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1.
Am Surg ; : 31348241248788, 2024 Apr 22.
Article in English | MEDLINE | ID: mdl-38648035

ABSTRACT

BACKGROUND: The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2 kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2 kg, additional data is needed to evaluate the safety of EC in infants <2 kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants. METHODS: We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4 kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications. RESULTS: Of 92 infants, 15 infants (16.3%) underwent EC at <2 kg, 16 (17.4%) at 2-2.49 kg, 31 (33.7%) at 2.5-2.99 kg, and 30 (32.6%) at ≥3 kg. Infants <2 kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2 kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032). CONCLUSION: Our findings suggest that EC in infants <2 kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.

2.
Pediatr Blood Cancer ; 69(11): e29934, 2022 11.
Article in English | MEDLINE | ID: mdl-36094157

ABSTRACT

Infantile hemangioma is the most common soft tissue tumor of infancy. Extensive organ involvement is rare. This report describes an infant with biopsy confirmed infantile hemangioma with diffuse organ involvement causing anemia and failure to thrive. Treatment was initiated with propranolol and led to initial improvement; however, course was complicated by several episodes of respiratory failure secondary to pulmonary edema. Propranolol therapy was interrupted for several months while patient was maintained on a diuretic regimen and treated with vincristine and high-dose corticosteroids. Patient was transitioned back to propranolol and is clinically thriving with objective improvement on radiographic imaging.


Subject(s)
Hemangioma, Capillary , Hemangioma , Respiratory Insufficiency , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Antagonists , Diuretics/therapeutic use , Hemangioma/complications , Hemangioma/drug therapy , Hemangioma, Capillary/complications , Hemangioma, Capillary/drug therapy , Humans , Infant , Propranolol/therapeutic use , Respiratory Insufficiency/etiology , Spinal Canal , Treatment Outcome , Vincristine/therapeutic use
3.
Pediatr Blood Cancer ; 69(1): e29392, 2022 01.
Article in English | MEDLINE | ID: mdl-34606171

ABSTRACT

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that mainly occurs during infancy or early childhood. Approximately 70% of cases are complicated by Kasabach-Merritt phenomenon. Although osseous extension of the primary lesion is relatively common, primary bone involvement by KHE is rare. Given the paucity of literature on primary KHE of the bone, we report a case series of primary KHE of the bone treated at our institution and describe the clinical presentation, radiologic and pathologic findings, management and outcomes.


Subject(s)
Hemangioendothelioma , Kasabach-Merritt Syndrome , Sarcoma, Kaposi , Vascular Neoplasms , Adolescent , Child , Child, Preschool , Hemangioendothelioma/diagnostic imaging , Humans , Sarcoma, Kaposi/diagnosis
4.
Pediatr Dermatol ; 38(5): 1276-1282, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34595775

ABSTRACT

We present a complex case of a neonate, delivered urgently for hydrops fetalis, with a large vascular mass of the extremity, diagnosed postnatally as a congenital hemangioma. The patient suffered immediate cardiac compromise and severe coagulopathy atypical for the diagnosis and subsequently died from these complications. Treatment was imperative but challenging due to a lack of a standardized treatment approach and few historical reports of equally critically ill patients. In this report, we review potential medical and surgical interventions and discuss treatment considerations in similar, life-threatening cases of congenital hemangiomas.


Subject(s)
Heart Failure , Hemangioma , Heart Failure/etiology , Hemangioma/complications , Hemangioma/diagnosis , Humans , Hydrops Fetalis , Infant, Newborn
5.
J Pediatr Surg ; 56(5): 1062-1067, 2021 May.
Article in English | MEDLINE | ID: mdl-33982660

