Replacement In Children Research Articles

Gastric Transposition for Esophageal Replacement in Children

To evaluate the authors' experience with gastric transposition as a method of esophageal replacement in children with congenital or acquired abnormalities of the esophagus.Esophageal replacement in children is almost always done for benign disease and thus requires a conduit that will last more than 70 years. The organ most commonly used in the past has been colon; however, most series have been fraught with major complications and conduit loss. For these reasons, in 1985 the authors switched from using colon interpositions to gastric transpositions for esophageal replacement in infants and children.The authors retrospectively reviewed the records of 41 patients with the diagnoses of esophageal atresia (n = 26), corrosive injury (n = 8), leiomyomatosis (n = 5), and refractory gastroesophageal reflux (n = 2) who underwent gastric transposition for esophageal replacement.Mean +/- SE age at the time of gastric transposition was 3.3 +/- 0.6 years. All but two transpositions were performed through the posterior mediastinum without mortality or loss of the gastric conduit despite previous surgery on the gastric fundus in 8 (20%), previous esophageal operations in 15 (37%), and previous esophageal perforations in 6 (15%) patients. Complications included esophagogastric anastomotic leak (n = 15, 36%), which uniformly resolved without intervention; stricture formation (n = 20, 49%), all of which no longer require dilation; and feeding intolerance necessitating jejunal feeding (n = 8, 20%) due to delayed gastric emptying (n = 3), feeding aversion related to the underlying anomaly (n = 1), or severe neurological impairment (n = 4). No redo anastomoses were required.Gastric transposition reestablishes effective gastrointestinal continuity with few complications. Oral feeding and appropriate weight gain are achieved in most children. Therefore, gastric transposition is an appropriate alternative for esophageal replacement in infants and children.

Technique of Pulmonary Autograft Aortic Valve Replacement in Children (The Ross Procedure)

Pulmonary autograft replacement has become a popular technique for relieving left ventricular outflow tract obstruction in children with aortic valvular or subvalvular disease. The advantages of the autograft are the avoidance of prosthetic valves that require anticoagulation and the potential for growth of a viable autograft aortic valve. Although many techniques for implantation of the autograft in the aortic outflow tract have been described, the most commonly preferred technique is the use of the autograft as a root replacement with reimplantation of the coronary ostia. This technique provides the optimal geometry of the autograft commissural attachments and also permits adjustment of the aortic annulus to enlarge the subaortic region in patients with complex left ventricular outflow tract obstruction or to narrow the aortic annulus in patients with primary aortic regurgitation and annular dilatation. Use of the autograft technique in children and young adults has resulted in excellent relief of outflow tract obstruction with low operative morbidity and mortality, and the intermediate results have been encouraging. The variations in surgical technique that have evolved have the potential to decrease the risk of late redilatation and regurgitation of the autograft valve and may provide better longevity. Copyright 1998 by W.B. Saunders Company

小児(15歳以下)に澄けるSt.Jude Medical(SJM)弁人工弁置換術の遠隔成績

小児(15歳以下)に澄けるSt.Jude Medical(SJM)弁人工弁置換術の遠隔成績

Vaginal Replacement in Children

Between 1980 and 1990, 17 patients underwent total vaginal replacement at our hospital. The majority of these patients presented with müllerian failure or gender reassignment for intersex. Colon vaginal replacement was done in 15 patients and small bowel was used in 2. Complications included prolapse in 2 patients and stenosis in 2. Of the 17 patients 4 are married, 10 are sexually active, only 1 reports dyspareunia and 1 requires home self-dilation.

Valve Replacement in Children: Early and Late Results

In order to analyze the problems associated with prosthetic valve replacement (PVR) in the pediatric population, we have reviewed 29 children, 3.5 to 15 years of age, who were operated upon from 1970 to 1986. The indications were congenital valve malformations in 16 patients, rheumatic valve disease in 7, degenerative disease in 2 and bacterial endocarditis in 4. Ten children underwent aortic valve replacement (AVR), 14 mitral valve replacement (MVR), 1 tricuspid valve replacement and 4 double valve replacement (mitral-aortic in 3 and mitral-tricuspid in 1). Twenty-one mechanical (11 aortic and 10 mitral) and 12 biological prostheses (8 mitral, 2 aortic, and 2 tricuspid) were implanted. There was 1 hospital death (3.4%). Follow-up data were available for all survivors from 3 to 184 months. There were 8 late deaths (5.9% patient-year), 4 among children with mechanical and 4 among those with biological prostheses. Overall actuarial survival at 14 years is 62.5 +/- 10.2% with no significant difference in survival between AVR (77.8 +/- 14%) and MVR (44.4 +/- 16%) (p = 0.31) at 10 years and between recipients of mechanical (65.7 +/- 13%) or biological prostheses (60.0 +/- 15%) (p = 0.62) at 6 years. No documented embolic or anticoagulant-related complications occurred in the entire series.(ABSTRACT TRUNCATED AT 250 WORDS)

