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van Braak H, de Beer SA, de Jong JR, Stevens MF, Musters G, Zwaveling S, Oomen MWN, der Made WV, Krug E, van Heurn LWE. Intercostal Nerve Cryoablation or Epidural Analgesia for Multimodal Pain Management after the Nuss Procedure: A Cohort Study. Eur J Pediatr Surg 2024. [PMID: 38242172 DOI: 10.1055/a-2249-7588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Nuss procedure for pectus excavatum is a minimally invasive, but painful procedure. Recently, intercostal nerve cryoablation has been introduced as a pain management technique. MATERIALS AND METHODS In this cohort study, we compared the efficacy of multimodal pain management strategies in children undergoing a Nuss procedure. The effectiveness of intercostal nerve cryoablation combined with patient-controlled systemic opioid analgesia (PCA) was compared with continuous epidural analgesia (CEA) combined with PCA. The study was conducted between January 2019 and July 2022. Primary outcome was length of stay (LOS), and secondary outcomes were operation room time, postoperative pain, opioid consumption, and gabapentin use. RESULTS Sixty-six consecutive patients were included, 33 patients in each group. The cryoablation group exhibited lower Numeric Rating Scale (NRS) pain scores on postoperative day 1 and 2 (p = 0.002, p = 0.001) and a shorter LOS (3 vs. 6 days (p < 0.001). Cryoablation resulted in less patients requiring opioids at discharge (30.3 vs. 97.0%; p < 0.001) and 1 week after surgery (6.1 vs. 45.4%; p < 0.001)). In the CEA group, gabapentin use was more prevalent (78.8 vs. 18.2%; p < 0.001) and the operation room time was shorter (119.4 vs. 135.0 minutes; p < .010). No neuropathic pain was reported. CONCLUSIONS Intercostal nerve cryoablation is a superior analgesic method compared with CEA, with reduced LOS, opioid use, and NRS pain scores. The prophylactic use of gabapentin is redundant.
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Affiliation(s)
- Hendrik van Braak
- Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
| | - Sjoerd A de Beer
- Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
| | - Markus F Stevens
- Department of Anesthesiology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Gijsbert Musters
- Department of Gastrointestinal Surgery and Surgical Oncology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Sander Zwaveling
- Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
| | - Matthijs W N Oomen
- Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
| | - Wendeline Van der Made
- Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | - Egbert Krug
- Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, AZ, Amsterdam, Noord-Holland, The Netherlands
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de Beaufort CMC, Hooijer IN, Kuijper CF, Arguedas Flores OE, de Jong JR, van den Boogaard E, Dekker JJML, Gorter RR. Anatomical Gynecological Anomalies in Girls Born with Anorectal Malformations: A Retrospective Cohort Study of 128 Patients. J Pediatr Adolesc Gynecol 2024; 37:56-62. [PMID: 37777168 DOI: 10.1016/j.jpag.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
STUDY OBJECTIVE In girls born with an anorectal malformation (ARM), anatomical gynecological anomalies (GA) may be present and might need treatment. Therefore, the aim of this study was to provide an overview of GA in girls born with ARM in our cohort. Additionally, diagnostic timing and methods for GA were assessed. METHODS A retrospective mono-center study was performed from January 2000 to December 2022. All patients assigned female at birth were eligible for inclusion. GA were classified according to ESHRE/ESGE classification. Outcomes were the number of girls with GA with subsequent screening methods, factors associated with GA, and GA requiring treatment. Uni- and multivariable logistic regression analyses were performed to identify the association between baseline characteristics and the presence of GA. RESULTS In total, 128 girls were included, of whom 30 (24.1%) had additional GA, with vaginal anomalies being present most often (n = 17). Fifty-six patients (43.8%) underwent full screening, and this number improved over time (37.7% before 2018 vs 72.7% after 2018; P = .003). Thirteen of 30 patients (43.3%) required surgical treatment for their GA, without the occurrence of postoperative complications. CONCLUSION Additional GA were present in almost a quarter of the girls born with an ARM, with vaginal anomalies most often identified. Despite GA being most often found in patients with cloacal malformations, these anomalies were also identified in patients with other ARM types. Surgical treatment was required in almost half of the girls with GA. Therefore, this study emphasizes the importance of screening for GA in patients with an ARM, regardless of the ARM type.