ABSTRACT

BACKGROUND/PURPOSE: Cervicofacial lymphatic malformations (CFLM) are rare, potentially life-threatening vascular anomalies, yet reports on multidisciplinary treatment strategies are lacking. We evaluated outcomes for CFLMs following sclerotherapy, surgical resection, and/or medical management. METHODS: We identified children with a CFLM at a vascular anomalies center from 2004 to 2019. EXCLUSION CRITERIA: retro-orbital malformations, untreated malformations, patients without follow-up. Primary clinical outcome was contour improvement, with significance defined as LM volume reduction of >50% by cross-sectional imaging. RESULTS: Sixty-three children met inclusion criteria: 35 with macrocystic CFLMs, six with microcystic CFLMs, and 22 with mixed-type malformations. Mean post-intervention follow-up was 27.5 months. Fifty-eight patients underwent sclerotherapy (median: two treatments). Doxycycline and/or bleomycin were used in 95% of patients. After sclerotherapy, 97% of macrocystic CFLMs improved significantly compared to 82% of mixed and 67% of microcystic lesions. Sixteen children underwent surgical resection with 75% significantly improving; two additional patients were successfully treated with sclerotherapy after debulking surgery. Six children received sirolimus for microcystic disease, of which 33% significantly improved. CONCLUSION: Sclerotherapy is very effective for macrocystic components of CFLMs, albeit less so for microcystic disease. Microcystic CFLMs frequently require surgical resection. Sirolimus is a helpful therapeutic adjunct, particularly for microcystic lesions, but more study is needed. LEVEL OF EVIDENCE: Level II, prognosis study.


Subject(s)
Lymphangioma, Cystic , Lymphatic Abnormalities , Bleomycin/therapeutic use , Child , Humans , Infant , Lymphatic Abnormalities/drug therapy , Retrospective Studies , Sclerosing Solutions/therapeutic use , Sclerotherapy , Treatment Outcome
6.
J Pediatr Surg ; 56(8): 1425-1429, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33526253

ABSTRACT

BACKGROUND/PURPOSE: Abdominal lymphatic malformations (LM) are a rare subset of vascular anomaly caused by abnormal development of the lymphatic system. They are classified as macrocystic, microcystic or combination macrocystic and microcystic. Surgical resection, percutaneous sclerotherapy, and medical therapy are all employed to treat these complex and often symptomatic lesions. No standardized treatment algorithm exists currently. The purpose of this study was to establish a multidisciplinary treatment approach to abdominal LMs. METHODS: A retrospective observational study was conducted from 2013 to 2019 on patients with abdominal LMs at a single tertiary children's hospital vascular anomalies center. Demographics, imaging, and treatment modality were recorded. Clinical and/or radiographic response to the primary treatment modality as well as complications was the outcomes measured. RESULTS: Nineteen patients (12 macrocystic, 5 microcystic and 2 combined) were identified, with a median age at diagnosis of 2.2 years (range 0.1-20.8 years). Sclerotherapy was the most common primary treatment, followed by surgical resection and sirolimus. No difference in clinical response (p = 0.58) or complications (p = 0.31) was observed based on primary treatment or subtypes. CONCLUSIONS: Based on our institutional experience, we propose an LM subtype-based treatment algorithm for abdominal LMs. It employs a multidisciplinary approach, and results in satisfactory patient outcomes with minimal complications. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Subject(s)
Lymphatic Abnormalities , Abdomen , Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Lymphatic Abnormalities/diagnostic imaging , Lymphatic Abnormalities/therapy , Retrospective Studies , Sclerotherapy , Treatment Outcome , Young Adult
7.
J Vasc Surg Venous Lymphat Disord ; 9(3): 781-784, 2021 05.
Article in English | MEDLINE | ID: mdl-32687897

ABSTRACT

We describe a 17-year-old boy with capillary malformation-arteriovenous malformation syndrome and a massive vascular malformation of the right chest wall, shoulder, and upper arm. Persistent growth of the malformation caused cutaneous ulcerations and recurrent massive bleeding episodes. We proceeded with a modified shoulder disarticulation preceded by ligation of the subclavian artery and innominate vein by median sternotomy. After a staged debulking resection of the residual chest wall arteriovenous malformation with rotational transverse rectus abdominis myocutaneous flap coverage, the patient was discharged home safely. This report demonstrates that a multidisciplinary approach is critical for management of life-threatening complications in capillary malformation-arteriovenous malformation patients.


Subject(s)
Arm/blood supply , Arteriovenous Malformations/therapy , Capillaries/abnormalities , Disarticulation , Hemorrhage/therapy , Hemostatic Techniques , Myocutaneous Flap , Port-Wine Stain/therapy , Shoulder/blood supply , Thoracic Wall/blood supply , Vascular Surgical Procedures , Adolescent , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnosis , Blood Transfusion , Embolization, Therapeutic , Hemorrhage/etiology , Humans , Male , Port-Wine Stain/complications , Port-Wine Stain/diagnosis , Recurrence , Treatment Outcome
9.
Fetal Diagn Ther ; 45(4): 275-280, 2019.
Article in English | MEDLINE | ID: mdl-29642057

