RESUMO
INTRODUCTION: Gastrostomy tube (GT) placement is common in infants following repair of congenital heart defects. We aimed to determine rate of operative complications and predictors of short-term GT use to counsel parents regarding the risks and benefits of GT placement. METHODS: We reviewed infants aged <1 y with congenital heart disease who underwent GT placement after cardiac surgery between 2018 and 2021. Demographics and clinical data were collected and analyzed. Comparisons were made between infants who required the GT for more than 1 y and those who required the GT for less than 1 y. RESULTS: One hundred thirty three infants were included; 35 (26%) suffered one or more complication including wound infection (4, 3%), granulation tissue (3, 2%), tube dislodgement (10), leakage from the tube (9), unplanned emergency department visit (15), and unplanned readmission (1). Thirty-four infants used the GT for feeds for 1 y or less (26%) including 17 (13%) who used it for 3 mo or less. Fifty-six infants had their GT removed during the study period (42%), 20 of whom required gastrocutaneous fistula closure (36%). Thirty-three infants had a GT placed on or before day of life 30, 17 (52%) used the GT for less than 1 y, and 10 (31%) used it for 3 mo or less. CONCLUSIONS: GT placement is associated with a relatively high complication and reoperation rate. GT placement in infants aged less than 30 d is associated with shorter duration of use. Risks, benefits, and alternatives such as nasogastric tube feeds should be discussed in the shared decision-making process for selected infants.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Fístula Gástrica , Lactente , Humanos , Gastrostomia/efeitos adversos , Fístula Gástrica/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Readmissão do Paciente , Intubação Gastrointestinal/efeitos adversos , Estudos RetrospectivosRESUMO
BACKGROUND: Juvenile myasthenia gravis (JMG) is an antibody mediated autoimmune disorder that manifests as progressive voluntary muscle weakness and fatigue. In medically refractory cases, thymectomy has been shown to abrogate symptoms and reduce glucocorticoid dependence. While transcervical or transsternal incisions have been the traditional approach, adult trends now favor thoracoscopic thymectomy. Little data exist to support this approach in children. METHODS: A retrospective review of all patients younger than 20â¯years of age who underwent a thymectomy for JMG at two pediatric institutions between 2001 and 2018 was performed. Children were divided into either an open (transcervical or transsternal) or thoracoscopic group and baseline characteristics, perioperative, and postoperative outcomes were compared. RESULTS: Thirty-four thymectomies were performed during the 18-year study period; 18 via an open and 16 via a thoracoscopic approach. The operative time was shorter for open procedures compared thoracoscopic ones (108⯱â¯49 and 145⯱â¯43â¯min, respectively, pâ¯=â¯0.025). Thoracoscopic thymectomy was associated with less intraoperative blood loss (5.5⯱â¯6.0 vs 55⯱â¯67â¯ml, pâ¯=â¯0.007), decreased duration of postoperative intravenous narcotic use (5.0⯱â¯1.5 vs 20⯱â¯23â¯h, pâ¯=â¯0.018), and a shorter length of hospitalization (1.7⯱â¯1.0 vs 2.7⯱â¯1.1â¯days, pâ¯=â¯0.009). No perioperative complication occurred in either group. Clinical improvement was reported in 94% of children in both groups. CONCLUSIONS: Thoracoscopic thymectomy in children is a safe and effective surgical technique for the treatment of JMG. Increased acceptance of this minimally invasive approach by children, families, and referring neurologists may enable earlier surgical intervention. TYPE OF STUDY: Clinical research paper. LEVEL OF EVIDENCE: III.
Assuntos
Miastenia Gravis/cirurgia , Toracoscopia , Timectomia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos , Toracoscopia/efeitos adversos , Toracoscopia/métodos , Timectomia/efeitos adversos , Timectomia/métodos , Adulto JovemRESUMO
OBJECTIVES: We sought to determine whether practice differences for fundoplication exist between 2 geographically distinct states, and to determine the reflux medication use pattern associated with concomitant fundoplication. METHODS: A retrospective observational cohort study of children in Colorado (CO) and North Carolina (NC) insured by Medicaid from 2006 to 2008. Children who received a surgical gastrostomy during the study period were included, and our primary outcome measure was the performance of a concomitant gastric fundoplication. Thirty-day prescription fills for reflux medications were examined before and after gastrostomy procedure. RESULTS: We examined 969 surgical gastrostomy admission in both states over the 3-year study period (CO, nâ=â341 and NC, nâ=â628). Patients in each state had similar age (median age, 6 months, Pâ=â0.97). Use of pH probe (CO: 15%, NC: 11%) and diagnosis of reflux (CO: 84%, NC: 72%) differed in each state. Concomitant fundoplication was performed in 60% of patients in CO and 43% in NC (Pâ<â0.01). Age less than 6 months was associated with an increased adjusted odds of fundoplication in CO (OR 9.77, CI, 3.91, 24.43), but less so in NC (OR 2.73, CI, 1.48, 5.04). Among patients undergoing gastrostomy, the proportion of patients on reflux medication 4 to 6 months post-discharge did not differ between those receiving fundoplication and those that did not in either state. CONCLUSIONS: Rates of concomitant fundoplication varied in the 2 states despite patients having similar demographic and clinical characteristics. Antireflux surgery was not associated with a reduction in reflux medications in either state.
Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/terapia , Fármacos Gastrointestinais/uso terapêutico , Gastrostomia/métodos , Adolescente , Criança , Pré-Escolar , Colorado , Feminino , Fundoplicatura/estatística & dados numéricos , Gastrostomia/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , North Carolina , Período Pós-Operatório , Estudos RetrospectivosRESUMO
Parenteral omega-3 fatty acid lipid emulsions have been evaluated for their potential role in reversing intestinal failure-associated liver disease. We report our experience using Omegaven in 2 patients with irreversible intestinal failure and intestinal failure-associated liver disease. Despite biochemical and histologic improvement in cholestasis, both patients had persisting, significant portal fibrosis on liver biopsy.