Rare Pediatric Cecal Anomalies: A Lesson in Pediatric Surgery.

BACKGROUND: Rare incidence cases are part of the routine work of pediatric surgeons. Cecal anomalies in children are an example of such cases. Objectives: To describe the presentation, workup, management and outcome of rare cecal anomalies in children and to analyze the skills needed for their successful treatment. METHODS: A retrospective chart review was conducted of all cases of cecal anomalies managed by the pediatric surgical service at a tertiary hospital from June 2017 to January 2020. Data regarding demographics, clinical presentation, radiological studies, surgical treatment, pathology, complications, and outcome were collected. RESULTS: Five cases of cecal anomalies were encountered over a period of 32 months, including a cecal volvulus, cecal duplication, cecal intussusception, and two cecal masses (one ulcerated lipoma and one polyp). All patients, except the patient with cecal duplication, presented acutely and were managed surgically. Long-term follow-up of 17-24 months was unremarkable in all cases. CONCLUSIONS: A wide knowledge base, careful judgment, and creativity enable pediatric surgeons to successfully treat rare conditions such as rare cecal anomalies. These skills should be part of the education of pediatric surgery trainees.

A comparison between one- and two-stage revisional gastric bypass.

BACKGROUND: The safety of performing a one-stage revision from laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) has been questioned. The objective of this study was to compare safety and outcomes of one-stage versus two-stage revisional LRYGB performed after failed LAGB. METHODS: A retrospective analysis of all patients undergoing revisional LRYGB after failed LAGB between January 2007 and March 2017 was performed. Patients undergoing one- and two-stage revisions were compared. The primary outcome assessed was the early complication rate, while secondary outcomes included late complications, weight loss, and improvement of comorbidities. RESULTS: During the study period, 161 revisional LRYGB's were performed, including 121 one-stage and 40 two-stage procedures. Baseline demographic data, BMI and presence of comorbidities were similar between the groups. In patients undergoing a two-stage procedure, band slippage, port infection, and erosion were more commonly cited as indications for revision. Similar early complication rates were demonstrated between the groups. However, late complications were more common in the two-stage group (20.0% vs. 7.4%, P = 0.03), including higher rates of gastro-gastric fistula (5.0% vs. 0%, P = 0.01) and anemia (10.0% vs. 1.1%, P = 0.02). Three-fourths of the cohort had a follow-up of more than 6 months, and the two groups demonstrated similar weight loss results and improvement/resolution of comorbidities. CONCLUSION: The performance of one-stage revisional LRYGB after failed LAGB seems to be a safe procedure, with noninferior outcomes when compared to a two-stage revisional procedure. It is a valid option, except in cases of mechanical and infectious band complications.