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Nonparasitic splenic cysts in children: a multicentric study
1310
International Abstracts of Pediatric Surgery
them from stoma complications. Morbidity was higher in loop colostomy and in neonates. High excoriation rate was explained due to nonavailability of properly fitting bags and expert stoma care giver. Prolaps was significantly more common in transverse loop colostomy and can be prevented by skin bridge or divided colostomy. Stenosis may be because of ischemia and should be prevented by careful handling of blood supply. Revisions were caused by obstruction or prolapse. The type of colostomy significantly affected the morbidity. Divided or skin bridge colostomy seem to be preferable. The authors think that one-stage procedures in newborns with congenital problems like anorectal malformations or Hirschsprung disease and avoidance of colostomy is most important to decrease this specific morbidity.—Peter Schmittenbecher doi:10.1016/j.jpedsurg.2007.03.016
Wall or machine suction rectal biopsy for Hirschsprung disease: a simple modified technique can improve the adequacy of biopsy Ali AE, Morecroft JA, Brown JC, et al. Pediatr Surg Int 2006 (August); 22:681 - 682 Rectal mucosal suction biopsy is usually successful for the diagnosis of Hirschsprung disease. If the specimen does not include enough submucosa, a deeper repeat biopsy is necessary. The study compared conventional syringe suction with wall or machine suction to see whether this technique improves the adequacy of biopsies. One hundred three biopsies were taken within 3 years by syringe suction (77%) or wall suction (23%) with a suction pressure of 500 mm Hg for 5 to 10 seconds. Eighty-one percent of syringe suctions and 100% of wall suctions were adequate for diagnosis or normal findings. Inadequate biopsies generate delay in diagnosis. The use of wall suction apparatus ensures an adequate volume of submucosa in all specimens and is recommended to reduce the incidence of repeat biopsies.—Peter Schmittenbecher doi:10.1016/j.jpedsurg.2007.03.017
Abdomen Liver transplantation for malignant tumors in children Avila LF, Luis AL, Hernandez F, et al. Eur J Pediatr Surg (December); 2006;16/6:411 - 414 The authors report on 12 children, aged 6 months to 14 years, with malignant hepatic tumors: 11 with hepatoblastoma and 1 with fibrolamellar hepatocellular carcinoma without cirrhosis. Liver transplantation (LTX) was the primary treatment in 10 patients, and a rescue therapy after recurrence in 1 patient and for unresectable macroscopic residuals in 2 patients. One of the patients who underwent LTX as primary therapy had lung metastases previously resolved with chemotherapy. The authors used chemotherapy in all children before and after transplantation. Procedure tolerances, survival, recurrence fate, disease-free period, and risk factors for an adverse course were analyzed. All patients overcame LTX, and no early graft loss was observed. Two patients died of tumor relapse, 1 after primary LTX, and 1 after rescue LTX. Graft and patient survival rates at 1, 3, 5, and 14 years, respectively, were 91%, 91%, 82%, and 82 %, respectively. The boy who presented with lung metastases developed new ones 1 year after LTX, which were removed, and he is currently free of disease. The disease-free period has a probability at 1, 3, and 5 years of 91%, 75%, and 75%, respectively. Tumor tissue persistence was the only risk factor for an adverse clinical course. It is concluded that LTX is a reasonable therapeutic approach in unresectable malignant liver tumors, providing outcomes comparable to those in resectable tumors.—Thomas A. Angerpointner doi:10.1016/j.jpedsurg.2007.03.018
Nonparasitic splenic cysts in children: a multicentric study Czauderna P, Vajda P, Schaarschmidt K. Eur J Pediatr Surg 2006 (December);16/6:415 - 419 Nonparasitic splenic cysts (NPSCs) are uncommon in children. The aim of this multinational and multicentric study was therefore to present the authors’ experience as well as changes in treatment over the last 25 years. Fifty children and adolescents were surgically treated for NPSCs in 6 pediatric surgical centers in 4 European countries. The medical records were evaluated retrospectively. There were 26 males and 24 females with a mean age of 11.9 years (1-17 years). Seventeen patients were symptomatic. Six total (4 open, 2 laparoscopic) and 26 (22 open, four laparoscopic) partial splenectomies were carried out. Laparoscopic fenestration or deroofing and open cystectomy were carried out in 9 patients. Histological findings revealed an epidermoid cyst (n = 28), a pseudocyst (n = 15), and a mesothelial cyst (n = 2). In 5 patients, hemangioma or lymphangioma was the pathological diagnosis. At a mean follow-up of 2.9 years, residual cysts were found in 8 laparoscopically treated patients, 4 of whom required a redo. It is concluded that over the last 2 decades, the surgical treatment of NPSCs has changed from a formerly customary total splenectomy to spleen-conserving procedures. These procedures can be performed laparoscopically, if technically feasible. Fenestration of deroofing of the cyst resulted in a high recurrence rate (7/9).—Thomas A. Angerpointner doi:10.1016/j.jpedsurg.2007.03.019
