RESUMEN
Chemotherapy of paediatric haematological malignancies can induce infectious complications of the gastrointestinal tract, with predilection of the ileocaecal region. Common causes of right lower abdominal pain in the febrile patient with neutropaenia include acute appendicitis, typhlitis, ileus and intussusception. In this case report, we describe a teenage boy with acute appendicitis presenting with pneumoperitoneum during his course of chemotherapy. The incidence, aetiology, diagnosis, investigations and management of this uncommon presentation in a common disease are discussed. The controversial topic of the management of acute appendicitis in a febrile patient with neutropaenia is also reviewed and discussed.
Asunto(s)
Dolor Abdominal/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Apendicectomía , Apendicitis/diagnóstico , Laparoscopía , Laparotomía , Neumoperitoneo/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Dolor Abdominal/inducido químicamente , Antibacterianos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Apendicitis/inducido químicamente , Apendicitis/cirugía , Niño , Diagnóstico Diferencial , Fiebre , Humanos , Masculino , Meropenem , Tienamicinas/administración & dosificación , Resultado del TratamientoRESUMEN
INTRODUCTION: The incidence of congenital cystic lung lesions has been increasing in recent years due to better antenatal detection. With the introduction and maturation of thoracoscopy, the operative management for these lesions has seen advancement in the last decade. In this study, we aimed to compare the post-operative outcomes of patients who had thoracoscopic resection with those who underwent open resection. METHODS: A retrospective review of all patients who underwent surgery for congenital cystic lung lesions between January 1996 and June 2012 in a tertiary referral center was conducted. Patients' demographics, operative procedures and post-operative outcomes were analyzed. RESULTS: Sixty-seven patients were identified over the past 15 years. Thirty-nine patients had thoracoscopic resections and 28 had open resections. Thirteen patients in the thoracoscopic group required conversion. Both groups had similar demographics in terms of age, body weight and laterality of lesions. The mean operative time and blood loss in the two groups were comparable. Patients in the thoracoscopic group had significantly shorter duration of chest tube drainage (4.3 vs. 6.9 days, p = 0.004), shorter intensive care unit stay (2.5 vs. 5.9 days, p = 0.003) and shorter hospital stay (6.9 vs. 12.0 days, p < 0.001). Post-operative complication rate was similar between the two groups. Patients with body weight less than 5 kg showed a significantly higher conversion to open surgery as compared to those with body weight more than 5 kg (62.5 vs. 25.8 %, p = 0.049). CONCLUSION: Successful thoracoscopic resection for congenital cystic lung lesions results in better post-operative outcomes. However, this technique remains technically challenging in patients with body weight less than 5 kg.
Asunto(s)
Enfermedades Pulmonares/congénito , Enfermedades Pulmonares/cirugía , Toracoscopía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Quiste Broncogénico/cirugía , Secuestro Broncopulmonar/cirugía , Preescolar , Conversión a Cirugía Abierta/estadística & datos numéricos , Malformación Adenomatoide Quística Congénita del Pulmón/cirugía , Femenino , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/epidemiología , Enfisema Pulmonar/congénito , Enfisema Pulmonar/cirugía , Estudios Retrospectivos , Toracoscopía/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: With advances in clinical medicine, many premature babies nowadays can have excellent survival outcomes. As the incidence of inguinal hernias in this group is high and there is scarce data in the literature regarding the optimal timing for repair, this study aims to review our experience in laparoscopic repair in premature infants. METHODS: In our centre, premature neonates with inguinal hernia noted during hospitalization were offered laparoscopic repair when the body weights reached 2.5 kg unless there is contraindication for laparoscopy. A retrospective review was carried out for all premature neonates who underwent laparoscopic inguinal hernia repair from 2001 to 2011. The operative results, complications, incarceration risk and postoperative apnea risk were recorded. RESULT: A total of 79 premature neonates received laparoscopic inguinal hernia repair during this period. The mean gestational age at birth was 31.9 weeks (27-36 weeks) and the mean gestational age at operation was 46.5 weeks (33-92 weeks). One patient had incarceration and required emergency operation while waiting for the elective repair. The mean operative time was 44.9 min (25-93 min). One patient (1.3 %) had recurrence. No postoperative apnea was noted in any patient. CONCLUSION: Laparoscopic hernia repair is safe and feasible in premature neonates when they attain reasonable body size, as long as there is excellent anaesthesia support. Low risk of incarceration was noted in this study and it is worth waiting for the body weight to build up and hence facilitate laparoscopic repair.