ABSTRACT

Fetuses with obstructive neck and orofacial lesions have been delivered via an ex utero intrapartum treatment (EXIT) procedure to facilitate securement of the airway while on placental circulation. Pregnancy-related cardiovascular changes and technical issues unique to an EXIT procedure increase fetal and maternal risks relative to a standard cesarean section. In order to circumvent such issues, fetal endoscopic intubation has been proposed. We report a case of a fetus with a large neck mass (mixed solid and multiloculated cystic lesion measuring 9.2 × 5.3 × 8.5 cm, neck hyperextension, protruding tongue, and serial gagging movements) that was successfully intubated in utero and delivered at 36 weeks and 0 days via standard cesarean section, thereby avoiding an EXIT procedure. The risks, benefits, and technical issues of in utero tracheal intubation are reviewed.


Subject(s)
Airway Obstruction/surgery , Delivery, Obstetric/methods , Intubation/methods , Female , Fetoscopy , Humans , Infant, Newborn , Minimally Invasive Surgical Procedures/methods , Pregnancy
10.
J Laparoendosc Adv Surg Tech A ; 27(4): 427-429, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28055335

ABSTRACT

INTRODUCTION: Conditions requiring an esophagectomy and esophageal replacement are rare in children. The preferred method and ideal replacement organ continue to be debated. We present long-term outcomes in children treated with esophagectomy and gastric pull-up. METHODS: We conducted a retrospective review of all the patients who underwent a esophagectomy and gastric pull-up at two major pediatric institutions from 2004 to 2015. Follow-up data were obtained for children when available, including any postoperative complications, need for dilation of strictures, and current feeding method. RESULTS: Minimally invasive procedures were performed on 7 patients (5 female and 2 male) with a median age of 3 years (range 2-20, standard deviation = 8). Three patients successfully underwent laparoscopic transhiatal esophagectomy and cervical gastric pull-up, and three patients successfully underwent combined laparoscopic and right thoracoscopic (Ivor-Lewis) esophagectomy and cervical gastric pull-up. We identified an additional 3 patients who had an open esophagectomy and gastric pull-up. Seven patients had tubularized gastric conduits, six without pyloroplasty and one with pyloroplasty. For those patients with tubularized conduits, the average time to achieve full oral feeds was 16 days, with 1 patient with pyloroplasty who took 27 days. Of the three whole-stomach conduits, one reached oral independence at 19 days and the other two had yet tolerated anything per os. Follow-up data were available for all patients. At the average 5 years follow-up (ranging from 1 month to 7 years), all but two were thriving well with full oral feeds. CONCLUSIONS: Minimally invasive esophagectomy and gastric pull-up is a good alternative in managing pediatric patients in need of esophagectomy and replacement; it offers acceptable early and long-term outcomes. Tubularized conduit appears to be superior to using the whole stomach and potentially avoids pyloroplasty. Ongoing study is needed to validate our findings.


Subject(s)
Burns, Chemical/surgery , Esophageal Atresia/surgery , Esophageal Stenosis/surgery , Esophagectomy/methods , Esophagus/surgery , Plastic Surgery Procedures/methods , Pylorus/surgery , Stomach/surgery , Adolescent , Child , Child, Preschool , Esophageal Achalasia/surgery , Esophageal Stenosis/chemically induced , Esophageal Stenosis/congenital , Esophagus/injuries , Female , Humans , Laparoscopy/methods , Male , Minimally Invasive Surgical Procedures , Neck , Postoperative Complications/epidemiology , Retrospective Studies , Young Adult
11.
J Pediatr Surg ; 52(4): 598-601, 2017 Apr.
Article in English | MEDLINE | ID: mdl-27622586

