Thoracoscopic surgery and other minimally invasive approaches in children achieved marked advancement and expanded to include several disciplines in the last decade. The new armamentarium of the ...minimally invasive surgery including the smaller instruments and better magnification led to the application of this technology in the small infants and neonates. Currently, thoracoscopy is considered the preferred surgical approach for various conditions in neonates and infants over the standard thoracotomy, and thoracoscopic training is included in the surgical training curriculum for the residents in many institutes worldwide. Children are different from adults, and technique modifications are required when using thoracoscopy in children. Thoracoscopy showed satisfactory results in several operations including pulmonary resections, mediastinal tumors biopsies or resections, repair of the diaphragmatic hernias, decortication, and tracheoesophageal fistula. This review aims to address the unique aspects of thoracoscopic surgery in children, identify its potential technical and anatomical challenges, and the proposed solutions. A literature search for latest and relevant publications was done using the keywords (thoracoscopy; pediatric; lung biopsy; decortication; lobectomy; mediastinum; esophagus; and diaphragmatic hernia).
Background/Aim: Percutaneous endoscopic gastrostomy tube (PEG) has replaced the standard open surgical gastrostomy for enteral nutrition. However, several complications were reported, especially in ...children less than 10 kg. Our objective was to report the outcomes of percutaneous endoscopic gastrostomy in children according to their weight.
Patients and Methods: 163 children had PEG tube insertion in our tertiary referral hospital from January 2007 to March 2019. Patients were divided into two groups according to the weight; group I (less than 10 kg; n = 112) and group II (more than 10 kg; n = 51). Comparisons were made between the two groups for incidence of postoperative complications, the need for reintervention, 30-day, and 1-year mortality.
Results: There were 51 males (45.5%) in group I and 27 in group II (52.9%) (P = 0.38). The mean weight at the time of endoscopy was 5.9 ± 1.53 and 17.3 ± 8.23 kg and the mean American Society of Anesthesiologists (ASA) score was 2.6 ± 0.67 and 2.43 ± 0.57 in group I and II, respectively (P = 0.101). The most common associated condition was cerebral palsy (50 (44.6%) and 24 (47.1%) in group I and II, respectively; P = 0.77). The mean operative time was 30.28 ± 11.57 min in group I and 33.62 ± 23.36 min in group II (P = 0.221). Skin complications were the most commonly encountered complications of PEG, and 49% (n = 48) required the removal and replacement of the tube under general anesthesia in group I and 41% (n = 21) in group II (P = 0.84). There was no significant difference in the complication between groups.
Conclusion: PEG is a safe technique in children less than 10 kg, and the complications rate is comparable with older children. The use of positive transillumination and small needle for measuring the distance between the skin and the stomach enhances the safety of the procedure. PEG should be considered in children less than 10 kg who need supportive or continuous enteral nutrition for different reasons.
Children undergoing bone marrow transplant need a double-lumen Hickman line. Therefore, changing Port-a-Cath ports to double-lumen Hickman catheter is mandatory. Several methods were described for ...changing Port-a-Cath ports either through the same-site or a new placement access site. The advantage of one method over the other is still debatable. We conducted this study to compare the safety and effectiveness of replacement versus salvage techniques to change ports to the Hickman lines before bone marrow transplants in pediatric patients.
We included 85 pediatric patients who underwent stem cell transplants. Their age ranged from 0.2 to 15 years. According to the Hickman reinsertion technique, we classified the patients into 2 groups; the Replacement group (n = 47) and the Same-site salvage group (n = 38). We compared the data before and after Hickman insertion between both groups. Study outcomes were the catheter duration, its complications, and mortality.
The mean age of all patients was 4.7 ± 3.9 years, and 65.9% were males. There was no difference in the baseline data between both groups. During Port-a- Cath first insertion; 16.5% of patients suffered complications, with 10.6% had conversion to cut down, 1.2% had a hematoma, and 4.7% had multiple site insertion. We did not report differences between groups in the complications of the first port insertion. The Hickman duration was longer in the replacement group (4 (Q1-Q2: 2-6) vs. 1 (0.5-3) months, P = 0.005). Increased age (odds ratio OR: 1.31, P = 0.001) and male gender (OR: 1.19, P = 0.046) were independent predictors of mortality.
Endovascular same-site salvage technique could help preserve vascular access during the tunnel catheter exchange for noninfectious reasons. We recommend the use of the same-site salvage technique in pediatric transplant patients.
Double gallbladder is a rare anomaly and an asymptomatic condition. However, it can sometimes present with abdominal pain. Gallbladder pathology requires precise diagnosis and a surgical procedure to ...relieve its symptoms. Here, we discuss a case of a child suffered from a congenital heart disease who presented with double gallbladder having gallstones. The case was resolved via surgical intervention without postoperative complications.
