Journal of Pediatric Surgery Open最新文献

{"title":"Late complications following infant male circumcision using Plastibell technique: Experience from a single facility in Pakistan","authors":"Shazia Moosa ,&nbsp;Maryam Sherwani ,&nbsp;Ammar Ali Muhammad ,&nbsp;Aqil Soomro ,&nbsp;Lubna Samad","doi":"10.1016/j.yjpso.2024.100171","DOIUrl":"10.1016/j.yjpso.2024.100171","url":null,"abstract":"<div><h3>Background</h3><p>Globally, millions of circumcisions are performed annually by both medical and non-medical providers, with minor and major adverse outcomes. Short-term outcomes are well documented but there are limited reports of long-term, group-based assessments after Plastibell circumcision of infants. Through this study, we aim to assess the rate and types of late complications in the group of boys circumcised as part of Safe Circumcision Program (SCP) in Karachi, Pakistan, to document the safety of our technique and approach in the long-term.</p></div><div><h3>Methods</h3><p>This cross-sectional study was conducted on male infants circumcised via Plastibell technique as part of the SCP from June 2016 to May 2021. A sample size of 602 was calculated using OpenEpi. After obtaining consent, telephone interviews of parents/guardians were conducted by health workers using a structured questionnaire. All complications reported by parents and identified by health workers were documented, and the babies were then referred to a pediatric surgeon for review.</p></div><div><h3>Results</h3><p>Parents of 46 (7.5%) children reported a total of 81 concerns. After health worker assessment, 20 babies were referred to a specialist for in-person review and complications were documented in four (adhesion, inclusion cyst, skin bridge and meatal stenosis); thus, a late complication rate of 0.7% was recorded.</p></div><div><h3>Conclusion</h3><p>The long-term complication rate for Plastibell circumcisions performed by trained providers is less than 1% with all reported complications minor and amenable to surgical correction.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400056X/pdfft?md5=db76304fbc64e18b830589c401bf144c&pid=1-s2.0-S294971162400056X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal meconium-related obstruction: Establishing a research strategy to evaluate an evolving disease","authors":"Jordan M. Rook ,&nbsp;Jay Vankawala ,&nbsp;Daniel A. DeUgarte","doi":"10.1016/j.yjpso.2024.100170","DOIUrl":"10.1016/j.yjpso.2024.100170","url":null,"abstract":"<div><h3>Purpose</h3><p>The link between prematurity and meconium-related obstruction is understudied. We sought to describe the contemporary spectrum of meconium-related obstruction and to validate the use of ICD-10 codes for the study of this family of diseases.</p></div><div><h3>Methods</h3><p>This retrospective cohort study included neonates within our health system treated for a radiographically or intraoperatively confirmed meconium-related obstruction from January 2018 to December 2022. We stratified obstructions by type (meconium ileus vs meconium plug syndrome) and need for intervention (contrast enema vs surgery). We evaluated the association of prematurity, cystic fibrosis, and Hirschsprung's disease with disease severity using t-tests, ANOVA, and chi-squared tests. We secondarily evaluated the accuracy of ICD-10 codes at identifying meconium-related obstructions using sensitivity, specificity, and predictive values.</p></div><div><h3>Results</h3><p>Over five years, 18 infants were treated for meconium-related obstruction. This included five patients (28%) with meconium ileus and 13 (72%) with meconium plug syndrome. Twelve neonates (67%) were preterm, including all five (100%) treated for meconium ileus, none of whom had cystic fibrosis or Hirschsprung's disease. Among infants with meconium plug syndrome, one (8%) had cystic fibrosis and two (15%) had Hirschsprung's disease. Eight (44%) patients required a contrast enema, 5 (28%) multiple contrast enemas, and 5 (28%) surgery. Increasing prematurity was associated with worse disease severity (p&lt;0.001). Diagnosis code P76.0 identified all cases of meconium-related obstruction (sensitivity=100%; specificity=95%).</p></div><div><h3>Conclusions</h3><p>Most meconium-related obstructions were related to prematurity and not cystic fibrosis or Hirschsprung's disease. The use of ICD-10 code P76.0 is a promising research strategy for this evolving condition.