A Simple Vacuum Dressing Reduces the Wound Infection Rate of Single-Incision Pediatric Endosurgical Appendectomy

A simple, low-cost umbilical vacuum dressing was found to decrease the wound infection rate after single-incision pediatric endosurgical appendectomy

Laparoscopic Appendectomy for Torsed Appendix Presenting as an Acute Abdomen in an Infant Female

These authors conclude that appendiceal torsion should be included in the differential diagnosis of a young child with right lower quadrant pain and no elevated inflammatory markers

Single Incision Laparoscopic Splenectomy in a 5-Year-Old With Hereditary Spherocytosis

Laparoscopic splenectomy in a pediatric patient was performed through a single umbilical incision by using 3 ports

A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

AIM OF THE STUDY Pediatric surgeons treat a vulnerable population in which unfavorable outcome can lead to substantial long-term costs, placing them at risk for malpractice claims. This study aims to characterize the frequency and circumstances in which malpractice claims were successfully brought against pediatric surgeons in Germany over the last 5 years. MATERIALS AND METHODS Anonymous data on medical treatment errors and payments were acquired from the Federal Chamber of Physicians from 2014 through 2018 and analyzed for most frequent diagnoses and circumstances that resulted in accusation or conviction. Those claims that were successfully rebutted were compared to as controls. Lifetime risk for being involved in litigation and its outcome was calculated. RESULTS There were 129 medical malpractice claims over the 5-year observation period. Medical error was confirmed in 56 cases (43%); the rest were successfully appealed. The risk of the prototypical German pediatric surgeon to be accused was 5.24% and to be convicted 2.27% per year in practice. The most common reasons for conviction (alone or in combination) were surgical-technical errors (23%), treatment delay (21%), insufficient workup (17%), incorrect diagnosis (17%), and incomplete consent (16%).The most frequent circumstances leading to a conviction were trauma (27%), inguinal hernia (7%), circumcision (7%), testicular torsion (7%), acute abdomen (7%), and appendicitis (5%). CONCLUSION Over a 40-year career, pediatric surgeons in Germany face an average calculated risk of 2.1 to be accused and 0.9 to be convicted of malpractice claims. Certain circumstances pose higher risks for litigation than others. Knowledge of these patterns may help practitioners avoid medicolegal confrontation

Paediatric trauma on the Last Frontier: an 11-year review of injury mechanisms, high-risk injury patterns and outcomes in Alaskan children

Background: Paediatric trauma system development in Alaska is complicated by a vast geographic coverage area, wide regional variations in environment and culture, and a lack of available published data. Objective: To provide a detailed description of paediatric trauma mechanisms, high-risk injury patterns and outcomes in Alaska. Design: This retrospective study included all children aged 17 years or younger in the State of Alaska Trauma Registry database admitted with traumatic injury between 2001 and 2011. Each injury record was reviewed individually and assigned a mechanism based on Centers for Disease Control E-codes. Geographic definitions were based on existing Emergency Medical Services regions. Mechanisms were compared by geographic region, patient demographics, injury characteristics and outcome. Subgroup analysis of fatal injuries was performed to identify causes of death. Results: Of 5,547 patients meeting inclusion criteria, the most common mechanisms of injury were falls (39%), motor vehicle collisions (10%) and all-terrain vehicle (ATV) accidents (9%). The overall case fatality rate was 2%. Mechanisms with the greatest risk of death were gunshot wounds (21%), pedestrians struck by motorized vehicles (9%) and motor vehicle collisions (5%). These 3 mechanisms accounted for 15% of injuries but 60% of deaths in the overall cohort. Injury patterns involving combined central nervous system (CNS) and torso injuries were unusual but especially lethal, occurring in 3% of patients but carrying a case fatality rate of 18%. Although the distribution of mechanisms was generally similar for each geographic region, ATV and snowmobile injuries were significantly more common in remote areas (23% remote vs. 7% non-remote, p < 0.0001). Conclusions: Mechanisms of paediatric trauma in Alaska have widely varying impacts on outcome and show some variation by region. Highest-risk mechanisms include gunshot wounds and motorized vehicle-related accidents. Prevention efforts should give special attention to CNS injury prevention, ATV and snowmobile safety in remote areas, and optimization of management of multisystem trauma. Further studies should investigate predictors of outcome in greater detail

Physical Fitness and Locomotor Skills in Children With Esophageal Atresia-A Case Control Pilot Study

Background: Patients with esophageal atresia (EA) often experience physical limitations. With increasing survival over the past decades, the focus in care shifted toward improving the long-term quality of life. We performed validated testing fitness and motor skills in children born with EA.Methods: Patients with EA were evaluated using the standardized Kinderturntest Plus/ Deutscher Motorik Test after caregiver's written consent. Test scores range from 1 to 5 (compared to an age- and gender matched standard population). Caregivers completed an online-questionnaire on patient history.Results: Seventeen patients (median age 7 [3–12] years) were included. Comorbidities were prematurity (54%), birth weight &lt;1,500 g (23%), congenital heart disease (46%), developmental delay (38%), skeletal deformity (23%), and anorectal malformation (15%). The mean test score was significantly lower in children with EA (2.19) compared to a control group matched for age, gender, body weight, and –height, (2.75, p = 0.04), and the general population (3, p = 0.00). Distribution of patient scores was below the 41st performance percentile for gender and age in 54–63%. Caregivers identified notable deficits of strength and endurance. All but one patient complained about discomfort during physical exercise, most commonly respiratory distress (46%) and gastroesophageal reflux symptoms (31%). Notably, 93% of subjects participated in regular school physical education classes, and 86% participated regularly in additional organized sporting activities.Conclusions: Children after EA repair have decreased physical fitness and impaired locomotor function compared to the general population on a standardized test. Physical discomfort is frequent during exertion. To avoid demotivation, locomotor skill should be promoted at each individual's comfortable level.The study was registered at www.researchregistry.com (No. 3707)