Bilateral congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with high neonatal mortality. The condition is rarely associated with hepatopulmonary fusion (HPF). We reported the ...surgical repair of bilateral CDH in a male infant aged 6 weeks. The patient had herniation of the liver on the right side with HPF in association with anomalous drainage of the right pulmonary vein into the hepatic vein and ventricular septal defect. We approached both sides thoracoscopically; however, the right side required a subcostal incision. We separated the liver from the right lower lung lobe laterally using electrocautery, and the defect was closed with a mesh. The medial portion was left intact to avoid injury of the anomalous pulmonary venous drainage. After 2 weeks, the patients had a surgical repair of the cardiac defects, and the postoperative course was complicated by bleeding and prolonged ventilation. No hernia recurrence was observed after 9 months.
Hemophiliac patients and their families have social pressure to undergo circumcision, despite the potential complications. The objective of this study was to report our experience in the circumcision ...of hemophilia patients.
We included 35 patients with hemophilia who had circumcision in 3 centers from January 2010 to August 2019. Their age ranged between 0.3 months and 8 years. Hemophilia a was classified as mild (n=3), moderate (n=4), and severe (n=28). Patients received 2 doses of factor VIII concentrate 50μ/kg, 1 hour before the procedure and 12 hours after it.
Four neonates were diagnosed with hemophilia after circumcision because of prolonged bleeding. Two patients with severe hemophilia A had bleeding after hospital discharge (6.5%). They received additional factor concentrate, and 1 patient had an extra stitch. Two patients had wound gaping (6.5%), and 1 patient had a wound infection (3.2%).
Hemophilia is not an absolute contraindication for circumcision. Circumcision of hemophilic children should be performed under appropriate conditions in hemophilia centers. Bleeding is not frequent but could be serious.
Abstract
Background:
Gastrostomy tube can be inserted through a single incision without laparoscopic or endoscopic guidance. The superiority of this approach over the laparoscopic technique is still ...debated. Therefore, we aimed to compare single-incision open and laparoscopic gastrostomy in infants.
Materials and Methods:
We retrospectively reviewed paediatric patients aged 12 months or less who required enteral feeding between 2006 and 2019. Patients were grouped according to the technique into two groups. Group 1 (
n
= 42) included patients who had a single incision open gastrostomy, and Group 2 (
n
= 45) included patients who underwent laparoscopic gastrostomy.
Results:
The median age was 2 months (Q1-Q3: 1–4 months) in Group 1 and 5 months (3–6 months) in Group 2 (
P
< 0.001). Male presented 52.38% in Group 1 and 37.78% in Group 2 (
P
= 0.17). There were no differences in cardiac and neurological comorbidities between the groups. Operative time was significantly shorter in Group 1 (23 20–25 vs. 40 35–45 min;
P
< 0.001). There were no differences in the post-operative leak around the tube (
P
> 0.99), granulation tissue formation (
P
= 0.36), wound dehiscence (
P
= 0.61), surgical site infection (
P
> 0.99) and pneumonia (
P
= 0.10) between the groups.
Conclusion:
Single-incision open and laparoscopic gastrostomy could be effective and safe techniques in infants. The minimal anaesthesia without gas insufflation and short time for the open gastrostomy make it not inferior to laparoscopic gastrostomy and should be considered in small infants.
and Objectives: Hypocalcemia is a commonly reported complication after thyroid surgery. Many possible risk factors have been identified. The purpose of this study is to analyze various risk factors ...possibly associated with development of postoperative hypocalcemia after thyroid surgery by dividing the sample population into postoperative hypocalcemia and normal calcium groups.
Retrospective.
Multiple centers in the Makkah region of Saudi Arabia.
Risk factors for postoperative hypocalcemia that were obtained for analysis include patient factors, perioperative blood parameters factors, disease-related factors, and surgical factors. Postoperative hypocalcemia was defined as a reduction of the total calcium level to <8.0 mg/dL. Hypocalcemic and normocalcemic patients were compared by multivariate logistic regression.
Distinguish independent risk factors for postoperative hypocalcemia after thyroidectomy.
215 patients.
The incidence of hypocalcemia was 52.1% (112 of 215 patients). According to multivariate analysis, statistically significant risk factors for predicting postoperative hypocalcemia included postoperative parathyroid hormone level <10 pg/dL, inadvertent parathyroid gland resection, and neck dissection surgeries.
The causes of postoperative hypocalcemia are multi-factorial. Because many of these factors are modifiable, they should be identified postoperatively to distinguish high-risk groups and implement early preventive measures.
Retrospective with a relatively small size. We encourage additional prospective studies with a larger sample size in multiple regions of the country, which might reveal further significant results.
Gaining vascular access in children is challenging. Ultrasound-guided central line insertion in adults became the standard of care; however, its role in children is not clear. Our objective was to ...evaluate the ultrasound-guided Port-A-Cath or totally implanted long-term venous access device insertion in pediatric patients compared to the traditional approach.
