorrhaphy from January 2001 to December 2005. Results The operation times were equal in both approaches. The incidence of stitch abscesses was a little higher in scrotal incision group. All the boys with the scrotal approach had excellent cosmetic results. Conclusion The median raphe approach for bilateral inguinal hernia repair is a good alternative to the conventional method for boys. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3049-3Authors Tune-Yih Shih, Chi-Mei Medical Center, YongKang, Tainan, Taiwan, ROCYih-Huei Uen, Chi-Mei Medical Center, YongKang, Tainan, Taiwan, ROC Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Transumbilical laparoendoscopic single-site pyeloplasty in infants and children: initial experience and short-term outcome

Abstract Background Scar-free abdominal wall surgery is a research hotspot in recent years. This study presented surgical skills of transumbilical laparoendoscopic single-site pyeloplasty (LESS-P) for pediatric patients with ureteropelvic junction obstruction (UPJO) and its clinical application. Methods Twenty-four pediatric patients with UPJO had transumbilical LESS-P performed by the same surgeon from June to December 2010. Among them, 16 were males and 8 females aged from 2 to 62 months with average of 14 months. Eighteen patients had obstruction on the left ureteropelvic junction and six on the right. The renal pelvis and ureter were anastomosed using 5-0 absorbable sutures and a double-J ureteric stent was placed through the anastomotic stoma. Results All operations were successful. None was converted to open surgery and no additional sheath tube or incision besides umbilicus was needed. No intraoperative complications occurred. Ectopic blood vessels were found in two cases during surgery. The mean operative time was 145 min, and the average blood loss about 10 ml. Abdominal drainage tubes were remained for 2–9 days after surgery. The mean postoperative hospital time was 7 days. Two patients had postoperative urinary fistula, which naturally disappeared at 4 and 7 days of postoperation, respectively. Ultrasound and diuretic renal scintigraphy in follow-up found 23 patients had significantly decreased renal pelvis diameter. Although the other one showed no obvious change, but diuretic renography showed significantly improved excretion as indicated by increased glomerular filtration rate from 29 ml/min before surgery to 46 ml/min 6 months after surgery. Conclusion Pediatric transumbilical LESS-P is not only safe and effective but also can well meet patient’s aesthetic desire for scar-free abdominal wall. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00383-011-3040-zAuthors Huixia Zhou, Department of Urology, Bayi Children’s Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People’s Republic of ChinaNing Sun, Department of Urology, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of ChinaXu Zhang, Department of Urology, China PLA General Hospital, Beijing, People’s Republic of ChinaHuawei Xie, Department of Urology, Bayi Children’s Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People’s Republic of ChinaLifei Ma, Department of Urology, Bayi Children’s Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People’s Republic of ChinaZhou Shen, Department of Urology, Bayi Children’s Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People’s Republic of ChinaXiaoguang Zhou, Department of Urology, Bayi Children’s Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People’s Republic of ChinaTian Tao, Department of Urology, Bayi Children’s Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People’s Republic of China Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Preserving the continuity of round ligament along with hernia sac in indirect inguinal hernia repair in female children does not increase the recurrence rate of hernia. Experience with 217 cases

Abstract Purpose In the standard classical method of indirect inguinal hernia (IIH) repair in female children, after transligation of hernia sac along with round ligament at the level of internal ring, the distal portion is divided or cut off, thereby removing a possible future support for the internal genital organs. In this article, we propose a modification to the standard technique for IIH repair which preserves the continuity of round ligament along with hernia sac without increasing the recurrence rate. Methods In a 3-year prospective clinical trial, from March 2007 to March 2010, IIH repairs were performed on 217 female children. In all of these cases, the hernia sac along with round ligament is only transligated at the level of internal ring and a window is created in the distal portion of the sac to prevent a hydrocele formation and the continuity of round ligament along with hernia sac was preserved. The charts of these patients were then analyzed to determine if recurrence had occurred. In addition, we noted any other early postoperative complications such as wound infection, bleeding, and tolerance. Results Within the 25-month mean follow-up period (6–36 months), none of the patients developed any of the above-mentioned complications. The most important result of this study was that preserving the continuity of round ligament along with hernia sac did not increase the rate of recurrence. Conclusion On the basis of results obtained from this study, we conclude that preserving the continuity of round ligament along with hernia sac in female children during IIH repair does not increase the rate of recurrence, and is less intrusive to the normal anatomy of the inguinal region and needs less time to do. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3025-yAuthors Mansour Mollaeian, Bahrami Children’s Hospital, Tehran University of Medical Science, Tehran, IranArash Mollaeian, Bahrami Children’s Hospital, Tehran University of Medical Science, Tehran, IranMaryam Ghavami-Adel, Bahrami Children’s Hospital, Tehran University of Medical Science, Tehran, IranAli Abdullahi, Bahrami Children’s Hospital, Tehran University of Medical Science, Tehran, IranBabak Torabi, Bahrami Children’s Hospital, Tehran University of Medical Science, Tehran, Iran Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Evaluation of intra-lesional corticosteroids in the treatment of peri-ocular haemangioma of infancy: still an alternative besides propranolol

Abstract Purpose Haemangioma of infancy (HOI) is the most frequently occurring benign tumour of infancy. Alarming HOI require treatment. Current therapy is empirically based; corticosteroids are often administered but in recent publications propranolol was reported to be more effective. Peri-ocular HOI are highly sensitive to corticosteroids. Our goal was to evaluate the effectiveness of intra-lesional corticosteroids in the treatment of peri-ocular HOI. Methods We selected all patients with peri-ocular HOI who had only been treated with intra-lesional corticosteroids at our hospital from 1993 until 2009. Treatment was standardized according to a prospective protocol. Results A total of n = 34 patients were included. There were no complications at all after therapy. A second intra-lesional injection was necessary in five patients. At follow-up after 6 and 12 months after injection, 94 and 91% of the patients, respectively, had regression of the HOI. Astigmatism, Haemangioma Activity Score and global assessments all had improved after therapy. Conclusions This study shows that intra-lesional therapy with corticosteroids is very safe in the treatment of peri-ocular HOI. It remains a good and safe alternative besides propranolol or when propranolol therapy is not possible (e.g. asthma, PHACE syndrome, and certain cardiac diseases). Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3037-7Authors Sherief R. Janmohamed, Department of Paediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The NetherlandsGerard C. Madern, Department of Paediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The NetherlandsKlaske Nieuwenhuis, Department of Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The NetherlandsPeter C. J. de Laat, Department of Paediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The NetherlandsArnold P. Oranje, KinderHaven, Havenziekenhuis, Rotterdam, The Netherlands Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Laparoscopic versus robot-assisted Nissen fundoplication in an infant pig model

