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Visch R, van Zwol A, van der Steeg H, Fuijkschot J, Nusmeier A. Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigation in a neonate, case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Fernandez-Portilla E, Davila-Perez R, Nieto-Zermeño J, Zalles-Vidal C, Abello-Vaamonde JA, Dominguez-Muñoz A, Reyes-Lopez A, Bracho-Blanchet E. Is colostomy closure without mechanical bowel preparation safe in pediatric patients? A randomized clinical trial. J Pediatr Surg 2023; 58:716-722. [PMID: 36257847 DOI: 10.1016/j.jpedsurg.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mechanical bowel preparation (MBP) is largely used worldwide prior to colostomy closure in children, although its benefits are questioned by scientific evidence, and its use can cause adverse reactions. We hypothesized that colostomy closure procedures in children are not associated with increased complications (surgical site infection [SSI] and anastomotic leakage) when performed without MBP. Thus, we conducted a noninferiority trial to compare the safety and efficacy of colostomy takedown with and without MBP. METHODS A randomized noninferiority clinical trial was conducted at Hospital Infantil de Mexico in Mexico City from 2015 to 2019, in which the experimental group did not receive MBP prior to colostomy closure. A total of 79 patients were analyzed, and the primary outcomes were safety-related. Data were analyzed using the chi-squared test, Student's t-test, or Mann-Whitney U test as appropriate. RESULTS The demographics in both groups were comparable. Statistical analysis revealed equivalence in safety outcomes (superficial SSI, 22.5% vs 15.3% p = 0.420; deep SSI, 7.5% vs 0% p = 0.081; reoperation, p = 0.320; intestinal occlusion, p = 0.986); no anastomotic leakage was observed in any group. Secondary outcomes such as fasting time and length of hospital stay after surgery were also similar between the groups. However, patients who received MBP were admitted 2 days before surgery. CONCLUSIONS Our findings indicate that withholding MBP prior to colostomy takedowns in children is not associated with increased complications. Omitting MBP also leads to less discomfort and shortens hospital length of stay, suggesting that it has safer and more effective procedures. LEVEL OF EVIDENCE Randomized controlled clinical trial with adequate statistical power.
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Affiliation(s)
- Emilio Fernandez-Portilla
- Pediatric Surgery Department, Hospital Infantil de Mexico Federico Gomez, Doctor Márquez 162, Mexico City, Cuauhtémoc 06720, Mexico.
| | - Roberto Davila-Perez
- Pediatric Surgery Department, Hospital Infantil de Mexico Federico Gomez, Doctor Márquez 162, Mexico City, Cuauhtémoc 06720, Mexico
| | - Jaime Nieto-Zermeño
- Pediatric Surgery Department, Hospital Infantil de Mexico Federico Gomez, Doctor Márquez 162, Mexico City, Cuauhtémoc 06720, Mexico
| | - Cristian Zalles-Vidal
- Pediatric Surgery Department, Hospital Infantil de Mexico Federico Gomez, Doctor Márquez 162, Mexico City, Cuauhtémoc 06720, Mexico
| | - Jorge A Abello-Vaamonde
- Pediatric Surgery Department, Hospital Infantil de Mexico Federico Gomez, Doctor Márquez 162, Mexico City, Cuauhtémoc 06720, Mexico
| | - Alfredo Dominguez-Muñoz
- Pediatric Surgery Department, Hospital Infantil de Mexico Federico Gomez, Doctor Márquez 162, Mexico City, Cuauhtémoc 06720, Mexico
| | - Alfonso Reyes-Lopez
- Clinical Research Department, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| | - Eduardo Bracho-Blanchet
- Pediatric Surgery Department, Hospital Infantil de Mexico Federico Gomez, Doctor Márquez 162, Mexico City, Cuauhtémoc 06720, Mexico