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Affiliation(s)
- Cunera M C de Beaufort
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Isabelle N Hooijer
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Caroline F Kuijper
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Urology, Amsterdam, the Netherlands
| | - Olga E Arguedas Flores
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Urology, Amsterdam, the Netherlands
| | - Justin R de Jong
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Emmy van den Boogaard
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Judith J M L Dekker
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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van Braak H, de Beer SA, Zwaveling S, Oomen MWN, de Jong JR. Ravitch Surgery or Dynamic Compression Bracing for Pectus Carinatum: A Retrospective Cohort Study. Ann Thorac Surg 2024; 117:144-150. [PMID: 36395878 DOI: 10.1016/j.athoracsur.2022.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pectus carinatum is a pediatric condition that can be treated by dynamic compression system (DCS) bracing or surgery. Several publications on DCS bracing or surgery are available; however, they do not compare both treatments. METHODS Over a 10-year period, 738 patients with pectus carinatum were treated at the Amsterdam Pectus Center (Amsterdam, The Netherlands). This study describes this 10-year experience and the results of both treatments. RESULTS Of the 631 patients who underwent DCS bracing treatment, 553 finished treatment, and 78 patients are still under treatment. A total of 73.8% (n = 408) of these patients finished treatment successfully, 13.6% (n = 75) experienced treatment failure, and 12.7% (n = 70) were lost to follow-up. The success rate decreased with an increasing pressure of initial compression (84.2%-67.3%). Marfan syndrome and Poland syndrome were associated with unfavorable results. Ravitch surgery was performed in 105 patients, with a success rate of 92.4%. Complications occurred in 32.4% of patients, and 6.7% of patients had complications for which surgery was needed. No relationship was found between osteotomy or sternal fixation and outcomes or complications. The Abramson procedure was performed in 2 patients. CONCLUSIONS DCS bracing should be the treatment of choice in patients with pectus carinatum because of its noninvasiveness, good results, and lower complication rate compared with surgery. Besides pressure of initial correction, motivation is an important factor influencing outcomes, and compliance remains a major challenge in treating pectus carinatum using DCS bracing. Bracing patients before their growth spurt should be discouraged. Patients with a higher pressure of initial compression (>8.0-8.5 psi) and Marfan syndrome or Poland syndrome have poorer outcomes. In those patients, surgery may be considered.
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Affiliation(s)
- Hendrik van Braak
- Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Sjoerd A de Beer
- Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sander Zwaveling
- Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Matthijs W N Oomen
- Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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de Beaufort CMC, Boom DT, Mackay TM, Dekker JJML, Arguedas Flores OE, de Jong JR, Kuijper CF, Gorter RR. Potential benefits of routine cystoscopy and vaginoscopy prior to reconstructive surgery in patients with an anorectal malformation. Pediatr Surg Int 2023; 39:284. [PMID: 37889354 PMCID: PMC10611826 DOI: 10.1007/s00383-023-05565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE First, to assess the number of patients with anorectal malformations (ARM) in whom additional urological and/or gynecological anomalies were identified through routine screening with cysto- or vaginoscopy prior to reconstructive surgery. Second, to assess potential procedure-related complications. METHODS Retrospective mono-center cohort study, including all ARM patients born between January 2019 and December 2022. Routine screening consisted of cystoscopy for male patients, with the addition of vaginoscopy for female patients. Chi-square was used to compare the screening percentages over time. RESULTS In total, 38 patients were included, of whom 27 (71.1%) underwent cystoscopy ± vaginoscopy, without the occurrence of complications. Nine of 13 females (69.2%) underwent cysto- and vaginoscopy and 18 of 25 males (72.0%) underwent a cystoscopy. The percentage of patients that underwent these procedures improved over the 2 time periods (50.0% in 2019-2020 vs 90.0% in 2021-2022, p = 0.011). In 15 of 27 patients (55.6%) that underwent cystoscopy ± vaginoscopy, additional anomalies were found that were not identified through physical examination or US-kidney. CONCLUSIONS In 56% of the patients that underwent cysto- ± vaginoscopy, additional anomalies were identified that were not with imaging studies or physical examination. This study emphasizes the potential benefit of routine cysto- and vaginoscopy in the diagnostic work-up of children with ARM. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cunera M C de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Daphne T Boom
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tara M Mackay