Abstract Purpose Surgical robots are designed to facilitate dissection and suturing, although objective data on their superiority are lacking. This study compares conventional laparoscopic Nissen fundoplication (CLNF) to robot-assisted Nissen fundoplication (RANF) using computer-based workflow analysis in an infant pig model. Methods CLNF and RANF were performed in 12 pigs. Surgical workflow was segmented into phases. Time required to perform specific actions was compared by t test. The quality of knot-tying was evaluated by a skill scoring system. Cardia yield pressure (CYP) was determined to test the efficacy of the fundoplications, and the incidence of complications was compared. Results There was no difference in average times to complete the various phases, despite faster robotic knot-tying (p = 0.001). Suturing quality was superior in CLNF (p = 0.02). CYP increased similarly in both groups. Workflow-interrupting hemorrhage and pneumothorax occurred more frequently during CLNF (p = 0.040 and 0.044, respectively), while more sutures broke during RANF (p = 0.001). Conclusion The robot provides no clear temporal advantage compared to conventional laparoscopy for fundoplication, although suturing was faster in RANF. Fewer complications were noted using the robot. RANF and CLNF were equally efficient anti-reflux procedures. For robotic surgery to manifest its full potential, more complex operations may have to be evaluated. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3045-7Authors Alexandra Krauss, Department of Pediatric Surgery, University of Leipzig, Leipzig, GermanyThomas Neumuth, ICCAS, Innovation Center Computer Assisted Surgery, Leipzig, GermanyRobin Wachowiak, Department of Pediatric Surgery, University of Leipzig, Leipzig, GermanyBernd Donaubauer, Department of Anesthesia and Intensive Care Medicine, University of Leipzig, Leipzig, GermanyWerner Korb, ICCAS, Innovation Center Computer Assisted Surgery, Leipzig, GermanyOliver Burgert, ICCAS, Innovation Center Computer Assisted Surgery, Leipzig, GermanyOliver J. Muensterer, Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Prune belly syndrome

Abstract The majority of paediatric surgeons will encounter a patient with prune belly syndrome (PBS) only a few times in their clinical practice. There have been many opposing views in the literature regarding the pathogenesis and management of this complex condition. A detailed review was conducted using PubMed to identify key publications involving PBS. This article discusses the evolution of our understanding of the pathogenesis and diagnosis of PBS, including its typical characteristics. We describe the management options available for bilateral intra-abdominal testes, the deficient abdominal wall, the dilated urinary system and examine the evidence base used to support the current approaches employed. Content Type Journal ArticleCategory Review ArticlePages 1-10DOI 10.1007/s00383-011-3046-6Authors S. Hassett, Douglas Cohen Department of Paediatric Surgery, The Children’s Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, NSW, AustraliaG. H. H. Smith, Department of Urology, The Children’s Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, NSW, AustraliaA. J. A. Holland, Douglas Cohen Department of Paediatric Surgery, The Children’s Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Isolated ruptured appendicitis presenting as pneumatosis intestinalis in a premature neonate

Abstract We report a novel case of ruptured appendicitis in a premature neonate which radiographically mimicked necrotizing enterocolitis with free intraperitoneal air. On exploratory laparotomy, both the large and small intestines were normal. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00383-011-3042-xAuthors Vaneet Kumar Kalra, Division of Neonatology, Department of Pediatrics, Children Hospital of Michigan, 3901 Beaubien St, #4C19, Detroit, MI 48201, USAGirija Natarajan, Division of Neonatology, Department of Pediatrics, Children Hospital of Michigan, 3901 Beaubien St, #4C19, Detroit, MI 48201, USAJanet Poulik, Department of Pediatric Pathology, Children Hospital of Michigan, Detroit, MI, USAPrem Arora, Division of Neonatology, Department of Pediatrics, Children Hospital of Michigan, 3901 Beaubien St, #4C19, Detroit, MI 48201, USAChristopher Gayer, Department of Pediatric Surgery, Children Hospital of Michigan, Detroit, MI, USADima Altaany, Division of Neonatology, Department of Pediatrics, Children Hospital of Michigan, 3901 Beaubien St, #4C19, Detroit, MI 48201, USAPaul Stockman, Department of Pediatric Surgery, Children Hospital of Michigan, Detroit, MI, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Single-incision laparoscopic surgery for pyloric stenosis

Abstract Background Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. Materials and methods Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The singl incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients’ demographics, operative report and early postoperative outcomes. Results All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. Conclusions The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3029-7Authors Yury Kozlov, Pediatric Hospital, Irkutsk, Russian FederationVladimir Novogilov, Pediatric Hospital, Irkutsk, Russian FederationAlexey Podkamenev, Pediatric Hospital, Irkutsk, Russian FederationAndrey Rasputin, Pediatric Hospital, Irkutsk, Russian FederationIrina Weber, Pediatric Hospital, Irkutsk, Russian FederationAlexey Solovjev, Pediatric Hospital, Irkutsk, Russian FederationPavel Yurkov, Pediatric Hospital, Irkutsk, Russian Federation Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Glutamine prevents intestinal mucosal injury induced by cyclophosphamide in rats

