Laparoscopic management of primary intestinal trichobezoar

AbstractWe report a rare case of primary small intestinal trichobezoar in a 5-year-old girl presenting as subacute intestinal obstruction. Clinical, radiological, endoscopic, and laparoscopic investigations suggested the diagnosis. Most reported cases use diagnostic or laparoscopic assisted removal mainly in the adults. We describe the complete laparoscopic removal of a primary intestinal trichobezoar without significant spillage. A retrieval bag allowed the trichobezoar to be removed via a small umbilical incision before closing the enterotomy

Development of a core outcome set for use in determining the overall success of gastroschisis treatment.

Background: Gastroschisis research is limited in quality by the presence of significant heterogeneity in outcome measure reporting (PloS One 10(1):e0116908, 2015). Using core outcome sets in research is one proposed method for addressing this problem (Trials 13:103, 2012; Clin Rheumatol 33(9):1313-1322, 2014; Health Serv Res Policy 17(1):1-2, 2012). Ultimately, standardising outcome measure reporting will improve research quality and translate into improvements in patient care.Methods/design: Candidate outcome measures have been identified through systematic reviews. These outcome measures will form the starting point for an online, three-phase Delphi process that will be carried out in parallel by three panels of experts. Panel 1 is a neonatal panel, panel 2 is a non-neonatal panel and panel 3 is a lay panel.In round 1, experts will be asked to score the previously identified outcome measures from 1–9 based on how important they think the measures are in determining the overall success of their/their child’s/their patient’s gastroschisis treatment.In round 2, experts will be presented with the same list of outcome measures and with graphical representations of how their panel scored that outcome in round 1. They will be asked to re-score the outcome measure taking into account how important other members of their panel felt it to be. In round 3, experts will again be asked to re-score each outcome measure, but this time they will receive a graphical representation of the distribution of scores from all three panels which they should take into account when re-scoring.Following round 3 of the Delphi process, 40 experts will be invited to attend a face-to-face consensus meeting. Participants will be invited in a purposive manner to obtain balance between the different panels. The results of the Delphi process will be discussed, and outcomes re-scored. Outcome measures where?&gt;?70 % of the participants at the meeting scored them as 7–9 and?&lt;?15 % scored them as 1–3 will form the core outcome set.Discussion: Development of a core outcome set will help to reduce the heterogeneity of the outcome measure reporting in gastroschisis. This will increase the quality of research taking place and ultimately improve care provided to infants with gastroschisis.<br/

Natural orifice endoluminal technique (NOEL) for the management of congenital duodenal membranes

Congenital Partial Duodenal Obstruction (CPDO) caused by membranes/webs/diaphragms has traditionally been managed by open or laparoscopic duodenoduodenostomy or duodenojejunostomy. We report a two center case series where Natural Orifice Endoluminal technique (NOEL) was used to treat children with CPDO

Gastroschisis: A national cohort study to describe contemporary surgical strategies and outcomes

Abstract Background: Information on adoption of newer surgical strategies for gastroschisis and their outcomes is largely limited to hospital-based studies. The aim of this study was to use a new UK national surveillance system to identify cases and thus to describe the contemporary surgical management and outcomes of gastroschisis. Methods: We conducted a national cohort study using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System to identify cases between October 2006 and March 2008. Results: All 28 surgical units in the United Kingdom and Ireland participated (100%). Data were received for 95% of notified cases of gastroschisis (n = 393). Three hundred thirty-six infants (85.5%) had simple gastroschisis; 45 infants (11.5%) had complex gastroschisis. For 12 infants (3.0%), the type of gastroschisis could not be categorized. Operative primary closure (n = 170, or 51%) and staged closure after a preformed silo (n = 120, or 36%) were the most commonly used intended techniques for simple gastroschisis. Outcomes for infants with complex gastroschisis were significantly poorer than for simple cases, although all deaths occurred in the simple group. Conclusions: This study provides a comprehensive picture of current UK practice in the surgical management of gastroschisis. Further follow-up data will help to elucidate additional prognostic factors and guide future research. © 2010 Elsevier Inc. All rights reserved. www.elsevier.com/locate/jpedsurg ☆ Contributions: A.O. assisted with the design of the study, carried out some analysis, and wrote a first draft of the paper. S.M. had the original idea for the investigation of management of gastroschisis, assisted with the design of the study, provided clinical input, and contributed to the analysis and writing the paper. P.J. provided clinical input to the study and contributed to the analysis and writing of the paper

Intussusception incidence among infants in the UK and Republic of Ireland: a pre-rotavirus vaccine prospective surveillance study

