Abdominoplasty for Ladd’s procedure: optimizing access and esthetics

Rotational anomalies occur when there is an abnormal arrest of rotation in the embryonic gut during development. The characteristic population affected is considered to be infants or young children, but in clinical practice, can be found in older children and adults as well. In these patients, the Ladd procedure is performed, whereby the abdomen is opened using traditional incisions, such as the midline laparotomy, for full visualization of the abdominal cavity. Despite providing excellent visualization, approaches such as this carry both increased surgical-site morbidity and an often-displeasing incision and visible scar. In this case report, we advocate consideration of the low transverse pfannenstiel incision and approach used traditionally in cosmetic and reconstructive abdominoplasty for surgical access to the abdomen for Ladd’s procedure. We believe that this alternative approach provides superior visualization without compromising the integrity or the esthetics of the abdominal wall in appropriate populations desiring to minimize the morbidity and visibility of their scar.Keywords: adult, adolescent, aesthetics, abdominoplasty, Ladd procedure, ope

Mechanical Evaluation of Balloon-Type Gastrostomy Devices

Purpose is to evaluate the durability of two commonly used gastrostomy devices. The performance of balloon-type gastrostomy devices was evaluated in an accelerated aging failure mode as well as a feeding tube interlock pullout failure mode. Two commonly used devices were tested: MINI (Applied Medical Technology Inc.) and MIC-Key (Kimberly Clark/Ballard Medical). In the aging test, devices (n = 20) from each manufacturer were pressurized and subjected to controlled pH and temperature conditions to evaluate the product life. In the pullout failure test, devices were subjected to controlled mechanical loading to evaluate the force at which each plastic interlock pulls out of the rubber that encapsulates it. In the aging testing, the MIC-Key devices had a lifespan of 98 ± 34 h and the MINI survived for 1187 ± 422 h. The difference was statistically significant (p \u3c 1 × 10-9). In the pullout testing, the MIC-Key failed at 183 ± 24 N whereas the MINI failed at 202 ± 26 N (p \u3c 0.04). Pullout strength for both devices appears adequate in view of estimated in vivo loads during normal use of the device with the MINI requiring a statistically significantly greater pullout strength. Although the aging tests were performed using an accelerated protocol, the aging tests suggest that the in vivo lifespan and failure mode of the MINI may be superior to the MIC-Key

Let them play: A prospective study of postoperative activity restrictions in children

Background: We aim to compare time to resume full activity, postoperative outcomes, and describe family preferences of self-directed activity restrictions (SDAR) and physician-directed activity restrictions (PDAR) following routine pediatric surgeries. Methods: We conducted a single institution, clinical trial (NCT04145895) from January 2020 to February 2022. Patients who presented for a routine inguinal hernia repair (ages 2-13) or laparoscopic appendectomy for uncomplicated appendicitis (aged ≤ 18) were eligible for participation. Participants chose to enroll in either the control (PDAR) or experimental (SDAR) groups. Control patients were instructed to restrict full activities for two weeks. For SDAR, patients were instructed to return to full activity when the patient and family felt comfortable doing so. Postoperatively, participants were asked to complete a survey to assess time to resume full activity, surgical complications, and patient and caregiver satisfaction. Results: 20 (24.4%) enrolled in PDAR and 62 patients (75.6%) enrolled in SDAR. The majority of patients underwent laparoscopic appendectomy (78%). Of patients who completed the postoperative survey, the average time to resume full activity was 11.91 days for PDAR and 9.51 days for SDAR (p = 0.328). There was no difference in parent satisfaction or postoperative complications (p >0.999). Conclusions: The time to resume full activity was two days sooner for SDAR without compromising post-operative outcomes. There are psychosocial benefits to children resuming normal activities, and SDAR may lessen a family's societal burden. Therefore, we propose that SDAR appears safe and should be utilized for routine surgery

The utility of ERCP in pediatric pancreatic trauma

© 2017 Elsevier Inc. Background/purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. Methods: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests. Results: ERCP was used at 14/22 centers for 26 patients. Indications were duct evaluation, duct leak control, pseudocyst, fistula, and stricture. ERCP altered management or improved outcomes in 13/26 (50%), most commonly in patients with ERCP for duct evaluation, stricture, and fistula. In patients managed nonoperatively, those with early endoscopic intervention (within one week of injury) with stent or sphincterotomy (n = 9) had similar time to regular diet [median (IQR)]: [10 (7–211) vs 7 (4–12) days; p = 0.55], similar hospital days: [12 (8–20) vs 11 (6–19) days, p = 0.63], and similar time on parenteral nutrition: [17 (10–40) vs 10 (6–18) days; p = 0.19] compared to patients who were only observed. Conclusions: In children with blunt pancreatic injury, ERCP can be useful to diagnose duct injury and for management of late complications such as stricture and fistula. However, early endoscopic intervention for pancreatic duct disruption may not improve outcome or expedite recovery. Further study is needed. Study type: Retrospective Study; Treatment Study. Level of evidence: III

The utility of ERCP in pediatric pancreatic trauma

© 2017 Elsevier Inc. Background/purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. Methods: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests. Results: ERCP was used at 14/22 centers for 26 patients. Indications were duct evaluation, duct leak control, pseudocyst, fistula, and stricture. ERCP altered management or improved outcomes in 13/26 (50%), most commonly in patients with ERCP for duct evaluation, stricture, and fistula. In patients managed nonoperatively, those with early endoscopic intervention (within one week of injury) with stent or sphincterotomy (n = 9) had similar time to regular diet [median (IQR)]: [10 (7–211) vs 7 (4–12) days; p = 0.55], similar hospital days: [12 (8–20) vs 11 (6–19) days, p = 0.63], and similar time on parenteral nutrition: [17 (10–40) vs 10 (6–18) days; p = 0.19] compared to patients who were only observed. Conclusions: In children with blunt pancreatic injury, ERCP can be useful to diagnose duct injury and for management of late complications such as stricture and fistula. However, early endoscopic intervention for pancreatic duct disruption may not improve outcome or expedite recovery. Further study is needed. Study type: Retrospective Study; Treatment Study. Level of evidence: III