Asunto(s)
Hernia Inguinal/cirugía , Enfermedades del Prematuro/cirugía , Laparoscopía , Estudios de Factibilidad , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Laparoscopía/efectos adversos , Masculino , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Contaminación de Alimentos , Riñón/efectos de los fármacos , Riñón/embriología , Leche , Triazinas/toxicidad , Animales , Células Cultivadas , Femenino , Feto/efectos de los fármacos , Humanos , Técnicas In Vitro , Cálculos Renales/inducido químicamente , Intercambio Materno-Fetal , Ratones , Nefritis/inducido químicamente , Embarazo , Efectos Tardíos de la Exposición Prenatal , Triazinas/metabolismoRESUMEN
BACKGROUND: With advances in minimally invasive surgery, thoracoscopic repair of oesophageal atresia has become popular in many centres worldwide and indeed has been described as the pinnacle of neonatal surgery. Here, we report our experience in two tertiary referral centres. METHODS: Thoracoscopic technique was introduced in 2007. Thus, a retrospective review of all patients diagnosed with oesophageal atresia was carried out. Patients who had thoracoscopic repair were included, and those who had open repair due to co-morbidities were excluded. Patient demographics, operative data, complications, and associated anomalies were noted. RESULTS: A total of thirty-three patients underwent thoracoscopic repair during the time period. Thirty-one were successfully repaired thoracoscopically. Two patients had conversions due to intra-operative instability. The mean body weight of the neonates was 2.58 kg. The mean operative time was 146 min. Three patients suffered from minor anastomotic leaks, which healed on conservative management. Seven patients had anastomotic strictures, which responded successfully to endoscopic dilatation. Two patients died in the post-operative period due to pneumonia. One patient had a recurrent fistula 3 months after the primary repair, and he subsequently underwent a successful second repair. CONCLUSIONS: In experienced hands, thoracoscopic repair of oesophageal atresia is at least as good as open surgery but with less surgical trauma. Standard of post-operative care contributes significantly to post-operative outcome. Thoracoscopic technique is now our preferred approach.
Asunto(s)
Atresia Esofágica/cirugía , Estenosis Esofágica/epidemiología , Toracoscopía/métodos , Fístula Traqueoesofágica/epidemiología , China , Estudios de Cohortes , Atresia Esofágica/diagnóstico , Atresia Esofágica/mortalidad , Estenosis Esofágica/etiología , Estenosis Esofágica/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Recién Nacido , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Centros de Atención Terciaria , Toracoscopía/efectos adversos , Fístula Traqueoesofágica/etiología , Fístula Traqueoesofágica/fisiopatología , Resultado del TratamientoRESUMEN
The introduction of Kasai portoenterostomy has dramatically improved the management and survival of children with biliary atresia. The success rate of this operation worldwide varies with different centers. In this respect, many authors have studied the correlation of a successful outcome with various factors, such as the experience and workload of the surgical center, the use of postoperative steroids, the underlying biliary anatomy, as well as the age of patients at the time of the operation. Indeed, the age of 60 days has been used by clinicians as a critical time beyond which the rate of success of the Kasai operation markedly reduces. Despite this worldwide adoption, clear evidence supporting this critical operative time is still lacking. We undertook a review of our experience in the management of children with biliary atresia and focused specifically on the issue of the timing of operation. We showed that performing the Kasai operation beyond the age of 60 days was not associated with a worse outcome and that a high percentage of patients could still achieve good bile flow with normal bilirubin postoperatively. Thus, we believe that until the age of 100 days, the age of the patients does not play a significant role in determining the success of the Kasai operation.