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Judith J M L Dekker
- Amsterdam UMC, Department of Gynecology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Olga E Arguedas Flores
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Caroline F Kuijper
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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de Beaufort CMC, Derikx JPM, de Jong JR, Burchell GL, Bosscha SRJ, de Beer SA, van Heurn LWE, Gorter RR. Outcomes after Surgical Treatment for Rectal Atresia in Children: Is There a Preferred Approach? A Systematic Review. Eur J Pediatr Surg 2023; 33:345-353. [PMID: 36516962 PMCID: PMC10564564 DOI: 10.1055/s-0042-1758152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/26/2022] [Indexed: 12/23/2022]
Abstract
Rectal atresia (RA) affects only 1 to 2% of all children with anorectal malformations. No consensus on optimal treatment strategy is yet achieved. Therefore, the aim of this systematic review is to summarize all surgical interventions for RA and outcomes described in the current literature. A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library on January 24, 2022. All studies describing treatment for RA in children (< 18 years) were included. Operation technique and postoperative complications were listed. Only descriptive analysis was anticipated. Quality of the studies was assessed using Johanna Briggs Institute critical appraisal checklist for case reports and series. The search yielded 6,716 studies of which, after duplicate removal, 4,028 were excluded based on title and abstract screening. After full-text assessment, 22 of 90 studies were included, yielding 70 patients. Posterior sagittal anorectoplasty (PSARP) and pull-through were most performed (43/70 and 18/70 patients, respectively). Four patients experienced postoperative complications: anal stenosis (n = 1), anastomotic stenosis (n = 2), and death due to a pulmonary complication (n = 1). In the low-quality literature available, most patients with RA are treated with PSARP or pull-through technique. A low complication rate of both has been described but follow-up was often not mentioned. Larger well-designed studies should be performed to determine optimal treatment strategy for children with RA. This study reflects level of evidence V.
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Affiliation(s)
- Cunera M. C. de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Joep P. M. Derikx
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Justin R. de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - George L. Burchell
- Department of Medical Library, Amsterdam University Medical Center, Vrije Universiteit of Amsterdam, Medical Library, Amsterdam, the Netherlands
| | - Sterre R. J. Bosscha
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sjoerd A. de Beer
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lodewijk W. Ernest van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Ramon R. Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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de Beaufort CMC, van den Akker ACM, Kuijper CF, Broers CJM, de Jong JR, de Beer SA, Straver B, Zwijnenburg PJG, Gorter RR. The Importance of Screening for Additional Anomalies in Patients with Anorectal Malformations: A Retrospective Cohort Study. J Pediatr Surg 2023; 58:1699-1707. [PMID: 36586784 DOI: 10.1016/j.jpedsurg.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In children with anorectal malformations (ARM), additional anomalies can occur within the VACTERL-association. Routine screening is of great importance for early identification and potential treatment. However, uniformity in screening protocols is lacking and only small cohorts have been described in literature. The aim of this study was to assess and describe a unique large cohort of ARM patients who underwent VACTERL screening in the neonatal period. METHODS A retrospective mono-center cohort study was performed. Included were all neonates born between January 2000 and December 2020 who were diagnosed with ARM and screened for additional anomalies. Full screening consisted of x-ray and ultrasound of the spine, cardiac and renal ultrasound, and physical examination for limb deformities, esophageal atresia, and ARM. Criteria for VACTERL-classification were predefined according to the EUROCAT-definitions. RESULTS In total, 216 patients were included, of whom 167 (77.3%) underwent full VACTERL-screening (66% in 2000-2006 vs. 82% in 2007-2013 vs. 86% in 2014-2020). Median age at follow-up was 7.0 years (IQR 3.0-12.8). In 103/167 patients (61.7%), additional anomalies were identified. Some 35/216 patients (16.2%) fulfilled the criteria of a form of VACTERL-association. In 37/216 patients (17.1%), a genetic cause or syndrome was found. CONCLUSIONS The majority of ARM patients underwent full screening to detect additional anomalies (77%), which improved over time to 86%. Yet, approximately a quarter of patients was not screened, with the potential of missing important additional anomalies that might have severe consequences in the future. Forms of VACTERL-association or genetic causes were found in 16% and 17% respectively. This study emphasizes the importance of routine screening. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cunera M C de Beaufort
