Emergency abdominal wall defects in neonates: saved by distress.

This report presents two cases of neonatal patients with abdominal wall defects requiring emergency intervention, a closing gastroschisis and a pedunculated exomphalos with eviscerated liver. Both presented as pre-partum fetal distress and were delivered in a tertiary centre, where they received antenatal care. Coordination in the multidisciplinary team and prompt surgical intervention prevented loss of the eviscerated abdominal contents and prevented mortality in both cases.

A simple scoring system to train surgeons in basic laparoscopic skills.

AIM: To develop and validate a scoring system for a training assessment tool using a box trainer which can objectively demonstrate progression in laparoscopic skills. METHOD: 170 assessments were performed over a 5-year period by doctors working in a busy paediatric surgical department. Each participant was scored based on experience and then undertook six laparoscopic tasks in a box trainer in a dry skills lab. The quicker and more accurate the performance, the lower the score. Validity and reliability tests were applied. RESULTS: Pearson correlation coefficient demonstrated that more experienced surgeons performed better than novices with an r of -0.63 (p < 0.001). The mean assessment scores improved (reduced) with increasing experience score [4140 (0-20), 2696 (21-40), 1969 (>40) p < 0.001]. Improvement in score was seen at all experience levels with greatest improvement seen in the less experienced (2315, 1820, 1571 p < 0.001). Cronbach's alpha was 0.70 and the intraclass correlation coefficient for test-retest reliability was 0.81. CONCLUSION: Construct validity with adequate reliability has been demonstrated for this simple training tool and scoring system. All experience levels demonstrated improvement in their laparoscopic skills by simulation training in a laparoscopic box trainer.

Slip-Knot-Loop Suture for Continuous Suturing in Laparoscopy.

AIMS: One of the challenges of laparoscopic surgery is the time required to perform intracorporeal knots. This can result in considerably longer operating times when compared with the open approach. An example of this is pediatric laparoscopic pyeloplasty, where extensive laparoscopic suturing is required. To reduce the time suturing, the authors developed a new knotting technique for laparoscopic suturing. MATERIALS AND METHODS: The authors modified a neurosurgical knot technique to speed up intricate continuous suturing, and a simple slip-knot-loop suture was created. Twenty continuous sutures were performed with five "bites" of tissue each. Ten were performed with a conventional intracorporeal knot to anchor the suture (Group 1), and 10 were performed using the slip-knot-looped suture to anchor (Group 2). This new knotting technique was used to perform five bowel anastomoses on pig intestine and tested for leaks by distending them with saline for 5 minutes. RESULTS: The mean time to perform the suture for Group 1 was 300 seconds, and the mean time for Group 2 was 236 seconds. Unpaired two-tailed Student's t test comparing the means was significant (P < .001). No leaks occurred in any of the five anastomoses. CONCLUSIONS: This new slip-knot-loop technique modified for pyeloplasty was easy to use, was quicker than conventional knot tying, and produced safe knots and leak-free anastomoses. This knot is transferable to any laparoscopic procedure where continuous suturing is to be used.

Challenges in the management of bilateral single-system ectopic ureters in male infants.

OBJECTIVE: To describe our experience of managing bilateral single-system ectopic ureters in boys. METHODS: We discuss difficulties in diagnosis, importance of appropriate preoperative imaging, and the individualized surgical management for this rare congenital malformation. RESULTS: The first patient aged 3 months presented with urosepsis-subsequent imaging demonstrated bilateral single-system ectopic ureters, which were reimplanted at age 7 months. The second case was an antenatal diagnosis of bilateral hydronephrosis. Postnatal imaging identified bilateral ectopic single-system ureters. A suprapubic catheter was inserted to ensure optimal bladder drainage. He underwent a Cohen reimplantation at age 7 months because of recurrent urinary tract infections. The third patient was born with a duodenal atresia (repaired in the neonatal period) and a complex anorectal malformation, including a pouch colon with a colourethral fistula, a dilated, ectopic left ureter, and a hypoplastic urethra. He was initially managed with a colostomy and suprapubic catheter. At age 14 months, he underwent a left nephrouretectomy for a nonfunctioning kidney and posterior sagittal anorectoplasty. The right ureter was noted to be ectopic at this time and was reimplanted. CONCLUSION: Our series highlights the many challenges for diagnosis and management in boys with this condition because of the diverse presentation and need for appropriate preoperative imaging. Treatment is by bilateral ureteric reimplantation at an appropriate age.

Embryology of the Absent Vas Supported by 2 Cases of Congenital Unilateral Absence of Vas With Varied Associations.

Congenital absence of the vas occurs in up to 1% of men. Congenital unilateral absence of the vas deferens can be related to cystic fibrosis transmembrane conductance regulator mutations or in 79% of cases, renal agenesis. We present a case of each, diagnosed in children at operation for elective inguinal hernia repairs. One patient had associated ipsilateral renal agenesis with a normal cystic fibrosis screen. The other patient had an ipsilateral pelvic kidney and a mutation detected on cystic fibrosis screening. Current understanding of the embryology of the relationship between these defects would seem to be supported by our cases.

Access to New Zealand Sign Language interpreters and quality of life for the deaf: a pilot study.

PURPOSE: This paper aims to: (1) explore usage and accessibility of sign language interpreters, (2) appraise the levels of quality of life (QOL) of deaf adults residing in New Zealand, and (3) consider the impact of access to and usage of sign language interpreters on QOL. METHOD: Sixty-eight deaf adults living in New Zealand participated in this study. Two questionnaires were employed: a 12-item instrument about access and use of New Zealand sign language interpreters and the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). RESULTS: The results showed that 39% of this sample felt that they were unable to adequately access interpreting services. Moreover, this group scored significantly lower than a comparable hearing sample on all four WHOQOL-BREF domains. Finally, the findings revealed that access to good quality interpreters were associated with access to health services, transport issues, engagement in leisure activities, gaining more information, mobility and living in a healthy environment. CONCLUSIONS: These findings have consequences for policy makers and agencies interested in ensuring that there is an equitable distribution of essential services for all groups within New Zealand which inevitably has an impact on the health of the individual.