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Ultrasonographic follow-up of infantile hypertrophic pyloric stenosis after pyloromyotomy: a controlled prospective study
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INTERNATIONAL ABSTRACTS
ALIMENTARY TRACT Ultrasonographic Follow-Up of Infantile Hypertrophic Pyloric Stenosis After Pyloromyotomy: A Controlled Prospective Study. B. Tander, A. Akalin, L. Abbasoglu, et al. Eur J Pediatr Surg 12:379-382, (December), 2002. Although the ultrasonographic assessment of hypertrophic pyloric stenosis (IHPS) has become the main clinical method in the diagnosis of this disease, the knowledge about postoperative ultrasonographic follow-up is very limited. To evaluate the ultrasonographic outcome of the pylorus, the authors performed ultrasonographic measurements of the pylorus in 22 children with IHPS before and after the operation in a prospective trial. The sonograms after surgery were taken at the end of the first postoperative week and the first, third and sixth month postoperatively. Three parameters were used: pyloric muscle thickness (MT), pyloric diameter (PD), and pyloric length (PL). The values of these parameters, especially the MT measurements, began to decrease almost by the end of the 1st postoperative week and were normal by the third month in the majority of cases. However, the PL and PD values never returned to normal throughout the 6 months of follow-up. The MT values before and after the operation (6 months) were significantly different (P ⫽ .001). Within one month after surgery, the ultrasononographic parameters decreased considerably. However, except for MT, they did not return to normal. Therefore, MT is the most useful parameter for postoperative ultrasonographic evaluation in IHPS.— Thomas A. Angerpointner Simultaneous Correction of Duodenal Atresia Caused by Annular Pancreas and Malrotation by Laparoscopy. S. Gluer, C. Petersen, and B.M. Ure. Eur J Pediatr Surg 12:423-425, (December), 2002. The authors report on a 3,450-g newborn girl with prenatally diagnosed duodenal obstruction. At operation, duodenal atresia caused by annular pancreas and intestinal, partially volvulated malrotation became apparent. Surgical correction was entirely laparoscopic with 3-mm intruments. The operation consisted of reduction of the volvulated bowel loops, division of obstructing bands, and creation of a side-to-side anastomosis (duodeno-duodenostomy). Postoperative course was unventful, and the girl is well 4 months after operation.— Thomas A. Angerpointner Is Outcome of Children With Acute Appendicitis Dependent on Preoperative Antibiotics Prophylaxis and Type of Surgical Approach? J. Niedzielski and P. Przewratil. Surg Child Intern 10:29-32, (January), 2002. The authors reviewed the records of 297 children with acute appendicitis (AA) operated on at the Department of Pediatric Surgery and Oncology, University School of Medicine in Lodz, Poland in the years 1990 through 1992 (period 1) and 1998 through 1999 (period 2). In period 1, various antibiotics were administered intra- and postoperatively depending upon the surgeon’s decision; appendectomy was performed through a lower longitudinal incision with opening of the right rectus sheath. In period 2, Cefotaxime or Amoxicill was administered as a single dose preoperatively as a routine and continued postoperatively if necessary. Appendectomy was performed through a transverse right lower quadrant incision. Fifty children of period 1 (26.9%) versus 22 patients (19.8%) of period 2 presented with advanced stages of AA. Overall postoperative complications were observed, respectively, in 7 (3.8%) and 4 (3.6%) instances. The authors conclude that neither preoperative antibiotic prophylaxis, nor different surgical approaches had significant impact on the outcome of children with AA, except for definitely better cosmetic results after appendec-
tomies performed via transverse incision (period 2).—John N. Schullinger Transumbilical Laparoscopic-Assisted Appendectomy (TULAA): A Safe and Useful Alternative for Uncomplicated Appendicitis. N. Pappalepore, L. Turaini, N. Marino, et al. Eur J Pediatr Surg 12:383-386, (December), 2002. The aim of this study was a comparison of transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) in cases of acute uncomplicated appendicitis. Fifty-eight TULAA and 65 OA patients with a preoperative diagnosis of uncomplicated appendicitis were studied. Pneumoperitoneum was obtained with a transumbilical 10-mm trocar (telescope access) and 5-mm operative channel introduced in the left iliac fossa. Appendectomy was performed outside the abdomen, after exteriorization of the appendix through the transumbilical incision. In the TULAA group, operating time and hospital stay were reduced. Conversion was necessary in one case (1.7%), and in another case (1.7%) an additional 5-mm operative channel was introduced. Neither intra- nor postoperative complications were encountered in the TULAA group with excellent cosmetic results. There was one wound infection in the OA group (1.5%), and an enlargement of the incision became necessary in 8 cases (12.3%). It is concluded that TULAA is the best approach in uncomplicated appendicitis. It is less invasive and traumatic and permits a complete evaluation of the peritoneal cavity with superior cosmetic results, especially in obese patients and in cases of ectopic appendix.