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Membranous pyloric atresia—Local excision by a new technique
INTERNATIONAL
ABSTRACTS
gus seemed continuous. The passage of an orogastric tube was attempted, but not possible. After opening of the esophagus via longitudinal incision, two intraluminal membranes were found and excised. Thereafter, the orogastric tube could be passed into the stomach. Postoperative course was uneventful.-7’homasrl. Angerpointner Esophageal Diverticula in Childhood Associated With Strictures From Unsuspected Foreign Bodies of the Esophagus. T.E. Herman and W.H. McAlister. Pediatr Radio1 21:410-412, (October), 1991. The authors report on esophageal diverticula and esophageal foreign bodies in two children. Both patients presented with progressive dysphagia. The authors conclude that the occurrence of esophageal diverticula above an area of narrowing should suggest a secondary pulsion diverticula above a foreign body, particularly when the level of the neck of the diverticulum is above the thoracic inlet or the aortic arch, common sites for foreign bodies.-Prem PWi Esophageal Foreign Bodies in Children With Vascular Ring or Aberrant Right Subclavian Artery: Coincidence or Causation? G. Currarino and H. Nikaidoh. Pediatr Radio1 21:406-408, (October),
1991.
The authors report four children who had vascular ring or an aberrant subclavian artery associated with a foreign body in the proximal esophagus above the level of the vascular anomaly. The foreign body caused a local esophageal erosion in two patients.Prem Pun The Effect of Steroid Treatment on Corrosive Oesophageal Burns in Children. E. Keskin, H. Okur, U. Koltuksuz, et al. Eur J Pediatr Surg 1:335-338, (December), 1991. The authors report on 351 children treated at a medical center in Turkey for corrosive agent ingestion over a 12-year period. In 235 the diagnosis of esophageal burn was confirmed by means of esophagoscopy. Children admitted within the first 48 hours received steroid, antibiotic, and fluid therapy, whereas fluid and antibiotics only were given in the remaining children. The type of corrosive agent, admission time, degree of esophageal burn, and stricture development were used as parameters for assessment of late results. Stricture development occurred significantly more often in late admitted patients as compared with early admissions. It is suggested that corticosteroid treatment is effective for prevention of stricture development secondary to corrosive esophageal burns.-Thomas A. AngeFointner Membranous Pyloric Atresia-Local Excision by a New Technique. K.L. Narasirnhan, K.L.N. Rao, and S.K. Mitra. Pediatr Surg Int 6:159-160, (March), 1991. Transgastric excision of the membrane for membranous pyloric atresia is reported by the authors. They recommend this procedure as the treatment of choice in cases of congenital membranous pyloric atresia because preservation of pyloric function will prevent duodenogastric reflux.-Prem Pun’ Congenital Microgastria-Management With a HuntLawrence Jejunal Reservoir Pouch. R.C. Cohen. Pediatr Surg Int 6:156-158, (March), 1991. A 6-month-old boy presented with symptoms of gastroesophageal reflux due to congenital microgastria. His stomach was enlarged using a Hunt-Lawrence jejunal reservoir pouch procedure.