Asunto(s)
Conductos Biliares/cirugía , Atresia Biliar/cirugía , Portoenterostomía Hepática/métodos , Factores de Edad , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
There has been an exponential rise in the use of minimally invasive procedures in surgery, with obvious benefits to patients. Recently, transumbilical single-port laparoscopic surgery has been championed as the next major technical advance. In this article, we report the first case where single-port laparoscopic surgery has been used to manage a paediatric problem in the region.
Asunto(s)
Laparoscopía/métodos , Nefrectomía/métodos , Ombligo , Niño , Femenino , Estudios de Seguimiento , Humanos , Riñón/patología , Riñón/cirugía , Resultado del Tratamiento , Uréter/patología , Uréter/cirugíaRESUMEN
BACKGROUND: Choledochal cyst is usually diagnosed in childhood. Early treatment can prevent further complication. We report on our series of patients over the past 30 years. METHODS: A retrospective study was performed on all pediatric patients who presented with choledochal cyst from January 1978 to December 2008. The main outcome measures recorded were the clinical presentation, management, and long-term outcome of the patients. RESULTS: Eighty-three patients presented to us during the caption period with a mean age at diagnosis of 45 months (0 month to 16 years). Diagnoses were made antenatally in 15 patients. The most common symptoms were abdominal pain (n = 39) and jaundice (n = 35). Seventy-five patients had surgery, in which 72 patients had resection of the cyst and Roux-en-Y hepaticojejunostomy. Ten were performed by laparoscopic means. We categorized the cysts based on the Todani classification. There was no mortality. No malignant change was documented. For those 4 who had Caroli disease, 2 underwent liver transplantation and 2 had hepatectomy. Overall early complication rate was 5.3% (4/75). CONCLUSIONS: Complete excision of cyst with Roux-en-Y hepaticojejunostomy is the treatment of choice, and the late result is good. Laparoscopic surgery is feasible. Long-term follow-up is necessary. There is no evidence to suggest that some type IV cysts are the result of disease progression from type I cysts.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Biliar , Quiste del Colédoco/cirugía , Adolescente , Anastomosis en-Y de Roux/métodos , Enfermedad de Caroli/clasificación , Enfermedad de Caroli/diagnóstico , Enfermedad de Caroli/cirugía , Niño , Preescolar , Quiste del Colédoco/química , Quiste del Colédoco/clasificación , Quiste del Colédoco/diagnóstico , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Hepatectomía/métodos , Humanos , Lactante , Recién Nacido , Laparoscopía/métodos , Trasplante de Hígado , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND AIMS: Laparoscopic anorectoplasty (LAR) is a relatively new procedure in the treatment of imperforate anus. Using magnetic resonance imaging (MRI), we evaluated the anatomical features of the anorectal region of children treated with LAR and compared this with conventional posterior sagittal anorectoplasty (PSARP). The findings were correlated with functional outcome. PATIENT/METHODS: A retrospective review of ten children with the high/intermediate types of imperforate anus underwent LAR between May 2000 and December 2002. MRI of the pelvis was performed post-operatively and a semi-quantitative score was used to assess the degree of sphincter symmetry, peri-rectal fibrosis, and the position of the pull-through rectum. The defecation status of these patients was also recorded. Eight historical patients who had undergone PSARP served as a control group. RESULTS/FINDINGS: When compared with PSARP patients, a significantly lower proportion of LAR patients had sphincter asymmetry (40 vs. 100%, p < 0.05) and peri-rectal fibrosis (40 vs. 87.5%, p < 0.05). The positioning of the rectum was, however, central for both groups (90 vs. 87.5%). No statistical correlation was found between defecation status and the degree of sphincter asymmetry or peri-rectal fibrosis. INTERPRETATION/CONCLUSION: LAR allows more optimal anatomical reconstruction for patients with the high/intermediate types of imperforate anus. However, additional factors that are not correctable by surgery, such as intrinsic innervation deficiency, also influence the clinical outcome.
