Cardiac anomalies associated with omphalocele.

Omphaloceles are ventral abdominal wall defects that are associated with significant other anomalies in up to 80% of cases in some descriptions. Of these abnormalities, Cardiac defects are some of the more common ones, and have the most substantial impact on outcomes and survival. In cases with a severe congenital heart defect (CHD), the omphalocele management changes significantly. This article addresses the common defects seen, and their management issues.

What pediatric surgeons read: Utilization of APSA e-mail blast literature reviews.

PURPOSE: American Pediatric Surgical Association (APSA) committees send monthly email blasts to members with links to peer-reviewed publications. This study assesses the utilization of this service. METHODS: Email-opening and click-through rates were analyzed from 5/2012 to 4/2017 and compared to APSA and industry standards. Access was analyzed based on subject, disease type, journal, impact factor, and committee. CME questions were added in 10/2014 and emails consolidated in 1/2016. Effects of these changes were analyzed. RESULTS: Over 60 months, 281 articles were distributed from 58 journals. Access increased significantly with impact factor (P = 0.0039). Overall email opening rate (53% ±â€¯3%) and click-through rate (37% ±â€¯10%) were significantly higher than all APSA emails (43%,18%, P < 0.0001) and 2017 industry standard (26%,12%,P < 0.0001). Access rates differed significantly between the twenty-five topics covered (P < 0.0001), with the highest access for appendicitis (240 ±â€¯79, P < 0.0001). Common condition articles (157 ±â€¯93) were accessed more than rare (55 ±â€¯60, P < 0.0001). With email consolidation, opening rates increased (53 ±â€¯3 to 55 ±â€¯2, P = 0.003) and click-through rates decreased (40 ±â€¯9 to 30 ±â€¯8, P = 0.0002). By adding CME questions, opening rates increased nonsignificantly (52 ±â€¯3 to 54 ±â€¯2, P = 0.066) and click-through rate decreased significantly(41 ±â€¯10 to 33 ±â€¯9, P = 0.001). CONCLUSIONS: APSA email blasts are valued by members based on high access rates. Click-through rates have declined, potentially indicating user fatigue. APSA members prefer common conditions and high impact factor journals. These data will help refine this service. LEVEL-OF-EVIDENCE: Level III.

Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: what is the optimal flush to use?

PURPOSE: Severe constipation and encopresis are significant problems in the pediatric population. Medical management succeeds in 50-70%; however, surgical considerations are necessary for the remainder such as the antegrade continence enema (ACE). The purpose of this study is to assess the long-term outcomes following the ACE procedure. METHODS: All patients undergoing an ACE over a 14-year period were included. Data on clinical conditions, treatments, and outcomes were collected. A successful outcome was defined as remaining clean with ≤ 1 accident per week. Comparative data were analyzed using the Fisher's exact test, Mann-Whitney U test, or Student's t test. RESULTS: There were 42 ACE patients, and overall, 79% had improvement in their bowel regimens. Encopresis rates decreased from 79 to 5% (P < 0.001). Admissions for cleanouts decreased from 52 to 19% (P = 0.003). All cases of Hirschsprung's, functional constipation and spina bifida were successful. Rates of success varied for other diseases such as slow-transit constipation (60%) and cerebral palsy (33%). A majority (85%) required a change in the enema composition for improvement. CONCLUSION: In our study, ACE reduced soiling, constipation, and need for fecal disimpaction. Higher volume saline flushes used once a day was the optimal solution and most preferred option. LEVEL OF EVIDENCE: Level 4 (retrospective case series or cohort).