</p></div><div><h3>Level of evidence</h3><p>Level III – retrospective comparative study</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000558/pdfft?md5=e3249b4c40b1424bb9d6625249f5fe2d&pid=1-s2.0-S2949711624000558-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and implications of pediatric spinal gun shot wounds: A cross-sectional analysis using 2017-2021 TQIP data","authors":"Matthew Merckling ,&nbsp;Victor Koltenyuk ,&nbsp;David Zuckerman ,&nbsp;Brianna Hayes ,&nbsp;Aryan Rafieezadeh ,&nbsp;Bardiya Zangbar ,&nbsp;Harshadkumar Patel ,&nbsp;Rachana Tyagi","doi":"10.1016/j.yjpso.2024.100169","DOIUrl":"10.1016/j.yjpso.2024.100169","url":null,"abstract":"<div><h3>Background</h3><p>Pediatric morbidity and mortality due to gun violence has steadily risen in recent years, becoming the leading cause of death among children and teens as of 2022 per the Center for Disease Control (CDC). For patients under the age of 17 in the United States, gunshot wounds (GSWs) are the underlying cause of traumatic spinal cord injury (tSCI) in 8.3% of patients. Although prior studies have examined the broader trends of firearm-related deaths in children, investigation specifically focusing on gunshot wounds to the spine has not addressed the pediatric population.</p></div><div><h3>Methods</h3><p>The TQIP database from 2017 to 2021 was queried for patients under the age of 18 with gunshot traumas, and ICD-10 diagnosis codes were used to identify associated spinal injuries. The incidence across time and risk factors for adverse hospital outcomes were analyzed using multivariate logistic regression. Factors of interest included demographic characteristics, insurance provider, and comorbidities.</p></div><div><h3>Results</h3><p>A total of 3,155 gunshot injuries to the spine (GSIS) in the pediatric population were reported to TQIP between 2017 and 2021. Average patient age was 16 ± 2.8 years old and the majority of patients (n=1819, 57.6%) were uninsured. Assault was the intent of firearm discharge in 2,582 (81.8%) patients and unintentional injury occurred in 322 (10.2%) cases. Mortality occurred in 11.7% of GSIS, twice that of the 5.8% seen in all pediatric GSW. Those with psychiatric disorders were more likely to result in extended LOS (OR, 2.538; 95% CI, 1.638-3.932; P &lt; 0.001) and in-hospital complications (OR, 1.841; 95% CI, 1.139-2.891; P = 0.012) when analyzed with multivariate binomial logistic regression.</p></div><div><h3>Conclusion</h3><p>In this large-scale retrospective study using TQIP data, we identified trends in spine injuries sustained from gun trauma in the pediatric population. Consideration of demographics, hospital course, and outcomes as examined in this study can provide valuable insights to clinicians, public health organizations, and policy makers.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000546/pdfft?md5=a7eccd1b20c4b35075beeb668a30bc07&pid=1-s2.0-S2949711624000546-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142137186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary results of thyroid surgery from a tertiary comprehensive children's hospital","authors":"Merve Duman Küçükkuray ,&nbsp;Ayşe Karaman ,&nbsp;Semra Çetinkaya ,&nbsp;Şenay Savaş Erdeve ,&nbsp;Çiğdem Üner ,&nbsp;Nebiyye Genel ,&nbsp;İbrahim Karaman","doi":"10.1016/j.yjpso.2024.100168","DOIUrl":"10.1016/j.yjpso.2024.100168","url":null,"abstract":"<div><h3>Background</h3><div>Thyroid nodules are rare in children and the risk of malignancy rate is considerably higher than in adults. In this study, we aimed to evaluate the patients who admitted to our hospital with thyroid nodules and underwent thyroid surgery examine the distributions of pathologies, changes in treatment protocols and results.</div></div><div><h3>Methods</h3><div>Pediatric patients &lt; 18-year-old, who presented with thyroid nodules and underwent thyroid surgery at our clinic between 2005 and 2018, were retrospectively examined. Demographic characteristics, complaints at presentation, ultrasonography findings, surgical method, histopathological results, and postoperative complications were evaluated. Data were compared between two time periods: before and after 2014.</div></div><div><h3>Results</h3><div>A total of 52 thyroid surgeries were performed on 45 patients with a female/male ratio of 3:1 and an average age of 14.1 ± 2.6 years. Differentiated thyroid carcinoma was detected in 12 (26.7 %) of the patients. The incidence of malignant tumors increased from 18.2 % to 26.7 % after 2014. Transient hypocalcemia was detected in 11 (21.1 %) patients. The risk of postoperative hypocalcemia was significantly increased in patients with bilateral resection (<em>p</em> &lt; 0.01). Parathyroid hormone level measured at 6–12 h postoperatively is useful in predicting hypocalcemia (<em>p</em> = 0.001). No significant relationship was found between high body mass index and thyroid malignancy. Fine needle aspiration biopsy results were found to be significant in predicting malignancy (<em>p</em> = 0.041).