45 research outputs found
Duodenal Atresia and Associated Intestinal Atresias: A Systematic Review and Meta-analysis.
No full textAim of the Study: A critical step in the classical DA repair consists in ruling out the presence of an associated intestinal atresia. Herein, we aimed to investigate: 1. the incidence of DA associated intestinal atresia; 2 the impact of DA surgical approach on outcome when an associated intestinal atresia is present. Methods: Using a defined search strategy, two independent investigators identified studies where patients with DA were reported to have an associated intestinal atresia. Case reports, opinion articles, and grey literature publications were excluded. The study was conducted according to PRISMA guidelines. A meta-analysis was performed using RevMan 5.3 to compare outcomes of open vs. laparoscopic DA repair. Data are expressed as mean±SD or risk ratio with 95% confidence intervals (95%CI). Main Results: Systematic review: Of 840 studies screened, 61 full-text articles were analyzed, and 18 studies (1,886 patients) were included. The incidence of an associated intestinal atresia was 2.5±1.5% (47/1,886 infants, range 0.5-6.7%). The reported incidence of missed intestinal atresias during DA repair was 0.8±2.4% (8/1,028 infants, range 0-9.5%). Meta-analysis: Three comparative retrospective studies (759 infants) were included. Laparoscopic DA repair was associated with a higher risk of missing an associated intestinal atresia (2.9±2.4%, 3/101 infants) than open DA repair (0.3±0.1%, 2/658 infants; p<0.01; risk ratio 8.99, 95%CI: 1.77 to 45.71; I2=0%; Figure). Conclusions: The incidence of associated intestinal atresia in infants with DA is rare, albeit possibly underestimated. Surgeons, especially those performing laparoscopic DA repair, should be aware of the risk of missing an associated intestinal atresia
Duodenal atresia and associated intestinal atresia: a cohort study and review of the literature
No full textPurposeTo determine the true incidence of associated intestinal atresia (AIA) in infants with duodenal atresia (DA) and to analyze whether the surgical approach, open versus laparoscopic, would impact on patient outcome when AIA is present.MethodsCohort study We review all DA infants treated at our institution (2001-2016) and analyzed the outcome of those with AIA. Systematic review/meta-analysis Using a defined search strategy and according to PRISMA guidelines, two investigators independently identified all studies on DA and searched cases of AIA to determine its incidence. Data are meanSD.ResultsCohort study Of 140 DA infants, 10 (7%) had AIA (4 type I, 4 type III, 2 type II). All type I AIA (webs) were found in the duodenum. Systematic review/meta-analysis Of 840 studies, 18 were included (2026 infants). The incidence of AIA was 2.8 +/- 1.6%. The incidence of missed AIA was 0.8 +/- 2.4%. Three comparative studies (759 infants) showed higher risk of missed AIA following laparoscopic (2.9 +/- 2.4%) than open repair (0.3 +/- 0.1%; p<0.01).Conclusions p id=Par4 The incidence of AIA in DA infants is low and the risk of missing it is higher at laparoscopy than at laparotomy. Regardless the approach, surgeons should carefully investigate bowel continuity to avoid the risk of missing AIA
Pneumotorace spontaneo in pazienti di età ≤18 anni: valutazione comparativa monocentrica tra approccio in chirurgia pediatrica e chirurgia toracica
No full textPremesse e scopo dello studio: Il management dello pneumotorace spontaneo primitivo (PSP) pediatrico è controverso ed esistono solo linee guida per l’ adulto. Le strategie terapeutiche prevedono: osservazione (OS), toracentesi (TO), drenaggio toracico (DT), chirurgia (CH). Si valutano:1-differente management del PSP nel reparto pediatrico e dell’adulto;2-rischio di recidiva a seconda della terapia;3-management del PSP “large”;4-ruolo della TC nel management del PSP. Materiali e Metodi: Revisione della casistica dei ricoveri per PSP (età ≤18anni) nella U.O.C. di Chirurgia Pediatrica (CP) e di Chirurgia Toracica (CT)dell’adulto dal 2011 al 2019. Risultati: 29/36pz sono stati inclusi (25M;4F):15 ricoverati in CP (15 episodi di PSP) e 14 in CT (15 PSP). In 9/15(60%)pz della CP il management è stato l’OS, mentre in 12/15(80%)episodi di PSP in CT è stato posizionato un DT. Le recidive sono state: 0/9 dopo OS; 7/15(46,7%) dopo DT(p=0,01). Su 42 episodi totali (comprese recidive) di PSP, 20 erano“large”(>3cm a livello apicale all’Rx):4(20%) trattati con OS, 10/20(50%) con DT, 2(10%) con TO, 4(20%) con CH. Recidive: 0% (0/4) nell’OS; 60%(6/10) nei DT(OR=0,05). 23/29 pazienti con PSP hanno eseguito una TC:17 presentavano distrofia bollosa (74%) e di questi 5(29%) hanno avuto una recidiva necessitando di CH in urgenza. Conclusioni: Il trattamento osservazionale sembrerebbe da preferire nel paziente pediatrico con PSP di qualsiasi dimensione ma clinicamente stabile. La TC è un ottimo strumento diagnostico ma non sembra guidare la scelta terapeutica
