Abstract Background In patients undergoing gastroschisis closure, the effects of timing of closure and patient and hospital-level characteristics on length of stay (LOS) and time to enteral autonomy ...are unknown. Study Design Using the Pediatric Health Information System, we compared neonates who underwent early (within 1 day of birth) versus delayed (> 1 day after birth) gastroschisis closure from 2005 to 2013. We evaluated the relationship between time to closure and both LOS and days on total parenteral nutrition (TPN). Results Of 4459 neonates with gastroschisis, 43.9% underwent early closure and 56.1% underwent delayed closure. Delayed closure, complicated gastroschisis, government insurance, lower birth weight, older age at closure, and complex chronic conditions were associated with longer LOS and days on TPN (all p < 0.05). There was significant inter-hospital variability in both outcomes, after adjusting for patient- and hospital-level characteristics, including hospitals' gastroschisis and neonatal volumes, median age at closure, and percentages of complicated and delayed gastroschisis patients, (p < 0.01). Conclusion Delayed gastroschisis closure is associated with longer LOS and duration of TPN, even after excluding complicated cases. Furthermore, after controlling for hospital volume, rate of complicated gastroschisis, and timing of closure, the persistent inter-hospital variability suggests that practice variability is partially responsible for these differences. Type of study retrospective study. Level of evidence III
The whole world is going through an unprecedented period during the pandemic of COVID-19. This pandemic has affected all aspects of daily life with far-reaching implications, especially in most ...aspects of healthcare. Practice of surgery across the globe is in a standstill as of now. When we restart surgical practices across world, we have to bring new protocols and practices in place to combat the transmission. This article discusses the major changes in surgical practice, which need to be brought in. This article is based on scientific information about transmission of virus and experiences of some of the authors from China, a country which successfully dealt with and contained the virus outbreak.
Background
Adnexal torsion requires treatment to limit ischemic injury and tissue loss. Optimal time to surgical intervention has not been established. We compared outcomes of ovarian loss amongst ...pediatric patients.
Methods
We conducted a retrospective review of 88 patients with adnexal torsion from March 2014 through April 2021. Rates of ovarian loss were compared for patients who underwent surgery within and beyond 60 minutes from diagnosis.
Results
Most patients underwent surgery more than 60 minutes from the time of diagnosis (83%; median time 116 minutes). Comparing patients with and without ovarian loss, there was no statistically significant difference in time to surgery from time of diagnosis (P = .618). Patients with ovarian loss had a longer duration of symptoms (24 vs 96 hours; P = .017).
Conclusions
While surgical repair of adnexal torsion may be urgent, this study suggests that duration of symptoms should be considered when assessing a patient’s likelihood of ovarian loss.
Anxiety experienced by parents is an important predictor of anxiety experienced by children. Different interventions are used to reduce the anxiety levels of children and their parents during the ...preoperative period. Apart from conventional training methods, watching videos about real-life operating rooms can reduce parents' and their children's anxiety levels. Children scheduled for surgery are likely to experience less anxiety if their parents experience less anxiety. A video-assisted operating room promotion program will develop for parents. This study will be aimed to evaluate the effect of the program on the anxiety levels of parents and children.
This study protocol is a single-center, single-blind, pre-test, post-test, follow-up parallel group randomized controlled trial. This study protocol was prepared with the Standard Protocol Items: Recommendations for Interventional Trials guidelines and will adhere to the Consolidated Standards of Reporting Trials Non-Pharmacologic Treatment Interventions checklist. A total of 100 eligible participants will be randomized into intervention and control groups. The intervention group will attend the program and receive standard care.
If we obtain the expected results, we think that they will help healthcare professionals develop methods and strategies to reduce the anxiety levels of parents and children through content covering the pre-, peri-, and post-surgical processes.
The results will assist healthcare professionals in the management of pain and guide them in developing technology-based nursing interventions.
Trial registration
It was registered at ClinicalTrials.gov in January 2022 (NCT05186766).
•The promotion program provides parents with visual and auditory information about the preoperative process.•The promotion program will encourage parents who experience anxiety to support their children more in the preoperative process.•The video-assisted operating room promotion program can help reduce the anxiety levels of parents and children.
According to recent estimates, at least 11% of the total global burden of disease is attributable to surgically-treatable diseases. In children, the burden is even more striking with up to 85% of ...children in low-income and middle-income countries (LMIC) having a surgically-treatable condition by age 15. Using population data from four countries, we estimated pediatric surgical needs amongst children residing in LMICs.
A cluster randomized cross-sectional countrywide household survey (Surgeons OverSeas Assessment of Surgical Need) was done in four countries (Rwanda, Sierra Leone, Nepal and Uganda) and included demographics, a verbal head to toe examination, and questions on access to care. Global estimates regarding surgical need among children were derived from combined data, accounting for country-level clustering.
A total of 13,806 participants were surveyed and 6,361 (46.1%) were children (0-18 years of age) with median age of 8 (Interquartile range IQR: 4-13) years. Overall, 19% (1,181/6,361) of children had a surgical need and 62% (738/1,181) of these children had at least one unmet need. Based on these estimates, the number of children living with a surgical need in these four LMICs is estimated at 3.7 million (95% CI: 3.4, 4.0 million). The highest percentage of unmet surgical conditions included head, face, and neck conditions, followed by conditions in the extremities. Over a third of the untreated conditions were masses while the overwhelming majority of treated conditions in all countries were wounds or burns.
Surgery has been elevated as an "indivisible, indispensable part of health care" in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care. Given the large burden of pediatric surgical conditions in LMICs, scale-up of services for children is an essential component to improve pediatric health in LMICs.
Pediatric gastric volvulus (GV) with diaphragmatic eventration is a rare but lethal condition.
A 1-year-old girl complained of progressive vomiting, abdominal pain, and distension. On examination, ...plain abdominal radiograph demonstrated an air bubble sign in the left upper abdomen with elevation of the hemidiaphragm, while water-soluble contrast follow-through imaging showed partial gastric rotation. During exploratory laparotomy, gastric volvulus (GV) with left diaphragmatic eventration was identified. This abnormality was reduced by performing diaphragmatic plication and gastropexy. Postoperatively, the patient recovered without complications and was discharged on the tenth day of treatment.
Pediatric gastric volvulus (GV) with diaphragmatic eventration is a surgical emergency. This case underscores the importance of considering GV in pediatric patients presenting with vomiting and abdominal symptoms, specifically when radiographic evidence suggests gastric distension and diaphragmatic abnormalities.
Left-Sided Amyand Hernia Murugan, Seema; Grenn, Emily E.; Morris, Michael W.
The American surgeon,
07/2022, Letnik:
88, Številka:
7
Journal Article
Recenzirano
An Amyand’s hernia is defined by the presence of the vermiform appendix in the inguinal hernia sac. Most cases of Amyand’s hernia are incidentally diagnosed intraoperatively while surgically reducing ...a right inguinal hernia. Right-sided Amyand’s hernias are more common than left-sided Amyand’s hernias for two reasons: the appendix is naturally located on the right side and right inguinal hernias are more common. The prevalence of an Amyand’s hernia has been reported as 1%, but the true prevalence is much lower than that. We report a particularly rare case of a 5-month-old boy with a left-sided Amyand’s hernia surgically repaired without appendectomy.
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