</div></div><div><h3>Conclusion</h3><div>We assert the critical importance of vigilant postoperative monitoring for hypocalcemia, particularly following total thyroidectomy and completion thyroidectomy. Since the incidence of thyroid pathologies requiring surgical intervention in children is relatively low, we think that such cases should be performed in comprehensive pediatric hospitals where a multidisciplinary approach is adopted.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital airway anomalies and syndromes associated in newborns with esophageal atresia","authors":"Claudia Norambuena ,&nbsp;Patricio Varela ,&nbsp;Yovanca Ramírez ,&nbsp;Eduardo Leopold ,&nbsp;Jorge Godoy ,&nbsp;Alvaro Weibel","doi":"10.1016/j.yjpso.2024.100167","DOIUrl":"10.1016/j.yjpso.2024.100167","url":null,"abstract":"<div><h3>Objective</h3><p>This study aims to define the associated comorbidities, syndromes and anatomic findings in newborns with esophageal atresia using bronchoscopy.</p></div><div><h3>Method</h3><p>Retrospective analysis of the database was performed on patients that underwent surgery with esophageal atresia or tracheoesophageal fistula diagnosis between 2016 and 2023 in Dr. Luis Calvo Mackenna Children´s Hospital in whom an airway study was done with rigid laryngotracheoscopy. Demographic data, comorbidities and airway anomalies were registered.</p></div><div><h3>Results</h3><p>Data from 37 patients was analyzed. Comorbidities were present in 62.1 % of the patients. Airway anomalies such as tracheomalacia, laryngomalacia, tracheal diverticulum, congenital tracheal stenosis and cleft were present in 56.75 % of the patients. 72.9 % of the patients had Type C EA and in 32.4 % of the cases tracheoesophageal fistula was located at the carina.</p></div><div><h3>Conclusion</h3><p>In the last 7 years we have done an airway study in 82.2 % of newborns with esophageal atresia. There is a high percentage of patients with airway anomalies, therefore we consider the importance of performing an endoscopic airway study in all patients with EA.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000522/pdfft?md5=c24d1b941bc7309659381cc12e3d6484&pid=1-s2.0-S2949711624000522-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142050140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric portal hypertensive enteropathy after Kasai surgery","authors":"Ho Jong Jeon ,&nbsp;Kyong Ihn ,&nbsp;In Geol Ho ,&nbsp;Seok Joo Han","doi":"10.1016/j.yjpso.2024.100166","DOIUrl":"10.1016/j.yjpso.2024.100166","url":null,"abstract":"<div><h3>Background</h3><p>Portal hypertensive enteropathy (PHE) can cause chronic or acute gastrointestinal (GI) bleeding. Although there is a consensus on the diagnosis and treatment guidelines for PHE in adults, there are few reports on children. We aimed to report the clinical progress and outcomes of children with PHE treated with Kasai surgery and compare them with those of adults with PHE.</p></div><div><h3>Methods</h3><p>In total, 309 patients who underwent postoperative endoscopy were enrolled among 336 patients who underwent Kasai surgery for biliary atresia at Severance Children's Hospital between May 2005 and March 2022.</p></div><div><h3>Results</h3><p>The PHE diagnosis rate was 15.2 % (<em>n</em> = 47). PHE was not diagnosed until 2012; however, the diagnosis rates significantly increased over time (13.3 % and 36.1 % between 2013 and 2017 and 2018–2022, respectively). Of the 47 patients diagnosed with PHE, 14 (29.8 %) had GI bleeding caused solely by PHE. None of the PHE patients required ICU care at the time of bleeding, compared to 32 (24.1 %) in the gastroesophageal varix (GEV) group. After initial management, the rates of re-bleeding, refractory bleeding, and mortality were 78.6 %, 28.6 %, and 0.0 %, respectively, in the PHE group.</p></div><div><h3>Conclusions</h3><p>Pediatric PHE diagnosis rates after Kasai surgery have increased since clinicians have become aware of the existence of the disease. Pediatric PHE has a high re-bleeding rate (78.6 %), although fatal GI bleeding is rare compared to GEV. Diagnosis and treatment of pediatric PHE can be performed according to adult guidelines.</p></div><div><h3>Level of evidence</h3><p>III.