ABSTRACT

BACKGROUND: Intramuscular venous malformations (VMs) are rare, but can be highly symptomatic. There are few reports on outcomes, particularly pain, functional limitations, and muscle contractures. We aimed to compare results of medical management, sclerotherapy, and surgical resection. METHODS: We retrospectively reviewed 45 patients with an extremity or truncal intramuscular VM between June 2005 and June 2015 at a single institution. Outcomes were compared between treatment modalities with ANOVA and χ2 tests. RESULTS: Six patients (13%) were treated with medical management, 4 (9%) with surgical resection, 23 (51%) with sclerotherapy, and 12 (27%) with both surgery and sclerotherapy. Sclerotherapy alone decreased pain in 72%. Only 20% of patients presented with muscle contracture. For these patients, 33% resolved with sclerotherapy, physical therapy, and aspirin; 22% resolved with surgery, and 45% had persistent contracture. 40% of patients treated with sclerotherapy then surgery developed new muscle contractures, compared to 4% of sclerotherapy only patients and 0% of surgery only patients (p=0.04). CONCLUSIONS: Medical management, surgery and sclerotherapy are effective treatments for intramuscular VMs. Observation and supportive care can be a primary treatment for patients with minimal symptomatology and no functional limitations. Sclerotherapy is more effective for treating pain than contractures and when used alone, rarely causes a new muscle contracture.


Subject(s)
Muscle, Skeletal/blood supply , Vascular Malformations/therapy , Veins/abnormalities , Adolescent , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Child , Child, Preschool , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Muscle, Skeletal/surgery , Physical Therapy Modalities , Retrospective Studies , Sclerotherapy , Treatment Outcome , Veins/surgery , Young Adult
12.
J Vasc Interv Radiol ; 27(12): 1846-1856, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27776983

ABSTRACT

PURPOSE: To evaluate efficacy of sclerotherapy with doxycycline versus sodium tetradecyl sulfate (STS) for treatment of macrocystic and mixed lymphatic malformations (LMs). MATERIALS AND METHODS: This single-center retrospective review identified 41 children (17 boys; 24 girls; age range, 1 month to 15.4 y) who underwent sclerotherapy with doxycycline (n = 32) or STS (n = 9) for macrocystic (n = 31) or mixed (n = 10) LMs. There were 114 treatments performed, averaging 2.8 treatments (range, 1-8 treatments) per patient. Average follow-up time was 10 months (range, 1-59 months). Clinical response was deemed excellent or moderate if > 90% or > 50% of LMs resolved based on visual estimate. RESULTS: With doxycycline, 87% of patients (28 of 32) had excellent or moderate response with an average of 2.8 treatments (range, 1-7 treatments); 13% required subsequent resection. With 3% STS monotherapy, only 55% of patients (5 of 9) had excellent or moderate response with an average of 2.8 treatments (range, 1-8 treatments), and 33% required subsequent resection. Significantly fewer patients treated with STS responded well compared with patients treated with doxycycline (P = .03). Patients treated with STS had significantly longer follow-up than patients treated with doxycycline (27 months vs 6 months, P = .0001). CONCLUSIONS: Doxycycline monotherapy resulted in a high rate of excellent clinical outcomes after a few treatments without increased need for subsequent operative resection. These results support use of doxycycline sclerotherapy as primary treatment for macrocystic and mixed LMs in children.


Subject(s)
Doxycycline/administration & dosage , Lymphatic Abnormalities/therapy , Sclerosing Solutions/administration & dosage , Sclerotherapy/methods , Sodium Tetradecyl Sulfate/administration & dosage , Adolescent , Age Factors , Child , Child, Preschool , Doxycycline/adverse effects , Female , Humans , Infant , Los Angeles , Lymphatic Abnormalities/diagnostic imaging , Lymphatic Abnormalities/surgery , Lymphography , Magnetic Resonance Imaging , Male , Retrospective Studies , Sclerosing Solutions/adverse effects , Sclerotherapy/adverse effects , Sodium Tetradecyl Sulfate/adverse effects , Time Factors , Treatment Outcome
13.
J Pediatr Surg ; 51(7): 1138-41, 2016 Jul.
Article in English | MEDLINE | ID: mdl-26831533

ABSTRACT

INTRODUCTION: The incidence of intestinal stricture is low for most conditions requiring a primary small bowel stoma in infants. Routine performance of contrast enemas (CE) prior to stoma closure adds cost and radiation exposure. We hypothesized that routine CE prior to ostomy reversal is not necessary in all infants, and sought to identify a subset of patients who may benefit from preoperative CE. METHODS: Medical records of infants under age 1 (N=161) undergoing small bowel stoma reversal at a single institution between 2003 and 2013 were retrospectively reviewed. Student's T-test was used to compare groups. RESULTS: Contrast enemas were performed on 80% of all infants undergoing small bowel ostomy reversal during the study period. Infants with necrotizing enterocolitis (NEC) were more likely to have a CE than those with intestinal atresia (p=0.03) or those with all other diagnoses combined (p=0.03). Nine strictures were identified on CE. Of those, 8 (89%) were in patients with NEC, and only 4 were clinically significant and required operative resection. The overall relevant stricture rate was 2.5%. No patient that underwent ostomy takedown without CE had a stricture diagnosed intraoperatively or an unrecognized stricture that presented clinically after stoma takedown. CONCLUSIONS: Routine CE is not required prior to small bowel ostomy reversal in infants. We recommend judicious use of enema studies in patients with NEC and high likelihood of stricture.


