ABSTRACT
OBJECTIVE: Evaluate neonatal management and outcome of neonates with either a prenatal or a post-natal diagnosis of EA type III. STUDY DESIGN: Population-based study using data from the French National Register for EA from 2008 to 2010. We compared children with prenatal versus post-natal diagnosis in regards to prenatal, maternal and neonatal characteristics. We define a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and mortality at 1 year. RESULTS: Four hundred and eight live births with EA type III were recorded with a prenatal diagnosis rate of 18.1%. Transfer after birth was lower in prenatal subset (32.4% versus 81.5%, P<0.001). Delay between birth and first intervention was not significantly different. Defect size (2cm vs 1.4cm, P<0.001), gastrostomy (21.6% versus 8.7%, P<0.001) and length in neonatal unit care were higher in prenatal subset (47.9 days versus 33.6 days, P<0.001). The composite variables were higher in prenatal diagnosis subset (38.7% vs 26.1%, P=0.044). CONCLUSION: Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity related to the EA type (longer gap). Even if it does not modify neonatal management and 1-year outcome, prenatal diagnosis allows antenatal parental counseling and avoids post-natal transfer.
Subject(s)
Esophageal Atresia/diagnosis , Esophageal Atresia/therapy , Prenatal Diagnosis , Age Factors , Esophageal Atresia/classification , Female , Humans , Infant, Newborn , Pregnancy , Prospective Studies , Treatment OutcomeABSTRACT
PURPOSE: The effectiveness of laparoscopic diagnosis of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia was evaluated. METHODS: Ninety-three consecutive children under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral CPPV was diagnosed by laparoscopy via the inguinal hernia sac before ligation. The laparoscopy results of this technique were correlated with those of herniography or inguinal exploration. RESULTS: Laparoscopy was performed on 88 patients; sensitivity was 71% and specificity 89%. The only complication arising from the procedure was wound infection in two patients. CONCLUSION: This method is a simple, safe, and accurate procedure for selecting children for contralateral surgical exploration.
Subject(s)
Hernia, Inguinal/diagnosis , Female , Hernia, Inguinal/diagnostic imaging , Hernia, Inguinal/surgery , Humans , Infant , Laparoscopy , Male , Predictive Value of Tests , Radiography , Sensitivity and SpecificityABSTRACT
BACKGROUND: Thirty children operated on for Crohn's disease (CD) were reviewed (1975-1994). The aim of the study was to assess their postoperative outcome. PATIENTS: 19 boys and 11 girls, aged 15.3 (2) years (range 11.3-20) at surgery were studied. RESULTS: Surgical indications were acute complications of CD and chronic intestinal illness. Six months after surgery, 11 of 12 patients had been weaned off steroids, and 22 of 23 patients were weaned off nutritional support; 17 patients without recurrence had a mean (SD) weight gain of 2.1 (8) kg and a height gain of 3.36 (3) cm. During 3.1 (2.7) years follow up, 12 patients (40%) had a recurrence of the disease after 19.4 (14) months (means (SD)): supra-anastomotic recurrence (six), severe perianal disease (two), and chronic illness (four). Six of 14 patients who were treated with mesalazine (13) or azathioprine (one) had recurrences. The postoperative recurrence rate was 50% at two years. CONCLUSION: Surgical treatment modifies the immediate outcome of severe or complicated CD, but does not prevent recurrence, despite localised resection or prophylactic postoperative treatment. Extension of the disease before surgery seems to be a major risk factor for postoperative recurrence in children.
Subject(s)
Crohn Disease/surgery , Adolescent , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Azathioprine/therapeutic use , Child , Crohn Disease/pathology , Female , Follow-Up Studies , Humans , Male , Mesalamine/therapeutic use , Postoperative Care , Recurrence , Risk Factors , Treatment OutcomeABSTRACT
Between 1989 and 1997, 23 children with primary obstructive megaureter underwent surgical repair, routinely using a vesico-psoas hitch ureteroneocystostomy. Ten of them had a antenatal diagnosis. Mean postoperative follow-up was 3 years. No postoperative obstruction and no vesicoureteric reflux occurred. Assessment of renal function on the operated side showed improvement in 7 cases and stabilization in all other cases. No bladder dysfunction was observed. Vesicopsoas hitch is an advantageous procedure in this indication. It is almost always unnecessary to perform ureteral tailoring and its specific complications can be avoided. Psoas hitch is easily performed in infants and young children and this technique is particularly appropriate in the subgroup of patients with antenatal diagnosis.
Subject(s)
Ureter/abnormalities , Ureter/surgery , Child, Preschool , Cystostomy/methods , Follow-Up Studies , Humans , Infant , Psoas Muscles/surgery , Radiography , Ureter/diagnostic imaging , Ureteral Obstruction/congenital , Ureteral Obstruction/surgery , Ureterostomy/methodsABSTRACT
The Duhamel abdominoperineal pull-through is the authors' preferred treatment for children with Hirschsprung's disease (HD). Advances in instrumentation and technique now make laparoscopic correction possible. This procedure was successfully performed in six children aged 5 weeks to 6 years. No colostomy was performed before or after the Duhamel procedure. The technique and its potential role in the treatment of HD are discussed.
Subject(s)
Colon/surgery , Hirschsprung Disease/surgery , Laparoscopy/methods , Rectum/surgery , Child, Preschool , Female , Hirschsprung Disease/complications , Humans , Infant , Infant, Newborn , Male , Postoperative ComplicationsABSTRACT
STUDY AIM: The aim of this prospective study was to evaluate the laparoscopic diagnosis of contralateral patent processus vaginalis in children with unilateral inguinal hernia. PATIENTS AND METHOD: Between November 1995 and February 1998, 91 consecutive children (78 boys, 13 girls) under the age of 1 year were operated on for a unilateral inguinal hernia. A contralateral hernia was diagnosed by a laparoscopy through the inguinal hernia sac before ligation. Results of this technique were correlated with those of herniography (79 cases) or with inguinal exploration (12 emergency). RESULTS: Laparoscopy was performed in 88 patients. Laparoscopy was impossible in three cases: one inguinal sac too thin, two cases of ectopic testis in the inguinal canal. Sensitivity was 73% and specificity 92%. The only complication arising from the procedure was wound infection in two patients. CONCLUSION: This method is a simple, safe and accurate procedure in order to select children for contralateral surgical exploration.
Subject(s)
Hernia, Inguinal/diagnosis , Laparoscopy , Choristoma/diagnosis , Female , Hernia, Inguinal/diagnostic imaging , Hernia, Inguinal/pathology , Hernia, Inguinal/surgery , Humans , Infant , Infant, Newborn , Laparoscopes , Laparoscopy/adverse effects , Laparoscopy/methods , Ligation , Male , Peritoneum/diagnostic imaging , Prospective Studies , Radiography , Safety , Sensitivity and Specificity , Surgical Wound Infection/etiology , Testis/pathology , Time FactorsABSTRACT
From 1979 to 1990 37 children with sickle cell disease underwent surgery for cholelithiasis. Mean age was 11,3 years. Twenty-four children had a history of recurrent abdominal pain; 8 of them were admitted for an acute gallstone complication. In 9 cases the stones were detected by systematic echography. The incidence of gallstones increasing with age, the rate of complications, the frequent resolution of recurrent abdominal pain after cholecystectomy justify elective surgery at the time of diagnostic of the stones. A transfusion preparation considerably reduces the risk of post-operative complications.