Abstract Purpose High doses of anticancer drugs often damage the intestinal mucosa. The purpose of the present study was to examine the effect of glutamine on mucosal damage induced by cyclophosphamide in a rat model, and to elucidate the mechanisms responsible for its protective effects. Method Rats were randomly assigned to one of the three experimental groups. Group A (control) (n = 8): intraperitoneal injection of saline, group B (n = 8): intraperitoneal injection of cyclophosphamide (300 mg/kg), group C (n = 8): intraperitoneal injection of cyclophosphamide (300 mg/kg) and oral glutamine (1.0 g/kg). After 3 days, the ileal segment was removed for morphological and the biochemical analyses. We also evaluated the level of mucosal apoptosis by the TUNEL method and enterocyte proliferation using bromodeoxyuridine (BrdU). Results Mucosal atrophy was observed in group B but not in groups A or C. The mucosal wet weight, protein and glutathione levels were significantly decreased in group B compared with group A, and were increased significantly in group C compared with group B. While enterocyte proliferation significantly decreased and the apoptotic index significantly increased in group B compared with group A, a significant increase in the enterocyte proliferation and a significant decrease in apoptosis were observed in group C compared with group B. Conclusions Glutamine prevented intestinal mucosal injury induced by cyclophosphamide via increased glutathione, decreased apoptosis and increased proliferation of intestinal epithelial cells. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00383-011-3023-0Authors Mitsugu Owari, Department of Surgery, Division of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanMasafumi Wasa, Department of Surgery, Division of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanTakaharu Oue, Department of Surgery, Division of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanSatoko Nose, Department of Surgery, Division of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanMasahiro Fukuzawa, Department of Surgery, Division of Pediatric Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Pediatric risk of malignancy index for preoperative evaluation of childhood ovarian tumors

Abstract Purpose This study aimed to develop and provisionally validate a novel scoring index for preoperative cancer-risk prediction in childhood ovarian tumors. Methods Fifty-five girls aged 18 and below underwent surgery for ovarian masses between 2004 and 2009. Benign or non-benign histological diagnoses (the latter including all malignant and borderline tumors and tumors containing immature components) were correlated with clinical and biochemical parameters, and blinded scores of ultrasound and computed-tomography using multivariate logistic regression. Regression coefficients were used as weighting factors to create an additive index. This index was validated prospectively against 23 consecutive adnexal masses operated in 2010. Results In total, 67 tumors were benign and 11 non-benign. Non-benign diagnosis was independently associated with the maximum diameter of the largest solid component (score = value in cm), the presence of sex hormone-related symptoms (score = +6), and enhancement or flow in a septum or solid papillary projection (score = +4). The novel scoring index was calculated as the total score of these three parameters. A cutoff score of 7 gave a specificity of 97.9% and sensitivity of 87.5% for the training data set, and specificity and sensitivity of 100% for the pilot testing set. Conclusion The novel pediatric risk-of-malignancy index is able to accurately discriminate between benign and non-benign ovarian tumors in children and adolescents. Its preoperative application may guide surgical management decisions before the availability of histological confirmation. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00383-011-3031-0Authors Amos Hong Pheng Loh, Department of Paediatric Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 SingaporeChiou Li Ong, Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore, SingaporeShu Lin Lam, Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore, SingaporeJoyce Horng Yiing Chua, Department of Paediatric Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 SingaporeChan Hon Chui, Department of Paediatric Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Infectious complications in the management of gastroschisis

Abstract Background/purpose Neonates with gastroschisis make up an increasing proportion of prolonged surgical NICU admissions. While infectious complications are known to increase patient morbidity, it is unclear whether they vary according to abdominal closure method, or can be predicted by initial patient assessment. Methods A national, prospective, disease-specific database was evaluated for episodes of wound infection (WI) and catheter-related infection (CRI). Antibiotic use and timing, as well as method and location of abdominal closure were studied. The gastroschisis prognostic score (GPS) was calculated and evaluated as a predictor of infectious complications. Results Of 395 patients, 48 (12.6%) had a documented abdominal WI, and 59 patients (14.9%) had at least one episode of CRI-most commonly coagulase negative staphylococcus. Most abdominal closures took place within 6 h of admission (194 = 51.3%), while 132 (34.9%) were delayed greater than 24 h. The WI rate was greater in the delayed group (21.2 vs. 8.2%, p = 0.0006). The GPS was found to predict development of an infectious complication (WI + CRI, p = 0.04). Conclusion Infectious complications remain an important consideration in the management of gastroschisis. GPS correlates with the development of infectious complications. Prophylaxis for skin flora and early closure, when feasible, may reduce WI rates. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3038-6Authors Robert Baird, Division of Pediatric Surgery, McGill University Health Center, The Montreal Children’s Hospital, McGill University, 2300 Tupper Street, Room C812, Montreal, QC H3H 1P3, CanadaPramod Puligandla, Division of Pediatric Surgery, McGill University Health Center, The Montreal Children’s Hospital, McGill University, 2300 Tupper Street, Room C812, Montreal, QC H3H 1P3, CanadaErik Skarsgard, Division of Pediatric Surgery, BC Children’s Hospital, University of British Columbia, Vancouver, BC, CanadaJean-Martin Laberge, Division of Pediatric Surgery, McGill University Health Center, The Montreal Children’s Hospital, McGill University, 2300 Tupper Street, Room C812, Montreal, QC H3H 1P3, CanadaThe Canadian Pediatric Surgical Network Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Surgical intervention in vascular trauma in children

Abstract Vascular trauma is uncommon in children but may be complex. Arterial injury in children presents a challenge to the surgeon and may have long-term implications. Children have major advantage of a rich-collateral circulation but are still growing and developing. Decisions about when to operate remain an issue. Methods Patients (<13 years) with vascular injury requiring surgical intervention were retrospectively reviewed from a trauma database of 446 trauma patients admitted to the Tygerberg Children’s Hospital. Demographic data, and factors influencing the outcome were studied, as well as different modalities of management. Results We reviewed a total of 20 children where surgical intervention for vascular trauma was required. Six resulted from penetrating injuries (two gunshots), ten followed blunt trauma (two popliteal extension injuries), one degloving injury, two presented later with arterio-venous fistulae. Haemorrhage from the wound in one haemophiliac patient made urgent surgery mandatory. One patient with a gunshot damage of the vertebral artery was successfully managed by radiological embolism (coils). Outcome was variable and long-term limb maldevelopment occurred in one patient. Conclusion Vascular injuries may be difficult to manage in childhood due to their complexity. Growth and developmental considerations must be borne in mind during treatment. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3033-yAuthors N. Tshifularo, Division of Paediatric Surgery, Faculty of Medicine, University of Stellenbosch, P. O. Box 19063, Tygerberg, Cape Town, 7505 South AfricaS. W. Moore, Division of Paediatric Surgery, Faculty of Medicine, University of Stellenbosch, P. O. Box 19063, Tygerberg, Cape Town, 7505 South Africa Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Augmented reality navigation system for laparoscopic splenectomy in children based on preoperative CT image using optical tracking device

