Anastomosis In Children Research Articles

30-Day Outcomes of Laparoscopic Versus Open Total Proctocolectomy with Ileoanal Anastomosis in Children and Young Adults: A Combined Analysis of the National Surgical Quality Improvement Project Pediatric and Adult Databases.

Studies comparing pediatric laparoscopic and open total proctocolectomy with ileoanal anastomosis (TPC-IAA) are limited in size and number. This study utilized the adult and pediatric databases of the National Surgical Quality Improvement Project (NSQIP) to evaluate 30-day outcomes of these two techniques. Patients younger than 21 years who underwent TPC-IAA from 2012 to 2016 were identified in both NSQIP databases. Simple and multivariate logistic regression was used to compare risk of reoperation, readmission, and postoperative occurrences between laparoscopic and open groups. Cox regression was used to evaluate length of stay (LOS). A total of 440 cases were identified, of which 421 (95.7%) were elective. Median age in the elective group was 15.8 years (interquartile range 13-18). Diagnoses included inflammatory bowel disease (47%), benign neoplasm (42%), and Hirschsprung disease (6%). The laparoscopic group (67.5%, n = 139) had shorter median postoperative LOS (6 versus 8 days, P < .001) and decreased incidence of pulmonary complications (risk ratio [RR] 0.09; CI: 0.01-0.80, P = .031) and superficial surgical site infections (SSI) (RR 0.30; 95% CI: 0.10-0.88, P = .028). Median operative time was shorter (4.6 versus 5.1 hours, P = .013) and risk of organ space SSI was lower (RR = 0.11, 95% CI: 0.01-0.80, P = .037) in the open group (n = 282). Rates of 30-day readmission and reoperation were similar between groups. In the first study to utilize data from both the pediatric and adult NSQIP databases, resulting in the largest pediatric sample of TPC-IAA to date, we found that 67.5% of elective cases were performed laparoscopically, the highest reported in a multi-institutional pediatric study, indicating increasing comfort with advanced laparoscopic techniques among pediatric surgeons. The laparoscopic approach resulted in shorter postoperative LOS and decreased risk of superficial SSI, whereas the open approach was associated with shorter operative time and lower risk of organ space SSI.

Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study

ObjectiveTo determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures.MethodsRetrospective national multicentre study in patients with OA born...

Laparoscopic proctocolectomy with ileal j-pouch anal anastomosis in children.

We aimed to evaluate postoperative fecal incontinence scales of children who underwent laparoscopic proctocolectomy and ileal J-pouch anastomosis for familial adenomateous polyposis (FAP) and inflammatory bowel disease (IBD). Fecal incontinence scores were collected at 3 months post-surgery. A retrospective chart review was also performed to obtain the demographic data and operative technical details. The postoperative Wexner Fecal Incontinence Score was 0 in 9 of 11 patients and satisfactory in the remaining two. None of the children had a major complication. Even though the presented study does not have any comparable data, it seems that laparoscopic total proctocolectomy with ileal J-pouch anal anastomosis (TP IPAA) might be the best choice of surgery because it provides good continence with low complication rates.

Hepaticoduodenostomy as a technique for biliary anastomosis in children with choledochal cyst

Objective The aim of this study was to investigate the efficacy and complications of hepaticoduodenostomy in the treatment of choledochal cyst in children. Summary background data The conventional treatment of choledochal cyst includes Roux-en-Y hepaticojejunostomy for biliary reconstruction. This procedure, however, disrupts normal bowel continuity and requires two anastomoses. We studied the technique of hepaticoduodenostomy as an effective alternative to this technique. Patients and methods A total of 31 children undergoing hepatoduodenostomy for choledochal cyst over a period of 9 years were included in this study. Results The patients operated upon had outcomes similar to those treated by the Roux-en-Y technique in other studies. Conclusion Hepaticoduodenostomy is an effective alternative to the conventional Roux-en-Y anastomotic technique in cases of choledochal cyst in children. Keywords : choledochal cyst, hepaticoduodenostomy, pediatric

Su1977 - Long-Term Outcomes after Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis in Children Compared to Adults

Su1977 - Long-Term Outcomes after Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis in Children Compared to Adults

DELAYED ESOPHAGO-ESOPHAGEAL ANASTOMOSIS IN ESOPHAGEAL ATRESIA

Purpose of the study: to estimate the efficacy of treatment and remote results of delayed esophago-esophageal anastomosis in children with EA. Material and methods. We analyzed 18 case histories of children with delayed esophago-esophageal anastomosis performed at N. F. Filatov Children’s Municipal Clinical Hospital No. 13 from 2006 to 2016. Results. Postoperative complications occurred in 16 children out of 18 (88.9%). Esophageal anastomotic leakage was developed in 4 patients (22.2%), anastomotic stenosis in 11 patients (61.1%) and gastroesophageal reflux in 14 children (77.8%). Lethality amounted to 16.7% (3 children) in the early postoperative period. As per the analysis of delayed results, dysphagia was noted in 92.3% of children. After delayed anastomosis 9 children underwent recurrent surgery, 4 of them had subsequent esophageal extirpation. Conclusions. Considering the high rate of complications (88.9%) and bad delayed results, our observations do not allow us to recommend the delayed esophago-esophageal anastomosis as the surgery of choice for children with EA.