—Thomas A. Angerpointner Air Reduction of Intussusception. I. Rubi, R. Vera, S.C. Rubi, et al. Eur J Pediatr Surg 12:387-390, (December), 2002. The aim of this study was to show that intussusception in children is reducible using air in most cases. Formerly, barium enemas were used to treat pediatric intussusception. The authors are using air enema and consider this reduction technique to be the method of choice in the treatment of intussusception. Whereas reduction of intussusception by means of barium enema was possible in 110 (84.6%) of 130 children, it could be achieved in 100% of 21 children using air reduction. If this method is applied correctly, it is almost always possible to correct intussusception conservatively using the air reduction method.— Thomas A. Angerpointner The Role of Transanal Endorectal Pull-Through in the Treatment of Hirschsprung’s Disease—A Multicenter Experience. M.E. Ho¨llwarth, M. Rivosecchi, I. Schleef, et al. Pediatr Surg Int 18:344-348, (September), 2002. During the last decade, pediatric surgeons have tried to reduce the surgical trauma for correction of Hirschsprung’s disease, eg, by laparoscopic approaches. In 1998, the first description of an entirely transanal pull-through (TAPT) was published. The authors collected their experience with TAPT technique in 18 patients within 2 years including 15 infants and 3 older children. All but one showed rectosigmoid aganglionosis, 3 had a preliminary enterostomy for neonatal obstruction. The rectal mucosa was incised above the dentate line, a mucosal cylinder formed, and the muscle layer penetrated cranial to the peritoneal reflection. The colon was mobilized by dividing the vessels up to the level of normal ganglion cells. After posterior myotomy of the distal muscle cuff, the colon was pulled through and anastomosed to the mucosal incision line. Fourteen children were treated with TAPT alone. In 3 patients, laparoscopy was necessary to (1) confirm proper penetration into the peritoneal cavity in 2 older children and (2) to mobilize the long aganglionic segment in an infant. Once laparotomy was necessary because of severe adhesions. The postoperative course was uneventful in 17 patients; one developed a retrorectal abscess. TAPT is
INTERNATIONAL ABSTRACTS
ALIMENTARY TRACT Ultrasonographic Follow-Up of Infantile Hypertrophic Pyloric Stenosis After Pyloromyotomy: A Controlled Prospective Study. B. Tander, A. Akalin, L. Abbasoglu, et al. Eur J Pediatr Surg 12:379-382, (December), 2002. Although the ultrasonographic assessment of hypertrophic pyloric stenosis (IHPS) has become the main clinical method in the diagnosis of this disease, the knowledge about postoperative ultrasonographic follow-up is very limited. To evaluate the ultrasonographic outcome of the pylorus, the authors performed ultrasonographic measurements of the pylorus in 22 children with IHPS before and after the operation in a prospective trial. The sonograms after surgery were taken at the end of the first postoperative week and the first, third and sixth month postoperatively. Three parameters were used: pyloric muscle thickness (MT), pyloric diameter (PD), and pyloric length (PL). The values of these parameters, especially the MT measurements, began to decrease almost by the end of the 1st postoperative week and were normal by the third month in the majority of cases. However, the PL and PD values never returned to normal throughout the 6 months of follow-up. The MT values before and after the operation (6 months) were significantly different (P ⫽ .001). Within one month after surgery, the ultrasononographic parameters decreased considerably. However, except for MT, they did not return to normal. Therefore, MT is the most useful parameter for postoperative ultrasonographic evaluation in IHPS.— Thomas A. Angerpointner Simultaneous Correction of Duodenal Atresia Caused by Annular Pancreas and Malrotation by Laparoscopy. S. Gluer, C. Petersen, and B.M. Ure. Eur J Pediatr Surg 12:423-425, (December), 2002. The authors report on a 3,450-g newborn girl with prenatally diagnosed duodenal obstruction. At operation, duodenal atresia caused by annular pancreas and intestinal, partially volvulated malrotation became apparent. Surgical correction was entirely laparoscopic with 3-mm intruments. The operation consisted of reduction of the volvulated bowel loops, division of obstructing bands, and creation of a side-to-side anastomosis (duodeno-duodenostomy). Postoperative course was unventful, and the girl is well 4 months after operation.