Journal of pediatric surgery最新文献

{"title":"A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children","authors":"Michela Carter ,&nbsp;Steven T. Papastefan ,&nbsp;Yao Tian ,&nbsp;Stephen J. Hartman ,&nbsp;Meredith S. Elman ,&nbsp;Sara G. Ungerleider ,&nbsp;Aaron P. Garrison ,&nbsp;Tolulope A. Oyetunji ,&nbsp;Matthew P. Landman ,&nbsp;Mehul V. Raval ,&nbsp;Seth D. Goldstein ,&nbsp;Timothy B. Lautz","doi":"10.1016/j.jpedsurg.2024.162056","DOIUrl":"10.1016/j.jpedsurg.2024.162056","url":null,"abstract":"<div><h3>Background</h3><div>Utilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort.</div></div><div><h3>Methods</h3><div>This retrospective analysis utilized the Pediatric Health Information System database to identify children &lt;18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017 to 2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates.</div></div><div><h3>Results</h3><div>We identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p = 0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98–1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p &lt; 0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90–4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS.</div></div><div><h3>Conclusion</h3><div>Laparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia.</div></div><div><h3>Level of evidence</h3><div>Treatment Study – Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162056"},"PeriodicalIF":2.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Prophylaxis for Elective Pediatric Laparoscopic Cholecystectomies","authors":"Christine Rodhouse ,&nbsp;Rachel Raymond ,&nbsp;Dan Neal ,&nbsp;Tyler J. Loftus ,&nbsp;Faraz A. Khan ,&nbsp;Ana R. Do ,&nbsp;Janice A. Taylor ,&nbsp;Philip A. Efron ,&nbsp;Shawn D. Larson ,&nbsp;Steven L. Raymond","doi":"10.1016/j.jpedsurg.2024.162055","DOIUrl":"10.1016/j.jpedsurg.2024.162055","url":null,"abstract":"<div><h3>Background</h3><div>The Surgical Infection Society (SIS) guidelines recommend against the use of surgical antibiotic prophylaxis (SAP) for low-risk patients undergoing elective laparoscopic cholecystectomies.</div></div><div><h3>Methods</h3><div>Using National Surgical Quality Improvement Program (NSQIP) data, 5440 pediatric patients were identified who underwent laparoscopic cholecystectomy from 2021 to 2022. Patients who had immunodeficiency, active malignancy, American Society of Anesthesiologists (ASA) physical status classification 3–5, procedure indicated for infection, emergent procedure, received intravenous antibiotics before the prophylaxis window, or missing SAP data were excluded.</div></div><div><h3>Results</h3><div>3959 patients were included in the analysis. Among these patients, 3570 (90.2 %) received SAP. Overall incidence of 30-day superficial incisional surgical site infection (SSI), deep incisional SSI, and organ space SSI were 0.9 %, 0.0 %, and 0.1 %, respectively. The incidence of superficial incisional SSI was significantly higher in the patients who did not receive SAP (SAP 0.8 %, no SAP 2.1 %; p = 0.024). The incidence of organ space SSI was also significantly higher in the patients who did not receive SAP (SAP 0.1 %, no SAP 0.8 %; p = 0.008). There was no difference in the incidence of <em>C. diff</em> colitis (SAP 0.1 %, no SAP 0.0 %; p = 1.000). Multivariable modeling, controlling for Hispanic ethnicity, age, and gender, demonstrated patients that received SAP were significantly less likely to have any postoperative SSI compared to patients who did not receive SAP (OR = 0.35).</div></div><div><h3>Conclusion</h3><div>Hospitals are not currently compliant with SIS guidelines regarding omission of antibiotic prophylaxis for low-risk patients undergoing elective laparoscopic cholecystectomies. The authors advocate for additional studies and reassessment of current guidelines for pediatric patients given the above findings.</div></div><div><h3>Type of Study</h3><div>Retrospective comparative study.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"Article 162055"},"PeriodicalIF":2.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Management After Neonatal Enteric Operations in US Children's Hospitals","authors":"Priyanka Jadhav ,&nbsp;Pamela M. Choi ,&nbsp;Romeo Ignacio ,&nbsp;Benjamin Keller ,&nbsp;Gerald Gollin","doi":"10.1016/j.jpedsurg.2024.162052","DOIUrl":"10.1016/j.jpedsurg.2024.162052","url":null,"abstract":"<div><h3>Background</h3><div>There are few evidence-based guidelines for perioperative antibiotic management in neonates who undergo enteric operations. We sought to assess antibiotic administration practices in a large population of patients who underwent operations involving enteric anastomoses and evaluate the incidence of postoperative infection and other outcomes based on antibiotic approach.