1249
After 17 months he was symptom-free, a normal appetite.--Prem Pun‘
feeding
normally,
and with
Percutaneous Endoscopic Gastrostomy in Children: The Technique in Detail. M. W.L. Gauderer and T.A. Stellato. Pediatr Surg Int 6:82-87, (March). 1991. Percutaneous endoscopic gastrostomy (PEG) is based on the principle of sutureless approximation of the stomach to the anterior abdominal wall without the use of celiotomy. It is primarily used for high-risk pediatric patients with inability to swallow and occasionally for gastrointestinal decompression. In this review, the authors comment on the technique based on their experience with 224 PEGS placed in 220 children and followed over a IO-year period. The indications in this series were inability to swallow in 159 (72%) patients, feeding supplementation in 41 (18%), continuous enteral feedings in 13 (6%), and miscellaneous, such as administration of long-term nonpalatable medication/diet in 4 patients. The authors prefer to perform the procedure in the operating room with surgical and anaesthetic teams in attendance. General anesthesia was used in 122 (54%) pediatric patients as compared with 5% of adult patients. Traditional pediatric gastroscopes were used with “pull” technique. The complication of greatest concern was the occurrence of gastrocolic fistulae in 5 (2.2%) patients. Also, complications such as pneumoperitoneum, injury to liver, migration of catheter, and gastroesophageal reflux were noted. The authors conclude that the PEG is faster and simpler than conventional gastrostomy but needs careful monitoring and follow-up because of the complexity of most of these cases. A good working relationship among the surgeon, gastroenterologist, nurse, and patient’s family will minimize long-term morbidity, particularly stoma-related problems.-Prem Puri Percutaneous Endoscopic Gastrostomy in Children Under One Year of Age: Indications, Complications and Outcome. J.P. Cough&, M. W.L. Gauderer, and T.A. Stellato. Pediatr Surg Int 6:88-91, (March), 1991. Percutaneous endoscopic gastrostomy (PEG) was initially developed for high-risk pediatric surgical patients to avoid celiotomy and its attendant morbidity. In this study the authors analyze the applicability, safety, and effectiveness of this procedure in the young and often critically ill patients. Sixty-nine PEG’s were performed in 68 infants over a 9-year period. Follow-up was possible in 67 of the 68 infants. The main indications for PEG were inability to swallow (48) and long-term continuous enteral feeding (20). The average weight of the children was 5 kg. Seventeen patients had previous abdominal operations. Major complications that resulted in death were related to cardiac failure (1). operative catheter change (l), and gastrocolic fistula (1). Of the 67 patients followed, 18 patients died of their original disease. In 19 the gastrostomy was removed when no longer necessary, and 31 were using PEG at the completion of the study. PEG gastroesophageal reflux (GER) was diagnosed in 27 patients (39%) and, of these, 14 had no long-term problems. Eleven of the remaining 13 required fundoplication, while two with reflux disease were too ill to undergo surgery. In the remaining 41 children no GER occurred. In this study only 19.3% of patients who had PEG required fundoplication for GER. The authors recommend PEG as a useful procedure for enteral access.Prem Pun’ Colocutaneous Gastric Fistula: A Complication of Percutaneous Endoscopic Gastrostomy. B.S. Kierstead. A. Khan, E. Ruppert, et al. Pediatr Surg Int 6:134-135, (March), 1991. Percutaneous endoscopic gastrostomy (PEG) a low complication rate, most series reporting
is associated with 5% to 8% total
ABSTRACTS
gus seemed continuous. The passage of an orogastric tube was attempted, but not possible. After opening of the esophagus via longitudinal incision, two intraluminal membranes were found and excised. Thereafter, the orogastric tube could be passed into the stomach. Postoperative course was uneventful.-7’homasrl. Angerpointner Esophageal Diverticula in Childhood Associated With Strictures From Unsuspected Foreign Bodies of the Esophagus. T.E. Herman and W.H. McAlister. Pediatr Radio1 21:410-412, (October), 1991. The authors report on esophageal diverticula and esophageal foreign bodies in two children. Both patients presented with progressive dysphagia. The authors conclude that the occurrence of esophageal diverticula above an area of narrowing should suggest a secondary pulsion diverticula above a foreign body, particularly when the level of the neck of the diverticulum is above the thoracic inlet or the aortic arch, common sites for foreign bodies.-Prem PWi Esophageal Foreign Bodies in Children With Vascular Ring or Aberrant Right Subclavian Artery: Coincidence or Causation? G. Currarino and H. Nikaidoh. Pediatr Radio1 21:406-408, (October),
1991.
The authors report four children who had vascular ring or an aberrant subclavian artery associated with a foreign body in the proximal esophagus above the level of the vascular anomaly. The foreign body caused a local esophageal erosion in two patients.Prem Pun The Effect of Steroid Treatment on Corrosive Oesophageal Burns in Children. E. Keskin, H. Okur, U. Koltuksuz, et al. Eur J Pediatr Surg 1:335-338, (December), 1991. The authors report on 351 children treated at a medical center in Turkey for corrosive agent ingestion over a 12-year period. In 235 the diagnosis of esophageal burn was confirmed by means of esophagoscopy. Children admitted within the first 48 hours received steroid, antibiotic, and fluid therapy, whereas fluid and antibiotics only were given in the remaining children. The type of corrosive agent, admission time, degree of esophageal burn, and stricture development were used as parameters for assessment of late results. Stricture development occurred significantly more often in late admitted patients as compared with early admissions. It is suggested that corticosteroid treatment is effective for prevention of stricture development secondary to corrosive esophageal burns.-Thomas A. AngeFointner Membranous Pyloric Atresia-Local Excision by a New Technique. K.L. Narasirnhan, K.L.N. Rao, and S.K. Mitra. Pediatr Surg Int 6:159-160, (March), 1991. Transgastric excision of the membrane for membranous pyloric atresia is reported by the authors. They recommend this procedure as the treatment of choice in cases of congenital membranous pyloric atresia because preservation of pyloric function will prevent duodenogastric reflux.-Prem Pun’ Congenital Microgastria-Management With a HuntLawrence Jejunal Reservoir Pouch. R.C. Cohen. Pediatr Surg Int 6:156-158, (March), 1991. A 6-month-old boy presented with symptoms of gastroesophageal reflux due to congenital microgastria. His stomach was enlarged using a Hunt-Lawrence jejunal reservoir pouch procedure.