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Alex C M van den Akker
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Caroline F Kuijper
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Urology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Chantal J M Broers
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatrics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Justin R de Jong
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Sjoerd A de Beer
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Bart Straver
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Petra J G Zwijnenburg
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Human Genetics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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de Beaufort CMC, Derikx JPM, Voskeuil ME, Atay J, Kuijper CF, de Beer SA, de Jong JR, de Bos A, Vennink S, van Heurn LWE, Gorter RR. Children with an Anorectal Malformation Going to Primary School: The Parent's Perspective. Children (Basel) 2023; 10:924. [PMID: 37371156 DOI: 10.3390/children10060924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Continence problems occur often in children with anorectal malformations (ARM). The aim of this study was to evaluate parental experiences with toilet facilities at Dutch primary schools and their experience with how schools deal with ARM children. METHODS This survey was developed in collaboration with the national patient advocacy group (PAG). Recruitment for participation was conducted by the PAG (email listing and social media) and one expertise center for ARM. Participants were parents of school-attending ARM children aged 3 to 12 years. RESULTS Sixty-one participants (31.9%) responded to the survey. The median age of the children was 7.0 years (IQR 5.0-9.0). Schools were often located in a village (63.9%) and encompassed 100-500 children (77.0%). In total, 14 parents (23.0%) experienced difficulties in finding a primary school. Experiences with the school were described as solely positive (37.7%), solely negative (9.8%), positive and negative (34.4%), and neither positive nor negative (16.4%). Regarding school toilet facilities, 65.6% of the toilets were reported clean and 78.7% were easily accessible. CONCLUSIONS About 25% of parents reported difficulties in enrolling their children into primary school, and 45% reported negative experiences. This highlights the need for improved guidance and the optimization of education in schools when dealing with ARM children.
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Affiliation(s)
- Cunera M C de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Marijke E Voskeuil
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Josef Atay
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Caroline F Kuijper
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sjoerd A de Beer
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Arnout de Bos
- Vereniging Anusatresie, 1273 ST Huizen, The Netherlands
| | | | - L W Ernest van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
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Eeftinck Schattenkerk LD, Vogel I, de Jong JR, Tanis PJ, Gorter R, Tabbers M, van Heurn LWE, Musters G, Derikx JPM. Impact of presence, level and closure of a stoma on growth in young children: A retrospective cohort study. Eur J Pediatr Surg 2023. [PMID: 37003263 DOI: 10.1055/a-2067-4847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Introduction A stoma will cause nutrients loss which could result in impaired growth. Impaired growth can negatively impact long-term development. This study aims to evaluate: 1) the effect of stomas on growth comparing small bowel stoma versus colostomy, 2) if early closure (within 6 weeks), proximal small bowel stoma (within 50 centimeters of Treitz), major small bowel resection (≥30 centimeters) or adequate sodium supplementation (urinary level ≤30mmol/L) influence growth. Methods Young children (≤3 years) treated with stomas between 1998-2018 were retrospectively identified. Growth was measured with weight-for-age Z-scores. Malnourishment was defined using the WHO-definition. Comparison between changes in Z-scores at creation, closure and a year following closure was done by Friedman-test with post-hoc-Wilcoxon-signed-rank-test or Wilcoxon-rank-sum-test when necessary. Results In the presence of a stoma in 172 children, 61% showed growth decline. Severe malnourishment was seen at time of stoma closure in 51% of the patients treated by small bowel stoma and 16% of those treated by colostomy. Within a year following stoma closure 67% showed a positive growth trend. Having a proximal small bowel stoma and undergoing major small bowel resection led to significantly lower Z-scores at closure. Adequate sodium supplementation and early closure didn't lead to significant changes in Z-scores. Conclusion Stomas have a negative impact on growth in the majority of children. This impact might be decreased by preventing small bowel stomas when possible, specifically proximal stomas, and limiting small bowel resection. Since stoma closure is essential in reversing the negative effect on growth, we opt that early closure might result in an early shift to catch-up growth.
