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ObjectiveCOVID-19 patients presenting with gastrointestinal (GI) symptoms occur in both adults and children. To date, however, no large sample size study focusing on gastrointestinal symptoms in pediatric cases has been published. We analyzed COVID-19 infected children in Wuhan who presented with initial GI symptoms to determine the GI characteristics and epidemiological trend of the disease. DesignWe retrospectively analyzed 244 children patients confirmed with COVID-19 at Wuhan Childrens Hospital from 21 Jan to 20 Mar 2020. Symptomatic cases were divided into two groups according to whether the patients presented with or without GI symptoms on admission. Demographic, epidemiological, symptoms, and laboratory data were compared. We also analyzed the respective trends of case number changes of GI cases and asymptomatic cases. Results34 out of 193 symptomatic children had GI symptoms. They had lower median age and weight, a higher rate of fever, a longer length of stay and more hematological and biochemical abnormalities than patients without GI symptoms. There was no significant difference in chest CT findings or stool SARS-CoV-2 test positive percentages between the two groups. The number of patients admitted with GI symptoms showed an overall downward trend with time. At the time of writing, 242 patients were discharged, one died, and one critically ill patient was still in the intensive care unit. ConclusionCOVID-19 infected children with GI symptoms are prone to presenting with more clinical and laboratory abnormalities than patients without GI symptoms. More attention and timely hospital admission are needed for these patients. Significance of this studyO_LSTWhat is already known on this subject?C_LSTO_LICOVID-19 is now a pandemic with more than 1.6 million people infected worldwide C_LIO_LIAlthough attacking the respiratory tract mostly, both adult and children infected with COVID-19 can present with GI symptoms C_LI O_LSTWhat are the new findings?C_LSTO_LIInfants younger than two years old and presence of fever are the two risk factors of presenting with GI symptoms C_LIO_LIA high proportion of patients without GI symptoms and asymptomatic patients will have positive RT-PCR for the virus in stool C_LIO_LIEarlier testing through contact screening of family members means more COVID-19 infected children are diagnosed when completely asymptomatic C_LI O_LSTHow might it impact on clinical practice in the foreseeable future?C_LSTO_LIThe presence of COVID-19 in stool in infected children will have a major implication for parents and carers of young infants C_LIO_LIIncreasing number of asymptomatic COVID-19 patients who are detected through screening could provide a useful lesson for other countries still experiencing the rise and peak of the pandemic C_LI
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ObjectiveTo evaluate totally laparoscopic Meckel's diverticulectomy in comparison with laparoscopic-assisted or open diverticulectomy.MethodsThe clinical data of 58 cases of Meckel's diverticulum admitted between January 2006 and January 2011 were analyzed.Cases were divided into three groups according to different period of time. As a result,totally laparoscopic surgery was performed in 13 cases,laparoscopic-assisted resection in 25 cases and open diverticulectomy in 20 cases. Totally laparoscopic group was compared with the other two groups in operation time,flatus defecation time,the incidence of postoperative complications and postoperative hospital stay.ResultsThe mean length of incision was ( 1.6 ± 0.4 ) cm,the mean operation time was ( 41 ± 5 ) min,flatus defecation time was (21.2 ±3.7) h,and the postoperative hospital stay was (6.3 ± 1.2) d in totally laparoscopic group.While that was (2.5 ± 1.2 ) m,( 38 ± 2 ) cm,( 23.6 ± 4.2 ) h,( 6.5 ± 2.3 ) d,respectively in laparoscopicassisted group,and the mean length of incision was (5.0 ± 2.2 ) cm,the mean operation time was (51 ± 6 )min,flatus defecation time was (32.3 ± 6.7) h,the postoperative hospital stay was (8.4 ± 3.8) d in open surgery group.Compared with conventional laparotomy,laparoscopic techniques enjoy advantages of minimal invasion,shorter operative time,fewer complications,shorter recovery period and earlier gastrointestinal recovery(P ＜ 0.05). There were nosignificant differences in operative time, recovery period and complications between totally laparoscopic group and laparoscopic-assisted group.ConclusionsTotally laparoscopic Meckel's diverticulectomy is safe,effective and miniinvasive in experienced hands.
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Objective To assess the efficacy and safety of the Nuss procedure in the treatment of pectus excavatum in children. Methods The Nuss procedure was performed in 38 patients.Under thoracoscopy,a convex steel bar was inserted under the sternum through small bilateral thoracic incisions,with the convexity facing posteriorly.When the bar was in position,it was turned over,thereby correcting the deformity.Two lateral stabilizing bars were employed.Out of the 38 patients,imported bars were used in 5 patients and China-made bars were used in 33 patients.Results The procedure was completed under thoracoscopy smoothly in all the 38 patients.The operating time was 40~80 min(mean,50 min) and the intraoperative blood loss was 5~30 ml(mean,16 ml).A single bar was utilized in 36 patients,and a second bar was required in 2.Complications included postoperative pneumothorax in 4 patients,subcutaneous emphysema in 16 patients,bar displacement in 1 patient,and lateral stabilizer dislocation in 1 patient.The length of postoperative hospital stay was 7~21 days(mean,8 days).Follow-up checkups in the 38 patients for 3~22 months(mean,11 months) showed excellent outcomes in 36 cases and good outcomes in 2 patients,the rate of excellent or good results being 100%. Conclusions The Nuss procedure is safe and reliable for the treatment of pectus excavatum in children.The best age range for surgery was 3~12 years old.