1249
After 17 months he was symptom-free, a normal appetite.--Prem Pun‘
feeding
normally,
and with
Percutaneous Endoscopic Gastrostomy in Children: The Technique in Detail. M. W.L. Gauderer and T.A. Stellato. Pediatr Surg Int 6:82-87, (March). 1991. Percutaneous endoscopic gastrostomy (PEG) is based on the principle of sutureless approximation of the stomach to the anterior abdominal wall without the use of celiotomy. It is primarily used for high-risk pediatric patients with inability to swallow and occasionally for gastrointestinal decompression. In this review, the authors comment on the technique based on their experience with 224 PEGS placed in 220 children and followed over a IO-year period. The indications in this series were inability to swallow in 159 (72%) patients, feeding supplementation in 41 (18%), continuous enteral feedings in 13 (6%), and miscellaneous, such as administration of long-term nonpalatable medication/diet in 4 patients. The authors prefer to perform the procedure in the operating room with surgical and anaesthetic teams in attendance. General anesthesia was used in 122 (54%) pediatric patients as compared with 5% of adult patients. Traditional pediatric gastroscopes were used with “pull” technique. The complication of greatest concern was the occurrence of gastrocolic fistulae in 5 (2.2%) patients. Also, complications such as pneumoperitoneum, injury to liver, migration of catheter, and gastroesophageal reflux were noted. The authors conclude that the PEG is faster and simpler than conventional gastrostomy but needs careful monitoring and follow-up because of the complexity of most of these cases. A good working relationship among the surgeon, gastroenterologist, nurse, and patient’s family will minimize long-term morbidity, particularly stoma-related problems.-Prem Puri Percutaneous Endoscopic Gastrostomy in Children Under One Year of Age: Indications, Complications and Outcome. J.P. Cough&, M. W.L. Gauderer, and T.A. Stellato. Pediatr Surg Int 6:88-91, (March), 1991. Percutaneous endoscopic gastrostomy (PEG) was initially developed for high-risk pediatric surgical patients to avoid celiotomy and its attendant morbidity. In this study the authors analyze the applicability, safety, and effectiveness of this procedure in the young and often critically ill patients. Sixty-nine PEG’s were performed in 68 infants over a 9-year period. Follow-up was possible in 67 of the 68 infants. The main indications for PEG were inability to swallow (48) and long-term continuous enteral feeding (20). The average weight of the children was 5 kg. Seventeen patients had previous abdominal operations. Major complications that resulted in death were related to cardiac failure (1). operative catheter change (l), and gastrocolic fistula (1). Of the 67 patients followed, 18 patients died of their original disease. In 19 the gastrostomy was removed when no longer necessary, and 31 were using PEG at the completion of the study. PEG gastroesophageal reflux (GER) was diagnosed in 27 patients (39%) and, of these, 14 had no long-term problems. Eleven of the remaining 13 required fundoplication, while two with reflux disease were too ill to undergo surgery. In the remaining 41 children no GER occurred. In this study only 19.3% of patients who had PEG required fundoplication for GER. The authors recommend PEG as a useful procedure for enteral access.Prem Pun’ Colocutaneous Gastric Fistula: A Complication of Percutaneous Endoscopic Gastrostomy. B.S. Kierstead. A. Khan, E. Ruppert, et al. Pediatr Surg Int 6:134-135, (March), 1991. Percutaneous endoscopic gastrostomy (PEG) a low complication rate, most series reporting
is associated with 5% to 8% total