Abstract Purpose In endoscopic surgery, limited views and lack of tactile sensation restrict the surgeon’s abilities and cause stress to the surgeon. Therefore, an intra-operative navigation system is strongly recommended. We developed an augmented reality (AR) navigation system based on preoperative CT imaging. The purpose of this study is to evaluate the usefulness, feasibility, and accuracy of this system using laparoscopic splenectomy in children. Methods Volume images were reconstructed by three-dimensional (3D) viewer application. We used an optical tracking system for registration between volume image and body surface markers. The AR visualization was superimposed preoperative 3D CT images onto captured laparoscopic live images. This system was applied to six cases of laparoscopic splenectomy in children. To evaluate registration accuracy, distances from the marker position to the volume data were calculated. Results The operator recognized the hidden vascular variation of the splenic artery and vein, accessory spleen, and pancreatic tail by overlaying an image onto a laparoscopic live image. The registration accuracy of six cases was 5.30 ± 0.08, 5.71 ± 1.70, 10.1 ± 0.60, 18.8 ± 3.56, 4.06 ± 1.71, and 7.05 ± 4.71. Conclusion This navigation system provides real-time anatomical information, which cannot be otherwise visualized without navigation. The registration accuracy was acceptable in clinical operation. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3034-xAuthors Satoshi Ieiri, Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 JapanMunenori Uemura, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, JapanKouzou Konishi, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanRyota Souzaki, Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 JapanYoshihiro Nagao, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanNorifumi Tsutsumi, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanTomohiko Akahoshi, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, JapanKenoki Ohuchida, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanTakeshi Ohdaira, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanMorimasa Tomikawa, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanKazuo Tanoue, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanMakoto Hashizume, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, JapanTomoaki Taguchi, Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Bowel injuries caused by ingestion of multiple magnets in children: a growing hazard

Abstract Purpose There are no definite guidelines on the management of ingested magnetic objects in children. The aim of this study was to present our experience and to highlight the importance of strict follow-up. Methods Within 6 months period, four children presented to the emergency department after ingestion of multiple magnets. We reviewed retrospectively the patients’ documents, radiological reports, operative findings and outcome. We also performed a literature search for all reports of multiple magnets ingestion on MEDLINE and EMBASE. Results Daily abdominal radiographs to monitor migration of magnetic objects together with clinical examination revealed early detection of perforations in two patients. Explorative laparoscopy and suturing of perforations resulted in a rapid recovery and good cosmetic appearance. Literature search resulted in 44 published articles with a total of 52 cases of multiple magnet ingestion in children. Conclusions This report stresses the need for prompt follow-up and early detection of complications in order to operate those patients without delay. Laparoscopy is the method of choice in exploring the abdomen when perforation is suspected. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00383-011-3026-xAuthors Hussein Naji, Astrid Lindgren Children’s Hospital, Karolinska University, Stockholm, Solna, SwedenDaniel Isacson, Astrid Lindgren Children’s Hospital, Karolinska University, Stockholm, Solna, SwedenJan F. Svensson, Astrid Lindgren Children’s Hospital, Karolinska University, Stockholm, Solna, SwedenTomas Wester, Astrid Lindgren Children’s Hospital, Karolinska University, Stockholm, Solna, Sweden Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Technical considerations in children undergoing laparoscopic ileal-J-pouch anorectal anastomosis for ulcerative colitis

Abstract Background Sub-total colectomy and restorative proctocolectomy with j-pouch ileo-anorectal anastomosis is the treatment of choice in children with ulcerative colitis uncontrolled with medical therapy. Objective To present some technical considerations about children undergoing laparoscopic ileal-J-pouch anorectal anastomosis. Settings and patients All patients with ulcerative colitis undergoing laparoscopic ileal-J-pouch anorectal anastomosis were evaluated from January 2006 to February 2011. Intervention The new technical innovations herein are (1) total laparoscopic approach, (2) a very short 3-cm J-pouch ileal reservoir created outside the stoma incision, (3) preservation of the entire anal canal and the Knight-Griffen double stapled anastomosis, less than 3 cm from the dentate line, (4) use of a Multiple Instrument Access Port system in the stoma skin incision to reduce the number of port site incisions and (5) proctectomy performed using only an electrosurgical vessels sealing device thus avoiding clips to close rectal pedicle. Results Seventeen laparoscopic ileo J-pouch low rectal anastomosis were performed by the same surgical staff. Three complications occurred postoperatively: one bowel obstruction, one ileostomy prolapse, and one anastomotic stricture. Satisfactory functional results were achieved in all, there was no significant perineal excoriation and quality of life was excellent. Conclusions A Multiport Instrument Access Port placed in the stoma site allowed the use of more instruments through a single incision. The very short ileo J-pouch low rectal anastomosis has been shown to be a safe, feasible, and effective reconstructive procedure. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3030-1Authors Girolamo Mattioli, Pediatric Surgery Department, Giannina Gaslini Children’s Hospital, University of Genova, Largo G. Gaslini 5, 16147 Genova, ItalyEdoardo Guida, Pediatric Surgery Department, Giannina Gaslini Children’s Hospital, University of Genova, Largo G. Gaslini 5, 16147 Genova, ItalyAlessio Pini-Prato, Pediatric Surgery Department, Giannina Gaslini Children’s Hospital, University of Genova, Largo G. Gaslini 5, 16147 Genova, ItalyStefano Avanzini, Pediatric Surgery Department, Giannina Gaslini Children’s Hospital, University of Genova, Largo G. Gaslini 5, 16147 Genova, ItalyValentina Rossi, Pediatric Surgery Department, Giannina Gaslini Children’s Hospital, University of Genova, Largo G. Gaslini 5, 16147 Genova, ItalyArrigo Barabino, Paediatric Gastroenterology Department, Giannina Gaslini Institute, Genova, ItalyArnold G. Coran, Section of Pediatric Surgery, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, MI, USAVincenzo Jasonni, Pediatric Surgery Department, Giannina Gaslini Children’s Hospital, University of Genova, Largo G. Gaslini 5, 16147 Genova, Italy Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Clinico-pathological correlation in duplex system ectopic ureters and ureteroceles: can preoperative work-up predict renal histology?

