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| 2. |
- Bjørnland, Kristin, et al.
(författare)
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A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease
- 2017
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468. ; 52:9, s. 1458-1464
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Transanal endorectal pull-through (ERPT) is the most popular technique to treat Hirschsprung disease (HD). Still, there is limited knowledge on long-term bowel function. This cross-sectional, multicenter study assessed long-term bowel function in a large HD population and examined predictors of poor outcome.METHODS: Patients older than four years or their parents filled out a validated questionnaire on bowel function. Clinical details were recorded retrospectively from medical records.RESULTS: 73/200 (37%) patients reported absolutely no impaired bowel function, meaning no constipation, fecal accidents, stoma, appendicostomy or need for enemas. Seven (4%) had a stoma, and 33 (17%) used antegrade or rectal colonic enemas. Most disarrangements of fecal control and constipation were significantly less common in older age group, but abnormal defecation frequency and social problems remained unchanged. Syndromic patients (n=31) experienced frequent fecal accidents (46%) more often than nonsyndromic (14%, P<0.001). Having a syndrome (adjusted OR 5.6, 95% CI 2.1-15, P=0.001) or a complete transanal ERPT (adjusted OR 2.4, 95% CI 1.1-5.7, P=0.038) was significantly associated with poor outcome defined as having a stoma, an appendicostomy, daily fecal accidents or need of regular rectal wash outs.CONCLUSION: A significant number of HD patients experience bowel problems many years after definite surgery. Fecal control was significantly better in older than younger HD patients, but some continued to have considerable bowel problems also as adults. A total transanal ERPT was associated with poorer outcome. Long-term follow-up of HD patients is warranted. Prognosis Study: Level II.
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| 3. |
- Brands Viktorsdóttir, Margrét, et al.
(författare)
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Complications according to underlying disease in children undergoing video-assisted gastrostomy
- 2017
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Ingår i: Medical Research Archives. - 2375-1916. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to identify short-term complications after video-assisted gastrostomy in children and to examine the association between complications and underlying disease.Methods: This was a retrospective study at a single institution. Data for all children who underwent video-assisted gastrostomy during 12 years was collected. Complications occurring within three months postoperatively were analyzed.Results: Among 421 children undergoing video-assisted gastrostomy, 402 were included in the study. The median age at surgery was two years (range one month-14 years). The most common underlying disorder was neurological disease (49%). There were two major postoperative complications and 78% had minor complications. Minor complications included granulation tissue (43%), leakage (16%), wound infection (14%), vomiting, dislodgement and pain. There was no significant difference in frequency of the various complications when compared between the underlying diseases (p=0.10-0.82). Wound infection was registered in overall 14% and occurred least frequently in children with neurologic disease and syndromes (10% and 9% respectively).Conclusion: Serious complications after video-assisted gastrostomy are rare, while minor complications occur in 78% of the children. There is no association between the frequency of complications and underlying disease according to this study.
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| 4. |
- Burman, Linnéa, et al.
(författare)
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Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants
- 2019
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Ingår i: The Surgery Journal. - : Georg Thieme Verlag KG. - 2378-5128 .- 2378-5136. ; 5:3, s. 96-102
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Tidskriftsartikel (refereegranskat)abstract
- Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1-24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4-30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes , but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.
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| 5. |
- Ekselius, Julia, et al.
(författare)
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Treatment and Outcome for Children with Esophageal Atresia from a Gender Perspective
- 2017
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Ingår i: Surgery research and practice. - : Hindawi Limited. - 2356-7759 .- 2356-6124. ; 2017
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Tidskriftsartikel (refereegranskat)abstract
- Background: Besides the incidence of esophageal atresia (EA) being higher in males, no other gender-specific differences in EA have been reported. The aim of this study was to search for gender-specific differences in EA.Methods: A retrospective study was conducted at a tertiary center for pediatric surgery. The medical charts of infants born with EA were reviewed. 20 girls were identified, and 20 boys were selected as matched controls with respect to concomitant malformations. Their treatment and outcome were evaluated.Results: Polyhydramnios was more common in pregnancies with boys, 40%, versus girls, 10%, with EA (p < 0.01). In total, 36 (90%) children had patent ductus arteriosus, without any gender difference (18 and 18, resp., p=1). The distribution of days at the different levels of care was not equally distributed between boys and girls. Boys with EA had significantly more postoperative days (median 5 days) in the ward than girls (median 5 and 2 days, resp., p=0.04). No other gender-specific differences in surgical treatment, complications, or symptoms at follow-up were identified.Conclusion: Polyhydramnios appears to be more frequent in pregnancies with boys than girls with EA. In this study, boys have longer stays than girls at the pediatric surgery ward.
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| 6. |
- Elofsson, Axel, et al.
(författare)
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Laparoscopic or Open Appendectomy for Pediatric Appendicitis?
- 2016
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Ingår i: MOJ Surgery. - : MedCrave Group, LLC. - 2379-6162. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aimed to compare open appendectomy (OA) and laparoscopic appendectomy (LA) in children by analyzing the differences in outcomes between the two techniques. Materials and Methods: This was a single-institution retrospective study. Data were collected from the medical records of all children <15 years of age who underwent an appendectomy from 2006 through 2014. Preoperative parameters, appendicitis severity, surgery time, complications, pain treatment, and postoperative outcome including days of hospital stay were collected. LA was performed with a two- or three-port technique, and a McBurney incision was adopted for OA. Conversions were regarded as OA. Results: A total of 406 appendectomies were performed during the study period, 146 (36%) OA (61 conversions) and 260 (64%) LA. No differences were found between the two groups regarding surgery time, operative and postoperative complications, and postoperative pain treatment. In cases of Phlegmonous appendicitis, LA was associated with a significantly shorter median hospital stay than was OA (1 and 1.8 days, respectively; p < 0.01). Healthy and Phlegmonous appendices were more commonly treated with LA (p < 0.01 for both); gangrenous, perforated, and abscessed appendices were more commonly treated with open surgery (p = 0.02, p < 0.01, and p < 0.01, respectively). Conclusion: The study identified no disadvantages of LA compared with OA. Therefore, LA should be the preferred technique because it is associated
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| 7. |
- Graneli, Christina, et al.