Predictive and Competing Risk Modeling: Risk Factors for Interstage Mortality between Norwood I Procedure and Total Cavopulmonary Anastomosis in Children with Hypoplastic Left Heart Syndrome

Predictive and Competing Risk Modeling: Risk Factors for Interstage Mortality between Norwood I Procedure and Total Cavopulmonary Anastomosis in Children with Hypoplastic Left Heart Syndrome

P524 Long-term outcomes after restorative proctocolectomy and ileal pouch-anal anastomosis in children compared to adults

P524 Long-term outcomes after restorative proctocolectomy and ileal pouch-anal anastomosis in children compared to adults

Intestinal anastomosis in children: it's time for a general consensus.

The search for most appropriate suture materials and suturing techniques is still a controversial aspect (1), both in general and pediatric surgery. Suture materials and suturing techniques for intestinal anastomosis are various. Suture materials can be of different type such as natural or synthetic, monofilament or multifilament, absorbable or non-absorbable. Suturing techniques are also assorted and can be hand-sewn or mechanical. Originally, intestinal anastomosis was exclusively hand-sewn and they were executed with a single layer, interrupted, absorbable suture (Vicryl) (2). In 1993, Martin and Motbey found that Maxon suture, a monofilament absorbable stitch, was superior to other available sutures for paediatric gastrointestinal surgery (3).

The extramucosal interrupted end-to-end intestinal anastomosis in infants and children; a single surgeon 21 year experience

Background/PurposeTo report outcomes of a standardised technique for intestinal anastomosis in infants and children. MethodsData were prospectively collected on all paediatric intestinal anastomosis by a single surgeon over a 21year period. Anastomoses were constructed using an end-to-end extramucosal technique with interrupted polypropylene sutures. Demographic and clinical data were recorded. ResultsSix-hundred and thirteen anastomoses were constructed in 550 patients. Median age at time of anastomosis was 6months (range 1day–226months). The most common reason for anastomosis was stoma closure (n=271, 49%). For those patients that required multiple anastomoses the most common pathology was acute NEC (n=22/41, 54%). One-hundred and one (18.4%) patients passed stool within 24hours of surgery, 175 (31.8%) between 24–48 hours and 95 (17.3%) between 48–72 hours. Anastomotic complications occurred in 7 patients (1.3%) including anastomotic leakage (n=5, 0.9%) and anastomotic stricture (n=2, 0.4%). The majority of anastomotic leakages (80%) followed resection of acute NEC. ConclusionsThe interrupted extramucosal anastomosis is safe and effective. The return of bowel function is rapid and the complication rate acceptable. We recommend this technique be used for all intestinal anastomoses in children and infants.

Renal Transplantation With Size-Matched End-to-End Venous Anastomosis in Children With Inferior Vena Cava Thrombosis

Due to surgical technical difficulties, inferior vena cava (VCI) thrombosis is contraindicated for renal transplantation in pediatric patients. Of 287 pediatric renal transplantations, 3 patients (9, 12, and 19 kg, respectively) with end-stage renal failure, who had VCI thrombosis at the level of renal vein, underwent end-to-end anastomosis to the proximal aspect of VCI for venous drainage. The latest creatinine values of the patients, who were in the postoperative 56th, 28th, and 14th months, were 0.6, 0.4, and 0.3 mg/dL, respectively, with graft and patient survival rates of 100%. We think that end-to-end venous drainage into the proximal caval system is the most appropriate surgical approach in pediatric recipients, who have an open suprarenal VCI and a small intra-abdominal cavity, in the presence of an appropriate size-matched graft.