This single-institution retrospective cohort study included 169 children who had port-A-catheters between May 2016 and Oct 2019. The patients were divided into two groups; group A included patients who had Port-A-Cath insertion using the landmark method (n = 117), and Group B included patients who had ultrasound-guided Port-A-Cath insertion (n = 52). Preoperative, operative, and postoperative data were collected and compared between the two groups. The study outcomes were operative time and catheter insertion-related complications.
There was no significant difference in age or gender between both groups (P = .33 and .71, respectively). Eleven cases in group A and two cases in group B were converted to cut down technique because of difficulty in inserting the guidewire. There was no difference in the indication of the need for the port-A-Cath between both groups. The mean operative time for group A was 47 min and for group B was 41.7 min (P < .042). Two patients had intraoperative bleeding and hemothorax and required blood transfusion and chest tube insertion in group A. No statistically significant difference was found in the reported complications between the groups. However, the insertion-related complications were higher in group A (P = .053). No procedure-related mortality was reported.
Ultrasound-guided insertion of Port-A-Cath is an effective and safe technique with a reduction of failure rate. It should be considered the standard technique for Port-A-Cath insertion in the pediatric population.
لدى الأطفال الخدج نسبة عالية من الفتق الإربي، في حين أن الإصلاح الجراحي هو عملية عالية الخطورة. لا يزال توقيت إصلاح الفتق مختلفا عليه. نهدف في هذا البحث إلى تحديد التوقيت الأمثل لإصلاح الفتق الإربي ...لحديثي الولادة في مستشفى عام.
أُجْرِيَت دراسة أتراب مستقبلية من مارس ٢٠١٤ إلى سبتمبر ٢٠١٨. تم قبول ما مجموعه ١٢٧ من الأطفال حديثي الولادة والخدج في عيادة جراحة الأطفال ممن لديهم فتق إربي غير مصحوب بمضاعفات. تم إصلاح الفتق لدى جميع حديثي الولادة وتمت متابعتهم لمدة ثمانية أشهر بعد العملية لمعرفة المضاعفات المصاحبة للعملية. تم توقيت العملية بناء على قرار الجرّاح بالإضافة إلى موافقة العائلة على التدخل الجراحي.
بلغ عدد مَن خضع لعملية إصلاح الفتق المبكرة ٥٣ من ١١٨ (٤٥٪) ومَن خضع لعملية إصلاح الفتق المتأخرة ٦٥ من ١١٨ (٥٥٪). وكانت البيانات الديموغرافية متشابهة بين المجموعتين دون وجود اختلافات ذات أهمية. كما أنه لم يكن هناك اختلاف ذو دلالة إحصائية في احتباس الفتق وتكوُّن القيلة إلا أنه كان هناك ارتفاع في معدل معاودة الفتق الإربي، وتوقف التنفس بعد العملية الجراحية في مجموعة الإصلاح المبكر.
الإصلاح الجراحي للفتق الإربي ممكن في الأطفال الخدج ويصحبه مضاعفات بسيطة. لم تزدد خطورة احتباس الفتق وضمور الخصية مع التأخر الاختياري لإصلاح الفتق لدى حديثي الولادة. وقد قلل تأخر إصلاح الفتق من احتمالية حدوث المضاعفات المصاحبة للعملية التي تحدث بعدها. توصي هذه الدراسة بتأخير إصلاح الفتق الاختياري لحديثي الولادة والأطفال الخدج.
The incidence of inguinal hernia is high in premature infants; however, surgical repair is a high-risk procedure for these patients. The timing of hernia repair is still controversial. This study aimed to determine the optimal timing for inguinal herniotomy in neonates in a general hospital.
A prospective cohort study was conducted from March 2014 to September 2018. A total of 127 neonates and preterm infants were admitted to the paediatric surgery clinic with uncomplicated inguinal hernia. Herniotomy was performed in all neonates, and the patients were followed up for up to 8 months after surgery for perioperative and postoperative complications. The timing of surgery was based on the surgeon's decision along with the consent of the family to the surgical intervention.
Of 118 neonates, as many as 53 (45%) underwent early repair and 65 (55%) underwent late repair of inguinal hernia. The demographic data were similar between the 2 groups with no significant difference. There were no significant differences in the incidence of inguinal hernia incarceration and hydrocele formation (p = 0.11 and p = 0.8, respectively); however, there was a higher incidence of inguinal hernia recurrence (p = 0.05) and postoperative apnoea (p = 0.02) in the early repair group.
Surgical repair of inguinal hernia is feasible with low morbidity in preterm babies. The risk of hernia incarceration and testicular atrophy did not increase with delayed elective hernia repair in neonates. Delayed hernia repair decreased the risk of perioperative and postoperative complications. This study recommends delaying elective hernia repair in neonates and preterm babies.
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