— Thomas A. Angerpointner Is Outcome of Children With Acute Appendicitis Dependent on Preoperative Antibiotics Prophylaxis and Type of Surgical Approach? J. Niedzielski and P. Przewratil. Surg Child Intern 10:29-32, (January), 2002. The authors reviewed the records of 297 children with acute appendicitis (AA) operated on at the Department of Pediatric Surgery and Oncology, University School of Medicine in Lodz, Poland in the years 1990 through 1992 (period 1) and 1998 through 1999 (period 2). In period 1, various antibiotics were administered intra- and postoperatively depending upon the surgeon’s decision; appendectomy was performed through a lower longitudinal incision with opening of the right rectus sheath. In period 2, Cefotaxime or Amoxicill was administered as a single dose preoperatively as a routine and continued postoperatively if necessary. Appendectomy was performed through a transverse right lower quadrant incision. Fifty children of period 1 (26.9%) versus 22 patients (19.8%) of period 2 presented with advanced stages of AA. Overall postoperative complications were observed, respectively, in 7 (3.8%) and 4 (3.6%) instances. The authors conclude that neither preoperative antibiotic prophylaxis, nor different surgical approaches had significant impact on the outcome of children with AA, except for definitely better cosmetic results after appendec-
tomies performed via transverse incision (period 2).—John N. Schullinger Transumbilical Laparoscopic-Assisted Appendectomy (TULAA): A Safe and Useful Alternative for Uncomplicated Appendicitis. N. Pappalepore, L. Turaini, N. Marino, et al. Eur J Pediatr Surg 12:383-386, (December), 2002. The aim of this study was a comparison of transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) in cases of acute uncomplicated appendicitis. Fifty-eight TULAA and 65 OA patients with a preoperative diagnosis of uncomplicated appendicitis were studied. Pneumoperitoneum was obtained with a transumbilical 10-mm trocar (telescope access) and 5-mm operative channel introduced in the left iliac fossa. Appendectomy was performed outside the abdomen, after exteriorization of the appendix through the transumbilical incision. In the TULAA group, operating time and hospital stay were reduced. Conversion was necessary in one case (1.7%), and in another case (1.7%) an additional 5-mm operative channel was introduced. Neither intra- nor postoperative complications were encountered in the TULAA group with excellent cosmetic results. There was one wound infection in the OA group (1.5%), and an enlargement of the incision became necessary in 8 cases (12.3%). It is concluded that TULAA is the best approach in uncomplicated appendicitis. It is less invasive and traumatic and permits a complete evaluation of the peritoneal cavity with superior cosmetic results, especially in obese patients and in cases of ectopic appendix.—Thomas A. Angerpointner Air Reduction of Intussusception. I. Rubi, R. Vera, S.C. Rubi, et al. Eur J Pediatr Surg 12:387-390, (December), 2002. The aim of this study was to show that intussusception in children is reducible using air in most cases. Formerly, barium enemas were used to treat pediatric intussusception. The authors are using air enema and consider this reduction technique to be the method of choice in the treatment of intussusception. Whereas reduction of intussusception by means of barium enema was possible in 110 (84.6%) of 130 children, it could be achieved in 100% of 21 children using air reduction. If this method is applied correctly, it is almost always possible to correct intussusception conservatively using the air reduction method.— Thomas A. Angerpointner The Role of Transanal Endorectal Pull-Through in the Treatment of Hirschsprung’s Disease—A Multicenter Experience. M.E. Ho¨llwarth, M. Rivosecchi, I. Schleef, et al. Pediatr Surg Int 18:344-348, (September), 2002. During the last decade, pediatric surgeons have tried to reduce the surgical trauma for correction of Hirschsprung’s disease, eg, by laparoscopic approaches. In 1998, the first description of an entirely transanal pull-through (TAPT) was published. The authors collected their experience with TAPT technique in 18 patients within 2 years including 15 infants and 3 older children. All but one showed rectosigmoid aganglionosis, 3 had a preliminary enterostomy for neonatal obstruction. The rectal mucosa was incised above the dentate line, a mucosal cylinder formed, and the muscle layer penetrated cranial to the peritoneal reflection. The colon was mobilized by dividing the vessels up to the level of normal ganglion cells. After posterior myotomy of the distal muscle cuff, the colon was pulled through and anastomosed to the mucosal incision line. Fourteen children were treated with TAPT alone. In 3 patients, laparoscopy was necessary to (1) confirm proper penetration into the peritoneal cavity in 2 older children and (2) to mobilize the long aganglionic segment in an infant. Once laparotomy was necessary because of severe adhesions. The postoperative course was uneventful in 17 patients; one developed a retrorectal abscess. TAPT is