Abstract Purpose Upper pole histology has been poorly investigated in duplex system ectopic ureters and ureteroceles. We aimed to determine the differences in histology between the conditions, and to identify clinical markers of renal damage. Methods Twenty-two patients undergoing partial nephrectomy between 2001 and 2007 for poorly functioning upper poles associated with ectopic ureters (n = 11) or ureteroceles (n = 11) were considered. Histology was classified into three groups: normal, chronic interstitial nephritis (CIN), and dysplasia. Clinical and radiological variables were compared between the two conditions and between cases with normal and abnormal histology. Results Of the 22 upper pole specimens, 9 had normal histology, 8 dysplasia, and 5 CIN. Statistical analysis failed to show any significant difference in preoperative variables or histology between ectopic ureters and ureteroceles, and in preoperative variables between cases with normal and abnormal histology. Conclusions We did not find significant differences in the histology of upper poles associated with ectopic ureters and ureteroceles. Histology was normal in more than one-third of patients, although the poles were poorly functioning. We hypothesize that these poles were hypoplasic rather than dysplasic. We failed to identify predictors of histological damage. Hence, the latter cannot be considered a factor guiding our decision-making. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3032-zAuthors Davide Meneghesso, Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padova, Padua, ItalyMarco Castagnetti, Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Monoblocco Ospedaliero, Via Giustiniani, 2, 35128 Padua, ItalyManuela Della Vella, Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Pediatrics, University Hospital of Padova, Padua, ItalyElisa Benetti, Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padova, Padua, ItalyPietro Zucchetta, Nuclear Medicine Unit, University Hospital of Padova, Padua, ItalyWaifro Rigamonti, Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Monoblocco Ospedaliero, Via Giustiniani, 2, 35128 Padua, ItalyLuisa Murer, Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padova, Padua, Italy Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Splenic size after division of the short gastric vessels in Nissen fundoplication in children

Abstract Purpose Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease (GERD). Mobilization of the gastric fundus during fundoplication requires division of short gastric vessels of the spleen, which may cause splenic ischemia. The aim of this study was to determine if Nissen fundoplication results in hypotrophy of the spleen. Methods We performed pre-operative and post-operative ultrasound measurements of the spleen in children undergoing Nissen fundoplication. During operation, the surgeon estimated the compromised blood flow by assessment of the percentage of discoloration of the spleen. Results Twenty-four consecutive children were analyzed. Discoloration of the upper pole of the spleen was observed in 11 patients (48%) of a median estimated splenic surface of 20% (range 5–50%). The median ratio for pre-operative and post-operative length, width, and area of the spleen was 0.97, 1.03, and 0.96, respectively. The percentage of the estimated perfusion defect during surgery was not correlated with the ratios. In three patients, the area ratio was smaller than 0.8 (0.67–0.75), meaning that the area decreased with at least 20% after surgery. In none of these patients a discoloration was observed. Conclusion Discoloration of the spleen after Nissen fundoplication is not associated with post-operative splenic atrophy. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3027-9Authors C. Driessen, Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The NetherlandsG. F. Paulus, Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The NetherlandsS. G. Robben, Department of Radiology, Maastricht University Medical Centre, Maastricht, The NetherlandsW. E. Tjon a Ten, Department of Pediatric Gastroenterology, Maastricht University Medical Centre, Maastricht, The NetherlandsA. Van den Neucker, Department of Pediatric Gastroenterology, Maastricht University Medical Centre, Maastricht, The NetherlandsB. H. Verhoeven, Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The NetherlandsL. W. E. Van Heurn, Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202 Maastricht, The Netherlands Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Effectiveness of a transluminal endoscopic fundoplication for the treatment of pediatric gastroesophageal reflux disease

Abstract Purpose Although laparoscopic Nissen fundoplication is the standard surgical treatment for gastroesophageal reflux disease (GERD), surgical complications and post-operative pain are not uncommon, especially for those patients who are neurologically impaired (NI) or undergoing re-operative procedures. To address this challenge, we utilized the transoral incisionless fundoplication (TIF) procedure to treat GERD via an endoscopic approach. Methods Eleven TIF patients were included with an average age of 16.5 ± 5.1 years and weight of 45.7 ± 13.3 kg. NI was present in nine patients (82%), including a predominant number of patients with a history of seizures and gastrostomy tube feeding. Five patients had a history of a previous failed fundoplication requiring a re-operative procedure (45%). A retrospective chart review evaluated patient outcomes and post-operative complications. Results The length of the TIF procedure was 113.3 ± 31.3 min with minimal blood loss. The length of stay was 1.2 ± 0.4 days, although one TIF patient was re-admitted for endoscopic clipping for gastric bleeding. At a follow-up of 8.2 ± 4.2 months, TIF effectively resolved GERD in 10 out of 11 children. A few of the patient’s families reported complaints of gagging or dysphagia (30%, 3/11); however it was difficult to determine if complaints were due the procedures itself or baseline NI. All patients who had a follow-up upper GI or pH probe study showed no evidence of reflux. One TIF patient had no recurrent reflux but required an esophago-gastric disconnection for retching. Conclusions The TIF procedure can complement the current surgically and medically available options for children with GERD, especially in complicated patients such as those with NI. However, complications including hemorrhage emphasize the potential risk of the procedure. Further studies with more patients and a longer follow-up course must be conducted to better assess efficacy. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3028-8Authors Stephanie Chen, Section of Pediatric Surgery, Department of Surgery and the C.S. Mott Children’s Hospital F3970, University of Michigan, Ann Arbor, MI 48109-5245, USAMarcus D. Jarboe, Section of Pediatric Surgery, Department of Surgery and the C.S. Mott Children’s Hospital F3970, University of Michigan, Ann Arbor, MI 48109-5245, USADaniel H. Teitelbaum, Section of Pediatric Surgery, Department of Surgery and the C.S. Mott Children’s Hospital F3970, University of Michigan, Ann Arbor, MI 48109-5245, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Mutational analysis of NOG in esophageal atresia and tracheoesophageal fistula patients