Subject(s)
Barium Enema/statistics & numerical data , Enterostomy , Intestinal Obstruction/diagnostic imaging , Intestine, Small/surgery , Practice Patterns, Physicians'/statistics & numerical data , Preoperative Care/methods , Unnecessary Procedures/statistics & numerical data , California , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestine, Small/diagnostic imaging , Male , Retrospective Studies
14.
Pediatr Dev Pathol ; 19(5): 417-420, 2016.
Article in English | MEDLINE | ID: mdl-26555222

ABSTRACT

We report a 7-year-old male with a history of recurrent kaposiform hemangioendothelioma (KHE) in the sacral area and multiple thoracic vertebral lesions. Tumor karyotyping revealed the balanced translocation t(13;16)(q14;p13.3). He had mildly decreased platelet counts but never experienced any episodes of Kasabach-Merritt phenomenon. He was treated with vincristine for 1 year but improvement was minor. Significant clinical improvement was seen with sirolimus therapy. To the best of our knowledge, this is the first report to demonstrate that KHE is associated with a clonal karyotypic abnormality.


Subject(s)
Chromosomes, Human, Pair 13/genetics , Chromosomes, Human, Pair 16/genetics , Hemangioendothelioma/genetics , Translocation, Genetic , Antibiotics, Antineoplastic/therapeutic use , Child , Hemangioendothelioma/pathology , Humans , Male , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/pathology , Sacrum , Sirolimus/therapeutic use
15.
Int J Pediatr Otorhinolaryngol ; 79(6): 883-887, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25887132

ABSTRACT

OBJECTIVES: Lymphatic malformations are congenital vascular anomalies that occur from abnormal development of the lymphatic channels. Studies have shown that sclerotherapy can be a reliable alternative to surgery. The purpose of this retrospective study is to evaluate the safety and efficacy of percutaneous sclerotherapy with doxycycline and 3% Sotradecol as primary treatment for pediatric head and neck LMs, and to assess outcomes based on lesion classification, location and sclerosant used. STUDY DESIGN: This study was a single center, retrospective, case series study. MATERIALS AND METHODS: The medical records of 38 children who underwent percutaneous sclerotherapy of LMs in the head and neck region at our tertiary care center between 1/1/2006 and 1/31/2011 were reviewed. A mean average of 2.9 (range 1-10) sclerotherapy sessions per child were performed. LMs involved primarily the face (61.3%), posterior neck (48.4%), submental area (45.2%), and anterior neck (35.5%). RESULTS: Twenty-nine subjects had adequate follow-up data, with 51.7% demonstrating complete resolution, 27.6% moderate improvement, and 20.7% no response. There was no significant difference in the outcome based on the sclerosant agent used or location of the lesion. Lesion type did affect outcome and macrocystic lesions were found to have a significantly higher resolution rate (95.2%) than microcystic or mixed lesions (p < 0.05). The total number of complications was similar between agents and all were minor. CONCLUSION: Our results indicate that percutaneous therapy with doxycycline and Sotradecol is safe and effective for children with LMs of the head and neck. Better outcomes were observed with macrocystic LMs. LEVEL OF EVIDENCE: 4.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Lymphatic Abnormalities/therapy , Sclerosing Solutions/therapeutic use , Sclerotherapy , Sodium Tetradecyl Sulfate/therapeutic use , Adolescent , Child , Child, Preschool , Face , Female , Humans , Infant , Lymphatic Abnormalities/pathology , Male , Neck , Retrospective Studies , Sclerotherapy/methods , Treatment Outcome
16.
Pediatr Dev Pathol ; 18(1): 66-70, 2015.
Article in English | MEDLINE | ID: mdl-25360560

ABSTRACT

Infantile hemangiomas are the most common benign neoplasm of infancy, with most occurring in the head and neck region. Predisposing factors include prematurity, low birth weight, multiple gestations, advanced maternal age, and chorionic villous sampling. In addition, white women, particularly those with a family history, are also at a higher risk. However, pulmonary infantile hemangiomas are exceedingly rare, with only a few case reports in the literature. Infantile hemangiomas should be considered in the differential diagnosis of a pulmonary mass in the early pediatric population. We present a case of pulmonary infantile hemangioma in a premature male infant successfully managed by surgical excision, with an emphasis on the pathogenesis and histologic features.


