Pectus Arcuatum: A Pectus Unlike Any Other.

BACKGROUND: Pectus arcuatum is often mistaken for a type of pectus carinatum. However, pectus arcuatum is a unique clinical form of pectus caused by premature obliteration of the sternal sutures (manubrial sternum, four sternebrae and xiphoïd process), whereas pectus carinatum is due to abnormal growth of the costal cartilage. In order to better describe pectus arcuatum, we analysed the files of patients with pectus arcuatum followed in our centers. METHODS: Multicenter retrospective study of young patients' files diagnosed with pectus arcuatum. RESULTS: The clinical diagnosis of pectus arcuatum was made in 34 patients with a mean age at diagnosis of 10.3 years (4-23 years). A chest profile X-ray or a CT scan was performed in 16 patients (47%) and confirmed the diagnosis of PA by the presence of a sternal fusion. It was complete in 12 patients. A malformation was associated in 35% of cases (Noonan syndrome 33%, scoliosis 25% or cardiopathy 16%). 11 patients (32%) had a family history of skeletal malformation. Orthopedic treatment was initiated in 3 patients without any success. 11 patients underwent surgical correction, which was completed in 7 of them. CONCLUSION: The diagnosis of pectus arcuatum is based on clinical experience and if necessary, on a profile chest X-ray showing the fusion of the sternal pieces. It implies the search for any associated malformations (musculoskeletal, cardiac, syndromic). Bracing treatment is useless for pectus arcuatum. Corrective surgery, based on a sternotomy associated with a partial chondro-costal resection, can be performed at the end of growth. LEVEL OF EVIDENCE: IV.

Two simple modifications can potentially change the future of proximal hypospadias surgery. Our series and a review of the literature.

BACKGROUND/OBJECTIVE: To draw a hint towards two simple modifications that could potentially decrease the complication rate. PATIENTS AND METHODS: It was a single center, single operator and retrospective study. All patients with severe hypospadias operated according to koyanagi with or without modifications were presented. The surgical technique was described. Complications like fistula, stenosis, dehiscence and urethral diverticulum were studied. RESULTS AND LIMITATIONS: Nineteen patients were included and presented in a chronological manner. The first four patients were operated according to the original koyanagi technique. The next 15 patients were operated according to koyanagi and the urethroplasty was covered by a tunica vaginalis flap. In 10 of them, glanduloplasty was done primarily and in the last 5 patients, glanduloplasty was done as a secondary procedure. The complication rates were 100% in the original koyanagi group, and 0% in the subset were glanduoplasty was deferred. CONCLUSIONS: Systematically covering the urethroplasty with a tunica vaginalis flap and deferring the glanuloplasty might ameliorate the results of the koyanagi technique.

Laparoscopic Pyloromyotomy: A Study of the Learning Curve.

INTRODUCTION: Laparoscopic pyloromyotomy (LPM) is a minimally invasive surgical technique used in pyloric stenosis treatment. This technique is safe, effective, and does not show more complications than laparotomy. Nevertheless, this technique requires an acquisition period to be optimally applied. This study analyses the learning curve of LPM. MATERIALS AND METHODS: Seven surgeons were retrospectively evaluated on their 40 first LPM. Patient data were recorded, including peroperative data (operation length and complications) and postoperative recoveries (renutrition, vomiting, and complications). The learning curves were evaluated and each variable was compared with the different moments of the learning curve. RESULTS: The mean operative time is 25 ± 11 minutes. It significantly decreases with the learning curve (p < 0.01). Ten procedures were necessary to acquire the operative technics. However, postoperative complications with a necessary redo procedure appear after the 10th patient. There is no significant difference concerning long-term postoperative complications according to the learning curve and to surgeons. The best results are recorded after the 20th patients. Hospital length of stay also decreases significantly after the 10th procedure. The recorded postoperative vomiting is independent to the operative time as the ad libitum feedings recovery. CONCLUSION: The learning curve of LPM is cut into three stages. Only 10 cases are needed to acquire the gesture. Complications appear after this acquirement period.

Which surgery for drooling in patients with cerebral palsy?

BACKGROUND: Surgery for drooling in patients with cerebral palsy should not produce xerostomia in order not to deteriorate speech, taste, or the status of oral hygiene. It must be a compromise between drooling and quality of life. The purpose of the present report is to describe our surgical strategy that respects the above principles. MATERIALS AND METHODS: Patients were initially operated on depending on the drooling severity. The results were evaluated according to the frequency of residual drooling and the Thomas-Stonel and Greenberg classification. Quantitative assessment was proposed 6 months after surgery. The data have been compared using the nonparametric Wilcoxon matched-pairs test. RESULTS: Thirty-five patients underwent surgery between 1991 and 2012. Owing to incomplete data, only 31 patients could be included, aged 5 to 24 years (mean: 12 years). All patients underwent surgery on the submandibular duct. Only 16 patients underwent a simultaneous surgery on the parotid duct. Six patients were reoperated: 3 because of an insufficient result and 3 because of a surgical complication. Changes/Day ranged from 1 to 7 (median: 3) before surgery and 0 to 2 (median: 1) after surgery (p < 0.01). Number of bibs/day ranged from 0 to 30 (median: 4) before surgery and 0 to 4 (median: 1) after surgery (p < 0.01). No dental deterioration and no caries occurred after surgery. CONCLUSION: Good results for drooling can be obtained with a simple surgical procedure on the submandibular ducts, maintaining quality of life, avoiding deterioration of speech, taste, and the status of oral hygiene.