Pediatric splenectomy for hematological disease: outcome analysis Durakbasa CU, Timur C, Sehiralti V, et al. Pediatr Surg Int 2006 (August); 22:635 - 639 The authors retrospectively reviewed the outcome data on efficacy and safety of open splenectomy to compare traditional open splenectomy with the new surgical options such as partial splenectomy, embolization, or laparoscopic splenectomy on the basis of actual data. One hundred nineteen consecutive children, electively splenectomized between 1993 and 2004, were retrospectively reviewed. Indications were idiopathic thrombocytopenic purpura (ITP), thalassemia, spherocytosis, or hemolytic anemia. Long-term penicillin prophylaxis and vaccinations were established. Standard splenectomy via left subcostal or transverse incision (operative time, 47 F 19 minutes) was followed by search for accessory splenic tissue (found in 22%) and palpation of the gallbladder for presence of stones (3 congenital hemolytic anemia). The aim of surgery was achieved in 90%, with 64% complete (N120,000 thrombocytes/mm3 in ITP, no transfusion in anemia) and 25% partial response (N50,000 thrombocytes/mm3 or 50% decrease in transfusion requirements). Spherocytosis had best results (96%/4% complete/partial response), ITP had better results (84%/13% once accessory tissue remained) than thalassemia (17%/59%) or other hemolytic anemias (50%/20%). Two children died from overwhelming postsplenectomy sepsis (OPSI), noncompliant to penicillin prophylaxis. Morbidity of open splenectomy is minor, and most of the patients had an improvement of the quality of life. Mortality by OPSI is caused by noncompliance in prophylaxis. Overwhelming postsplenectomy sepsis risk may be reduced after partial splenectomy in anemias, but data are still not sufficient to delineate whether this is actually the case; splenic remnants may regrow, and the risk of gallstones is not abolished. Laparoscopic splenectomy is safe and feasible, but it needs to be shown that ability to search for accessory tissue is not limited. Traditional splenectomy is still safe and efficient with cure or improvement of life quality of the patients.—Peter Schmittenbecher
doi:10.1016/j.jpedsurg.2007.03.020
International Abstracts of Pediatric Surgery
them from stoma complications. Morbidity was higher in loop colostomy and in neonates. High excoriation rate was explained due to nonavailability of properly fitting bags and expert stoma care giver. Prolaps was significantly more common in transverse loop colostomy and can be prevented by skin bridge or divided colostomy. Stenosis may be because of ischemia and should be prevented by careful handling of blood supply. Revisions were caused by obstruction or prolapse. The type of colostomy significantly affected the morbidity. Divided or skin bridge colostomy seem to be preferable. The authors think that one-stage procedures in newborns with congenital problems like anorectal malformations or Hirschsprung disease and avoidance of colostomy is most important to decrease this specific morbidity.—Peter Schmittenbecher doi:10.1016/j.jpedsurg.2007.03.016
Wall or machine suction rectal biopsy for Hirschsprung disease: a simple modified technique can improve the adequacy of biopsy Ali AE, Morecroft JA, Brown JC, et al. Pediatr Surg Int 2006 (August); 22:681 - 682 Rectal mucosal suction biopsy is usually successful for the diagnosis of Hirschsprung disease. If the specimen does not include enough submucosa, a deeper repeat biopsy is necessary. The study compared conventional syringe suction with wall or machine suction to see whether this technique improves the adequacy of biopsies. One hundred three biopsies were taken within 3 years by syringe suction (77%) or wall suction (23%) with a suction pressure of 500 mm Hg for 5 to 10 seconds. Eighty-one percent of syringe suctions and 100% of wall suctions were adequate for diagnosis or normal findings. Inadequate biopsies generate delay in diagnosis. The use of wall suction apparatus ensures an adequate volume of submucosa in all specimens and is recommended to reduce the incidence of repeat biopsies.—Peter Schmittenbecher doi:10.1016/j.jpedsurg.2007.03.017
