Journal of Pediatric Surgery Open最新文献

{"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}

{"title":"Association of social vulnerability and rehospitalization in pediatric motor vehicle trauma patients","authors":"Meagan Rosenberg ,&nbsp;Alexander Knee ,&nbsp;Aixa Perez Coulte ,&nbsp;Michael V. Tirabassi","doi":"10.1016/j.yjpso.2024.100161","DOIUrl":"10.1016/j.yjpso.2024.100161","url":null,"abstract":"<div><h3>Introduction</h3><p>We investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC).</p></div><div><h3>Materials and Methods</h3><p>An exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0–15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI ≥90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression.</p></div><div><h3>Results</h3><p>Of 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61–2.29). However, although estimates were unstable, there was a possibility of increased risk of re-hospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68–8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively).</p></div><div><h3>Conclusion</h3><p>We observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations.</p></div><div><h3>Level of Evidence</h3><p>Level IV; Prognosis Study.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000467/pdfft?md5=6b69c0987cfa5a18a3f8c0cc58296bd2&pid=1-s2.0-S2949711624000467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705245","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":"Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes","authors":"Gwyneth A. Sullivan ,&nbsp;Yao Tian ,&nbsp;Willemijn L.A. Schäfer ,&nbsp;Kayla M. Giger ,&nbsp;Maxwell Joseph Willberding ,&nbsp;Audra J. Reiter ,&nbsp;Bonnie Essner ,&nbsp;Andrew J. Hu ,&nbsp;Martha C. Ingram ,&nbsp;Salva Balbale ,&nbsp;Julie K. Johnson ,&nbsp;Jane L. Holl ,&nbsp;Mehul V. Raval","doi":"10.1016/j.yjpso.2024.100159","DOIUrl":"10.1016/j.yjpso.2024.100159","url":null,"abstract":"<div><h3>Background</h3><p>: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes.</p></div><div><h3>Methods</h3><p><em>:</em> We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10–18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness.</p></div><div><h3>Results</h3><p><em>:</em> 41 % (<em>n</em> = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (<em>n</em> = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10–0.91; <em>p</em> = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL.</p></div><div><h3>Conclusions</h3><p><em>:</em> Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000443/pdfft?md5=a3f602fe152265a0786fd9d56fcd2472&pid=1-s2.0-S2949711624000443-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639420","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":"Segmental intestinal reconfiguration (SIR) in combined reconstructions for ultrashort bowel syndrome","authors":"Vasily V. Nikolaev ,&nbsp;Julia Averyanova","doi":"10.1016/j.yjpso.2024.100158","DOIUrl":"10.1016/j.yjpso.2024.100158","url":null,"abstract":"<div><h3>Background</h3><p>Ultrashort bowel syndrome represents the most rare and complex variant of the short bowel syndrome. Autologous intestinal reconstructions for ultrashort bowel syndrome is typically reserved for severe cases characterized by symptomatic dysmotility within the ultrashort dilated segments. Limited surgical techniques are available to substantially increase the length of ultrashort bowels with asymmetric and highly dilated segments.</p><p>We present a case series detailing the application of a technique for lengthening and tapering significantly dilated ultrashort bowels – segmental intestinal reconfiguration (SIR), based on the Yang-Monti principle. Our analysis delves into the technical features across various anatomical variants and provides mid-term results.</p></div><div><h3>Methods</h3><p>From 2021 to 2022, patients experiencing dysmotility in dilated ultrashort bowel segments with a preserved colon underwent sequential combined intestinal reconstructions. Assessments were conducted 18–24 months post-surgery, and statistical calculations employed nonparametric methods to compare pre- and postoperative results.</p></div><div><h3>Results</h3><p>Six patients, with a median age of 48.5 months, underwent autologous intestinal reconstructions, including SIR. The serial transverse enteroplasty (STEP) was performed on the dilated duodenum in five children, and colon interposition in two. The length of the small bowel exhibited a significant difference before and after surgery (<em>p</em> = 0.031). No complications were observed in the postoperative period. The postoperative group demonstrated a lower dependence on parenteral nutrition (NPEI/REE &lt; 80 % in 6 (100.0 %); <em>p</em> = 0.007). Enteral autonomy was restored in two children.</p></div><div><h3>Conclusions</h3><p>The results of SIR technique in combined reconstructions for ultrashort bowel syndrome in a carefully selected cohort of children demonstrate feasibility and reliability, as well as the restoration of intestinal transport function at midterm evaluation. This comprehensive approach resulted in increased enteral tolerance and reduced parenteral requirements.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000431/pdfft?md5=5c4615bdc1f13994ab332d608b77ec64&pid=1-s2.0-S2949711624000431-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710046","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}