Subject(s)
Hemangioma/diagnosis , Hemangioma/surgery , Diagnosis, Differential , Endothelial Cells/cytology , Glucose Transporter Type 1/metabolism , Humans , Infant, Newborn , Infant, Premature , Lung Neoplasms/diagnosis , Male , Tomography, X-Ray Computed , Treatment Outcome
19.
J Laparoendosc Adv Surg Tech A ; 23(10): 876-80, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24079961

ABSTRACT

BACKGROUND: Laparoscopic repair of congenital duodenal obstruction has become popularized over the past decade. Comparative data on outcomes, however, are sparse. We hypothesized that laparoscopic repair of congenital duodenal obstruction could be performed with similar outcomes to traditional open repair. PATIENTS AND METHODS: Medical records for all cases of congenital duodenal obstruction from 2005 to 2011 at three academic teaching hospitals were retrospectively reviewed. Patients were excluded from the analysis if they had confounding surgical diseases, did not have duodenoduodenostomy during the first hospital admission, had the repair performed before transfer from a referring hospital, or weighed less than 1.7 kg at the time of surgery. Analysis was performed as intention to treat, with laparoscopic converted to open cases included in the laparoscopic group. RESULTS: Sixty-four cases were included in the analysis (44 open, 20 laparoscopic). Baseline characteristics were similar between the two groups with the exception that the open group, on average, underwent repair later than the laparoscopic group (6 days versus 4 days, respectively). Seven laparoscopic cases were converted to an open procedure (35%), most commonly for difficulty in exposing the decompressed distal duodenum. Laparoscopic repair did take significantly longer than open repair (145 minutes versus 96 minutes, respectively), but clinical outcomes were similar. Complications were rare and were similar between methods of repair. Two patients in the laparoscopic group required subsequent open revision. CONCLUSIONS: Laparoscopic duodenoduodenostomy for congenital duodenal obstruction is a technically challenging procedure with a steep learning curve. Despite a relatively high conversion rate, clinical outcomes remained similar to the traditional open repair in selected patients.


Subject(s)
Duodenal Obstruction/congenital , Duodenal Obstruction/surgery , Laparoscopy , Age Factors , Body Weight , Clinical Competence , Female , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Time Factors , Treatment Outcome
20.
Pediatr Surg Int ; 29(7): 715-8, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23728507

ABSTRACT

PURPOSE: Ovarian masses in the pediatric population are commonly resected with a three or four port laparoscopic approach. Single-incision laparoscopic (SIL) resection is an alternative approach. However, there is limited experience with this modality in ovarian mass resection. METHODS: We reviewed SIL ovarian mass resections performed by our group from 2010 to 2012. We evaluated patient demographics, surgery statistics, and hospital course. RESULTS: Six patients were identified with mean age of 14 years. Imaging studies showed cystic masses ranging 4-6 cm in five patients, and 20 cm in one patient. One patient presented with recurrent teratoma. Pathology revealed four benign teratomas, one benign cyst, and one serous cystadenoma. Average operating time was 75 min. All patients had an ovarian-preserving resection. Three patients had cyst spillage, including the one who presented with recurrence (this was the only patient with a subsequent recurrence). Hospital stay averaged 37 h. Narcotic use averaged 9.9 mg of morphine daily. All patients had excellent cosmetic results, and no postoperative complications. CONCLUSIONS: Ovarian cystic mass excision using the SIL approach carries a higher risk of tumor spillage. Although the incidence of malignancy is low, they cannot be conclusively excluded with our current preoperative evaluations. At this time, we recommend SIL resection only for simple cysts with low malignant potential; however, further experience with this procedure will likely improve the risk of tumor spillage in the future.


Subject(s)
Cystadenoma, Serous/surgery , Laparoscopy/methods , Ovarian Cysts/surgery , Ovarian Neoplasms/surgery , Teratoma/surgery , Adolescent , Child , Female , Humans , Length of Stay/statistics & numerical data , Treatment Outcome
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