INTRODUCTION: Intussusception, an abdominal emergency in young children, has been linked to a previous vaccine used to prevent rotavirus gastroenteritis. Although this vaccine was withdrawn, recent studies have suggested a potential, very small increased risk of intussusception following the administration of newly developed rotavirus vaccines. We aimed to determine the baseline incidence of intussusception among infants in the UK and Republic of Ireland - prior to the imminent introduction of the rotavirus vaccine into the UK schedule this year. METHODS: Prospective, active surveillance via the established British Paediatric Surveillance Unit (BPSU) was carried out from March 2008 to March 2009. Clinicians across 101 National Health Service (and equivalent) hospitals, including 27 paediatric surgical centres, reported cases admitted for intussusception in the UK and Republic of Ireland. The standard Brighton Collaboration case definition was used with only definite cases included for incidence estimation. RESULTS: The study response rate was 94.5% (379 questionnaires received out of 401 case notifications). A total of 250 definite cases of intussusception were identified. The annual incidence among infants in the UK and Republic of Ireland was 24.8 (95% CI: 21.7-28.2) and 24.2 (95% CI: 15.0-37.0) per 100,000 live births. In the UK, the highest incidence occurred in Northern Ireland (40.6, 95% CI: 21.0-70.8), followed by Scotland (28.7, 95% CI: 17.5-44.3), England (24.2, 95% CI: 20.9-27.9), then Wales (16.9, 95% CI: 6.8-34.8). In England, regional incidence was highest in London and lowest in the West Midlands. By age, the highest incidence (50.3/100,000 live births, 95% CI: 33.4-72.7) occurred in the fifth month of life (for England). A seasonal trend in the presentation of intussusception was observed with the incidence significantly (p=0.001) increased during winter and spring. CONCLUSION: The baseline rates obtained in this study will inform rotavirus vaccine-safety policy by enabling comparison with post-introduction incidence

The impact of trisomy 21 on epidemiology, management, and outcomes of congenital duodenal obstruction: a population-based study

Abstract: Purpose: Congenital duodenal obstruction (CDO) is associated with trisomy 21 (T21), or Down’s syndrome, in around a third of infants. The aim of this study was to explore the impact of T21 on the epidemiology, management, and outcomes of infants with CDO. Methods: Data were prospectively collected from specialist neonatal surgical centres in the United Kingdom over a 12 month period from March 2016 using established population-based methodology for all babies with CDO. Infants with T21 were compared to those without any chromosomal anomaly. Results: Of 102 infants with CDO that underwent operative repair, T21 was present in 33 [32% (95% CI 23–41%)] babies. Cardiac anomalies were more common in those with T21 compared to those without a chromosomal anomaly (91 vs 17%, p < 0.001), whereas associated gastrointestinal anomalies were less common in infants with T21 (3 vs 12%, p = 0.03). Surgical management was not influenced by T21. Time to achieve full enteral feed, need for repeat related surgery, and mortality were similar between groups. Infants with T21 had a longer median initial inpatient stay (23 vs 16.5 days, p = 0.02). Conclusions: Infants with T21 have a higher incidence of cardiac anomalies and a longer initial inpatient stay; however, it does not change CDO management or outcomes. This information is important for prenatal and postnatal counselling of parents of infants with CDO and T21

The impact of trisomy 21 on epidemiology, management, and outcomes of congenital duodenal obstruction: a population-based study

Abstract: Purpose: Congenital duodenal obstruction (CDO) is associated with trisomy 21 (T21), or Down’s syndrome, in around a third of infants. The aim of this study was to explore the impact of T21 on the epidemiology, management, and outcomes of infants with CDO. Methods: Data were prospectively collected from specialist neonatal surgical centres in the United Kingdom over a 12 month period from March 2016 using established population-based methodology for all babies with CDO. Infants with T21 were compared to those without any chromosomal anomaly. Results: Of 102 infants with CDO that underwent operative repair, T21 was present in 33 [32% (95% CI 23–41%)] babies. Cardiac anomalies were more common in those with T21 compared to those without a chromosomal anomaly (91 vs 17%, p < 0.001), whereas associated gastrointestinal anomalies were less common in infants with T21 (3 vs 12%, p = 0.03). Surgical management was not influenced by T21. Time to achieve full enteral feed, need for repeat related surgery, and mortality were similar between groups. Infants with T21 had a longer median initial inpatient stay (23 vs 16.5 days, p = 0.02). Conclusions: Infants with T21 have a higher incidence of cardiac anomalies and a longer initial inpatient stay; however, it does not change CDO management or outcomes. This information is important for prenatal and postnatal counselling of parents of infants with CDO and T21

Gastric duplication cyst as a differential for an intra-thoracic cystic mass

We report a case of a neonate who presented with respiratory distress initially managed for a suspected pneumothorax before being transferred to a tertiary centre where he had a thoracotomy. A large cystic structure was excised later histologically confirmed to be a gastric duplication cyst. We discuss its management

Development of a gastroschisis core outcome set

ObjectiveOutcome reporting heterogeneity impedes identification of gold-standard treatmentsfor children born with gastroschisis. Use of core outcome sets (COS) in research reducesoutcome reporting heterogeneity and ensures that studies are relevant to patients. Theaim of this study was to develop a gastroschisis COS.Design and SettingSystematic reviews and stakeholder nomination were used to identify candidateoutcomes that were subsequently prioritised by key stakeholders in a three-phaseonline Delphi process and face-face consensus meeting using a nine-point Likert scale.In phases two and three of the Delphi process, participants were shown graphical andnumerical representations of their own, and all panels scores for each outcomerespectively and asked to review their previous score in light of this information.Outcomes were carried forward to the consensus meeting if prioritised by two or threestakeholder panels in the third phase of the Delphi process. The COS was formed fromoutcomes with consensus meeting scores ≥70% 7–9 and &lt;15% 1-3.Results71 participants (84%) completed all phases of the Delphi process, during which, 87outcomes were assessed. Eight outcomes, mortality, sepsis, growth, number ofoperations, severe gastrointestinal complication, time on parenteral nutrition, liverdisease and quality of life for the child met criteria for inclusion in the COS.ConclusionsEight outcomes have been included in the gastroschisis COS as a result of theirimportance to key stakeholders. Implementing use of the COS will increase the potentialfor identification of gold standard treatments for the management of children born withgastroschisis