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Affiliation(s)
| | - Irene Vogel
- Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Justin R de Jong
- Pediatric surgery, 1 Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands, Amsterdam, Netherlands
| | - Pieter J Tanis
- Surgery, Erasmus MC Department of Surgery, Rotterdam, Netherlands
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Childrens' Hospital UMC, Amsterdam, Netherlands
| | - Merit Tabbers
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, 1. Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
| | - L W Ernest van Heurn
- Pediatric surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands, Amsterdam, Netherlands
| | - Gijsbert Musters
- Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Joep P M Derikx
- Pediatric surgery, 1 Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands, Amsterdam, Netherlands
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de Beaufort CMC, Groenveld JC, Mackay TM, Slot KM, de Beer SA, de Jong JR, van Schuppen J, McDonald CJ, Bakker DP, van den Berg E, Kuijper CF, Gorter RR. Spinal cord anomalies in children with anorectal malformations: a retrospective cohort study. Pediatr Surg Int 2023; 39:153. [PMID: 36934393 PMCID: PMC10025224 DOI: 10.1007/s00383-023-05440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/20/2023]
Abstract
PURPOSE First, to assess the number of spinal cord anomalies (SCA), specifically tethered spinal cord (TSC) in patients with anorectal malformations (ARM), identified with spinal cord imaging (i.e. spinal cord US and/or MRI). Second, to report outcomes after TSC treatment. METHODS A retrospective mono-center study was performed. All ARM patients born between January 2000 and December 2021 were included. Screening for SCA consisted of spinal cord US and/or MRI. Radiology reports were scored on presence of SCA. Data were presented with descriptive statistics. RESULTS In total, 254 patients were eligible for inclusion, of whom 234 (92.1%) underwent spinal cord imaging. In total, 52 (22.2%) patients had a SCA, diagnosed with US (n = 20, 38.5%), MRI (n = 10, 19.2%), or both US and MRI (n = 22, 42.3%), of whom 12 (23.5%) with simple, 27 (52.7%) intermediate, and 12 (23.5%) complex ARM types. TSC was identified in 19 patients (8.1%), of whom 4 (21.1%) underwent uncomplicated neurosurgical intervention. CONCLUSIONS SCA were present in 22% of ARM patients both in simple, as well as more complex ARM types. TSC was present in 19 patients with SCA, of whom 4 underwent uncomplicated neurosurgical intervention. Therefore, screening for SCA seems to be important for all ARM patients, regardless of ARM type. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Cunera M C de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology and Metabolism Research Institute and Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Julia C Groenveld
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tara M Mackay
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - K Mariam Slot
- Amsterdam UMC, Department of Neurosurgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sjoerd A de Beer
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Joost van Schuppen
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Carola J McDonald
- Amsterdam UMC, Department of Pediatric Neurology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dewi P Bakker
- Amsterdam UMC, Department of Pediatric Neurology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Elske van den Berg
- Amsterdam UMC, Department of Pediatric Neurology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Caroline F Kuijper
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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10
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Eeftinck Schattenkerk RM, Eeftinck Schattenkerk LD, Musters GD, van Schuppen J, de Jong JR, Gorter RR, de Jonge WJ, van Heurn ELW, Derikx JP. Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema. J Pediatr Surg 2023; 58:440-444. [PMID: 35871857 DOI: 10.1016/j.jpedsurg.