Collis–Nissen plastikos metodas esant labai ilgam tarpui tarp stemplės galų

Objective The purpose of this study is to evaluate the modified Collis-Nissen gastroplasty and fundoplication method in children with a very long gap esophageal atresia.Methods During the period of 1996–2016 years there were 151 patients having esophageal atresia and 23 patients had a long gap esophageal atresia were treated in our hospital. 3 patients had a very long gap esophageal atresia and the Collis-Nissen late esophagoplasty were performed. The remote results were observed retrospectively from the outpatient charts.Results Three boys who were born at the gestational age of 35, 35 and 37 weeks within the first few hours were diagnosed having type B, C and C esophageal atresia. Two of these patients had surgeries on their first day and the third patient was operated on his second day. The closure of tracheoesophageal fistulas and gastrostomy were performed for all of these newborns, the sigmostoma – for one patient. They were diagnosed having a very long gap (diastasis at 7, 4 and 6 cm) esopha­geal atresia. Before the Collis-Nissen gastroplasty and fundoplication was performed, the esophagus was elongated till the patients were 7, 7 and 4 months old. All of the boys experienced early and late complications: anastomosis leaking, medias­tinitis, sepsis, scarring stenosis have occurred, but remediastinotomies, drainages of mediastinum, dilatations of esophagus were successful. All three patients quickly were able to eat normally. Records in the outpatient charts show the boys having no complaints, eating well, having a good appetite.Conclusion Collis-Nissen esophagoplasty is a good alternative comparing with other surgical reconstructions when dealing with a very long gap esophageal atresia.Tikslas Išanalizuoti stemplės plastikos modifikuotu Collis–Nissen metodu efektyvumą gydant vaikus dėl stemplės atrezijos esant la­bai ilgam tarpui tarp stemplės galų.Medžiaga ir metodai 1996–2016 metais buvo gydytas 151 ligonis dėl stemplės atrezijos, iš jų 23 pacientams buvo ilgas tarpas tarp stemplės galų. Trims ligoniams buvo atlikta Collis–Nissen vėlyvoji stemplės plastika. Atokieji rezultatai analizuoti iš ambulatorinių kortelių.Rezultatai Trims berniukams, gimusiems 35 sav., 35 sav. ir 37 sav., per pirmąsias gyvenimo valandas buvo diagnozuota B, C ir C tipo stemplės atrezija. Du pacientai buvo operuoti pirmą gyvenimo parą, trečiasis – antrą. Visiems ligoniams buvo likviduotos tracheoezofaginės fistulės, atliktos gastrostomijos, vienam – ir sigmostomija. Nustatyti labai ilgi tarpai (7 cm, 4 cm ir 6 cm) tarp stemplės galų. Stemplės auginimas vyko iki 7 mėn., 7 mėn. ir 4 mėn., kol buvo atlikta Collis–Nissen gastroplastika ir fundo­plikacija. Visi pacientai patyrė ankstyvų ir vėlyvų komplikacijų: pasireiškė anastomozių nesandarumas, mediastinitas, sepsis, randinė stemplės stenozė, tačiau atlikta remediastinotomija, tarpuplaučio drenavimas, stemplės bužavimas buvo sėkmingi. Visi pacientai gana greitai pradėti maitinti pro burną. Ligonių ambulatorinių kortelių įrašuose matyti, jog skundų pacientai neturi, maitinasi įprastai, apetitas geras.Išvada Collis–Nissen stemplės plastika – gera alternatyva kitoms rekonstrukcinėms stemplės operacijoms esant labai ilgam tarpui tarp stemplės galų

Įgimta dvylikapirštės žarnos obstrukcija dėl preduodeninės vartų venos ir atvirkštinės skrandžio ir blužnies padėties