Valve Replacement in Children: Guidelines for Selection of Prosthesis and Timing of Surgical Intervention

One hundred fifty-nine patients ranging from 3 months to 18 years old (mean, 8.1 ± 3.7 years) underwent 162 primary valve implantations. A porcine valve was used in 104 patients, a St. Jude Medical valve in 40, and a Björk-Shiley valve in 18. The valve replaced was the aortic in 25 patients, the mitral (systemic atrioventricular [AV] valve) in 43, the pulmonary in 71, and the tricuspid (pulmonary AV valve) in 23. Hospital mortality was 6%. Patients with a Björk-Shiley valve received warfarin sodium anticoagulation, and those with a St. Jude Medical valve were given salicylates and dipyridamole. Follow-up is available on all patients 0.6 to 12 years postoperatively (mean, 6.3 ± 2.6 years). New York Heart Association Functional Class improved in 62% and remained unchanged in 38% of the patients. Thromboembolic complications occurred in only 8 (57%) of 14 patients with a St. Jude Medical valve in the right (pulmonary) side and in 3 (12%) of 26 with the valve in the left (systemic) side of the circulation. Bacterial endocarditis developed in 3 patients, all with porcine valves. Early valve replacement, less than 2 years after detection of hemodynamic deterioration, resulted in improvement in the ventricular ejection fraction in 25 of 29 patients (from 81 ± 14% to 90 ± 12% of normal; p < 0.05). In contrast, the ejection fraction remained abnormal in all 22 patients with delayed valve insertion (more than 2 years) (81 ± 16% of normal preoperatively and 80 ± 10% of normal following operation; p = not significant). Actuarial functional life, free from all prosthesis-related complications including major hemodynamic abnormalities, was 92 ± 6% for right-sided and 67 ± 8% for left-sided porcine valves versus 47 ± 3% for right-sided and 88 ± 7% for left-sided St. Jude Medical valves at 5 years. The data indicate that the St. Jude Medical valve has excellent durability and hemodynamic function in the left (systemic) side without need of warfarin anticoagulation. The good long-term performance of right-sided (pulmonary circulation) porcine valves encourages their continued use for tricuspid and pulmonary valve replacements. Timely valve insertion can preserve myocardial function.

Intestinocystoplasty and Total Bladder Replacement in Children and Young Adults: Followup in 129 Cases

A review of 129 consecutive young patients (average age 13.4 years) who underwent intestinocystoplasty or total bladder replacement during a 6½-year period at our institution is presented. The most common diagnosis was myelodysplasia and the average followup was 44 months. The clinical and urodynamic aspects of 4 types of intestinocystoplasty (ileocecal, tubular sigmoid, sigmoid patch and ileal patch) are presented.All 4 operations resulted in a significant increase in bladder volume, with a decrease in filling pressure and, thus, improved vesical compliance. In combination with clean intermittent catheterization renal function was maintained or improved in 91 per cent and urinary continence was achieved in 82 per cent of the patients. Hyperchloremic acidosis requiring therapy was noted only in patients with pre-existing renal insufficiency, although mild hyperchloremia after cystoplasty was seen with all 4 types of cystoplasty. There were no operative mortalities. Significant surgical complications occurred in 36 per cent of the patients, the most common of which was vesicoureteral reflux in the ileocecal cystoplasty. Mass unit peristaltic contractions occurred in 34 per cent of the tubular-shaped bowel segments compared to only 10 per cent of the patch segments. These peristaltic contractions contributed to the greater postoperative morbidity noted in the tubular large bowel cystoplasties. The over-all success rate for intestinocystoplasty in this series was 84 per cent.Intestinocystoplasty is an effective procedure when used to increase the compliance of the lower urinary tract. In combination with clean intermittent catheterization it can be applied successfully to patients with neurogenic bladder dysfunction. Large and small bowel seem to have similar clinical and urodynamic properties. The type of intestinal segment used for intestinocystoplasty seems to be of less importance than the size and configuration. Large bowel in its native tubular configuration should be avoided. (J. Urol., 138: 579–584, 1987)

Aortic and Mitral Valve Replacement in Children

This article presents a retrospective review of 20 aortic and 43 mitral prosthetic valves in 47 children over a 21-year period. The authors discuss the problems encountered during the early years of mechanical valve replacement in children, the enthusiasm for tissue valves in the mid to late 1970s as well as the early failure of these valves, and their current preference for mechanical aortic and mitral prostheses for children in most clinical situations.