Comparison of laparoscopic-assisted and open total proctocolectomy and ileal pouch anal anastomosis in children and adolescents

BackgroundLaparoscopic techniques have been applied to restorative proctocolectomy since the early 2000's. We have employed a technique for laparoscopic-assisted total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) for the treatment of children with ulcerative colitis (UC). MethodsWe retrospectively reviewed 68 laparoscopic-assisted TPCs and 39 open TPCs performed at our institution for UC between January 1997 and February 2011. Case duration, postoperative length of stay, and complications of the two groups were compared, and multivariable analysis was applied. ResultsThe two groups were comparable with respect to gender, age, and postoperative length of stay. Total abdominal colectomy (TAC) duration was significantly longer in the laparoscopic-assisted group (P < .001). Complications were similar in the laparoscopic and open group, although small bowel obstruction (SBO) was significantly less frequent in the laparoscopic group (log-rank test = 8.88, P = .003). Kaplan–Meier estimated freedom from SBO at 1 year follow-up is 99% for patients treated laparoscopically (95% CI: 98%–100%) and 76% for those undergoing an open surgical approach (95% CI: 64%–88%). ConclusionsThe significantly lower SBO rate, low complication rates, and equivalent length of stay favor use of the laparoscopic-assisted approach for TPC and IPAA in children.

Early Feeding vs 5-Day Fasting after Distal Elective Bowel Anastomoses in Children. A Randomized Controlled Trial

Purpose: Determine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. Methods: Controlled randomized trial including pediatric patients with DEBA, excluding non-elective and high risk patients. Variables: Demographics, operative time, anastomosis placement, beginning peristalsis and bowel movement, time to full diet intake, post-operative stay, persisting vomiting and abdominal distention, wound infection or dehiscence, anastomotic leak, reoperation, death. Randomization into: 1) Experimental group (EG): early feeding group, after a minimum 24 hours fasting period, oral fluids and diet was started; 2) Control group (CG): obligatory 5-day fasting. Descriptive Statistics: Student’s t test for quantitative and Chi square for qualitative variables, a p-value 0.05 was considered significant. Results: 60 patients were included since June 2003 to May 2004, 30 ineach group. Mean age 2 years, weight16 kg, malnutrition 33%. Stomal Ethiology: Anorectal-malformation 46%, Hirschsprung 13%, inflammatory 35%, tumoral 5%. Mostly in colon 71%. Mean surgical time 142 min. None developed vomiting or required nasogastric-tube. Mild abdominal distension 13%, mild fever 16.5% and wound complications 18%. Anastomosis leakage 6.5%, none required reoperations. Demographic variables showed no statistical differences. Full oral intake was in the 2nd postoperative day in the EG vs CG (p = 0.001). Postoperative hospital stay was 6.0 ± 3 in the EG vs 9.8 ± 4 days in the CG with clinical but not statistical significance. Peristalsis beginning, first flatus passage and bowel movements showed no statistical differences. The complication incidence was low and equally distributed. Conclusions: Early feeding after DEBA is safe and well tolerated in children.

The comparative study of the outcomes of early and late oral feeding in intestinal anastomosis surgeries in children

A leakage of intestinal anastomosis is typically regarded as a devastating post-operative complication. Traditionally its believed that long fasting after intestinal surgery protect anastomosis site and most surgeons applied this method. Post-operative long fasting has many physical and mental adverse effects, especially in children, but its benefit has not proven yet. This study aimed to compare the outcomes of early and late oral feeding in intestinal resection and anastomosis surgery in children. This randomized, double-blind controlled trial evaluated the outcome of early-feeding following in children aged 1 month to 12 years who underwent intestinal resection and anastomosis and compared the results with those who had late-feeding. The results were anlysed for fever, nausea and vomiting, abdominal distension, first passage of gas and stool were also evaluated hospital stay time, major post-operative complications such as anastomosis leakage, wound infection or dehiscence, intra-abdominal abscess between the two groups. The mean time of first oral feeding in the early feeding group (study group) was 2.5 ± 0.7 days but it was 5.3 ± 0.6 days in the late feeding group (control group). There was no mortality in both groups. There was no difference in major complications in both groups (anastomosis leakage). In the study group, first defecation time was shorter than the control group (3.7 days v. 4.4 days) and they had less hospital stay also (5.2 days vs. 8.3 days) and lower cost of hospitalization. Early oral feeding after intestinal resection and anastomosis in children is a safe method, it has many benefits and does not increase the major or minor post-operative complications (anastomosis leakage) long time fasting is not necessary and has not any beneficial effect and early feeding increases satisfaction of the parents and children, and reduce hospital stay and costs.

Long-term outcomes of ileal pouch-anal canal anastomosis in children with ulcerative colitis

Long-term outcomes of ileal pouch-anal canal anastomosis in children with ulcerative colitis

Technique of laparoscopic-assisted total proctocolectomy and ileal pouch anal anastomosis in children and adolescents: a single center's 8-year experience

BackgroundLaparoscopic techniques have been applied to restorative proctocolectomy since the early 2000s. We have employed a technique for laparoscopic-assisted total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) for the treatment of children with ulcerative colitis (UC). MethodsA total of 68 children underwent laparoscopic-assisted TPCs at our institution from June 2003 to February 2011. The patients ranged from 5 to 22 years of age. We progressively modified our surgical approach in positioning, equipment use, and operative technique. ResultsA total of 68 children underwent laparoscopic-assisted TPC within the 8-year time period. Two major complications occurred (2/68=3%) consisting of 1 duodenal injury and 1 small bowel injury. There were 6 minor complications (6/68=9%), including 5 stoma revisions and 1 port site hernia. There were no superficial wound infections. There were no reported cases of pouch fistulas, anastomotic breakdown, or neurovascular injuries. ConclusionsOur surgical technique is safe and effective in treating children with UC.