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Contrast enemas are often made prior to stoma reversal in order to detect distal intestinal strictures distal of the stoma. If untreated these strictures can cause obstruction which might necessitate redo-surgery. However, the value of contrast enemas is unclear. Therefore, we aim to evaluate the contrast enema's diagnostic accuracy in detecting strictures in children with a stoma. METHODS Young children (≤3 years) treated with a stoma between 1998 and 2018 were retrospectively included. The STARD criteria were followed. Patients treated for anorectal malformations and those that died before stoma reversal were excluded. Surgical identification of strictures during reversal or redo-surgery within three months was used as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) reflected diagnostic accuracy. RESULTS In 224 included children, strictures were found during reversal in 10% of which 95% in patients treated for necrotizing enterocolitis. Contrast enema was performed in 68% of all patients and detected 92% of the strictures. In the overall cohort, the sensitivity was 100%, specificity 98%, PPV 88% and NPV 100% whilst the AUC was 0.98. In patients treated for NEC, the sensitivity was 100%, specificity 97%, PPV 88% and NPV 100% whilst the AUC was 0.98. CONCLUSION Strictures prior to stoma reversal seem to be mainly identified in patients treated for NEC and not in other diseases necessitating a stoma. Moreover, the contrast enema shows excellent diagnostic accuracy in detecting these strictures. For this reason we advise to only perform contrast enemas in patients treated for NEC. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Robert M Eeftinck Schattenkerk
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1005 AZ, the Netherlands.
| | - Laurens D Eeftinck Schattenkerk
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1005 AZ, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D Musters
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1005 AZ, the Netherlands
| | - Joost van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Justin R de Jong
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1005 AZ, the Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1005 AZ, the Netherlands
| | - Wouter J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Ernest L W van Heurn
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1005 AZ, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joep Pm Derikx
- Emma Children's Hospital, Amsterdam UMC, Department of Paediatric Surgery, University of Amsterdam, Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam 1005 AZ, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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11
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de Waal AC, van Amstel T, Dekker JJML, Ket JCF, Kuijper CF, Salvatore CM, de Jong JR, Gorter RR. Outcome after vaginal delivery of women with a previous medical history of surgically corrected anorectal malformations: a systematic review. BMC Pregnancy Childbirth 2023; 23:94. [PMID: 36739371 PMCID: PMC9898899 DOI: 10.1186/s12884-023-05389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Discussion remains on how to advise women with a past medical history of surgically corrected anorectal malformations (ARMs) regarding vaginal delivery. The aim of this review is to evaluate and review the reported obstetrical complications and outcomes after vaginal delivery for these women. DATA SOURCES A systematic search was performed from inception up to 25 July 2022 in PubMed, Embase.com and Clarivate Analytics/Web of Science Core Collection, with backward citation tracking. STUDY ELIGIBILITY CRITERIA/APPRAISAL All articles reported on the outcomes of interest in women with a past medical history of surgically corrected anorectal malformation and had a vaginal delivery were included with the exception of editorial comments or invitational commentaries. Screening, data extraction and risk of bias assessment was done by two authors independently with a third and fourth reviewer in case of disagreement. Tool for Quality assessment depended on the type of article. As low quality evidence was expected no meta-analysis was performed. RESULTS Only five of the 2377 articles screened were eligible for inclusion with a total of 13 attempted vaginal deliveries in eight women. In three patients complications were reported: failed vaginal delivery requiring urgent cesarean section in two patients, and vaginal tearing in one patient. CONCLUSION High quality evidence regarding outcomes and complications after vaginal delivery in women with a history of surgically corrected anorectal malformation is lacking. Therefore, based upon this systematic review no formal recommendation can be formulated regarding its safety. Future studies are essential to address this problem. TRIAL REGISTRATION CRD42020201390. Date: 28-07-2020s.