</div></div><div><h3>Methods</h3><div>The Pediatric Health Information Systems database was queried for patients who underwent repair of esophageal, duodenal or jejuno-ileal atresia in 2021. The type and number of consecutive days of perioperative antibiotics was determined and ICD-10 codes corresponding to infection were noted. The incidences of post operative infections (bacterial and fungal), antibiotic-resistant infections and anti-fungal medication administration were determined.</div></div><div><h3>Results</h3><div>516 infants were identified. A wide variety of antibiotics were administered and 39 % of patients received more than one day of treatment. There were no differences in the incidence of postoperative infection between those who received more or less than one day of perioperative antibiotics for any of the operations assessed. The incidence of bacterial infection in patients treated with cefazolin or cefoxitin monotherapy was no different than that for all other regimens. There were no significant differences in the incidence of post-operative fungal infection based on antibiotic type or duration.</div></div><div><h3>Conclusion</h3><div>There was substantial variation in the duration and type of antibiotics administered after neonatal enteric operations. We identified a low incidence of infection with only one day of perioperative antibiotics and there was no evidence that longer treatment reduced infection risk. Cefazolin monotherapy was likewise associated with a low risk for perioperative infections.</div></div><div><h3>Study type</h3><div>Non-interventional observational database study.</div></div><div><h3>Level of evidence</h3><div>3.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"Article 162052"},"PeriodicalIF":2.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracheal Allotransplantation to Deliver Growing Airway Implants for Infants and Children.","authors":"Adam Lorio, Herra Javed, Eli Contorno, Lawrence Greiten, Brian Reemtsen, Taufiek Konrad Rajab","doi":"10.1016/j.jpedsurg.2024.162048","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162048","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162048"},"PeriodicalIF":2.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Injection Sclerotherapy With Doxycycline in Lymphatic, and Veno-lymphatic Malformation in Children: A Single Centre Experience.","authors":"Abhinav Sihag, Priya Ramachandran, Balagopal Subramaniam, Senthil Ganesh Kamaraj, Muhammed Jaseel","doi":"10.1016/j.jpedsurg.2024.162054","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162054","url":null,"abstract":"<p><strong>Aim: </strong>Lymphatic malformations (LMs) and Veno-lymphatic malformations (VLMs) are congenital slow flow vascular malformations. Intralesional sclerotherapy is a good alternate option for treatment of LMs and VLMs. Our aim was to evaluate the outcome of doxycycline sclerotherapy for lymphatic and veno-lymphatic malformation in children in our institute.</p><p><strong>Methods: </strong>Retrospectively review of children with LMs or VLMs, primarily treated with doxycycline sclerotherapy in our hospital from January 2012 to December 2023. Patient's demographics, type and location of lesion, number of sclerotherapy sessions, final outcome and complications were recorded and data was analyzed. The clinical response was deemed excellent if lesion resolved completely (>90 % resolution) and satisfactory if there was >50 % resolution of lesion based on visual estimate. The response was considered as poor if <50 % resolution of lesion.</p><p><strong>Results: </strong>Out of 70 patients, 34 (48 %) patients had lesion located in cervicofacial region. 164 sessions were required (range 1-7/patient). 47/70 (68 %) patients showed excellent response, 9/70 (12 %) patients showed satisfactory response and remaining 14/70 (20 %) patients showed poor response. 8 patients (11 %) required subsequent surgery after sclerotherapy. Sclerotherapy with doxycycline was successful in 80 % of patients. No major complication was noted in any patient.</p><p><strong>Conclusion: </strong>Doxycycline sclerotherapy resulted in excellent clinical outcome and complete resolution of lesions in majority of cases without increased need for subsequent surgical resection. Doxycycline is a readily available and cost effective treatment option with minimum side effects. It should be considered as a primary treatment for LM and VLM in children.