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Objective To evaluate the value of laparoscopic-assisted cholangiography in diagnosing prolonged jaundice in infants.Methods Through an umbilical troear,an laparoscope was placed into the abdominal cavity to detect the gallbladder and liver.After confirming that the choleeyst is normal,we pulled out the fundus of the gallbladder through the right subcostal trocar,and then inserted a catheter into the gallbladder for cholangiography.If the fundus could not be exteriorized because of gallbladder atresia, the patient would be converted to an open surgery.Results Cholangiography showed infant hepatitis syndrome or cholestasis in 8 cases,biliary hypoplasia in 2,and biliary atresia in 2.In 5 patients,the gallbladder was dissected from the liver bed before cholangiography,2 of them had biliary hypoplasia and 3 showed biliary atresia.Cholangiography was given up in 21 children because of liver cirrhosis.These patients were diagnosed with biliary atresia and then were treated by Kasai portoenterostomy. Conclusions Laparoscopic-assisted cholangiography is a simple,accurate,and safe method in the diagnosis of prolonged jaundice in infants.By using the procedure,the whole biliary tree can be shown clearly without leading to serious injuries.
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Objective To assess the middle-term results of laparoscopy in resection of congenital choledochal cyst,hepaticojejunostomy,and extra-abdominal Roux-en-Y anastomosis. Methods We retrospectively studied 50 patients who had undergone laparoscopic choledochal cyst excision in our institute from 2005 to 2008.For large cysts,we dissected and separated the cyst at the middle portion,and then opened the inferior wall of the cyst to dissect the posterior wall of the cyst from the portal vein.For small cysts,we divided the cysts circumferentially and then completely excised the dilated bile duct.When the cyst was intensely inflamed,excision of the cysts was performed as Lilly's technique.Roux-en-Y jejunojejunostomy was performed extracorporeally through an umbilical incision(1.5 cm),afterwards,end-to-side anastomosis was carried out intracorporeally.The conversion to open surgery,and morbidity and mortality rates of the patients was analyzed.Results The cysts were completely excised in 16 cases,and Lilly's technique was performed on 34 cases.One patient was converted to open surgery due to hemorrhage resulted from recurrent inflammatory-caused tight adhesion between the cyst and surrounding tissues.The mean operation time was 226 minutes(range: 190 to 450 minutes).Eight patients received blood transfusion during the operation.The children were discharged from hospital in 6 to 16 days after the surgery(mean,8 days).A mean of 26 months follow-up was achieved in 49 patients(ranged 3 to 39 months).Four patients developed complications: one of them showed bile leakage and then were cured by intra-abdominal drainage;one patient developed acute pancreatitis and one suffered from adhesive small bowel obstruction,both recovered after conservative treatment;intestinal necrosis was detected in one patient,who received another operation for resection of the necrotic bowel and anastomosis of the bile duct and intestine.In the other 45 patients,no abdominal pain,fever,jaundice,etc.were detected.No patient showed bile duct stenosis or reflux gastritis,no one died because of the surgery.Conclusions Laparoscopic approach is effective for congenital choledochal cyst,hepaticojejunostomy,and extra-abdominal Roux-en-Y anastomosis.Dissection of the posterior cyst wall to avoid injury to the portal vein is the key to the procedures,while extra-abdominal Roux-en-Y anastomosis is one of the most difficult steps.
