Modified Scharli technique for the very long gap esophageal atresia.

This modification of the Scharli technique which creates an isoperistaltic tube to overcome very long gap esophageal atresia involves retention of the short distal esophageal segment and creation of a neo-esophagus of tubularized gastric fundus of even calibre, similar to that of the upper esophageal segment. It has proved simple and effective in establishing esophageal continuity.

Trends in the use of minimally invasive surgery in children.

AIM: To determine trends in the scope of use of minimally invasive surgical (MIS) techniques in children as a predictor of future operative workload and operating theatre requirements. METHOD: A retrospective review was conducted of all paediatric patients less than 16 years of age who underwent minimally invasive surgical procedures at Christchurch Hospital, New Zealand between 1996 and 2007. RESULTS: There were 1693 children who received 1826 MIS procedures during a period in which 11,893 operative procedures were performed. MI case-weights, an indirect measure of the financial burden and technical difficulty of the procedures, represented 29% of the workload of the unit overall. There was a rapid rise of the number of MIS procedures from 1996 to 2000, but since then the scope and volume has changed little. CONCLUSION: Use of MIS in children increased rapidly until 2000 since which time it has remained relatively constant. Recent additional applications have involved a small number of rare low-volume and more complex procedures. These observations may assist in the planning of theatre allocation requirements for MIS in children.

Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times.

INTRODUCTION: Laparoscopic nephrectomy is an accepted alternative to open nephrectomy. We analyzed our first 80 procedures of laparoscopic nephrectomy to evaluate the effect of experience and configuration of service on operative times. MATERIALS AND METHODS: A retrospective review of 80 consecutive children who underwent retroperitoneal laparoscopic nephrectomy or heminephrectomy during an 11-year period from 1997 at Christchurch Hospital (Christchurch, New Zealand) was conducted. Operative times, in relation to the experience of the surgeon for this procedure, were analyzed. RESULTS: Four surgeons, assisted by an annually rotating trainee registrar, performed the procedure in 26 girls and 54 boys (range, 8 months to 15 years). Operating times ranged from 38 to 225 minutes (mean, 104). The average operative time fell from 105 to 90 minutes. One surgeon performed 40% of the procedures and assisted with a further 55%. The operative times for all surgeons showed a tendency to reduce, but this was not marked. CONCLUSIONS: Most procedures were performed by two surgeons working together, although one surgeon was involved in the majority of cases. The lead surgeon is often assisted by a fellow consultant colleague. Operative times were influenced by experience, but not markedly so. The shorter operative times and minimal "learning curve," compared with other reported series, may, in part, be due to the involvement of two surgeons experienced in laparoscopy for the majority of cases.

Burn injury care for Special Forces and far-forward deployed troops.

Special Forces are at risk of serious burn injury. We have suggested standard operating procedures for burn injury management in a constrained environment, with novel uses of operational kit components for trauma care. In addition, we propose instruction in basic skills of escharotomy for forward troops.

Congenital trismus secondary to masseteric fibrous bands: a 7-year follow-up report as an approach to management.

A 7-year prospective follow-up report, which was previously presented in this journal as an initial pediatric case report, is presented as an approach to management of congenital trismus secondary to masseteric fibrous bands. Adams and Rees discussed management, including endoscopic exploration at 18 months of age with early recurrence of trismus. Under the care of the same plastic surgeon and his team, the progress of this patient over 7 years has given us an insight into management. The cause of trismus is not fully elucidated, but the condition can result in compromised caloric intake, speech development, facial appearance, dental care, and oral hygiene. The decreased oral opening may be secondary to shortening of the muscles of mastication, which may cause tension moulding and distortion of the coronoid process; yet, there is no consensus on the optimal management of temporomandibular joint trismus and all its causes. The patient presented in this report, now aged 7 years, has proceeded through to open surgery on two occasions yet, regrettably, has persistently tight masseter muscles and only 8 mm of jaw opening.

Reduced hospitalisation of burns patients following a multi-media campaign that increased adequacy of first aid treatment.

CONTEXT: Concern engendered by a previous study that showed inadequate first aid for burn injuries was prevalent in the community led to a novel multi-media public health campaign ensued to address the issue. OBJECTIVE: To determine whether this public health campaign influenced behaviour by altering first aid treatment for burn injuries (BFAT). DESIGN, SETTING AND POPULATION: Prospective intervention study. Consecutive patients with acute burn injuries over two 4-month intervals, presenting to a regional burn service, Auckland, New Zealand. This research was ethically approved by the Local Research Ethics Committee. MAIN OUTCOME MEASURES: Demographics, burn size, adequacy of burn first aid, outpatient/inpatient wound care and operative intervention requirement. RESULTS: Adequacy of BFAT improved following the campaign (59% versus 40%, P=0.004). Fewer inpatient admissions (64.4% versus 35.8%, P<0.001) and surgical procedures (25.6% versus 11.4%, P<0.001) were undertaken following the campaign with a corresponding increase in outpatient care. Greatest decreases were observed in Maori and Pacific Islanders, and in children <10 years old. CONCLUSIONS: Adequacy of BFAT together with a reduction in the numbers of patients requiring inpatient surgical care was improved by a multi-media public awareness campaign.

Burns treatment for children and adults: a study of initial burns first aid and hospital care.

AIM: To assess the adequacy of initial burns first aid treatment in the community and its subsequent impact on treatment outcome. METHODS: Four-month prospective study of consecutive burn patients presenting to Middlemore Hospital. Patients were interviewed to determine initial burns first aid treatment (BFAT) and assessed as "adequate" or "inadequate", then compared with subsequent treatment. Inpatient care was wound debridement with/without dressings (DO/DB) or split skin grafting (SSG). RESULTS: 40.5% of total 121 patients received adequate BFAT, 59.5% did not, p = <0.001. 50% Caucasians received adequate BFAT, compared with 25% Maori and 33% Pacific Island people, p = 0.084. 15.7% of adequate BFAT patients received DO/DB and 6.6% had SSG, compared with 23.4% and 19.3% respectively for inadequate BFAT, p = 0.03. Scald burns occurred most frequently, 4% adequate BFAT scald patients required SSG compared with 20% of inadequate BFAT scald patients, p = 0.003. Maori and Pacific Island people were over-represented as inpatients (collectively 34.8%) when compared to Caucasian (24.8%) or other ethnic groups, p = 0.25. 38% of all patients were children under 10 with inadequate BFAT tendency compared with adults, p = 0.067. Hospital stay decreased among adequate BFAT paediatric patients, p = 0.016. CONCLUSIONS: A public education strategy is required to improve BFAT, targeting at-risk communities. Following this, the study should be repeated to determine the effectiveness of the campaign and any resultant change in community behaviour.