Abstract Purpose The NOG protein is a secretory antagonist of bone morphogenetic proteins (BMPs). Nog−/− mouse embryos demonstrate proximal esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) compatible with the most common configuration of EA/TEF observed in humans. Four microdeletions that span the NOG locus at 17q22 have been described in human patients having EA/TEF. We investigated the incidence of point mutations in the coding region of the NOG gene in human EA/TEF. Methods DNA was collected from 50 patients previously treated for EA/TEF. PCR was used to amplify the coding region of NOG. To detect single nucleotide polymorphisms (SNPs), amplicons were subjected to temperature gradient capillary electrophoresis (TGCE). Candidate SNPs were directly sequenced. Results TGCE analysis revealed a SNP in the coding region of NOG in 1 of 50 patients (2%). DNA sequencing revealed a synonymous SNP at position 468 (C–T) of the NOG coding region. Conclusion SNPs in the coding region of the NOG gene are identified infrequently in human cases of EA/TEF. Further investigation of SNPs in the promoter region of NOG is warranted, as is the effect of synonymous SNPs on NOG mRNA stability. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3022-1Authors Andrew J. Murphy, Department of Pediatric Surgery, Vanderbilt University Children’s Hospital, Doctor’s Office Tower, Suite 7102, 2200 Children’s Way, Nashville, TN 37232-9780, USAYina Li, Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USAJoshua B. Pietsch, Department of Pediatric Surgery, Vanderbilt University Children’s Hospital, Doctor’s Office Tower, Suite 7102, 2200 Children’s Way, Nashville, TN 37232-9780, USAChin Chiang, Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USAHarold N. Lovvorn, Department of Pediatric Surgery, Vanderbilt University Children’s Hospital, Doctor’s Office Tower, Suite 7102, 2200 Children’s Way, Nashville, TN 37232-9780, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

The herbal medicine Inchinko-to reduces hepatic fibrosis in cholestatic rats

Abstract Purpose Several studies have reported the herbal medicine Inchinko-to (ICKT) to have an antifibrotic effect which thus leads to an improvement of hepatic injury. However, there are still few reports of its use in the treatment of cholestatic liver disorder. The aim of this study was to clarify whether the administration of ICKT will ameliorate hepatic fibrosis and injury in cholestatic rats. Materials and methods We performed bile duct ligation on 7-week-old male cholestatic Wistar rats and assigned them to one of three groups according to the method of treatment : (1) the SHAM group, (2) the NT-group (non-treatment group), and (3) the T-group (treatment-group). Rats in the T-group were orally administered ICKT (TJ-135) at a dose of 1 g/kg/day and were killed on the 17th postoperative day. We subsequently investigated the levels of fibrosis and various clinical markers through measurement of the following: serum levels of AST and ALT; tissue transforming growth factor-beta 1 (TGF-beta1); tissue inhibitor metalloprotease-1 mRNA (TIMP-1 mRNA) through real-time PCR analysis; and Azan staining and immunohistochemical staining of alfa-smooth muscle actin (alfa-SMA) to evaluate the degree of fibrosis. Results The levels of serum AST, serum ALT, and TGF-bata1 in the T-Group were significantly lower than those in the NT-Group. In addition, staining of Azan and alfa-SMA in the T-Group was significantly lower than those in the NT-Group. Conclusion ICKT may help reduce hepatic fibrosis and injury by controlling stellate cell activation. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-2974-5Authors Takahiro Asakawa, Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, JapanMinoru Yagi, Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, JapanYoshiaki Tanaka, Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, JapanKimio Asagiri, Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, JapanHidefumi Kobayashi, Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, JapanHideaki Egami, Department of Innovative Kampo Medicine, Kurume University School of Medicine, Kurume, JapanKen Tanikawa, Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, JapanMasayoshi Kage, Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Abnormal development of intrinsic innervation in murine embryos with anorectal malformations

Abstract Introduction Constipation, soiling, and incontinence are common problems after definitive repair of anorectal malformations (ARMs) in children. We studied the expression of substance P (SP), vasoactive intestinal peptide (VIP), and c-kit in the rectum of murine embryos with or without ARMs at later developmental stages. Methods On the 9th embryonic day (E9), pregnant Institute of Cancer Research mice were fed etretinate, a synthetic vitamin A analogue (60 mg/kg), whereas controls were fed only with sesame oil. Embryos were excised between E14 and E18, and prepared for histological examination. The SP, VIP, and c-kit expressions were examined by immunohistochemical staining for the SP, VIP, and c-kit antigens, respectively. Results On E14 and E15, the expression levels of the anti-SP and anti-VIP antibodies in the rectum did not differ between the control and etretinate-treated group. However, as compared to the controls, a decreased SP and VIP immunoreactivity was observed in the circular muscle layer of the rectum between E16 and E18. On the other hand, on E14 and E15, the expression of anti-c-kit antibody in the rectum did not differ between the etretinate-treated and control group. However, c-kit immunoreactivity was slightly higher in the circular muscle layer of the rectum in the controls on E16 and E17, and considerably higher on E18 than that of the muscle layer in the etretinate-treated group. Conclusion At later developmental stages, the expression levels of SP, VIP, and c-kit reduced in the circular muscle layer of the rectum in mice with etretinate-induced ARMs. This result indicates that reduced SP, VIP, and c-kit expression levels in the circular muscle layer may cause severe constipation in children who develop severe ARMs after definitive surgery. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3017-yAuthors Yoshihiro Kubota, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, JapanHirotomi Cho, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, JapanTomoko Umeda, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, JapanHajime Abe, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, JapanYoshimasa Kurumi, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, JapanToru Tani, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Aspects of esophageal atresia in a population-based setting: incidence, mortality, and cancer risk

Abstract Purpose To estimate the incidence, mortality and cancer risk of the congenital malformation esophageal atresia (EA) in a population-based investigation. Methods A population-based cohort study of EA patients registered in three nationwide registers in Sweden in 1964–2007. The incidence of EA per total number of live births was assessed. Mortality and cancer occurrence were expressed as standardized mortality ratio (SMR) and standardized incidence ratio (SIR) with 95% confidence intervals (CI). Mortality was further analyzed by Cox regression and expressed as hazard ratio with 95% CI. Results The EA cohort comprised 1,126 patients. The mean incidence was 3.16 per 10,000 live births, without any temporal changes (p for trend =0.94). Associated anomalies were present in 42% and chromosomal abnormalities in 5%. EA patients had an almost 12 times higher risk of mortality compared to the background population (SMR 11.8, 95% CI 10.3–13.5). The mortality increase was most pronounced during the first 5 years after birth. Survival improved during the study period (p for trend =0.0001). EA did not entail a strongly increased cancer risk (SIR 0.9; 95% CI 0.2–2.6). Conclusions EA has a stable incidence, the survival has improved substantially during recent decades, and the cancer risk might not be increased. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00383-011-3014-1Authors Jenny Oddsberg, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, SwedenYunxia Lu, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, SwedenJesper Lagergren, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Paediatric sutureless circumcision—an alternative to the standard technique