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000510/pdfft?md5=8d8e3f0c2bce1483a19f2621fe3748b1&pid=1-s2.0-S2949711624000510-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications of Indocyanine Green (ICG) fluorescence in pediatric colorectal conditions","authors":"Ismael Elhalaby ,&nbsp;Elizaveta Bokova ,&nbsp;Seth Saylors ,&nbsp;Irene Isabel P. Lim ,&nbsp;Rebecca M. Rentea","doi":"10.1016/j.yjpso.2024.100165","DOIUrl":"10.1016/j.yjpso.2024.100165","url":null,"abstract":"<div><p>Postoperative success in pediatric colorectal surgery hinges on achieving adequate perfusion during complex reconstructive procedures. This review synthesizes findings from recent publications regarding the application of Indocyanine Green (ICG) in various surgical interventions for conditions such as Hirschsprung disease, anorectal malformations, cloacal reconstructions, and others.</p><p>Preliminary evidence suggests that ICG fluorescence enhances intraoperative decision-making by improving vascular visualization and assessing tissue perfusion. Compared to conventional methods, ICG may offer superior evaluation of intestinal perfusion.</p><p>While initial reports indicate a favorable safety profile for ICG use in pediatric patients, further prospective studies are needed to confirm these observations, quantify benefits, and assess its impact on surgical outcomes. By providing real-time perfusion data, ICG holds promise for enhancing surgical precision and improving patient outcomes in pediatric colorectal surgery.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000509/pdfft?md5=670c14d5c570d20c446f79748f4dc6cc&pid=1-s2.0-S2949711624000509-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway exploration when suspected foreign body aspiration. Is it always indicated?","authors":"Maria Martinez Diaz,&nbsp;Vicente Ibañez Pradas,&nbsp;Miguel Couselo Jerez,&nbsp;Estíbaliz Valdés Diéguez","doi":"10.1016/j.yjpso.2024.100163","DOIUrl":"10.1016/j.yjpso.2024.100163","url":null,"abstract":"<div><h3>Background</h3><p>Foreign body aspiration (FBA) is an important cause of morbidity and mortality in pediatrics. Flexible or rigid bronchoscopy is the gold standard for its diagnosis and treatment. However, despite being a minimally invasive test, it is not without risk and, given the low specificity of symptoms involved, between 45 and 70 % of diagnostic bronchoscopies (DB) performed are normal. The aim of this paper is to develop a strategy in order to reduce this percentage.</p></div><div><h3>Methods</h3><p>Observational, analytical, and retrospective study of DB performed for suspected FBA between 2018 and 2022. Demographic, clinical, and radiological data, bronchoscopy findings and complications were obtained.</p></div><div><h3>Results</h3><p>96 patients admitted to DB were analyzed. 72 out of 96 (75 %) were normal. The risk of presenting a foreign body was significantly higher in patients with suspected nuts, so DB should be always indicated. In patients with suspected other materials aspiration, a multivariate analysis was performed using logistic regression. Statistically significant association was found between dyspnea, asymmetric auscultation and abnormal chest radiography with the presence of a foreign body on the DB; AUC = 0.97 (95 % CI 92.4 %-100 %). The proposed algorithm establishes patients at high risk of FBA and therefore the DB is recommended, with a sensitivity of 100 % and a specificity of 87.2 %.</p></div><div><h3>Conclusions</h3><p>The application of the algorithm to patients with suspected aspiration of a foreign body other than nuts can facilitate the identification of patients with high risk of aspiration and reduce the percentage of negative DB.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000480/pdfft?md5=e7d34cece036084576aa31733293e5b7&pid=1-s2.0-S2949711624000480-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical evaluation and fecal continence of laparoscopic-assisted procedures for total colonic aganglionosis","authors":"Chaosheng He ,&nbsp;Suolin Li","doi":"10.1016/j.yjpso.2024.100160","DOIUrl":"10.1016/j.yjpso.2024.100160","url":null,"abstract":"<div><p>Total colonic aganglionosis (TCA), defined as aganglionosis extending from the anus up to the distal ileum, is a rare variant of Hirschsprung's disease. Surgery for TCA aims to remove the aganglionic colon and reconstruct the intestinal tract by bringing the normally innervated ileum down to the anus while preserving normal sphincter function. Laparoscopy with surgeries including laparoscopic-assisted Duhamel-like and Soave-like pull-through procedures have