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162054"},"PeriodicalIF":2.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Splenectomy Versus Total Splenectomy in Sickle Cell Disease: A Systematic Review and Meta-Analysis","authors":"Merna Raafat Roshdy ,&nbsp;Mina Botros ,&nbsp;Abanoub Mokhles ,&nbsp;Mohamed A. Aldemerdash ,&nbsp;Haneen Sabet ,&nbsp;Bishoy Fahim ,&nbsp;Mahmoud Diaa Hindawi","doi":"10.1016/j.jpedsurg.2024.162058","DOIUrl":"10.1016/j.jpedsurg.2024.162058","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease (SCD) patients encounter various complications, such as acute splenic sequestration crisis and hypersplenism that may require splenectomy. This systematic review and meta-analysis aims to clarify differences between total splenectomy (TS) or partial splenectomy (PS) in terms of hematological and postoperative outcomes.</div></div><div><h3>Methods</h3><div>We identified studies involving SCD patients who underwent PS or TS, whether open or laparoscopic, and whose hematological and operative outcomes were evaluated, through searching PubMed, Web of Science, Scopus, Embase and Cochrane databases from inception until June 2024. Primary outcomes: hemoglobin concentration and reticulocytes %. Secondary outcomes: operative blood transfusion need, length of hospital stay (LoS), postoperative infections, overwhelming postsplenectomy sepsis (OPSS), acute chest syndrome (ACS), thromboembolic events and mortality.</div></div><div><h3>Results</h3><div>Eighteen studies were included; 17 cohort and one case series. Seven studies collected data from the same SICHA institutions, so a total of 756 SCD patients is included. According to the most recent study, no significant changes in hemoglobin (preoperative 10.5 ± 0.3 vs 9.6 ± 0.4 one year postoperative in 24 PS cases, and 9.7 ± 0.1 vs 9.7 ± 0.2 in 73 TS cases), however, both TS and PS significantly decreased reticulocyte by 2 % (0.8–3.2 %). Proportional analysis of short-term infection revealed a lower incidence in TS 2.71 % vs 8.64 % in PS, and similarly for ACS, it is 6.97 % in TS vs 14.90 % in PS.</div></div><div><h3>Conclusion</h3><div>This first systematic review and meta-analysis shows that TS and PS have no or minimal effect on hemoglobin but a strong lowering effect on reticulocyte %. Proportional analysis reveals lower short-term infections and ACS following TS than PS. However, further clinical trials are necessary to draw definite conclusions and improve surgical decision making.</div></div><div><h3>Type of study</h3><div>Systematic review and meta-analysis of cohort studies.</div></div><div><h3>Level of evidence</h3><div>II.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162058"},"PeriodicalIF":2.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Cecostomy Placement for Antegrade Enema Access in the Pediatric Population.","authors":"Wendy Jo Svetanoff, Shruthi Srinivas, Kristine Griffin, Karen A Diefenbach, Ihab Halaweish, Richard Wood, Alessandra Gasior","doi":"10.1016/j.jpedsurg.2024.162053","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162053","url":null,"abstract":"<p><strong>Aim: </strong>Use of the appendix for an antegrade continence enema (ACE) is not always possible. Various methods exist for creating cecostomy tubes, including percutaneous, endoscopic, or surgical placement. We describe our laparoscopic cecostomy technique and review short- and long-term outcomes.</p><p><strong>Methods: </strong>Single institution retrospective review of children who underwent laparoscopic cecostomy placement from June 2016-June 2023. The cecum is secured to the abdominal wall with trans-fascial sutures and placement of an enterostomy button under direct vision. Half-volume flushes begin after 48 h; after two weeks, patients transition to full flushes. Demographic, intraoperative, and postoperative variables were analyzed.</p><p><strong>Results: </strong>Forty patients were included [24 (60 %) female; 31 (77.5 %) Caucasian]. Twenty-one (52.5 %) had myelomeningocele, 15 (37.5 %) had an anorectal malformation and 4 (10 %) had functional constipation. Twenty-five (62.5 %) underwent laparoscopic cecostomy placement alone, while 15 (37.5 %) had it performed with another procedure. Median operative time was 1.12 (IQR 0:93-1.45) hours for isolated cecostomy placement, with median post-operative stay of 2.0 days (2.2-3.1) days. Post-operatively, one patient had severe withholding, ultimately requiring a diverting ileostomy. No other 30-day complications (surgical site infection, tube removal) were identified. One patient required revision four months post-op due to inadvertent placement in the sigmoid. At one-year follow-up, 11/36 (30.6 %) children noted granulation tissue, and 11 (30.6 %) noted superficial leakage. Two (6 %) patients had transitioned to oral laxatives.