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Liang Y, Xin W, Xi L, Fu H, Yang Y, Yang G, Li X. Role of mechanical and oral antibiotic bowel preparation in children with Hirschsprung's disease undergoing colostomy closure and pull-through. Transl Pediatr 2021; 10:153-159. [PMID: 33633947 PMCID: PMC7882283 DOI: 10.21037/tp-20-306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mechanical and oral antibiotic bowel preparation (MOABP) has been performed routinely before colorectal surgery in children, but the necessity was questioned recently. We evaluated the utility of MOABP in children with Hirschsprung's disease (HSCR) undergoing colostomy closure and pull-through. METHODS The medical records of pediatric patients with HSCR who underwent colostomy closure and pull-through in a single center from January 2010 to January 2020 were reviewed. The use of MOABP was noted. The incidence of postoperative complications, duration of postoperative antibiotic therapy, total hospital cost and length-of-stay were compared between patients receiving MOABP and no bowel preparation (NBP). RESULTS A total of 64 patients were included in the study: 33 received MOABP and 31 had NBP. The respective postoperative complications in the MOABP and NBP groups were: intra-abdominal infection (18.2% vs. 29.0%), wound infection (9.1% vs. 16.1%), anastomotic leak (0 vs. 0), intestinal obstruction (6.1% vs. 0) and enterocolitis (3.03% vs. 12.90%). The duration of antibiotic therapy was 4.91±4.21 and 5.23±3.77 days (P=0.75) and hospitalization was 18.21±7.26 and 16.26±6.63 days (P=0.27) respectively. The total hospital cost in the MOABP group (4,720.14±1,858.89 USD) was higher than in the NBP group (3,749.06±2,009.97 USD) (P=0.049). CONCLUSIONS We did not find any clear benefit of MOABP in children with HSCR before colostomy closure and pull-through. However, a multicenter randomized controlled trial is needed to more definitely determine the best preoperative approach for children with HSCR.
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Affiliation(s)
- Yuanyuan Liang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenqiong Xin
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Xi
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Huan Fu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoling Li
- West China School of Nursing, Sichuan University, Chengdu, China
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Janssen Lok M, Miyake H, O'Connell JS, Seo S, Pierro A. The value of mechanical bowel preparation prior to pediatric colorectal surgery: a systematic review and meta-analysis. Pediatr Surg Int 2018; 34:1305-1320. [PMID: 30343324 DOI: 10.1007/s00383-018-4345-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The use of mechanical bowel preparation (MBP) before pediatric colorectal surgery remains the standard of care for many pediatric surgeons, though the value of MBP remains unclear. The aim of this study was to systematically review and analyze the effect of MBP on the incidence of postoperative complications; anastomotic leakage, intra-abdominal infection, and wound infection, following colorectal surgery in pediatric patients. METHODS Embase, MEDLINE, Web of Science, and CINAHL databases were searched to compare the effect of MBP versus no MBP prior to elective pediatric colorectal surgery on postoperative complications. After critical appraisal of included studies, meta-analyses were conducted using a random-effect model. RESULTS 1731 papers were retrieved; 2 randomized controlled trials and 4 retrospective cohort studies met the inclusion criteria. The overall quality of evidence was low. MBP before colorectal surgery did not significantly decrease the occurrence of anastomotic leakage, intra-abdominal infection, or wound infection compared to no MBP. CONCLUSIONS On the basis of the existing evidence, the use of MBP before colorectal surgery in children seems not to decrease the incidence of postoperative complications compared to no MBP. To overcome confounding factors such as antibiotic prophylaxis, age and type of operation, a multicentre prospective study is suggested to validate these results.
