Dilations of anastomotic strictures over time after repair of esophageal atresia

Aim of the study: Anastomotic strictures commonly occur in patients undergoing surgery for esophageal atresia (EA). The primary aim of this study was to determine the age distribution of dilation procedures for anastomotic strictures over the patient’s childhood after reconstruction of EA. The secondary aim was to evaluate the effect of postoperative proton pump inhibitors (PPIs) on the frequency of dilations. Methods: This observational study was conducted at a single tertiary center of pediatric surgery. The times that dilations of strictures were performed were assessed during three study periods: 1983–1995, 2001–2009, and 2010–2014. PPIs were not used during the first period, and then, respectively, for 3 and 12 months postoperatively. The indications for dilation were signs of obstruction and/or radiological signs of stricture. Primary results: A total of 131 children underwent esophageal reconstruction, and of those, 60 (46%) required at least 1 dilation procedure for strictures. There were no differences in the frequencies of dilation procedures between the three study periods (28/66, 18/32 and 14/33, respectively; P = 0.42). The overall median number of dilations per patient was 3 (range 1–21) with no differences between the study periods. The differences between ages at which the first dilation was performed during each study period were significant, as follows: 7, 2, and 8 months, respectively (P = 0.03). Fiftyone percent of all dilation procedures were performed during the first year of life, 16% during the second year, and 33% during years 2–15. Four children (2%) underwent >12 dilations. Conclusion: The first year of life was the time of greatest need for dilation of AS after reconstruction of EA; however, dilations were also performed several years later. PPIs did not affect the frequency of dilations during the first year of life

Prophylactic treatment with proton pump inhibitors in children operated on for oesophageal atresia.

Introduction Oesophageal stricture is a frequent complication following repair of oesophageal atresia (EA). The aim of this study was to conduct a pre- and postintervention study and analyze the incidence of stricture formation and need for balloon dilatation after introducing prophylactic proton pump inhibitor (PPI) treatment.Children and Design All children operated for EA during 2001 to 2009 (n = 39) were treated with prophylactic PPIs (PPI group) for at least 3 months postoperatively. The frequency of stricture formation in the anastomosis and need for balloon dilatation was registered. A previously published group of children (n = 63) operated for EA during 1983 to 1995 not treated with prophylactic PPI was used as control group. Duration of follow-up time in the PPI group was equal to the one in the control group, and set to 1 year after the last oesophageal dilatation procedure.Results The PPI and control group were comparable regarding patient characteristics, gestational age and birth weight, prevalence of chromosomal aberration, and VACTERL (vertebral, and, cardiac, tracheal, esophageal, renal, limb) malformations. Also, survival rate and prevalence of surgery were similar in both groups. Mortality was mainly determined by associated malformations.The dilatation frequency needed in each child did not differ between the two groups. The prevalence of stricture formation was 42% in the control group compared with 56% in the PPI group, p = 0.25. Number of dilatations needed varied between 1 and 21, with a median value of 3 and 4, respectively, for the PPI and the control group. The children in the PPI group were significantly younger at the time of dilatation. This difference reflects a change in policy and increased experience.Conclusion The incidence of anastomotic stricture following repair for esophageal atresia remains high also after introduction of PPI. The results cannot support that prophylactic treatment with PPI prevent anastomotic stricture formation

Rectal Atresia—Operative Management with Endoscopy and Transanal Approach: A Case Report

The aim of this study is to present the technique and outcome of the management of a newborn child with rectal atresia. A girl born with rectal atresia was diagnosed during physical examination and confirmed with X-ray. The anatomic appearance of the external anus, and lower pelvis was normal. The rectal ending was located 2 cm cranial from the anus and the distance between the rectal endings was 2 cm. A colostomy was established. At the age of five months the child was operated on with a rectal anastomosis using the endoscopic and transanal approach. Closure of the colostomy was performed at the age of ten months. The rectal anastomosis was treated with rectal dilatation weekly in order to avoid stricture. The patient was faecally continent at followup one and three months postoperatively. In conclusion, the endoscopic and transanal approach is an alternative to other surgical techniques in the management of rectal atresia

Literature Review Comparing Laparoscopic and Percutaneous Endoscopic Gastrostomies in a Pediatric Population

Objective. This study compares laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a paediatric population to test the hypothesis that there is a difference in the frequency of serious gastrointestinal complications between the two methods. Methods. All reports published between 1995 and 2009 on laparoscopic gastrostomy and PEG in children was included. Prospective and retrospective trials, comparing the two methods or dealing with one of them only were included. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Results. 822 publications were found when using the search terms: gastrostomy, gastrointestinal complications, and all child: 0–18 years. From these, 54 studies were extracted for this investigation. These studies reported a total of 4331 children undergoing gastrostomy operation, 1027 by using the laparoscopic technique and 3304 using the PEG technique. The number of serious gastrointestinal fistulas to colon or small bowel was 0% and .27%, respectively, P < .05. Conclusions. The results suggest that by performing laparoscopic gastrostomy in children it is possible to avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG

Outcome after Computer-Assisted (Robotic) Nissen Fundoplication in Children Measured as Pre- and Postoperative Acid Reducing and Asthma Medications Use.