(författare)
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Appendicostomy for Bowel Control in Children after Transanal Endorectal Pull-Through for Hirschsprung Disease
- 2016
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Ingår i: Journal of Pediatric Surgical Specialties. ; 10:4, s. 5-14
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the indications for, and outcome, of appendicostomy for patients with Hirschsprungs disease (HD) who underwent transanal endorectal pull-through (TERPT). Method: Children with HD > 4 years old who received an appendicostomy between 2005 and 2011 at a tertiary pediatric surgery center were included. Pre- and post-appendicostomy bowel function was evaluated by a bowel function score. HD-patients not receiving an appendicostomy were the controls. The study was approved by an institutional ethics committee (2010/49). Results: Seven of 37 HD-patients received an appendicostomy. Syndromes were present in 43% of the appendicostomy and 6% of the controls (controls reported absence of fecal accidents (p=0.297). Three (60%) with appendicostomy and 14 (47%) controls, respectively, reported absence of soiling or soiling RPT.
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| 8. |
- Granéli, Christina, et al.
(författare)
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Development of Frequency of Stools over Time in Children with Hirschsprung Disease Posttransanal Endorectal One-Stage Pull-through.
- 2015
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 25:4, s. 359-364
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Tidskriftsartikel (refereegranskat)abstract
- Background The transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung disease (HD) is frequently used worldwide. To give the children's families realistic expectations and to plan the medical care for the period after TERPT, the outcome is of great importance. Aim The aim of this article is to collect information on the number of stools passed daily after one-stage TERPT procedure for HD. Patients and Methods A prospective follow-up study for collecting information on the outcome of planned TERPT from 2005 through 2012 was performed. A control group consisting of age and gender matched children was used. Results The results show an initial high frequency of daily stools, median 12 stools/day (range, 3-30 stools/day), reaching an acceptable situation with median 4 stools/day (range, 0-10 stools/day) after 1 year. After 4 years, the number of stools did not differ significantly from healthy controls. Conclusion This study shows that it takes 4 years after TERPT before the number of stools becomes normalized. To compare the long-term outcome, it would be desirable to have uniform regular reports on the daily frequency of passed stools, incontinence, and constipation during the years after TERPT.
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| 9. |
- Granéli, Christina, et al.
(författare)
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Diagnosis, Symptoms, and Outcomes of Hirschsprung's Disease from the Perspective of Gender
- 2017
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Ingår i: Surgery research and practice. - : Hindawi Limited. - 2356-7759 .- 2356-6124. ; 2017
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim. Hirschsprung's disease (HD) has a skewed gender distribution, with a female to male ratio of 1 : 4. This study aims to examine differences between boys and girls with HD regarding preoperative features and postoperative treatment and outcome. Method. The first part of the study was conducted as a retrospective review of all HD patients who underwent transanal endorectal pull-through (TERPT). Pre-, peri-, immediate post-, and first-year postoperative data were collected. The second part was conducted as an observational cross-sectional study by comparing bowel function scores (BFS) determined by structured interviews of patients 4 years old and older. Results. Included were 39 boys and 12 girls. Of these, 25 boys and 9 girls were older than 4 years and participated in the BFS interview. Boys had a higher frequency of hospitalizations during the first postoperative year compared to girls (n = 20 and n = 2, p < 0.05). At long-term follow-up, more boys reported abnormal frequency of defecation, 16 compared to 2 (p < 0.05). There was no difference between genders in terms of preoperative symptoms and overall bowel function later. Conclusion. Boys with HD had more hospitalizations and a higher rate of abnormal frequency of defecation than girls with HD.
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| 10. |
- Granéli, Christina, et al.
(författare)
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Outcome after Computer-Assisted (Robotic) Nissen Fundoplication in Children Measured as Pre- and Postoperative Acid Reducing and Asthma Medications Use.
- 2015
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Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 25:6, s. 532-536
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study aims to report the clinical outcome of computer-assisted fundoplication (CAF) in children. Methods As our center changed policy to using computer-assisted surgery only, a prospectively studied cohort of 40 children underwent CAF, during the period from January 2006 through May 2013. The collected data include patient demographics and postoperative complications as well as medication, 24-hour pH measurements and DeMeester scores before and after surgery. Results In the studied group, the median percentage of the duration of the 24-hour pH < 4 decreased postoperatively from 11 (range, 5-39) to 1% (range, 0-12) (p < 0.001); the DeMeester score decreased from 40 (range, 17-137) to 5 (range, 1-42) (p < 0.001). All 40 patients required antireflux medication before the fundoplication. This number decreased significantly to 8 (20%) after the fundoplication (p < 0.001). Before the fundoplication, 22 children (55%) were using asthma medication and 12 (30%) after the fundoplication (p = 0.04). Conclusions The CAF significantly reduced the acid reflux from the stomach to the esophagus and the use of antireflux as well as asthma medication during the median observation period of 5 years. The evidence of advantages compared with conventional laparoscopic fundoplication remain to be confirmed.
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