| 1. |
- 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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| 2. |
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| 3. |
- 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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| 4. |
- Erlöv, Tobias, et al.
(författare)
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A Computer Program for Assessing Histoanatomical Morphometrics in Ultra-High-Frequency Ultrasound Images of the Bowel Wall in Children : Development and Inter-Observer Variability
- 2023
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Ingår i: Diagnostics. - 2075-4418. ; 13:17
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Tidskriftsartikel (refereegranskat)abstract
- Ultra-high-frequency ultrasound (UHFUS) has a reported potential to differentiate between aganglionic and ganglionic bowel wall, referred to as histoanatomical differences. A good correlation between histoanatomy and UHFUS of the bowel wall has been proven. In order to perform more precise and objective histoanatomical morphometrics, the main research objective of this study was to develop a computer program for the assessment and automatic calculation of the histoanatomical morphometrics of the bowel wall in UHFUS images. A computer program for UHFUS diagnostics was developed and presented. A user interface was developed in close collaboration between pediatric surgeons and biomedical engineers, to enable interaction with UHFUS images. Images from ex vivo bowel wall samples of 23 children with recto-sigmoid Hirschsprung’s disease were inserted. The program calculated both thickness and amplitudes (image whiteness) within different histoanatomical bowel wall layers. Two observers assessed the images using the program and the inter-observer variability was evaluated. There was an excellent agreement between observers, with an intraclass correlation coefficient range of 0.970–0.998. Bland–Altman plots showed flat and narrow distributions. The mean differences ranged from 0.005 to 0.016 mm in thickness and 0 to 0.7 in amplitude units, corresponding to 1.1–3.6% and 0.0–0.8% from the overall mean. The computer program enables and ensures objective, accurate and time-efficient measurements of histoanatomical thicknesses and amplitudes in UHFUS images of the bowel wall. The program can potentially be used for several bowel wall conditions, accelerating research within UHFUS diagnostics.
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| 5. |
- Evertsson, Maria, et al.
(författare)
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Design of a Pediatric Rectal Ultrasound Probe Intended for Ultra-High Frequency Ultrasound Diagnostics
- 2023
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Ingår i: Diagnostics. - 2075-4418. ; 13:10
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Tidskriftsartikel (refereegranskat)abstract
- It has been shown that ultra-high frequency (UHF) ultrasound applied to the external bowel wall can delineate the histo-anatomic layers in detail and distinguish normal bowel from aganglionosis. This would potentially reduce or lessen the need for biopsies that are currently mandatory for the diagnosis of Hirschsprung’s disease. However, to our knowledge, no suitable rectal probes for such a use are on the market. The aim was to define the specifications of an UHF transrectal ultrasound probe (50 MHz center frequency) suitable for use in infants. Probe requirements according to patient anatomy, clinicians’ requests, and biomedical engineering UHF prerequisites were collected within an expert group. Suitable probes on the market and in clinical use were reviewed. The requirements were transferred into the sketching of potential UHF ultrasound transrectal probes followed by their 3D prototype printing. Two prototypes were created and tested by five pediatric surgeons. The larger and straight 8 mm head and shaft probe was preferred as it facilitated stability, ease of anal insertion, and possible UHF technique including 128 piezoelectric elements in a linear array. We hereby present the procedure and considerations behind the development of a proposed new UHF transrectal pediatric probe. Such a device can open new possibilities for the diagnostics of pediatric anorectal conditions.
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| 6. |
- Fransson, Emma, et al.