Short and Long-Term Outcomes of PSARP versus LAARP and Single versus Staged Repair for Infants with High-Type Anorectal Malformations: A Systematic Review and Meta-Analysis
No full textBackground: We aimed to compare among patients with high-type anorectal malformations (ARM): (i) short- and long-term outcomes of laparoscopic-assisted anorectoplasty (LAARP) compared to classic posterior sagittal anorectoplasty (PSARP) and (ii) the results of single-stage versus staged PSARP. Methods: Using a defined search strategy, two independent investigators systematically reviewed the English literature. PRISMA guidelines were followed, and meta-analysis was performed using RevMan5.3. Results: Of 567 abstracts screened, 7 papers have been included (254 pts; 121 PSARP, 133 LAARP) in the first systematic review and meta-analysis. The length of hospitalization was shortened in LAARP versus PSARP (10.9 versus 14.4 days; p < 0.0001). PSARP and LAARP were comparable in terms of early postoperative complications (28.9% versus 24.7%; p = ns) and rectal prolapse (21.6% versus 17.5%; p = ns). At long-term follow-up, the presence of voluntary bowel movements (74.0% versus 83.5%; p = ns) and the incidence of soiling (45.5% versus 47.6%; p = ns) were similar in both PSARP and LAARP. Six papers (297 pts) were included in the second systematic review, with three comparative studies included in the meta-analysis (247 pts; 117 one-stage, 130 staged procedures). No significant difference in terms of presence of voluntary bowel movements after single-stage versus staged procedures (72.6% versus 67.3%; p = ns) has been detected. Conclusions: LAARP seems to be a safe and effective procedure, showing short- and long-term outcomes similar to PSARP. One-stage PSARP could be a safe alternative to the classic three-stage procedure, even for those infants with high-type ARM. Further and larger comparative studies would be needed to corroborate these partial existing data
Unilateral Papillary Cystadenoma of the Epididymis as a First Presentation of Von Hippel-Lindau Disease
No full textAssociation between papillary cystadenoma of the epididymis (PCE) and Von Hippel-Lindau Disease (VHLD) is well known and stronger for bilateral tumours. Unilateral PCE occurs either as a sporadic tumor without evidence of VHLD or in the context of a known diagnosis of VHLD, indeed it has never been reported as the first manifestation of VHLD. In contrast we report the case of a boy with an apparently isolated, unilateral PCE, that resulted to be the first manifestation of an unknown VHLD. Thus we recommend screening for VHLD in patients with a new diagnosis of unilateral PCE, especially if young
Pediatric primary spontaneous pneumothorax: a comparison of treatment at pediatric surgery vs. thoracic surgery departments
No full textManagement of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of “large” pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 “large” pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence
Intestinal malrotation in infants with omphalocele: A systematic review and meta-analysis
No full textPurpose: The management of intestinal malrotation in infants with omphalocele varies among surgeons. Herein, we aimed to determine whether infants with omphalocele should be investigated for malrotation. Methods: Using a defined search strategy, three investigators identified all studies reporting patients with omphalocele and malrotation. Outcome measures included: 1. incidence of malrotation; 2. correlation with the abdominal size defect in patients with omphalocele; 3. risk of volvulus in those not investigated for malrotation; 4. incidence of adhesive bowel obstruction in those who underwent Ladd's procedure. The meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. Results: Of 111 articles analyzed, 12 (3888 children) reported malrotation in 136 patients (3.5%). Malrotation was equally found in patients with major (15.2%) and minor (13.6%; p = 0.52) omphalocele. A volvulus was more common in children who had Ladd's procedure (8%) than in those who did not (1%; p = 0.03). Adhesive bowel obstruction rate was similar in both groups (5% vs. 3%; p = 0.21). Conclusion: The incidence of malrotation in infants with omphalocele is low but probably underreported, and is not influenced by the size of the defect. At present, there is no evidence in the literature to support investigations to detect malrotation in infants with omphalocele. Type of study: Therapeutic. Level of evidence: II
Atresia Esofagea associata ad Atresia Duodenale: esperienza monocentrica e revisione della letteratura.