Pranas Gurskas, Kęstutis Trainavičius, Aidas Ivanauskas, Arūnas Strumila Vilniaus universiteto Vaikų ligų klinikos Vaikų chirurgijos centras, Santariškių g. 7, LT-2600 Vilnius El paštas: [email protected] Įvadas / tikslas Preduodeninė vartų vena (PDVV) yra labai reta įgimta anomalija. Literatūroje aprašyta per 80 atvejų. Preduodeninė vartų vena dažniausiai nesukelia jokių klinikinių simptomų. Tik nedaugeliui pacientų ji gali būti dvylikapirštės žarnos nepraeinamumo priežastis. Tyrimo tikslas – aprašyti labai retą, įgimtą dvylikapirštės žarnos obstrukcijos priežastį ir pasidalyti šios anomalijos diagnostikos ir gydymo patirtimi. Ligoniai ir metodai Mes gydėme du pacientus dėl dvylikapirštės žarnos nepraeinamumo, kurio priežastis – preduodeninė vartų vena kartu su atvirkštine skrandžio ir blužnies padėtimi, nevisiškas žarnyno posūkis. Rezultatai Naujagimis ir 1 metų 4 mėnesių mergaitė buvo operuoti dėl preduodeninės vartų venos, sukėlusios dvylikapirštės žarnos obstrukciją. Abiem vaikams buvo atliktos duodenoduodenostomijos. Pooperacinė abiejų ligonių eiga buvo sklandi. Vaikai pradėjo normaliai valgyti, nustojo vemti, ėmė priaugti svorio. Išvados Duodenoduodenostomija yra veiksminga operacija gydant dvylikapirštės žarnos obstrukciją dėl preduodeninės vartų venos. Reikšminiai žodžiai: įgimtas dvylikapirštės žarnos nepraeinamumas, preduodeninė vartų vena Congenital duodenal obstruction due to preduodenal portal vein, associated with situs inversus of stomach and spleen Pranas Gurskas, Kęstutis Trainavičius, Aidas Ivanauskas, Arūnas Strumila Vilnius University Children’s Hospital, Center of Pediatric Surgery, Santariškių Str. 7, LT-2600 Vilnius, Lithuania E-mail: [email protected] Background / objective Preduodenal portal vein (PDPV) is a rare congenital anomaly. There are only 80 cases described in the world literature. The presence of this anomaly is rarely recognized as an emergency condition, and it can manifest as duodenal obstruction in very few patients. The aim of our study was to descibe this uncommon reason for duodenal obstruction and to share experience in recognizing and treating this pathology. Patients and methods Authors present two cases of duodenal obstruction caused by the preduodenal portal vein and associated with the inverted gastric and spleen position and malrotation of the gut. Results A male newborn and a 1 yr 4 mon old girl were operated on due to duodenal obstruction caused by the preduodenal portal vein. Both patients received a duodenoduodenostomy procedure. The recovery was uneventful. The patients became free of symptoms, returned to oral feeds, started to thrive. Conclusions Duodenoduodenostomy is a safe and effective procedure in treating duodenal obstruction caused by the preduodenal portal vein. Key words: duodenal obstruction, preduodenal portal vei

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Duplication cyst of the pylorus: a case report

Introduction: Pyloric duplication is an extremely rare gastrointestinal tract malformation in neonates. This is the first case report of pyloric duplication in our country (Lithuania). Case presentation: We report the case of a 2-day-old Lithuanian girl who suffered from pyloric duplication mimicking an alternative common bile duct cyst or other intra-abdominal organs cysts. A laparotomy was performed and the cystic formation of the pyloric area was successfully resected. The postoperative course was uneventful. Conclusions: There are only a few reports describing abdominal masses caused by pyloric duplication mimicking common bile duct cyst or other intra-abdominal organs cysts. Therefore thorough clinical and instrumental examination is needed to determine the most accurate diagnosis that allows one to choose the right treatment

Cloacal Exstrophy: A Case Report and Literature Review

Cloacal exstrophy is an extremely rare congenital malformation resulting in an exstrophy of the urinary, intestinal, and genital organs and associated with anomalies of other organ systems. We present a complicated case of cloacal exstrophy and the recent progress in the management of this probably most complicated anomaly in pediatric urology and surgery