</p><p><strong>Conclusion: </strong>Laparoscopic cecostomy tube placement is a safe and alternative method of developing ACE access that can be done concurrently with other procedures.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162053"},"PeriodicalIF":2.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clean Intermittent Catheterisation via a Mitrofanoff Is Superior to Long Term Suprapubic Catheters for Bladder Drainage.","authors":"Elmarie Van der Merwe, Rosy Loveday, Laura Jackson, Liam McCarthy","doi":"10.1016/j.jpedsurg.2024.162050","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162050","url":null,"abstract":"<p><strong>Aim: </strong>Some children require long-term drainage of the bladder but do not tolerate clean intermittent catheterisation (CIC) urethrally. We aimed to compare long term suprapubic catheter (SPC) drainage vs Mitrofanoff conduit (allowing CIC) by comparing the survival of the drainage methods and rates of urinary tract infection (UTI).</p><p><strong>Method: </strong>Retrospective review of a single surgeon's experience (2007-2023). Data collection included diagnosis, age at procedures, date of surgery, date of most recent follow-up and date and reason for unplanned surgery. For SPCs, initial insertion of SPC and then conversion to a Foley catheter under GA was taken as normal (event free survival) and only further operations were counted as complication events. For Mitrofanoffs, any subsequent operation was counted as a complication. Data were given as a number (%) or median (interquartile range) as appropriate. Data analysed by Fisher exact and Mann-Whitney U-test. Kaplan Meier (KM) survival of drainage routes was compared, P < 0.05 taken as significant.</p><p><strong>Results: </strong>There were 45 patients (n = 86 SPC episodes) compared to 108 patients (n = 110 Mitrofanoff procedures). Data were available in 73 SPC episodes and 109 Mitrofanoff episodes, including 3 redo procedures (one from another centre). There was no difference in gender (SPC group, 67 % male vs. Mitrofanoff group, 77 %; N.S.). There was no difference in age at procedure [7.5 (2.9-11.5) years vs 8.3 (5.9-11.4) years respectively; N.S.) KM comparison showed that Mitrofanoff have a better event-free survival than SPC (91 % vs 52 % at 1 year; 80 % vs. 13 % at 5 years; P < 0.0001). Paired data showed a significant (86 %) reduction in rate of UTI with conversion from SPC to Mitrofanoff drainage in 15 patients; SPC: 0.13 (0-0.46) UTIs/month vs subsequent Mitrofanoff: 0.02 (0-0.08) UTI/month, P = 0.04).</p><p><strong>Conclusion: </strong>SPCs had a much higher rate of unplanned surgery than Mitrofanoffs, creating a considerable unplanned burden of care for families and clinical staff. For long-term bladder drainage CIC via a Mitrofanoff conduit should be considered in preference to SPC where urethral CIC is not possible.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162050"},"PeriodicalIF":2.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Survival of Bladder Augmentation is Influenced by its Shape and Mucosal Lining.","authors":"Emma Parkinson, Andrew Robb, Liam McCarthy","doi":"10.1016/j.jpedsurg.2024.162051","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162051","url":null,"abstract":"<p><strong>Introduction: </strong>Bladder augmentation in the UK has been largely by enterocystoplasty or ureterocystoplasty (UC). Ileocystoplasty can be simple patch placement (SPP), or formation of an ileal cup (IC). Urothelium is the \"right\" mucosa, whereas intestinal mucosa exhibits absorption, mucus production, malignancy. On videourodynamics it can be shown that SPP fills with a poor conformation (irregular shape), while IC was good, and UC adequate. Our aim was to measure the long-term outcomes of augmentation, comparing UC (\"right\" mucosa and adequate conformation), to SPP (\"wrong\" mucosa and poor conformation) to IC (\"wrong mucosa\" and good conformation).