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Affiliation(s)
- Ayla C. de Waal
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Tim van Amstel
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Judith J. M. L. Dekker
- grid.7177.60000000084992262Department of Obstetrics and Gynecology Division of Reproductive Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes C. F. Ket
- grid.12380.380000 0004 1754 9227Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Caroline F. Kuijper
- grid.7177.60000000084992262Department of Paediatric Urology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Concetta M. Salvatore
- grid.7177.60000000084992262Department of Obstetrics and Gynecology Division of Reproductive Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Justin R. de Jong
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Ramon R. Gorter
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
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12
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Vogel I, Eeftinck Schattenkerk LD, Venema E, Pandey K, de Jong JR, Tanis PJ, Gorter R, van Heurn E, Musters GD, Derikx JPM. Major stoma related morbidity in young children following stoma formation and closure: A retrospective cohort study. J Pediatr Surg 2022; 57:402-406. [PMID: 34949444 DOI: 10.1016/j.jpedsurg.2021.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about stoma related morbidity in young children. Therefore, the aim of this study is to assess major morbidity after stoma formation and stoma closure and its associated risk factors. METHODS All consecutive young children (age ≤ three years) who received a stoma between 1998 and 2018 at our tertiary referral center were retrospectively included. The incidence of major stoma related morbidity (Clavien-Dindo grade ≥III) was the primary outcome. This was separately analysed for stoma formation alone, stoma closure alone and all stoma interventions combined. Non-stoma related morbidity was excluded. Risk factors for major morbidity were identified using multivariable logistic regression analysis. RESULTS In total 336 young children were included with a median follow-up of 6 (IQR:2-11) years. Of these young children, 5% (n = 17/336) received a jejunostomy, 57% (n = 192/336) an ileostomy, and 38% (n = 127/336) a colostomy. Following stoma formation, 27% (n = 92/336) of the young children experienced major stoma related morbidity, mainly consisting of high output stoma, prolapse and stoma stenosis. The major morbidity rate was 23% (n = 66/292) following stoma closure, most commonly comprising anastomotic leakage/stenosis, incisional hernia and adhesive obstructions. For combined stoma interventions, major stoma related morbidity was 39% (n = 130/336). Ileostomy was independently associated with a higher risk of developing major morbidity following stoma formation (OR:2.5; 95%-CI:1.3-4.7) as well as following closure (OR:2.7; 95%-CI:1.3-5.8). CONCLUSIONS Major stoma related morbidity is a frequent and severe clinical problem in young children, both after stoma formation and closure. The risk of morbidity should be considered when deliberating a stoma.
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Affiliation(s)
- Irene Vogel
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Esmée Venema
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Karan Pandey
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Justin R de Jong
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ramon Gorter
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ernest van Heurn
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D Musters
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joep P M Derikx
- Emma Childen's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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13
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Zwetsloot SLM, de Jong JR, van Rijn RR. [A young teenager with chronic postprandial emesis]. Ned Tijdschr Geneeskd 2022; 166:D6656. [PMID: 35499608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A girl, 11 years of age, presented with progressive abdominal pain and emesis after eating since 9 months. Her blood count only showed an iron deficiency anaemia. Diagnostic work-up suggested an ileo-ileal intussusception caused by a pedunculated polyp. Diagnosis was confirmed by laparoscopic-assisted resection of the involved small bowel.