Purpose This study aims to report the clinical outcome of computer-assisted fundoplication (CAF) in children. Methods As our center changed policy to using computer-assisted surgery only, a prospectively studied cohort of 40 children underwent CAF, during the period from January 2006 through May 2013. The collected data include patient demographics and postoperative complications as well as medication, 24-hour pH measurements and DeMeester scores before and after surgery. Results In the studied group, the median percentage of the duration of the 24-hour pH < 4 decreased postoperatively from 11 (range, 5-39) to 1% (range, 0-12) (p < 0.001); the DeMeester score decreased from 40 (range, 17-137) to 5 (range, 1-42) (p < 0.001). All 40 patients required antireflux medication before the fundoplication. This number decreased significantly to 8 (20%) after the fundoplication (p < 0.001). Before the fundoplication, 22 children (55%) were using asthma medication and 12 (30%) after the fundoplication (p = 0.04). Conclusions The CAF significantly reduced the acid reflux from the stomach to the esophagus and the use of antireflux as well as asthma medication during the median observation period of 5 years. The evidence of advantages compared with conventional laparoscopic fundoplication remain to be confirmed

Laparoscopic or Open Appendectomy for Pediatric Appendicitis?

Background: This study aimed to compare open appendectomy (OA) and laparoscopic appendectomy (LA) in children by analyzing the differences in outcomes between the two techniques. Materials and Methods: This was a single-institution retrospective study. Data were collected from the medical records of all children <15 years of age who underwent an appendectomy from 2006 through 2014. Preoperative parameters, appendicitis severity, surgery time, complications, pain treatment, and postoperative outcome including days of hospital stay were collected. LA was performed with a two- or three-port technique, and a McBurney incision was adopted for OA. Conversions were regarded as OA. Results: A total of 406 appendectomies were performed during the study period, 146 (36%) OA (61 conversions) and 260 (64%) LA. No differences were found between the two groups regarding surgery time, operative and postoperative complications, and postoperative pain treatment. In cases of Phlegmonous appendicitis, LA was associated with a significantly shorter median hospital stay than was OA (1 and 1.8 days, respectively; p < 0.01). Healthy and Phlegmonous appendices were more commonly treated with LA (p < 0.01 for both); gangrenous, perforated, and abscessed appendices were more commonly treated with open surgery (p = 0.02, p < 0.01, and p < 0.01, respectively). Conclusion: The study identified no disadvantages of LA compared with OA. Therefore, LA should be the preferred technique because it is associate

Robotics versus laparoscopy - an experimental study of the transfer effect in maiden users

ABSTRACT: BACKGROUND: Robot-assisted laparoscopy (RL) is used in a wide range of operative interventions, but the advantage of this technique over conventional laparoscopy (CL) remains unclear. Studies comparing RL and CL are scarce. The present study was performed to test the hypothesis that maiden users master surgical tasks quicker with the robot-assisted laparoscopy technique than with the conventional laparoscopy technique. METHODS: 20 subjects, with no prior surgical experience, performed three different surgical tasks in a standardized experimental setting, repeated four times with each of the RL and CL techniques. Speed and accuracy were measured. A cross-over technique was used to eliminate gender bias and the experience gained by carrying out the first part of the study. RESULTS: The task "tie a knot" was performed faster with the RL technique than with CL. Furthermore, shorter operating times were observed when changing from CL to RL. There were no time differences for the tasks of grabbing the needle and continuous suturing between the two operating techniques. Gender did not influence the results. CONCLUSION: The more advanced task of tying a knot was performed faster using the RL technique than with CL. Simpler surgical interventions were performed equally fast with either technique. Technical skills acquired during the use of CL were transferred to the RL technique. The lack of tactile feedback in RL seemed to matter. There were no differences between males and females

Two-trocar appendectomy in children – description of technique and comparison with conventional laparoscopic appendectomy

Background: The aim of the study was to describe the technique of two-trocar laparoscopic appendectomy and compare the outcome between two- and three-trocar techniques in children. Methods: All children who underwent laparoscopic surgery for suspected appendicitis from 2006 to 2014 in a center for pediatric surgery were included in the study. Converted surgeries and patients with appendiceal abscess or concomitant intestinal obstruction were excluded. A total of 259 children underwent appendectomy with either two (35 %) or three (65 %) laparoscopic trocars according to the surgeons' preference and intraoperative judgment. Patient demographics, clinical symptoms, surgery characteristics, and complications were reviewed. Results: The mean age of the children was 10.4 years (range, 1-14 years). The mean follow-up time was 41.2 months (SD ± 29.2). No significant differences in age, gender, weight, or signs and symptoms were found between the two- and three-trocar groups. The mean surgery time was significantly shorter in the two-trocar group (47 min) than in the three-trocar group (66 min; p < 0.001). The rates of surgical complications were 2 % vs. 4 %, (p = 0.501), and the rates of postoperative complications were 0 % vs. 5 % (p = 0.054), in the two- and three-trocar groups. The overall incidence of postoperative wound infection was low (<1 %) and did not differ between groups. Conclusions: Two-trocar laparoscopic appendectomy seems to be a safe and feasible technique with a low rate of postoperative wound infections. The present findings demonstrate that when the two-trocar technique could be applied, it is a good complement to the conventional three-trocar technique