Abstract Introduction Circumcision is one of the most commonly performed surgical procedures in male children. A range of surgical techniques exist for this commonly performed procedure. The aim of this study is to assess the safety, functional outcome and cosmetic appearance of a sutureless circumcision technique. Methods Over a 9-year period, 502 consecutive primary sutureless circumcisions were performed by a single surgeon. All 502 cases were entered prospectively into a database including all relevant clinical details and a review was performed. The technique used to perform the sutureless circumcision is a modification of the standard sleeve technique with the use of a bipolar diathermy and the application of 2-octyl cyanoacrylate (2-OCA) to approximate the tissue edges. Results All boys in this study were pre-pubescent and the ages ranged from 6 months to 12 years (mean age 3.5 years). All patients had this procedure performed as a day case and under general anaesthetic. Complications included: haemorrhage (2.2%), haematoma (1.4%), wound infection (4%), allergic reaction (0.2%) and wound dehiscence (0.8%). Only 9 (1.8%) parents or patients were dissatisfied with the cosmetic appearance. Conclusion The use of 2-OCA as a tissue adhesive for sutureless circumcisions is an alternative to the standard suture technique. The use of this tissue adhesive, 2-OCA, results in comparable complication rates to the standard circumcision technique and results in excellent post-operative cosmetic satisfaction. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3015-0Authors Brian D. Kelly, Department of Urology, Galway University Hospital, Galway, IrelandDara J. Lundon, Department of Urology, Galway University Hospital, Galway, IrelandMarie E. Timlin, Department of Urology, Galway University Hospital, Galway, IrelandMazhar Sheikh, Department of Urology, Galway University Hospital, Galway, IrelandNadeem B. Nusrat, Department of Urology, Galway University Hospital, Galway, IrelandFrank T. D’Arcy, Department of Urology, Galway University Hospital, Galway, IrelandSyed Q. Jaffry, Department of Urology, Galway University Hospital, Galway, Ireland Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

The utility of muscle sparing axillar skin crease incision for pediatric thoracic surgery

Abstract Background Posterolateral or standard axillar incisions for the pediatric thoracic surgery are occasionally associated with poor motor as well as cosmetic results, including chest deformities and large surgical scars. A muscle sparing axillar skin crease incision (MSASCI) was initially proposed by Bianchi et al. (in J Pediatr Surg 33:1798–1800, 1998) followed by Kalman and Verebely (in Eur J Pediatr Surg 12:226–229, 2002) resulting in satisfactory cosmetics. However, they performed operations through the third or fourth intercostals space (ICS), therefore the target organs were restricted in the upper two-thirds of the thoracic cavity. Patients and methods Thoracic surgeries were performed using MSASCI in 27 patients (1-day to 9-year old). There were ten patients with esophageal atresia, seven with congenital cystic adenomatoid malformation, five with pulmonary sequestration, two with mediastinal neuroblastoma, two with right diaphragmatic hernia, and one with pulmonary hypertension. A thoracotomy was performed through the appropriate ICS (from third to eighth). Results In all patients, the expected procedures, including pulmonary lower lobectomy, were successfully performed by MSASCI throughout the thoracic cavity. A good operational field was easily obtained in neonates and infants. Most of the patients achieved excellent motor and aesthetic outcomes. Conclusions MSASCI may become the standard approach for the thoracic surgery for small children. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3013-2Authors Tomoaki Taguchi, Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanKouji Nagata, Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanYoshiaki Kinoshita, Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanSatoshi Ieiri, Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanTatsuro Tajiri, Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanRisa Teshiba, Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanGenshiro Esumi, Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanYuji Karashima, Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanSumio Hoka, Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanKouji Masumoto, Department of Thoracic, Endocrine, and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Could clinical scores guide the surgical treatment of necrotizing enterocolitis?

Abstract Purpose Test the diagnostic reliability of the score for neonatal acute physiology-perinatal extension-II (SNAPPE-II) and the metabolic derangement acuity score (MDAS) as predictors of surgery in patients with necrotizing enterocolitis (NEC). Methods The SNAPPE-II and the MDAS were applied to 99 patients with NEC. Both the scores were calculated at the moment of diagnosis (T0) and when surgical assessment was required (T1). The main outcome was the need of surgical revision. Comparison between models was made through their receiver operator characteristics (ROC) curves. Results Thirty-five patients required surgical treatment (group A) and 64 responded to medical therapy (group B). Median SNAPPE-II was 22 versus 5 for group A (U test 621, p = 0.002) at T0; and 22 versus 10 for group A (U test 487, p = 0.01) at T1. Measuring the value of the SNAPPE-II as a predictor of surgery, the ROC curve was 0.69 (CI 95%, 0.57–0.80) at T0 and 0.67 (CI 95%, 0.55–0.80) at T1. Median MDAS were 2 for both groups A and B at T0 (U test 890.5, p = 0.113) and 2 versus 1.5 for group A at T1 (U test 570, p = 0.043). The ROC curve for MDAS was 0.59 (CI 95%, 0.47–0.71) at T0 and 0.64 (CI 95%, 0.52–0.77) at T1. Conclusions The diagnostic performance of the SNAPPE-II offers mild results in the moment of the diagnosis of NEC, and at T1. The MDAS is non significant at T0 and obtains moderate results at T1. These results do not encourage using the SNAPPE-II and the MDAS as definite tools to decide for surgical treatment of the patients affected by NEC. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3016-zAuthors Vicente Ibáñez, Hospital Infantil La Fe, Valencia, SpainMiguel Couselo, Hospital Infantil La Fe, Valencia, SpainVerónica Marijuán, Hospital Infantil La Fe, Valencia, SpainJuan José Vila, Hospital Infantil La Fe, Valencia, SpainCarlos García-Sala, Hospital Infantil La Fe, Valencia, Spain Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