Bladder Replacement in Children and Young Adults

Our experience with total and subtotal bladder replacement in 23 patients is reviewed. The patients were divided into 3 categories, depending upon how much functional bladder, bladder neck or urethra was present at the time of reconstruction. The general indications for operation were urinary incontinence in 13 cases and prior urinary diversion in 10. Bladder reconstruction was performed using a segment of the right colon in 18 patients and the left colon in 5.Renal function has remained stable in 20 patients, deteriorated in 2 and improved in 1. Of the patients 14 are dry day and night (8 on clean intermittent catheterization and 2 with an artificial urinary sphincter), 7 are dry by day and wet at night, and 2 are wet day and night. Of the 23 patients 15 experienced a postoperative complication, the most common of which was loss of the antireflux ileocecal mechanism in 8.Bladder replacement with an isolated bowel segment is feasible in properly selected patients. Our series illustrates many of the areas of consideration in total and subtotal bladder replacement.

Gastric Tube Interposition: A Satisfactory Alternative to the Colon for Esophageal Replacement in Children

The gastric tube was used as the primary method of esophageal reconstruction in 15 infants and children, 9 with isolated esophageal atresia and 6 with Iye stricture. The youngest patient was 8 months old and the oldest, 5 years old at the time of the procedure. The technique of gastric tube construction is described. There have been both major and minor complications but the gastric tube has proved very satisfactory as a conduit from mouth to stomach. Growth and development have been acceptable in all 15 children, although most remain in the lower percentiles for growth and height, a condition that usually predates the esophageal substitution. In our institution the gastric tube is the preferred method of esophageal substitution.

Mitral Valve Replacement in Children for Congenital Mitral Insufficiency

Mitral Valve Replacement in Children for Congenital Mitral Insufficiency

To assess fluid imbalance and to monitor I.V. fluid replacement IN children, you need four things

To assess fluid imbalance and to monitor I.V. fluid replacement IN children, you need four things

Multiple Valve Replacement in Children with Rheumatic Heart Disease

Multiple Valve Replacement in Children with Rheumatic Heart Disease

Evaluation of Central Venous Pressure as a Guide to Volume Replacement in Children Following Cardiopulmonary Bypass

After cardiopulmonary bypass in three groups of children whole blood was replaced on the basis of measured intraoperative losses; intraoperative losses plus the deficit recorded by direct blood volume measurement; and intraoperative losses plus elevation of central venous pressure (CVP) to double preoperative levels. Blood replacement by intraoperative losses alone led to blood volume deficits and low creatinine clearances postoperatively. Adequate replacement was achieved by direct measurement of blood volume or by maintaining an elevated CVP immediately after bypass.

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the “ileal Ureter”

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the “ileal Ureter”

