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An Evaluation of Medium-term Outcomes of Thoracoscopic Congenital Diaphragmatic Hernia Repair in Neonates and Infants
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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
further characterized by PGP9.5 staining to identify neurons and nNOS immunohistochemistry to identify differentiated nNOS-expressing neurons. Intestinal neuronal apoptosis was assessed by TUNEL assay. Intestinal motility was quantified after gastric gavage of methylene blue. Lastly, mortality was determined. Results: Rat pups exposed to experimental NEC had significantly increased intestinal neuronal apoptosis and significantly decreased expression of nNOS compared to breast fed pups. in pups exposed to NEC but treated with NSC transplantation, engrafted NSCs homed to the submucosal and intramuscular layers of the intestine, and differentiated into PGP 9.5-positive neurons with some neurons expressing nNOS. Rat pups receiving NSC transplantation had significantly improved intestinal motility, represented by increased migration distance of methylene blue dye through the intestines, compared to control pups (64.5 6 8.4% vs. 29.6 6 5.7% of total intestinal length, p¼0.018). Furthermore, pups subjected to experimental NEC but treated with NSC transplantation had significantly decreased mortality compared to non-treated pups exposed to NEC (7.5 6 3.9% vs. 47.26 7.4%, p¼0.007). Conclusions: Our results show that NSC transplantion replaces injured intestinal neurons and improves intestinal motility after NEC-induced intestinal injury, supporting a role for neurotransplantation as a potential therapeutic treatment for post-injury intestinal dysmotility in the future.
three converted to open repair. the open procedures were performed on patients with a younger estimated gestational age (37.4 wks vs. 38.5 wks, p<0.02) and patches were utilized more often (83% vs. 23%, p<0.0001) in the open group. Follow-up was longer in the open cohort (3.562.5 years vs. 2.562.1 years, p¼0.05). There was no difference in recurrence between the two groups (open 15% vs. MIS 12%, p¼0.25). There was a significantly higher proportion of Ladd’s procedures performed in the open group (45.5% vs. 5.7%, p<0.0002) with all but one in the open group performed at the time of CDH repair whereas both in the MIS group were performed separately. None of the three Ladd’s procedures performed at the time of CDH repair were performed for midgut volvulus. the proportion of chest wall abnormalities was marginally significantly higher in the open group (14% vs. 2.9%, p¼0.068) and the proportion of patients developing scoliosis was significantly higher (22.7% vs. 2.8%, p<0.01). to date, none of the chest wall abnormalities required therapy while three open scoliosis patients and the one MIS scoliosis patient were treated with a brace. Conclusions: The results of this study suggest that neonatal MIS CDH repair is associated with lower medium term morbidity, including development of scoliosis, than open repair. in contrast to recent reports we observed no increased risk of recurrence. Addressing the concomitant malrotation at the time of MIS CDH repair may not be necessary given the low proportion of subsequent Ladds procedures performed for symptomatic malrotation. Given the increasing rates of neonatal MIS CDH repair we will continue to prospectively collect long term outcomes for additional evaluations.