Early oral feeding following intestinal anastomoses in children is safe

Oral feeding following intestinal anastomoses is frequently delayed. In settings with limited utilisation of parenteral nutrition, this policy is problematic. This report evaluates the safety of early oral feeding following intestinal anastomoses in children. A prospective study including 64 children aged ≤ 12-year-old who had intestinal anastomoses for varying surgical indications over a 6-year period. Oral feeding was started within 72 hours following surgery, if there was no contraindication. There were 41 (64.1%) boys and 23 (35.9%) girls aged 6 hours to 12 years (median, 6 years). The indication for surgery was perforated typhoid enteritis (33, 51.6%), intestinal atresia (8, 12.5%), colostomy closure for anorectal anomaly (8, 12.5%), intussusception (3, 4.7%) and ileostomy closure (3, 4.7%). Type anastomoses were 39 (60.9%) ileoileal, 4 (6.3%) colocolic, 8 (12.5%) jejunoileal and 4 (6.3%) ileocolic. Oral feeding was commenced in 17 (26.6%) of the patients within 48 hours, 36 (56.3%) by third day and 45 (70.3%) before fifth day post-operative. Feed-related complication occurred in 5 (7.8%) patients, 3 (8.3%) of which was in patients fed within 72 hours post-operative and 2 (7.1%) in those fed after 72 hours. Full oral feed was achieved by fifth and seventh day post-operative in 42 (65.6%) and 61(95.3%), respectively. Two (6.1%) patients had oral feeding stopped and recommenced at seventh day post-operative due to feed-related complications. Early oral feeding following intestinal anastomoses in children is safe, particularly in the setting of limited availability of parenteral nutrition.

いわゆる“もやもや”病の小児に対するSTA-MCA anastmosisの経験

いわゆる“もやもや”病の小児に対するSTA-MCA anastmosisの経験

Experience performing 64 consecutive stapled intestinal anastomoses in small children and infants

Background/Purpose Intestinal anastomosis in children has traditionally been performed using hand-sewn techniques. Little data exist evaluating the efficacy of stapled intestinal anastomoses in the infant and pediatric populations. Methods A review of a 5-year experience using a mechanical stapler to treat 64 consecutive children requiring intestinal anastomoses was performed. An intestinal stapler was used to complete a side-to-side functional end-to-end anastomosis. Postoperative outcomes and modifications made to the technique were identified. Results Since 2004, 64 children (median age, 3 months; range, newborn to 24 months) underwent procedures requiring intestinal anastomosis. Twenty-six children (41%) were 1 week or less in age. Twenty-seven children (42%) underwent a stoma closure using a stapler. Thirty-seven children (58%) underwent bowel resection and stapled anastomosis in treating a variety of surgical disorders. Complications included wound infection (n = 2) and anastomotic stricture (n = 1). No issues suggesting anastomotic dilatation and subsequent stasis/overgrowth were identified. Conclusions These results suggest that stapled bowel anastomosis is an effective approach applicable to a variety of surgical diseases in newborns and infants.

The Utility of Nasogastric Decompression After Intestinal Surgery in Children

Evaluation of: Davila-Perez R, Bracho-Blanchet E, Tovilla-Mercado JM et al.: Unnecessary gastric decompression in distal elective bowel anastomoses in children: a randomized study. World J. Surg. 34(5), 947–953 (2010). Although the use of nasogastric decompression after intestinal surgery has been a common practice for decades, there has not been a prospective randomized trial that supports its purported benefits in children. Davila-Perez and colleagues undertook a scientific approach to the use of nasogastric decompression in children undergoing intestinal anastomoses to determine if clinical benefits could be identified. They randomized 60 pediatric patients undergoing intestinal anastomoses to either undergo nasogastric decompression for 5 days or to not have gastric decompression during the postoperative period. The study was designed as an equivalence study, with a goal to demonstrate that there was equivalence between the treatment arms. The results, with the use of sophisticated statistics, supported the authors conclusions that there is no difference in the postoperative course of pediatric patients that undergo gastric decompression when compared with those not undergoing gastric decompression, and that routine use of gastric decompression should be eliminated.