The use of honey in button battery ingestions: a systematic review

BackgroundButton battery (BB) ingestions may cause severe and possibly fatal complications, especially if the battery is located in the esophagus. The application of oral honey has recently been proposed by the National Capital Poison Center in the USA and in an ESPGHAN position paper in Europe, but clinical trials and experimental studies are limited. The goal of this systematic review was to analyze the evidence for this approach.Materials and methodsA systematic review of clinical trials and experimental studies on the oral application of honey after BB ingestion in children was performed. Inclusion criteria according to the PICO format were patient age 0–18 years, ingestion of BB, oral administration of honey or other substances, all in vivo and in vitro studies, as well as reported complication rate, esophageal injury, and mortality. A manual search in the databases MEDLINE, Web of Science and Cochrane was performed to identify relevant search terms to form the following queries and to construct the extensive search. Furthermore, the search was extended by using snowballing on the reports reference lists. The review is registered at Research Registry. The identifying number is reviewregistry1581.ResultsWe found four publications that investigated the effects of honey after button battery ingestion. Three of these presented experimental in vitro and in vivo results and one reported a clinical retrospective study of 8 patients.ConclusionFollow up studies are required to further elucidate the effectiveness of the treatment with honey. The time intervals in which the use of honey is effective is not clear. Furthermore, a physiological model is needed for in vitro testing, preferably mimicking peristalsis and dynamic flow of the applied substances. However, since it is easy to apply and of minimal risk in patients over one year of age, honey should be considered a possible treatment option during the interval between presentation and endoscopic removal of the retained BB.Systematic Review Registrationhttps://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/643e9df96750410027ee11b0/, identifier: reviewregistry1581

Nationwide trends of laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis in Germany: A slow path forward

Since its introduction, laparoscopic pyloromyotomy (LP), has become increasingly popular in many countries. We have noticed an attenuated trend in Germany. The aim of this study was to analyse the distribution of open and LP in Germany. The national database of administrative claims data of the Institute for the Remuneration System in Hospitals (InEK) was analysed regarding numbers of patients with pyloromyotomy in the years 2019–2021. The German quality reports of the hospitals of 2019 and 2020 were analyzed regarding the number of procedures performed per hospital and pediatric surgical department. A total of 2050 patients underwent pyloromyotomy. The incidence of hypertrophic pylorus stenosis (HPS) was 699 and 657 patients in 2019 and 2021, respectively. Regarding age, 31.1% were admitted before 28 days of age. LP gradually increased from 216 patients (30.9%) in 2019 to 239 patients (36.4%) in 2021. Thirty-three laparoscopic operations (4.8%) were converted to an open approach. In 24 of all patients, there was an injury to the stomach, in 20 patients to the duodenum, needing repair with sutures. Analysis of the quality reports indicated that 44% of pediatric surgical departments performed LP. Although LP has became more prevalent in Germany recently, about two thirds of patients still undergo an open procedure

Tracheal bifurcation located at proximal third of oesophageal length in Sprague Dawley rats of all ages

Levrat’s rat model is often the first choice for basic studies of oesophageal adenocarcinoma. The position of the tracheal bifurcation represents the preferred location for the high-intrathoracic anastomosis following oesophagectomy for cancer and is thus of importance in basic research of oesophageal adenocarcinoma. In addition, it is also the typical location for trachea-oesophageal fistulae in congenital oesophageal atresia and its rat model. We thus analysed whether the position of the tracheal bifurcation would be affected by a rat’s growth throughout life. We analysed absolute and relative carinal position of the tracheal bifurcation and its relationship to oesophageal length in two cohorts of Sprague Dawley rats (RjHan:SD) of both sexes: one consisted of 30 eight-week old rats and the other of 20 rats aged between 15 and 444 days. We analysed their relationship by Pearson’s r and univariate linear regression. Bootstrap confidence intervals were calculated for all calculated coefficients. Absolute carinal position correlated with oesophageal length in the eight-week old cohort (r=0.4, 95% CI: 0.08-0.71, p=0.015) and those of different ages (r=0.92, 95% CI: 0.77-0.96, p=0.0066). Absolute carinal position increased with oesophageal length in both cohorts (F(1,28)=5.56; p=0.0256 and F(1,18)=94.93; p&lt;0.0001 respectively). Consequently, relative tracheal bifurcation position was not influenced by oesophageal length in both cohorts (F(1,28)=2.49; p=0.1257 and F(1,18)=1.92; p=0.183). Absolute carinal position increased with oesophageal length, but relative position remained constant at around 30% of proximal oesophageal length throughout life