42.9. Early Results After Laparoscopic Sleeve Gastrectomy in Adolescents With Morbid Obesity. E. P. Nadler, F. G. Qureshi, L. Barefoot; Children’s National Medical Center, Washington, DC
42.8. An Evaluation of Medium-term Outcomes of Thoracoscopic Congenital Diaphragmatic Hernia Repair in Neonates and Infants. H. L. Chang, L. Cassidy, D. M. Gourlay, T. T. Sato, D. Lambropoulos, J. Enters, J. J. Aiken, C. M. Calkins, J. C. Densmore, D. R. Lal, R. Jamshidi, M. J. Arca; Children’s Hospital of Wisconsin, Milwaukee, WI Introduction: Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has become more widespread. Our previous study demonstrated improved short term outcomes with minimally invasive surgical (MIS) repair of CDH, including quicker return to enteral nutrition, shorter duration of narcotic use, and fewer major complications. the current study evaluates medium term outcomes of neonatal thoracoscopic CDH repair compared to open repair. Methods: Institutional review board approval was obtained to analyze data from our neonatal surgical registry to study patients under six months of age who underwent CDH repair from January 2003 to July 2011. Patients with Morgagni’s defects, inadequate records, or traumatic diaphragmatic hernias were excluded. Demographic, operative details and follow-up data were analyzed to identify associations with recurrence, Ladd’s procedures for malrotation, and the development of chest wall deformities and scoliosis. Results: Seventy-nine patients (46 male, 33 female) were included. Forty-four (56%) were performed open and 35 (44%) thoracoscopically with
Introduction: Obesity has been clearly identified as one of the most important public health concerns in both children and adolescents. Unfortunately, even the most comprehensive and aggressive multi-disciplinary weight management programs have shown only modest weight loss results. Thus, there has been increasing enthusiasm for bariatric surgery for obese adolescent patients. Due to the relatively high morbidity and mortality associated with gastric bypass, and the lack of approval by the FDA for laparoscopic adjustable gastric bands in patients less than 18 years of age, we have begun to explore laparoscopic sleeve gastrectomy (LSG) as an option for morbidly obese adolescents. We hypothesized that it would be a safe and effective short-term strategy. Methods: We have prospectively collected data from all patients undergoing bariatric surgery at our institution since the inception of our adolescent weight loss surgery program in January 2010. Baseline data collected include age, gender, race/ethnicity, height, weight, body mass index (BMI), comorbid conditions, and a variety of laboratory evaluations. Post-operative data collected included type of operation, length of stay (LOS), operative morbidity, need for re-operation, as well as percent excess weight loss (%EWL) and BMI at 3 month intervals. Laboratory evaluations were repeated at one year after surgery. Results: There were 14 patients who underwent LSG since January 2010. of these, 9 were female and 5 were male. the mean age was 17.6 6 1.6 years of age. the mean pre-operative weight was 153 6 35 kg with a BMI of 51 6 10. There were no intra-operative complications, and the only post-operative complication has been pancreatitis in one patient. Mean LOS was 2.4 6 1.2 days. Mean follow-up was 7.7 6 5.7 months. the %EWL at 3 months, 6 months, and 1 year post-operatively were 30%, 40%, and 41% respectively (Table). Conclusions: LSG is a safe operation for morbidly obese pediatric patients and represents an effective early treatment strategy with approximately 40%EWL at 6 months and one year follow-up. Due to the minimal morbidity associated with LSG, it may be the optimal non-device surgical option for adolescent patients with morbid obesity.
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
further characterized by PGP9.5 staining to identify neurons and nNOS immunohistochemistry to identify differentiated nNOS-expressing neurons. Intestinal neuronal apoptosis was assessed by TUNEL assay. Intestinal motility was quantified after gastric gavage of methylene blue. Lastly, mortality was determined. Results: Rat pups exposed to experimental NEC had significantly increased intestinal neuronal apoptosis and significantly decreased expression of nNOS compared to breast fed pups. in pups exposed to NEC but treated with NSC transplantation, engrafted NSCs homed to the submucosal and intramuscular layers of the intestine, and differentiated into PGP 9.5-positive neurons with some neurons expressing nNOS. Rat pups receiving NSC transplantation had significantly improved intestinal motility, represented by increased migration distance of methylene blue dye through the intestines, compared to control pups (64.5 6 8.4% vs. 29.6 6 5.7% of total intestinal length, p¼0.018). Furthermore, pups subjected to experimental NEC but treated with NSC transplantation had significantly decreased mortality compared to non-treated pups exposed to NEC (7.5 6 3.9% vs. 47.26 7.4%, p¼0.007). Conclusions: Our results show that NSC transplantion replaces injured intestinal neurons and improves intestinal motility after NEC-induced intestinal injury, supporting a role for neurotransplantation as a potential therapeutic treatment for post-injury intestinal dysmotility in the future.