(författare)
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Diagnostic Efficacy of Rectal Suction Biopsy with Regard to Weight in Children Investigated for Hirschsprung's Disease
- 2022
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Ingår i: Children. - : MDPI AG. - 2227-9067. ; 9:2, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIM: Diagnostic efficacy, defined as the percentage of rectal suction biopsy (RSB) specimens sufficient enough to determine the absence of ganglia cells in Hirschsprung's disease (HD) diagnosis, has been reported to be low, requiring repeated biopsies. The aim was to explore whether RSB diagnostic efficacy was influenced by the child's weight and to ascertain whether RSB efficacy differed between aganglionic and ganglionic tissue.MATERIALS AND METHODS: Efficacy analyses were conducted in a national HD-center's register on children 0-15 kg, examined between 2011-2019. First-time RSB diagnostic efficacy was correlated to the children's weight and final HD diagnosis.RESULTS: Among the 84 children who had first-time RSB, the overall diagnostic efficacy was 85% (71/84). The efficacy was higher among children weighing less than the identified cut-off of 9.0 kg (89% in 0-9.0 kg versus 62% in 9.01-15.0 kg, p = 0.026). Among children diagnosed with HD, 96% (26/27) weighed 0-9.0 kg. In this weight group, the diagnostic efficacy was lower in aganglionosis compared to ganglionosis (77%; 20/26 versus 96%; 43/45), p = 0.045).CONCLUSIONS: The RSB diagnostic efficacy was significantly higher in children weighing less than 9.0 kg and was less in aganglionic compared to ganglionic tissue. Therefore, weight can be useful to predict RSB diagnostic efficacy.
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| 7. |
- Fransson, Emma, et al.
(författare)
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Systematic orientation of fresh rectal suction biopsies improves histopathological diagnostics in hirschsprung’s disease – a method description and preliminary report
- 2023
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Ingår i: BMC Pediatrics. - 1471-2431. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Optimizing rectal suction biopsy (RSB) diagnostics in Hirschsprung’s disease (HD) may shorten diagnostic time and prevent need for repeated biopsies. Aim: To explore whether systematic orientation of fresh RSB specimens increased biopsy quality, diagnostic times, diagnostic efficacy, and histopathologic workload, and to explore these outcome measures for aganglionic specimens. Materials/Methods: This was an observational case-control study conducted at a national referral center for HD on data collected from the local HD-diagnostic register. From 2019 each fresh RSB was oriented by the collector in a notch in a foam cushion, placed in a separate cassette, and sent in formalin for pathological analysis. Outcome measures of oriented RSB samples collected 2019–2021 were compared to those of non-oriented RSB samples collected 2015–2018. Staining/immunohistochemistry consisted of hematoxylin eosin, S-100 and calretinin. Results: 78 children with 81 RSBs and 242 biopsy analyzes were included. The frequency of high-quality RSB specimens was higher in oriented: 40% (42/106) versus non-oriented 25% (34/136) (p = 0.018), the diagnostic turnaround time was shorter: 2 days (1–5) versus 3 days (2–8) (p = 0.015), and the number of additional sectioning/leveling/re-orientation per biopsy was lower: 7 (3–26) versus 16 (7–72) (p = 0.011). Specifically for aganglionic specimens, the frequency of high-quality biopsies was generally higher in oriented than in non-oriented RSB specimens: 47% (28/59) versus 14% (7/50) (p < 0.001); the diagnostic efficacy was higher 95% (19/20) versus 60% (9/15) (p = 0.027) and the diagnostic turnaround time shorter: 2 days (2–3) versus 3 days (2–8) (p = 0.036). Conclusions: Systematic orientation of fresh RSB specimens improves HD diagnostics. Improvement was consistent in aganglionic specimens.
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| 8. |
- 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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| 9. |
- Granéli, Christina, et al.
(författare)
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Clinical Examinations of the Rectoanal Inhibitory Reflex Correlated with Anography Findings, Histopathological Findings, and Clinical Outcomes
- 2014
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Ingår i: Surgery: Current Research. - : OMICS Publishing Group. - 2161-1076. ; 4:6
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Tidskriftsartikel (refereegranskat)abstract
- The diagnostic method for Hirschsprung’s disease (HD) involves rectal biopsy to determine the presence of histopathological findings for aganglionosis. Contrast enema (CE) and anorectal manometry help to support the indication for biopsies. Patients with HD lack a rectoanal inhibitory reflex (RAIR) that can be studied using manometry, ultrasound, or a modified contrast enema (CE), which provokes the RAIR with an injection of cold fluid. A question that arises is whether the RAIR also could be visualized with only a specific clinical examination.
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| 10. |
- 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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