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Objective To explore the feasibility of laparoscopic-assisted partial and subtotal colectomy and per anum intrarectal pull-through procedures for Hirschsprung's disease-allied disorder(HAD).Methods From October 1999 to May 2006,38 infants and children with HAD or Hirschsprung's disease(HD) associated with HAD,to whom conservative treatments proved ineffective or relapse occurred,were treated by laparoscopic-assisted partial or subtotal colectomy and per anum intrarectal pull-through procedures.Four 5 mm trocars were inserted at the edge of umbilicus,right upper,right lower and left center quadarant of abdomen when subtotal colectomy was carried out.Two trocars were placed in the left side,lied in left upper and mid lower quadarant of abdomen respectively.Colon descendens,colon transversum,colon ascendens and ileocecal junction lateral peritoneum were mobilized under laparoscope.The operation on anus was referred to modified Soave procedures.Results 38 patients underwent the operations successfully.Left hemicolon resection were performed in 9 cases,with operation time being 110-180 min(mean,135 min).Subtotal colectomy were performed in 29 cases and colon ascendens were rotated reversal clockwise 270? and pulled down using Deloyers procedures,lengths of remaining colon ascendens being 7-13 cm(mean,11.5 cm),operation time being 140-220 min(mean,175 min),intraoperative blood loss being 15-70 ml(mean,35 ml).Postoperative pathological diagnosis showed 10 cases of intestine neuron developmental anormaly(IND),3 cases of hypoganglionosis(HG),4 cases of immature gangliocyte(IGC),9 cases were not classified,6 cases of HD complicated with IND,2 cases of HD complicated with HG,4 cases of HD complicated with ICG.38 cases were followed up for a mean of 3 years and 5 months(range,6 months to 7 years).9 cases of left hemicolon resection had 1-2 stools per day at 6 months postoperatively without stoma stenosis and constipation recurrence.Conclusions Laparoscopic-assisted partial or subtotal colectomy and radical per anum pull-through procedures for HAD are safe,effect,feasible,with minimal invasion,but some laparoscopic procedure experiences are required.
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Objective To compare postoperative complic at ions and defecation functions between laparoscopic pull-through heart-shape colo proctectomy (LHSC) and open pull-through surgery in the treatment of Hirchsprung 's disease (HD). Methods A total of 57 children with HD were g iven LHSC from August 1999 to November 2003. Among them, 54 children were follow ed for a mean of 2.8 years (range, 6 months ~ 4.8 years). The operation time, co mplications, defecation functions, and hospitalization costs of these patients w ere analyzed. And the data of the 54 patients (Laparoscopic Group) were compared with those from other 48 patients (Open Group) who had undergone open pull-thro ugh surgery before August 1999. Results The operation time was longer in the Laparoscopic Group(169?59 min) than in the Open Group(138?43 mi n)(t=2.903,P=0.005). The total hospitalization costs of the Laparoscopic Group (12 030?1 050 yuan) was significantly higher than that of the Open G roup (10 500?1 500 yuan) (t=6.019,P=0.000). There were no statisti cal differences in the rate of postoperative complications between the two group s (?~2=2.86,P=0.091), but less wound infections and adhesive ileus and more urinary retention were seen in the Laparoscopic Group as compared with the Open Group. In the Laparoscopic Group, the rate of anorectal reflex recover y was 55.6%, the anorectal angle was 83.4??10.4?, and the incidence of abnorm al defecation, 11.1% (constipation and faecal contamination respectively account ed for 50%), all of which were similar to those in the Open Group. No significan t differences were found in the anorectal resting pressure and the length of ana l high-pressure zone between the two groups (t=-0.979, P=0.334; t=-0.234, P=0.816). Conclusions LHSC technique is a safe and effectiv e method for Hirchsprung's disease, with postoperative advantages of quick reco very, few complications, and defecation functions similar to open surgery.
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Objective To analyze the relationship between polymorphisms of EDNRB gene and Hubei provincial patients of Han ethnicity with sporadic Hirschsprung disease(sHD). Methods Peripheral blood samples from 104 patients with sHD and 84 parents of 42 patients, and 120 normal children(as controls) were collected. PCR-SSCP and direct DNA sequencing were used to detect mutations and polymorphisms of exon-4 in EDNRB gene. The differences of allele frequencies and genotype distribution in polymorphic sites were further analyzed between the three groups. Allele frequencies of SNPs in forty-two sHD trios were analyzed by transmission disequilibrium test(TDT), and the association between phenotype of HD and SNPs was analyzed. Results No mutant site was detected and one polymorphic site of c831 G→A(L277L) was observed in Hubei provincial patients of Han ethnicity with sHD. The allele frequency of A(68% vs 53%) and genotype frequency of AA(49% vs 30%) were significantly higher in sHD group than that in control group(P
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Objective To compare the therapeutic results of laparoscopic-assisted endorectal colon pull-through with radical Swenson's technique for Hirschsprung's disease Methods 39 children who had undergone Swenson pull-through were retrospectively reviewed.The patients were divided into 2 groups:open Swenson(n=20),laparoscopic procdeures(n=19). Use of laparoscopic equipment,operating time,hospital day,intraoperative blood loss,cost of hospital and postoperative complications were chosen as itews for comparisiom. Results The patienst in open Swenson passed stool and flatus in (78?28) hours and those in laparoscopic procedures did in (27?7) hours(t=2.87, P0.05),no major complications were found Conclusions The therapeutic results of laparoscopic-assisted coloc pull-through are similar to those of open and this procedure is economical.It appears to reduce postperative intestinal adhesion and postoperative recovery time dramatically, has smaller incision and renders itself more acceptable by the parents.