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Affiliation(s)
- Maarten Janssen Lok
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Hiromu Miyake
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Joshua S O'Connell
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Shogo Seo
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Gordon M, Karlsen F, Isaji S, Teck GO. Bowel preparation for elective procedures in children: a systematic review and meta-analysis. BMJ Paediatr Open 2017; 1:e000118. [PMID: 29637141 PMCID: PMC5862165 DOI: 10.1136/bmjpo-2017-000118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Reviews have investigated preparation for colonoscopy, but not for surgery, They are also often limited to patients up to 16 years, despite many paediatric gastroenterologists caring for older patients. We carried out a systematic review investigating the optimum bowel preparation agents for all indications in children and young people. DESIGN A Cochrane format systematic review of randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool. PATIENTS Young people requiring bowel preparation for any elective procedure, as defined by the primary studies. INTERVENTIONS RCTs comparing bowel preparation with placebo or other interventions. MAIN OUTCOME MEASURES Adequacy of bowel preparation, tolerability and adverse events. RESULTS The search yielded 2124 results and 15 randomised controlled studies (n=1435)but heterogeneity limited synthesis. Meta-analysis of two studies comparing polyethylene glycol (PEG) with sodium phosphate showed no difference in the quality of bowel preparation (risk ratio (RR) 1.27(95% CI 0.66 to 2.44)). Two studies comparing sodium picosulfate/magnesium citrate with PEG found no difference in bowel preparation but significantly higher number of patients needing nasogastric tube insertion in the polyethylene glycol-electrolyte lavage solution (RR 0.04(95% CI 0.01 to 0.18), 45 of 117 in PEG group vs 2 of 121 in sodium picosulfate group). Meta-analysis of three studies (n=241) found no difference between PEG and sennasoids (RR 0.73(95% CI 0.31 to 1.71)). CONCLUSIONS The evidence base is clinically heterogeneous and methodologically at risk of bias. There is evidence that all regimens are equally effective. However, sodium picosulfate was better tolerated than PEG. Future research is needed with all agents and should seek to consider safety and tolerability as well as efficacy.
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Affiliation(s)
- Morris Gordon
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.,Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
| | - Fiona Karlsen
- Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
| | - Sahira Isaji
- Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
| | - Guan-Ong Teck
- Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK
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Ostlie DJ, St Peter SD. The current state of evidence-based pediatric surgery. J Pediatr Surg 2010; 45:1940-6. [PMID: 20920710 DOI: 10.1016/j.jpedsurg.2010.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/03/2010] [Accepted: 05/06/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The efficiency of medical care in the United States has become intensely scrutinized with expectations from patients, families, payors, lawmakers, and, currently, the President. The most effective vehicle to bring more efficient care is the employment of evidence-based medicine whenever possible. Evidence-based medicine is dependent on best evidence, and best evidence is generated from prospective trials. To evaluate current state of evidence based practice in pediatric surgery we reviewed the literature for trials conducted in our field the past 10 years. METHODS All randomized controlled trials from January 1999 through December 2009 published in the English literature were identified through a literature search using PubMed (www.pubmed.com). We included only those in pediatric general surgery excluding transplant, oncology, and the other nongeneral subspecialties. RESULTS The search criteria produced 56 manuscripts, of which 51 described appropriate randomization techniques. A definitive trial design with a sample size calculation was utilized in only 19 studies (34%). A statistically significant difference between treatment arms was identified in 29 of the 56 (52%) trials. There were 26 different journals of publication, with the Journal of Pediatric Surgery being most common (20) followed by Pediatric Surgery International (7). The combined total publications from January 1999 through December 2009 for the 26 journals these randomized trials represent 0.04% of all publications. Appendicitis was the most common condition that was studied (n = 10) followed by pyloric stenosis (n = 4). Trials originated in 19 different countries led by the United States (28%), United Kingdom (14%), and Turkey (12%). There was a generally progressive increase in published trials from 1999 to 2009, however, the percentage of prospective articles published in pediatric surgery was similar to a previous review published in 1999. CONCLUSIONS The current state of evidence-based surgery in pediatric surgery has remained stable in the first decade of the 21st century. Randomized controlled trials represent less than 0.05% of all publications involving pediatric surgery. Some of the hurdles to evidence based surgery are identified and reviewed.
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Affiliation(s)
- Daniel J Ostlie
- Center for Prospective Trials, Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA.
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