No full textPremesse e scopo dello studio: L’Atresia Esofagea (AE) si presenta in associazione con l’Atresia Duodenale (AD) nel 3-6% dei casi. La letteratura è scarsa a riguardo e l’approccio alla doppia patologia non è univocamente definito. Materiali e Metodi: Si effettua: 1. revisione della casistica dei pazienti con AE+AD trattati dal 2000 ad oggi nel nostro Centro, valutando approccio chirurgico ed outcomes; 2. revisione della letteratura, includendo gli articoli in lingua inglese con case series di 3 o più pazienti. Risultati: Casistica: Sono stati inclusi 5 pz con AE+AD. In 4/5 casi (80%) l'approccio è stato in tempo unico, con anastomosi esofagea primaria e correzione dell’AD, in 1/4 pz (25%) con gastrostomia protettiva. In 1/5 neonati (20%), vi è stata una diagnosi ritardata di membrana perforata (in IX giornata). Systematic review: Di 128 abstracts, 6 articoli rientravano nei criteri di inclusione, per un totale di 68 pz (41 M, 27 F). Di questi, 24 (35,3%) sono stati sottoposti ad intervento in tempo unico, 36 (52,9%) a stadi e 7 (10,3%) sono deceduti prima dell’intervento. In 36/68 (52,9%) è stata confezionata una gastrostomia. Dei 36 pz sottoposti a correzione a stadi, in 16 (44,4%) è stata corretta prima l’AD e poi l’AE, con una mortalità del 31% (5/16). Nove/68 (13%) hanno avuto diagnosi ritardata di AD (range 3°-22° giornata). Conclusioni: L’associazione AE+AD presenta diverse problematiche gestionali e non bisogna sottovalutare la presenza di AD in pz con AE. La correzione in tempo unico senza gastrostomia di protezione sembra essere un valido e sicuro management
Video-Assisted Thoracoscopic Surgery Versus Tube Thoracostomy with Fibrinolytics for Treatment of Empyema in Children: A Meta-Analysis of Randomized Controlled Studies
No full textBackground: The British Thoracic Society recommended tube thoracostomy plus intra-pleural fibrinolytics to treat empyema in children in 2005. However, numerous comparative studies have suggested Video-Assisted Thoracoscopic Surgery (VATS) as a first line of treatment for pediatric empyema due to its superior outcomes, including shorter length of hospital stay (LOS). This meta-analysis aimed to compare the following: (1) the LOS for VATS versus fibrinolytics to treat empyema in children; (2) secondary post-operative outcomes (fever, O2 support, time taken for chest tube removal, analgesia, complications, failure, and abnormal chest X-ray at follow-up). Methods: The study was conducted according to PRISMA guidelines. A systematic search of PubMed, Cochrane, Web of Science, and Scopus was conducted according to PRISMA guidelines. Two independent investigators identified relevant studies, excluding case reports, opinion articles, and gray literature publications. A meta-analysis of randomized controlled trials (RCTs) was performed using RevMan 5.4, with data expressed as mean ± standard deviation (SD). Results: Of 1374 abstracts screened, 104 full-text articles were analyzed, and 6 RCTs (345 patients) were included in the meta-analysis. Patients undergoing VATS had significantly shorter LOS compared to those receiving fibrinolytics (9.1 ± 1.8 vs. 11.5 ± 2.5 days, p = 0.05). VATS patients also experienced shorter postoperative fever duration (4.2 ± 0.8 vs. 6.9 ± 4.6 days, p = 0.007) and earlier chest tube removal (5.0 ± 2.6 vs. 9.5 ± 3.3 days, p = 0.01). No significant differences were found between the two groups for other secondary outcomes. Conclusions: Children with empyema appear to benefit from VATS compared to tube thoracostomy plus fibrinolytics, with improved outcomes. Further RCTs are needed to corroborate these results
Management and outcomes of acute appendicitis in children during the COVID-19 pandemic: a systematic review and meta-analysis
No full textThe COVID-19 pandemic has changed the way to manage the emergencies, as people faced fear of the hospitals, with possible delay in the diagnosis. Moreover, clinicians had to rearrange protocols for diagnosis and treatment. We aimed to assess whether COVID-19 pandemic influenced severity of inflammation, management, and outcomes of acute appendicitis (AA), when compared to the pre-COVID era. Using defined search strategy, two independent investigators identified those studies comparing pediatric AA during COVID-19 pandemic versus the pre-COVID-19 period. Meta-analysis was performed using RevMan 5.3. Data are mean ± SD. Of 528 abstracts, 36 comparative studies were included (32,704pts). Time from symptoms onset to surgery was longer during the pandemics compared to the pre-COVID-19 (1.6 ± 0.9 versus 1.4 ± 0.9 days; p < 0.00001). Minimally Invasive Surgery was similar during COVID-19 (70.4 ± 30.2%) versus control period (69.6 ± 25.3%; p = ns). Complicated appendicitis was increased during the pandemics (35.9 ± 14.8%) compared to control period (33.4 ± 17.2%; p < 0.0001). Post-operative complications were comparable between these two groups (7.7 ± 6.5% versus 9.1 ± 5.3%; p = ns). It seems that the COVID-19 pandemic influenced the time of diagnosis, severity of inflammation, and type of surgery. However, the number of post-operative complications was not different between the two groups, leading to the conclusion that the patients were correctly managed. LEVEL OF EVIDENCE: Level 3 Meta-analysis on Level 3 studies
