Magnamosis for esophageal atresia is associated with anastomotic strictures requiring an increased number of dilatations.

BACKGROUND/PURPOSE: Magnamosis is a novel technique which utilizes high power magnets to anastomose the esophageal ends in children with esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF), theoretically avoiding the need for thoracotomy. The objective of this study was to compare anastomotic stricture formation requiring dilatation after magnamosis versus after conventional anastomosis. METHODS: Our center treated the first 3 cases of EA ±â€¯TEF with magnamosis in Canada. One was unsuccessful and excluded from our study. The number of postintervention dilatations was compared to controls from our database, which includes all children with EA ±â€¯TEF treated between 1991 and 2015. The controls had EA ±â€¯TEF treated with pouch-to-end anastomosis or colonic interposition (n = 65). Mann-Whitney U tests were used with p < 0.05 being significant. RESULTS: The 2 magnamosis cases had a mean of 13.5 dilatations, compared to 2.6 for the controls. Those managed with pouch-to-end anastomosis or colonic interposition had a mean of 2.3 and 2.7 dilatations, respectively. We found that the cases required more dilatations than controls (p = 0.022) and pouch-to-end anastomosis (p = 0.021), but not than colonic interposition (p = 0.106). CONCLUSION: Our results indicate that magnamosis is associated with more postintervention dilatations than conventional anastomotic techniques, suggesting that magnamosis results in more frequent and/or more resilient anastomotic strictures. LEVEL OF EVIDENCE: 3.

Applying vacuum to accomplish reduced wound infections in laparoscopic pediatric surgery.

INTRODUCTION: The prevention of surgical site infections has received little attention in pediatric surgery. Negative pressure wound therapy is used to treat complex wounds. We hypothesized that this principle could reduce wound infection rates following laparoscopic surgery. We tested this in a randomized controlled trial. MATERIALS AND METHODS: We randomized pediatric patients with an umbilical port site to a standard dressing or a vacuum dressing. The dressings were removed 48h after surgery. A nurse blinded for the treatment inspected the umbilical wound between post-operative days 7-10 for infection. Data comparison was performed using a Fisher exact test with p<0.05 defined as significant. RESULTS: We recruited 90 patients over 2 years and randomized 44 to the vacuum dressing arm and 42 to the control arm. We observed a 2.8% (n=1/35) infection rate in the vacuum dressing group and 3.3% (n=1/30) in the control group (p=1.0). DISCUSSION: We ended our study early when an interim analysis showed an impractical number of patients would be required to achieve sufficient power. We did not find a significant difference between the control and vacuum dressings in reducing post-operative wound infections. LEVEL OF EVIDENCE: 3.

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury.

Abdominal compartment syndrome (ACS) is a known complication of the large-volume resuscitation that burn patients receive. Bowel ischemia has been theorized to occur in ACS but has yet to be described in the literature. The authors report an occurrence of late bowel obstruction related to ACS-associated bowel ischemia in a burn patient. A four-year-old previously well girl sustained 70% total body surface area burns with inhalation injury. The areas injured were the anterior neck, circumferential torso from neck to waist, left arm, left thigh and two-thirds of her right thigh. Fluid resuscitation was initially administered using the modified Parkland formula. Her transfer to the regional burn unit from a local hospital was complicated by early septic shock from a line infection, which increased her resuscitation fluid requirements. Infection ultimately led to multiple instances of ACS. Intervention with percutaneous drainage led to immediate improvement; however, the episodes of ACS resulted in a late small bowel obstruction secondary to stricture, requiring a laparotomy and bowel resection.

Le syndrome du compartiment abdominal (SCA) est une complication connue du volume liquidien important que reçoivent les patients brûlés pendant la réanimation. Théoriquement, l'ischémie intestinale est liée au SCA, mais elle n'a jamais été décrite dans des publications scientifiques. Les auteurs présentent un cas d'obstruction intestinale tardive liée à une ischémie intestinale associée à un SCA chez une patiente brûlée.Une fillette de quatre ans auparavant en santé a subi des brûlures sur 70 % de la surface totale de son corps, de même que des brûlures par inhalation. Elle était brûlée sur la partie antérieure du cou, la circonférence du torse entre le cou et la taille, le bras gauche, la cuisse gauche et les deux tiers de la cuisse droite. La réanimation liquidienne a d'abord été administrée selon la formule de Parkland modifiée. Le transfert de la patiente d'un hôpital local à l'unité régionale des brûlés a été compliqué par un choc septique précoce causé par une infection liée à un cathéter, ce qui a accru la réanimation liquidienne. L'infection a provoqué de multiples SCA. Un drain percutané a favorisé une amélioration clinique immédiate de la patiente, mais les épisodes de SCA ont entraîné une obstruction tardive de l'intestin grêle attribuable à un rétrécissement, laquelle a exigé une laparotomie et une résection intestinale.

Early analgesia for children with acute abdominal pain.

OBJECTIVES: The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain. METHODS: This was a double-blind, randomized, placebo-controlled trial involving 5- to 16-year-old children who presented to the emergency department of a children's hospital with a chief complaint of acute abdominal pain that was thought by the pediatric emergency attending physician to require a surgical consultation. Subjects were randomized to receive intravenously administered morphine or normal saline solution. Clinical data and the emergency physician's confidence in his or her clinical diagnosis (0-100%) were recorded systematically with a standardized form. This was repeated 15 minutes after administration of the study medication. The surgeon assessed the child within 1 hour and completed a similar data collection sheet. Pain was assessed, with a color analog scale, before and after study medication administration. Each subject was monitored for 2 weeks after enrollment. RESULTS: One hundred eight children were enrolled; 52 received morphine and 56 received a placebo saline solution. There were no differences between groups in demographic variables or the degree of pain. There were no differences between groups in the diagnoses of appendicitis or perforated appendicitis or the number of children who were observed and then underwent laparotomy. The reduction in the mean pain score was significantly greater in the morphine group (2.2 vs 1.2 cm). The emergency physicians' and surgeons' confidence in their diagnoses was not affected by the administration of morphine. CONCLUSIONS: Our data show that morphine effectively reduces the intensity of pain among children with acute abdominal pain and morphine does not seem to impede the diagnosis of appendicitis.