</p><p><strong>Methods: </strong>Single-centre retrospective review. Patients were identified from operative logs for the period 2005 to 2022. Registered as an audit (CARMS 31503). Data collected included: demographics, dates: operation, redo-surgery, imaging, stones (renal/bladder) and any intervention. Data were given as numbers (%), median (range) analysed by Fisher exact test where P < 0.05 was taken as significant.</p><p><strong>Results: </strong>There were 168 bladder augmentations: UC (n = 24), SPP (n = 72), and IC (n = 72). Follow-up was no different for IC 4.23 (0.05-11.50) vs SPP 4.43 (0.15-13) yrs, but was longer for UC at 6.2 (4.1-8.9) yrs. Age at augmentation was 6.7 (2.5-17.1) vs 8.1 (2-17) vs 11.6 (5.9-17) yrs respectively (UC vs IC vs SPP, P = 0.0001). Revision surgery was required in 3/24 (12.5 %) UC, 6/72 (8.3 %) SPP, and 0/72 (0 %) IC. IC had fewer redos than SPP, P = 0.028. Long-term survival was significantly better for IC (100 % at 10 years, vs UC 85 % at 10 years and SPP 96 % at 5 yrs and 75 % at 10 yrs, log-rank P < 0.05). Imaging follow-up was available in SPP (n = 56) IC (n = 62), UC (n = 24) with renal stones identified in 7/56 (%) SPP, 2/62 (%) IC, and 0 in UC. Bladder stones were present in SPP 5/56 (8.9 %) vs IC 2/62 (3.2 %), NS. Stone-free survival was 100 % at 10yrs in UC, 95 % in IC, and 62 % in SPP, P = 0.028. Combining bladder failure leading to reaugmentation and bladder stones requiring surgery, allows comparison between SPP and IC: In SPP bladder stones and augment failure occurred in 15.3 %, vs 2.8 % in IC. There is a 6.3-fold increase in bladder stones and augment redo with SPP [irregular filling bladder (poor conformation) and the \"wrong\" mucosa] vs IC (good confirmation, but \"wrong\" mucosa).</p><p><strong>Conclusion: </strong>Augmentation survival is influenced by conformation and presence of the \"right\" mucosa. UC is only possible in 14 % of cases, and an IC is preferable to SPP when an enterocystoplasty is needed.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162051"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery After Surgery for Pediatric Abdominal Tumor Resections: A Prospective Multi-institution Study","authors":"Sara A. Mansfield ,&nbsp;Meera Kotagal ,&nbsp;Stephen J. Hartman ,&nbsp;Andrew J. Murphy ,&nbsp;Andrew M. Davidoff ,&nbsp;Brady Hogan ,&nbsp;Darren Ha ,&nbsp;Doralina L. Anghelescu ,&nbsp;Marc Mecoli ,&nbsp;Nicholas G. Cost ,&nbsp;Kyle O. Rove","doi":"10.1016/j.jpedsurg.2024.162046","DOIUrl":"10.1016/j.jpedsurg.2024.162046","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced recovery after surgery (ERAS) protocols are multi-disciplinary approaches to standardize perioperative care. This is the first prospective, multi-institutional study to evaluate ERAS in pediatric patients undergoing abdominal tumor resections.</div></div><div><h3>Methods</h3><div>All patients &gt;1-month-old undergoing abdominal tumor resection at one of three children’s hospitals between 2020 and 2022 were eligible. ERAS counseling was performed, and informed consent obtained. The ERAS protocol was standardized across institutions. We compared the prospective cohort to a propensity-matched historical cohort (2014–2020) from each institution utilizing 16 variables. Categorical variables were compared using McNemar’s and/or Stuart–Maxwell testing. Continuous data was compared using logistic regression.</div></div><div><h3>Results</h3><div>Ninety-five patients enrolled in the prospective cohort and were compared to 95 well-matched historic patients. Median LOS was 5.3 (4.1–7.2) days in the historic cohort, and 4.3 (3.3–6.2) days in the ERAS cohort (<em>p</em> = 0.053). Post-operative opioid consumption was lower in ERAS patients at 0.08 (0.03–0.16) MME mg/kg/day versus 0.23 (0.12–0.52) in historic patients (<em>p</em> = 0.013). ERAS patients received clear (POD#0, 0-0) and regular (POD#1, 1.0–1.0) diets two days sooner (both <em>p</em> &lt; 0.001). ERAS patients ambulated two days sooner (1.0, 1.0–2.0 versus 3.0, 2.0–5.0). The number of patients who experienced any complication was significantly lower in the ERAS cohort (44, 44.2 %) compared to historic (82, 86.3 %, <em>p</em> &lt; 0.001). This reduction was seen across each Clavien-Dindo grade 1–3 category (all <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>ERAS protocols are feasible in pediatric patients undergoing abdominal tumor resections. Use of an ERAS protocol significantly reduced complications, opioid consumption, time to mobility, and time to diets.</div></div><div><h3>Level of Evidence</h3><div>II.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162046"},"PeriodicalIF":2.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}