three converted to open repair. the open procedures were performed on patients with a younger estimated gestational age (37.4 wks vs. 38.5 wks, p<0.02) and patches were utilized more often (83% vs. 23%, p<0.0001) in the open group. Follow-up was longer in the open cohort (3.562.5 years vs. 2.562.1 years, p¼0.05). There was no difference in recurrence between the two groups (open 15% vs. MIS 12%, p¼0.25). There was a significantly higher proportion of Ladd’s procedures performed in the open group (45.5% vs. 5.7%, p<0.0002) with all but one in the open group performed at the time of CDH repair whereas both in the MIS group were performed separately. None of the three Ladd’s procedures performed at the time of CDH repair were performed for midgut volvulus. the proportion of chest wall abnormalities was marginally significantly higher in the open group (14% vs. 2.9%, p¼0.068) and the proportion of patients developing scoliosis was significantly higher (22.7% vs. 2.8%, p<0.01). to date, none of the chest wall abnormalities required therapy while three open scoliosis patients and the one MIS scoliosis patient were treated with a brace. Conclusions: The results of this study suggest that neonatal MIS CDH repair is associated with lower medium term morbidity, including development of scoliosis, than open repair. in contrast to recent reports we observed no increased risk of recurrence. Addressing the concomitant malrotation at the time of MIS CDH repair may not be necessary given the low proportion of subsequent Ladds procedures performed for symptomatic malrotation. Given the increasing rates of neonatal MIS CDH repair we will continue to prospectively collect long term outcomes for additional evaluations.
42.9. Early Results After Laparoscopic Sleeve Gastrectomy in Adolescents With Morbid Obesity. E. P. Nadler, F. G. Qureshi, L. Barefoot; Children’s National Medical Center, Washington, DC
42.8. An Evaluation of Medium-term Outcomes of Thoracoscopic Congenital Diaphragmatic Hernia Repair in Neonates and Infants. H. L. Chang, L. Cassidy, D. M. Gourlay, T. T. Sato, D. Lambropoulos, J. Enters, J. J. Aiken, C. M. Calkins, J. C. Densmore, D. R. Lal, R. Jamshidi, M. J. Arca; Children’s Hospital of Wisconsin, Milwaukee, WI Introduction: Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has become more widespread. Our previous study demonstrated improved short term outcomes with minimally invasive surgical (MIS) repair of CDH, including quicker return to enteral nutrition, shorter duration of narcotic use, and fewer major complications. the current study evaluates medium term outcomes of neonatal thoracoscopic CDH repair compared to open repair. Methods: Institutional review board approval was obtained to analyze data from our neonatal surgical registry to study patients under six months of age who underwent CDH repair from January 2003 to July 2011. Patients with Morgagni’s defects, inadequate records, or traumatic diaphragmatic hernias were excluded. Demographic, operative details and follow-up data were analyzed to identify associations with recurrence, Ladd’s procedures for malrotation, and the development of chest wall deformities and scoliosis. Results: Seventy-nine patients (46 male, 33 female) were included. Forty-four (56%) were performed open and 35 (44%) thoracoscopically with
Introduction: Obesity has been clearly identified as one of the most important public health concerns in both children and adolescents. Unfortunately, even the most comprehensive and aggressive multi-disciplinary weight management programs have shown only modest weight loss results. Thus, there has been increasing enthusiasm for bariatric surgery for obese adolescent patients. Due to the relatively high morbidity and mortality associated with gastric bypass, and the lack of approval by the FDA for laparoscopic adjustable gastric bands in patients less than 18 years of age, we have begun to explore laparoscopic sleeve gastrectomy (LSG) as an option for morbidly obese adolescents. We hypothesized that it would be a safe and effective short-term strategy. Methods: We have prospectively collected data from all patients undergoing bariatric surgery at our institution since the inception of our adolescent weight loss surgery program in January 2010. Baseline data collected include age, gender, race/ethnicity, height, weight, body mass index (BMI), comorbid conditions, and a variety of laboratory evaluations. Post-operative data collected included type of operation, length of stay (LOS), operative morbidity, need for re-operation, as well as percent excess weight loss (%EWL) and BMI at 3 month intervals. Laboratory evaluations were repeated at one year after surgery. Results: There were 14 patients who underwent LSG since January 2010. of these, 9 were female and 5 were male. the mean age was 17.6 6 1.6 years of age. the mean pre-operative weight was 153 6 35 kg with a BMI of 51 6 10. There were no intra-operative complications, and the only post-operative complication has been pancreatitis in one patient. Mean LOS was 2.4 6 1.2 days. Mean follow-up was 7.7 6 5.7 months. the %EWL at 3 months, 6 months, and 1 year post-operatively were 30%, 40%, and 41% respectively (Table). Conclusions: LSG is a safe operation for morbidly obese pediatric patients and represents an effective early treatment strategy with approximately 40%EWL at 6 months and one year follow-up. Due to the minimal morbidity associated with LSG, it may be the optimal non-device surgical option for adolescent patients with morbid obesity.