Abdomen Liver transplantation for malignant tumors in children Avila LF, Luis AL, Hernandez F, et al. Eur J Pediatr Surg (December); 2006;16/6:411 - 414 The authors report on 12 children, aged 6 months to 14 years, with malignant hepatic tumors: 11 with hepatoblastoma and 1 with fibrolamellar hepatocellular carcinoma without cirrhosis. Liver transplantation (LTX) was the primary treatment in 10 patients, and a rescue therapy after recurrence in 1 patient and for unresectable macroscopic residuals in 2 patients. One of the patients who underwent LTX as primary therapy had lung metastases previously resolved with chemotherapy. The authors used chemotherapy in all children before and after transplantation. Procedure tolerances, survival, recurrence fate, disease-free period, and risk factors for an adverse course were analyzed. All patients overcame LTX, and no early graft loss was observed. Two patients died of tumor relapse, 1 after primary LTX, and 1 after rescue LTX. Graft and patient survival rates at 1, 3, 5, and 14 years, respectively, were 91%, 91%, 82%, and 82 %, respectively. The boy who presented with lung metastases developed new ones 1 year after LTX, which were removed, and he is currently free of disease. The disease-free period has a probability at 1, 3, and 5 years of 91%, 75%, and 75%, respectively. Tumor tissue persistence was the only risk factor for an adverse clinical course. It is concluded that LTX is a reasonable therapeutic approach in unresectable malignant liver tumors, providing outcomes comparable to those in resectable tumors.—Thomas A. Angerpointner doi:10.1016/j.jpedsurg.2007.03.018
Nonparasitic splenic cysts in children: a multicentric study Czauderna P, Vajda P, Schaarschmidt K. Eur J Pediatr Surg 2006 (December);16/6:415 - 419 Nonparasitic splenic cysts (NPSCs) are uncommon in children. The aim of this multinational and multicentric study was therefore to present the authors’ experience as well as changes in treatment over the last 25 years. Fifty children and adolescents were surgically treated for NPSCs in 6 pediatric surgical centers in 4 European countries. The medical records were evaluated retrospectively. There were 26 males and 24 females with a mean age of 11.9 years (1-17 years). Seventeen patients were symptomatic. Six total (4 open, 2 laparoscopic) and 26 (22 open, four laparoscopic) partial splenectomies were carried out. Laparoscopic fenestration or deroofing and open cystectomy were carried out in 9 patients. Histological findings revealed an epidermoid cyst (n = 28), a pseudocyst (n = 15), and a mesothelial cyst (n = 2). In 5 patients, hemangioma or lymphangioma was the pathological diagnosis. At a mean follow-up of 2.9 years, residual cysts were found in 8 laparoscopically treated patients, 4 of whom required a redo. It is concluded that over the last 2 decades, the surgical treatment of NPSCs has changed from a formerly customary total splenectomy to spleen-conserving procedures. These procedures can be performed laparoscopically, if technically feasible. Fenestration of deroofing of the cyst resulted in a high recurrence rate (7/9).—Thomas A. Angerpointner doi:10.1016/j.jpedsurg.2007.03.019
Pediatric splenectomy for hematological disease: outcome analysis Durakbasa CU, Timur C, Sehiralti V, et al. Pediatr Surg Int 2006 (August); 22:635 - 639 The authors retrospectively reviewed the outcome data on efficacy and safety of open splenectomy to compare traditional open splenectomy with the new surgical options such as partial splenectomy, embolization, or laparoscopic splenectomy on the basis of actual data. One hundred nineteen consecutive children, electively splenectomized between 1993 and 2004, were retrospectively reviewed. Indications were idiopathic thrombocytopenic purpura (ITP), thalassemia, spherocytosis, or hemolytic anemia. Long-term penicillin prophylaxis and vaccinations were established. Standard splenectomy via left subcostal or transverse incision (operative time, 47 F 19 minutes) was followed by search for accessory splenic tissue (found in 22%) and palpation of the gallbladder for presence of stones (3 congenital hemolytic anemia). The aim of surgery was achieved in 90%, with 64% complete (N120,000 thrombocytes/mm3 in ITP, no transfusion in anemia) and 25% partial response (N50,000 thrombocytes/mm3 or 50% decrease in transfusion requirements). Spherocytosis had best results (96%/4% complete/partial response), ITP had better results (84%/13% once accessory tissue remained) than thalassemia (17%/59%) or other hemolytic anemias (50%/20%). Two children died from overwhelming postsplenectomy sepsis (OPSI), noncompliant to penicillin prophylaxis. Morbidity of open splenectomy is minor, and most of the patients had an improvement of the quality of life. Mortality by OPSI is caused by noncompliance in prophylaxis. Overwhelming postsplenectomy sepsis risk may be reduced after partial splenectomy in anemias, but data are still not sufficient to delineate whether this is actually the case; splenic remnants may regrow, and the risk of gallstones is not abolished. Laparoscopic splenectomy is safe and feasible, but it needs to be shown that ability to search for accessory tissue is not limited. Traditional splenectomy is still safe and efficient with cure or improvement of life quality of the patients.—Peter Schmittenbecher
doi:10.1016/j.jpedsurg.2007.03.020