Asunto(s)
Canal Anal/cirugía , Ano Imperforado/cirugía , Laparoscopía/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias , Canal Anal/patología , Estudios de Casos y Controles , Femenino , Fibrosis , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: Whereas endoscopic balloon dilatation (EBD) of benign esophageal strictures is an established mode of therapy in adults, this has not been accepted universally in the pediatric population. The aim of this study is to report the safety, efficacy, and long-term results of EBD for children in the authors' center. METHODS: Between 1986 and 2002, a total of 77 children (median age, 1.8 years; range, 2 months to 20 years) were treated by EBD for various causes: 2 had achalasia, and 75 had esophageal strictures (postesophageal atresia repair, 63; reflux esophagitis, 7; postfundoplication, 2; caustic injury, 3). Dilatations were performed using flexible endoscopy and fluoroscopic screening under general anesthesia. RESULTS: A total of 260 dilatations were carried out with the mean number of EBD per patient being 3.4 (range, 1 to 19). A mean period of 5 months (maximum, 28 months) for each patient was required. Four complications of esophageal perforations (1.5%) were observed, but only one required surgical repair because of persistent leakage. The remaining patients have undergone long-term follow-up (median follow-up, 6.6 years), and all are asymptomatic. CONCLUSIONS: This large series has shown that EBD can provide a safe and effective mean of relieving esophageal strictures with good long-term results.
Asunto(s)
Cateterismo , Estenosis Esofágica/terapia , Adolescente , Cateterismo/efectos adversos , Niño , Preescolar , Perforación del Esófago/etiología , Humanos , Lactante , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: This study aimed to evaluate clinically and manometrically the anorectal function of patients with imperforate anus after repair with laparoscopically assisted anorectoplasty (LAR), as compared with the function of patients after undergoing the conventional method, posterior sagittal anorectoplasty (PSARP). METHODS: The defecation status and anorectal manometry of patients with high or intermediate type imperforate anus repaired with LAR ( n = 9) and age-matched patients repaired with PSARP ( n = 13) were assessed and compared during the first year of postoperative follow-up evaluation. The defecation status was classified by the frequency of bowel openings (<1, 1-4, and >5 times per day). Manometric assessment was performed by an open-tip hydraulic capillary infusion system. The presence of the rectoanal relaxation reflex was determined, and the resting sphincteric pressure and resting rectal pressure were measured. RESULTS: Seven of nine LAR patients had an "acceptable" frequency of one to four bowel openings per day, in contrast to 7 of 13 PSARP patients. The difference in the presentation of daily stooling is not significant ( p > 0.05). A positive RAR was detected in 88.9% (8/9) of the LAR patients, and in only 30.8% (4/13) of the PSARP patients ( p < 0.01). The presence of a rectoanal relaxation reflex also significantly correlated with an acceptable frequency of bowel opening (1-4 times per day) in both LAR and PSARP patients ( p < 0.05). Moreover, a rectoanal relaxation reflex was detected significantly earlier in LAR than in PSARP patients (4.9 +/- 1.2 vs 10.1 +/- 2.5 months; postoperatively p < 0.0001). Both the LAR and PSARP patients had a similar resting sphincteric pressure (21.5 +/- 4.7 vs 25.4 +/- 6.2 cm H2O; p > 0.05). By contrast, the resting rectal pressure was significantly lower in LAR than in PSARP patients (7.7 +/- 1.5 vs 11.5 +/- 1.3 cmH(2)O; p < 0.05). CONCLUSIONS: In the early postoperative stage, patients repaired with LAR had more favorable findings in anorectal manometry than patients repaired with PSARP. Long-term follow-up studies to confirm a superior defecation continence achieved with LAR are warranted.