Results of Sigmoidocystoplasty

No AccessJournal of Urology1 Dec 1958Results of Sigmoidocystoplasty Chester C. Winter and Willard E. Goodwin Chester C. WinterChester C. Winter More articles by this author and Willard E. GoodwinWillard E. Goodwin More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)66209-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1958 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited by Dewan P and Rao P (2017) Bladder Augmentation in Children Radiology and Follow-up of Urologic Surgery, 10.1002/9781119162117.ch9, (109-123) Gough D Metabolic Consequences and Long-Term Complications of Enterocystoplasty in Children Pediatric Neurogenic Bladder Dysfunction, 10.1007/3-540-30867-9_43, (325-327) Gough D and Guys J Enterocystoplasty Pediatric Neurogenic Bladder Dysfunction, 10.1007/3-540-30867-9_29, (235-240) Gough D (2001) EnterocystoplastyBJU International, 10.1046/j.1464-4096.2001.gough.2464.x, VOL. 88, NO. 7, (739-743), Online publication date: 1-Nov-2001. Hendren W (1997) HISTORICAL PERSPECTIVE OF THE USE OF BOWEL IN UROLOGYUrologic Clinics of North America, 10.1016/S0094-0143(05)70412-2, VOL. 24, NO. 4, (703-713), Online publication date: 1-Nov-1997. Spencer J and Filmer R (1992) Malignancy associated with urinary tract reconstruction using enteric segments Therapy for Genitourinary Cancer, 10.1007/978-1-4615-3502-7_7, (75-87), . Hendren W and Hendren R (2018) Bladder Augmentation: Experience with 129 Children and Young AdultsJournal of Urology, VOL. 144, NO. 2 Part 2, (445-453), Online publication date: 1-Aug-1990.Filmer R and Spencer J (2018) Malignancies in Bladder Augmentations and Intestinal ConduitsJournal of Urology, VOL. 143, NO. 4, (671-678), Online publication date: 1-Apr-1990.Ami Sidi A, Becher E, Reddy P and Dykstra D (2018) Augmentation Enterocystoplasty for the Management of Voiding Dysfunction in Spinal Cord Injury PatientsJournal of Urology, VOL. 143, NO. 1, (83-85), Online publication date: 1-Jan-1990. McMullin N (1988) URINARY TRACT RECONSTRUCTION IN CHILDRENANZ Journal of Surgery, 10.1111/j.1445-2197.1988.tb07572.x, VOL. 58, NO. 8, (619-629), Online publication date: 1-Aug-1988. King L, Webster G and Bertram R (2018) Experiences with Bladder Reconstruction in ChildrenJournal of Urology, VOL. 138, NO. 4 Part 2, (1002-1006), Online publication date: 1-Oct-1987.Mitchell M and Piser J (2018) Intestinocystoplasty and Total Bladder Replacement in Children and Young Adults: Followup in 129 CasesJournal of Urology, VOL. 138, NO. 3, (579-584), Online publication date: 1-Sep-1987.Sidi A, Reinberg Y and Gonzalez R (2018) Influence of Intestinal Segment and Configuration on the Outcome of Augmentation EnterocystoplastyJournal of Urology, VOL. 136, NO. 6, (1201-1204), Online publication date: 1-Dec-1986.Mitchell M, Kulb T and Backes D (2018) Intestinocystoplasty in Combination with Clean Intermittent Catheterization in the Management of Vesical DysfunctionJournal of Urology, VOL. 136, NO. 1 Part 2, (288-291), Online publication date: 1-Jul-1986. Mitchell M (1986) Use of Bowel in UndiversionUrologic Clinics of North America, 10.1016/S0094-0143(21)01744-4, VOL. 13, NO. 2, (349-359), Online publication date: 1-May-1986. Robertson C and King L (1986) Bladder Substitution in ChildrenUrologic Clinics of North America, 10.1016/S0094-0143(21)01742-0, VOL. 13, NO. 2, (333-344), Online publication date: 1-May-1986. Mitchell M (1981) The role of bladder augmentation in undiversionJournal of Pediatric Surgery, 10.1016/S0022-3468(81)80820-2, VOL. 16, NO. 6, (790-798), Online publication date: 1-Dec-1981. Smith R, Van Cangh P, Skinner D, Kaufman J and Goodwin W (2018) Augmentation Enterocystoplasty: A Critical ReviewJournal of Urology, VOL. 118, NO. 1 Part 1, (35-39), Online publication date: 1-Jul-1977.Winter C (2018) Complete Ileocystoplasty (Uretero-Ileo-Urethrostomy): Long-Term FollowupJournal of Urology, VOL. 111, NO. 1, (19-21), Online publication date: 1-Jan-1974. McGuire E, Lytton B and Cornog J (1973) Interstitial cystitis following colocystoplastyUrology, 10.1016/0090-4295(73)90209-4, VOL. 2, NO. 1, (28-29), Online publication date: 1-Jul-1973. Goodwin W (1972) The Uses of Intestine in Urology (A “Gut Reaction,” for W. W. S.) Urological Research, 10.1007/978-1-4684-1941-2_10, (75-80), . Charghi A, Charbonneau J and Gauthier G (2018) Colocystoplasty for Bladder Enlargement and Bladder Substitution: A Study of Late Results in 31 CasesJournal of Urology, VOL. 97, NO. 5, (849-856), Online publication date: 1-May-1967. Volume 80Issue 6December 1958Page: 467-472 Advertisement Copyright & Permissions© 1958 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Chester C. Winter More articles by this author Willard E. Goodwin More articles by this author Expand All Advertisement PDF downloadLoading ...