Surgery In Pediatric Population Research Articles

Sleep related quality of life before and after adenotonsillar surgery in pediatric population

ObjectiveTo assess the quality of life in children with adenotonsillar problems before and after adenotonsillectomy in short term follow-up. MethodsQuasi-experimental study (before and after study) of children with adenotonsillar problems at Tehran University of Medical Sciences, Amir’Alam hospital. Eighty six pediatric patients aged 3 through 13 years (58 boys and 28 girls) who underwent adenotonsillectomy, for treatment of sleep disordered breathing or recurrent throat infection, were recruited. Parents completed OSA-18 quality of life survey and Brouillette score questionnaire before and one month after surgery. ResultsReliability of the Brouillette score and OSA-18 survey was established by evaluating the Cronbach α value. Cronbach α for Brouillette score was 0.70 and for OSA-18 survey it was 0.88. Preoperative values for the OSA-18 total and domain scores were high in children: mean±SD; 61.65±20.78. Preoperative values for the Brouillette score were: mean±SD; 0.41±2.34. The total OSA-18 survey score and the scores for all domains showed significant improvement after surgery: mean±SD; 28.01±9.09 (P<0.001). Post-operative Brouillette score had a significant improvement: mean±SD; −3.57±0.91 (P<0.001). ConclusionConsidering the OSA-18 survey and Brouillete score results, surgical therapy with adenotonsillectomy is associated with marked improvement in quality of life in both obstructive and infective adenotonsillar disease.

Single Incision Laparoscopic Ileocecectomy for Pediatric Crohn Disease

The single-incision laparoscopic technique has become an increasingly popular alternative for conventional pediatric laparoscopic surgery. Ileocecectomy is a mainstay surgical therapy for pediatric Crohn disease. However, there are few descriptions on the technique and experience of single-incision laparoscopic ileocecectomy (SIL-I) in the pediatric population. We describe our technique and initial experience with SIL-I for the surgical management of pediatric patients with Crohn disease. Records of all patients with Crohn disease who underwent SIL-I between 2010-2012 were retrospectively reviewed. Variables including patient demographics, operative information, length of stay, and postoperative complications were collected. The operation is generally performed by placing an Olympus Triport 15®, first releasing adhesions and separating the terminal ileum from associated abscess, when one was present. The right colon is then mobilized distally around the hepatic flexure to the level of the duodenum. This gives adequate mobilization to allow a safe extracorporeal anastomosis. The proximal extent of disease is identified, and the mesentery is divided with the ligature to the level of the ileocecal valve. The small intestine is divided with a laparoscopic stapler. The port is removed, and the incision is extended to approximately 3.5 cm through the base of the umbilicus. The specimen is externalized, remaining mesentery to the cecum is taken, and the right colon is divided using a surgical stapler. The anastomosis is performed by creating a 12 cm, side-by-side, functional end-to-end stapled anastomosis. Thirty-one SIL-I cases (mean patient age 17 ± 4 years) were reviewed. The average time from diagnosis of Crohn disease to surgery was 4.8 ± 4.5 years. Seven patients (23%) were below the 5th percentile for weight preoperatively. The major indication for surgery was obstruction/stricture (n = 23) followed by refractory inflammatory disease (n = 18). Three patients had undergone prior abdominal operation. Twenty patients underwent epidural placement and four patients underwent ureteral stent placement under the same anesthetic prior to SIL-I. There were no operations where an additional laparoscopic port was placed; however, one operation required conversion to a midline laparotomy in the setting of extensive interloop abscesses, dense adhesions and interloop fistulae. All anastomoses were stapled extracorporeally. The mean operative time was 3.8 ± 1.1 hours. There were no intraoperative complications. Five postoperative complications were documented, including one superficial wound infection, 2 intraabdominal abscesses (1 within 30 days of operation, 1 more than 3 months post-procedure), 1 PICC-associated bacteroides bacteremia, and 1 small bowel obstruction. Average postoperative length of stay was 7.1 ± 2.9 days, and median length of follow up was 5.27 months. This is the largest reported series of SIL-I in the pediatric surgery population. Our presented technique is safe, effective, and may be adopted by any pediatric surgeon with laparoscopic experience. Further studies are necessary to demonstrate both cost-effectiveness and long-term outcomes of SIL-I versus conventional laparoscopic techniques.

Lumbar disc surgery in pediatric population, Is it a special entity distinct from adult?

Lumbar disc surgery in pediatric population, Is it a special entity distinct from adult?

PERI-OPERATIVE RISK FACTORS FOR SURGICAL COMPLICATIONS IN PEDIATRIC UROLOGY

that correlate with postoperative outcomes in adults. However, there is a paucity of similar data in the pediatric surgery population. The goal of this study was to elucidate which peri-operative patient characteristics are associated with an increased risk of surgical complications in children undergoing urological surgery. METHODS: We retrospectively reviewed all pediatric urological surgeries performed between April 2003-September 2006 at our institution. Patients who had an adverse or unexpected event within

Simple technique of head fixation for image-guided neurosurgery in infants

Dear Editor: I read with interest the technical note by Agrawal and Steinbok [1] describing the technique of head fixation for image-guided neurosurgery in infants entitled “Simple technique of head fixation for image-guided neurosurgery in infants.” However, we have earlier described a novel technique [3] of using plaster of Paris mould for head fixation during stereotactic surgery in 48 patients, which has not been referenced in the present manuscript. We feel that our technique has important points relating to the fixation of head during image-guided surgery in pediatric patients. It has a crucial bearing on the technique and should have been discussed in relation to the technique described by the authors. It is well known that image-guided surgery in pediatric population is evolving and technical standardization for frame fixation is still not firmly established. The differential variations in the thickness of the calvaria in infants and young children as well as the reduced pin pressure provide impedance in the performance of the procedure. Commercially available pediatric pins are not suitable for fear of depressed fracture. The authors’ technique of using an adhesive drape for firm head fixation obviates the problems related to pin fixation. The authors remark that any kind of pin fixation may be hazardous in infants as changes in cerebrospinal fluid volume can potentially decrease the size of the infants’ head and allow for loss of fixation and scalp lacerations. The authors mention that simultaneous use of pins and horseshoe has been attempted [2]. However, we have recently described a novel method of a plaster of Paris mould for rigid frame fixation to the head using pins during stereotactic surgery in 48 patients [3]. It is a useful adjunct that can help mould to the various sizes and shapes of the head. It circumvents the need for a set of pins of varying length and thickness. The Plaster of Paris cast is simple, easily available, not labor-intensive, and is cost-beneficial. The multiple layers of the plaster of Paris provide and imparts a symmetrical, smooth, and even surface for the pin application. The spatial relation of the stereotactic frame to the “virtual head” remains constant during the entire stereotactic procedure. It is ideal for children with a low pain threshold. Prolonged sedation and anesthesia can be avoided. The authors use an adhesive drape over a horseshoe such that the adhesive edge is partly on the head and partly on the horseshoe and the tails of the adhesive drape stuck down inferiorly along the front of the shoulders and the chest. However, the potential variability in the elasticity of the adhesive drape may be a limiting factor in achieving a rigid head fixation and maintaining the accuracy of registration with the image guidance system. They further remark that the head fixation is not absolutely rigid and there is a possibility of relative motion between the head and the horseshoe. In contradistinction, the plaster of Paris cast is snugly fit around the head and the firm setting of the plaster allows for secure placement of the pins and rigid fixation of the head.