Споредба на лапаро- ÑкопÑка херниоплаÑтика Ñо конвенционална техника кај женÑки деца Ñо индиректна ингвинална хернија

The study aims to compare the conventional open technique for treating inguinal hernia versus laparoscopic assisted technique of percutaneous closure of the internal inguinal ring in female children with clinically diagnosed indirect inguinal hernia. Materials and methods: The study is a prospective analytical (case control) study performed at the University Clinic for Pediatric Surgery in Skopje in the period 2015-16. Twenty  female children aged 1-14 years with clinically diagnosed indirect inguinal hernia were analyzed. Children from the experimental group were treated with laparoscopic hernia repair, and those from the control group with conventional techniques. Results: The average duration of the intervention in the experimental and control group was 27.6 ± 6.1 vs.64.8 ± 7.2 minutes. The length of hospital stay in the two groups was 10.8 ± 3.1 vs. 27.2 ± 4.2 hours. The shortest stay was 8 vs. 24 hours and the longest 18 vs. 36 hours. Fifty percent of the children in the experimental group took up a normal position in bed for less than 4 hours compared to the control group in which it happened in 9 hours. The average time to recovery from bed in the two groups was 4.1 ± 0.9 vs. 9.9 ± 1.8 hours with a minimum of 3 vs. 7 and maximum of 6 vs. 12 hours. The average length of the mark was 1.9 ± 0.9 mm in the experimental and 34.8 ± 17.4 mm in the control group. Analgesia because of pain was given to 2 (20%) children in the experimental group and to 8 (80%) in the control group. Easy impressive scar have 8 (80%) patients in the control group and no patient in the experimental group. The mark does not disturb the esthetics in 9 (90%) of patients in the experimental group and in 2 (20%) in the control group. Conclusion: Laparoscopic assisted technique of percutaneous closure of the internal inguinal ring with one port represents a minimally invasive method and ultimate achievement in this field for treatment of inguinal hernias in children, with special advantage in females.ИÑтражувањето има за цел да ги Ñпореди отворената конвенционална техника за третман на ингви- налните хернии наÑпроти лапароÑкопÑки аÑиÑтирана техника на перкутано затворање на внатреш- ниот ингвинален прÑтен кај женÑки деца Ñо клинички дијагноÑтицирана индиректна ингвинална хернија. Матерјал и методи: ИÑтражувањето претÑтавува проÑпективна аналитичка (case control) Ñтудија, Ñпроведенa на УниверзитетÑката клиника за детÑка хирургија во Скопје во периодот 2015-16. Опфатени Ñе 20 женÑки деца на возраÑÑ‚ од 1-14 години Ñо клинички дијагноÑтицирана индирекна ингвинална хернија. ИÑпитаниците од иÑпитуваната група Ñе третирани Ñо лапароÑкопÑка херни- оплаÑтика, а оние од контролната група Ñо конвенционална техника. Резултати: ПроÑечното време- трање на интервенцијата во иÑпитуваната, одноÑно контролната група изнеÑува 27,6±6,1 vs. 64,8±7,2 минути. Должината  на преÑтојот во болница во двете групи  Ð¸Ð·Ð½ÐµÑува  10,8±3,1 vs. 27,2±4,2 чаÑови. Ðајкраткиот преÑтој изнеÑува 8 vs. 24 чаÑа, а најдолгиот 18 vs. 36 чаÑа. ПедеÑет проценти од децата во иÑпитуваната група заземале нормална положба во кревет за помалку од 4 чаÑа Ñпоредено Ñо оние од контролната група кај кои тоа изнеÑувало 9 чаÑа. ПроÑечното време до вертикализација во кревет во двете групи изнеÑува 4,1±0,9 vs. 9,9±1,8 чаÑови Ñо минимум 3 vs. 7 и макÑимум 6 vs. 12 чаÑови. ПроÑечната должина на белегот изнеÑува 1,9±0,9 мм во иÑпитуваната и 34,8±17,4 мм во контролната група. Ðналгезија поради болка е дадена кај 2 (20%) од децата во иÑпитуваната и 8 (80%) од оние во контролната група. ЛеÑно впечатлив белег имаат 8 (80%) од пациентите во контролната група и ние- ден пациент од иÑпитуваната група. Белегот не ја нарушува еÑтетиката кај 9 (90%) од пациентите во иÑпитуваната група, и кај 2 (20%) од оние во контролната група. Заклучок: ЛапароÑкопÑки аÑиÑтирана техника на перкутано затворање на внатрешниот ингвинален канал Ñо еден порт претÑтавува мини- мално инвазивна метода за третман на ингвинални хернии во детÑка возраÑÑ‚ и врвно доÑтигнување во оваа проблематика, Ñо поÑебни предноÑти кај женÑките деца

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