been progressively applied to the treatment of TCA over the past two decades and may become the dominant treatment for TCA in the future. Postoperative fecal continence, involving issues such as normal defecation, Hirschsprung-associated enterocolitis (HAEC), frequent stool and perianal erosion (perineal rash), soiling/fecal incontinence and constipation/obstructive symptoms, is very important to patients. These complications require nutritional support and comprehensive postoperative gastroenterological care and even require permanent ileostomy and redo pull-through. Some patients have previously seen a psychologist for frequent complaints of diarrhea and other physical symptoms. Patients with TCA postoperatively must be evaluated regularly by pediatric surgeons, enterostoma therapists, gastroenterologists, dieticians and psychologists to achieve a good nutritional status and psychological health.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000455/pdfft?md5=c54cdbcd99cd55eb2821c766db896617&pid=1-s2.0-S2949711624000455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective comparison of minimally invasive glaucoma surgery techniques for goniotomy in primary congenital glaucoma: Optimizing intraocular pressure control","authors":"Mayor Orezime Atima ,&nbsp;Ugbede Idakwo ,&nbsp;Ayodele Jacob Orugun ,&nbsp;Oyeronke Komolafe ,&nbsp;Melchizedek Ignatius Munaje ,&nbsp;Eisuke Shimizu ,&nbsp;Nakayama Shintaro ,&nbsp;Emmanuel Oluwadare Balogun ,&nbsp;Emeka John Dingwoke","doi":"10.1016/j.yjpso.2024.100162","DOIUrl":"10.1016/j.yjpso.2024.100162","url":null,"abstract":"<div><h3>Background</h3><p>A family of less invasive glaucoma procedures has been developed to provide moderate reductions in intraocular pressure and medication burden in eyes with therapeutic needs that may not warrant the risks associated with trabeculectomy and tube shunt implantation. This study aims to compare the effectiveness and clinical outcomes of pediatric goniotomy using minimally invasive glaucoma surgery techniques to manage primary congenital glaucoma.</p></div><div><h3>Materials and methods</h3><p>Using a computer-generated set of random numbers, the patients were randomized into three groups: Kahook blade group, microvitreoretinal blade group, and 23G needle group. Each group contained 22 eyes. All patients underwent anesthesia for intraocular pressure measurement, corneal diameter evaluation, and fundoscopy. Preoperative intraocular pressure at presentation and postoperative intraocular pressure were recorded during a one-year follow-up period. Outcome measures included decreases in corneal diameter from preoperative size, mean postoperative reduction in intraocular pressure for each minimally invasive glaucoma surgery technique and absence of intraoperative or postoperative complications. Surgical success was defined as a postoperative intraocular pressure of ≤20 mmHg without antiglaucoma medications or reoperation, based on the last recorded intraocular pressure during postoperative follow-up.</p></div><div><h3>Results</h3><p>A total of 66 eyes were diagnosed with primary congenital glaucoma and underwent goniotomy surgeries during the study period in 2022. The majority (89%) were bilateral cases. Among the patients, there were 26 males and 9 females, which makes up an 8: 2 male-to-female ratio, with an average age range of 2 months to 2 years. After a one-year postoperative follow-up, a significant reduction in intraocular pressure was achieved of ≤18 mmHg. In terms of surgical success with minimally invasive glaucoma surgery techniques, goniotomy with a 23-gauge needle had the most postoperative intraocular pressure, followed by the microvitreoretinal blade and the Kahook blade. On average, the 23-gauge needle had a corneal diameter of 13.8 mm, while the microvitreoretinal blade was 13.9 mm and the Kahook blade recorded 14 mm.</p></div><div><h3>Conclusions</h3><p>Goniotomy using minimally invasive glaucoma surgery techniques has been proven to be an effective surgical technique for the management of childhood glaucoma among Nigerian patients. A reduction in postoperative intraocular pressure, corneal diameter, and absence of complications provide clinical evidence of successful glaucoma management and preservation of outcomes of visual function in patients.</p></div><div><h3>Level of evidence</h3><p>Level 1 (Prospective study)</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000479/pdfft?md5=ae7958077c9c2eb16403b1d9b0b2a15f&pid=1-s2.0-S2949711624000479-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}