A review: the role of high dose methylprednisolone in spinal cord trauma in children

Abstract Background The use of steroids in traumatic spinal cord injury (SCI) in children is controversial. There is a paucity of literature on its usage. To help clarify recommendations on steroid use in children, we reviewed the current literature on the administration of high dose methylprednisolone (MP) use in traumatic spinal cord injuries with an emphasis in pediatric spinal cord trauma. Methods A retrospective review of the current literature on traumatic spinal cord injuries was conducted. Outcomes were critically reviewed from the National Acute Spinal Cord Injury Studies (NASCIS) II and III and Cochrane review; as well as, other randomized and retrospective studies. Papers describing objective neurological outcomes were only included. Results The outcomes of neurological improvement following steroid infusion have not been reproducible outside of the NASCIS and one single Japanese trial. High dose steroids significantly increase the risk of infections leading to prolonged hospital stay and ventilator dependence. Conclusion Data from adult studies remains controversial with insufficient data to support administration of MP for treatment of traumatic spinal cord injuries. Randomized controlled trials are needed in the pediatric population to assess the advantages of steroid use after SCI in children. On the basis of the current evidence, the use of steroids in patients is associated with increased infectious risks and no neurological improvements. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00383-011-3012-3Authors Janine N. Pettiford, Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USAJai Bikhchandani, Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USADaniel J. Ostlie, Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USAShawn D. St. Peter, Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USARonald J. Sharp, Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USADavid Juang, Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Early post-operative interleukin-6 and tumor necrosis factor-α levels after single-port laparoscopic varicocelectomy in children

Abstract Purpose Laparoendoscopic single-site surgery has recently been described in children and regarded as an improved technology leading to less pain and better cosmetic outcome. Compared to the traditional three-port method, it is not known if the single-port method is less invasive. The aim of this study was thus to investigate the post-operative acute inflammatory response in order to evaluate surgical stress in the two surgical approaches in children. Methods A prospective, single blinded, case-control study was carried out. Thirteen male patients who presented with unilateral varicocele were divided into two groups. Six children underwent single-port laparoscopic procedure, while the other seven children underwent three-port laparoscopic procedure. Pre-operative and post-operative blood samples were taken for the measurement of tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) using ELISA. Demographics including the operation time, and complications were recorded. Data between the two groups were analyzed using unpaired t-test and a p value of <0.05 was taken as statistically significant. Results The mean age of patients was 14.5 years (range 12–19 years). There was no significant difference between the two groups in terms of operative time, nor there was any complication recorded. The change in serum TNF-α and IL-6 concentrations pre- and post-operatively between the single-port group and three-port group was not statistically significant. Overall, patients in the two groups showed excellent satisfaction in terms of post-operative cosmesis. Conclusion Single-port laparoscopic varicocelectomy is safe, effective and produces excellent cosmesis with minimal surgical stress. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-011-3011-4Authors Wei Hao, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, ChinaIvy H. Y. Chan, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, ChinaXueLai Liu, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, ChinaPaula M. Y. Tang, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, ChinaPaul K. H. Tam, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, ChinaKenneth K. Y. Wong, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Intussusception as a presenting feature of Burkitt lymphoma: implications for management and outcome

Abstract Purpose Intussusception is a recognised but unusual presenting feature of Burkitt lymphoma. We sought to identify the clinical features associated with intussusception in this setting, and assess the outcome following protocol directed chemotherapy. Methods A retrospective case note review was performed on patients treated for Burkitt lymphoma at our institution between 1976 and 2010. Cases presenting with intussusception were identified from hospital records and oncology database. Results Fourteen of the 210 children seen with a diagnosis of Burkitt lymphoma during the study period (6.7%) developed intussusception. Median age was 6.1 years (range 2.5–10.9). Twelve patients presented with recurrent abdominal pain, and two patients with a jaw mass associated with endemic Burkitt lymphoma. Nine patients underwent a right hemicolectomy with ileo-colic anastomosis, and five had segmental small-bowel resections. Three patients had bone marrow involvement at diagnosis, two of whom died. All patients received chemotherapy. Median follow-up was 6.07 years (range 0.1–28.8). Conclusions Small bowel lymphoma should be considered in children presenting with intussusception above the normal infantile peak age range. The presentation is often insidious, and complete obstruction may not be apparent. However, when surgically resected, the majority can achieve a good outcome with additional chemotherapy. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-2982-5Authors R. J. England, Department of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700 South AfricaK. Pillay, Division of Anatomical Pathology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South AfricaA. Davidson, Department of Paediatrics and Child Health, Haematology/Oncology Service, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South AfricaA. Numanoglu, Department of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700 South AfricaA. J. W. Millar, Department of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358

Thoracoscopic excision of the sympathetic chain: an easy and effective treatment for hyperhidrosis in children

Abstract Background Thoracoscopic sympathectomy (TS) is an effective treatment for hyperhidrosis. Various surgical approaches are described in the literature. We describe the technique of thoracoscopic excision of the sympathetic chain done exclusively in children younger than 13 years. Methods All patients younger than 13 years who underwent TS from 2006 at a single institution were prospectively identified and fully evaluated with emphasis on demographic data, age, surgical management, complications and follow-up. All patients were contacted again at the end of 2009 to complete a follow-up questionnaire. Results Twelve patients underwent TS between 2006 and 2009. Age ranged from 6 to 13 years. This involved T2–T3 excision for nine patients with isolated palmar hyperhidrosis, and T2–T3–T4 excision for three with additional axillary hyperhidrosis. Six underwent bilateral TS at the same session and six underwent unilateral TS for the dominant side. Four of them had their contralateral operation performed 2–3 months later. Dry limbs were immediately achieved in all patients. Compensatory sweating (CS) was noted in eight patients. Complications included transient ptosis in two and mild recurrence in one. Conclusions Thoracoscopic excision of the sympathetic chain is a simple and safe procedure that relieves hyperhidrosis in all cases and significantly improves the quality of life. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-2984-3Authors Mohamed Sameh Shalaby, Ain Shams University, Cairo, EgyptEhab El-Shafee, Ain Shams University, Cairo, EgyptHesham Safoury, Ain Shams University, Cairo, EgyptSameh Abd El Hay, Ain Shams University, Cairo, Egypt Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358