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Affiliation(s)
- Sabrina L M Zwetsloot
- Vrije Universiteit Amsterdam, Faculteit der Geneeskunde, Amsterdam
- Contact: Sabrina L.M. Zwetsloot
| | - Justin R de Jong
- Amsterdam UMC, locatie UvA, Amsterdam: Emma Kinderziekenhuis, Afd. Kinderchirurgie
| | - Rick R van Rijn
- Amsterdam UMC, locatie UvA, Amsterdam: Afd. Radiologie en Nucleaire Geneeskunde
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14
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Markus J, Sibbing IC, Ket JCF, de Jong JR, de Beer SA, Gorter RR. Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review. J Pediatr Surg 2021; 56:605-613. [PMID: 32553455 DOI: 10.1016/j.jpedsurg.2020.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children. Currently, both nonsurgical and surgical treatment options are available to treat this disease. The objective was to give insight into the success rate of different treatment strategies for children with ACNES, and provide treatment recommendations for physicians based on the published evidence. METHOD A literature search of PubMed, Embase.com and the Wiley/Cochrane Library was conducted for studies published up to 25 February 2020. Randomized controlled trials, prospective or retrospective cohort studies, meta-analyses and literature reviews describing the outcome of different treatment strategies for children (<18 years old) with ACNES with a follow-up duration of at least four weeks were included. RESULTS Six studies, involving 224 patients, were included with an overall quality reported to be between fair and poor. Treatment success of local injections with an anesthetic agent into the trigger point ranged from 38% to 87% with a follow-up ranging from 4 weeks to 39 months. In addition, treatment success of anterior neurectomy ranged from 86% to 100%, with a follow-up duration ranging from 4 weeks to 36 months. CONCLUSION A step-up treatment strategy should be applied when treating pediatric patients with ACNES. This strategy starts with an injection with a local anesthetic agent, reserving surgery (anterior neurectomy) as a viable option in case of persistent pain. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jasper Markus
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands.
| | - Iris C Sibbing
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | | | - Justin R de Jong
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | - Sjoerd A de Beer
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
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15
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Markus J, van Montfoort M, de Jong JR, de Beer SA, Aronica EMA, Gorter RR. Histopathologic examination of resected nerves from children with anterior cutaneous nerve entrapment syndrome: Clues for pathogenesis? J Pediatr Surg 2020; 55:2783-2786. [PMID: 32156426 DOI: 10.1016/j.jpedsurg.2020.01.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome (ACNES) has been described as a possible cause for chronic pain in the pediatric population. However, the exact pathophysiology of ACNES is unknown. It may be caused by compression or traction of cutaneous nerve branches of intercostal nerves, or it may be the result of an infection. Therefore, we present histopathological evidence to determine the pathophysiology of ACNES. METHODS A total of seven pediatric patients underwent a neurectomy for ACNES. All specimens were sent for histopathological evaluation, including immunohistochemical staining, to evaluate if there were any signs of infection, inflammation or compression. RESULTS Seven out of seven (100%) histopathological specimens showed non-specific nerve degeneration. Immunohistochemical evaluation showed there were several CD68-positive macrophages present in the specimens. Four out of seven (57%) specimens showed the presence of a few CD3-positive T-cells, however, this was not suggestive for inflammation or infection. CONCLUSION Our study supports the hypothesis that ACNES is caused by compression of the nerves rather than inflammation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jasper Markus
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands.
| | - Maurits van Montfoort
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Justin R de Jong
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | - Sjoerd A de Beer
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | - Eleonora M A Aronica
- Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
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16
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Vriesman MH, Noor N, Koppen IJ, Di Lorenzo C, de Jong JR, Benninga MA. Outcomes after enterostomies in children with and without motility disorders: A description and comparison of postoperative complications. J Pediatr Surg 2020; 55:2413-2418. [PMID: 32600839 DOI: 10.1016/j.jpedsurg.2020.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung's disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders (including necrotizing enterocolitis, anorectal malformation and inflammatory bowel disease). METHODS We performed a retrospective study of children who underwent an enterostomy procedure at our institution. The number and type of complications and subsequent reoperations after ostomy formation were determined. Complications were scored using the Clavien-Dindo classification. A complication of ≥ grade III-b was considered a high-grade complication. RESULTS 129 children with an ileostomy and 61 children with a colostomy were included. Of these, 62 children (32.6%) had motility disorders; functional constipation (n=40), Hirschsprung's disease (n=18) and PIPO (n=4). The total prevalence of complications was 73.2%. Comparing the perioperative data, children with motility disorders significantly more often underwent a laparoscopic procedure (59.7% vs. 10.9%, p=0.000) and had an end stoma-configuration (37.1% vs. 14.1%, p=0.000) as compared to children without motility disorders. Children with motility problems had a higher complication rate (88.7% vs. 65.5%, OR 4.1, 95% CI 1.7-9.8, p=0.001) compared to children without motility problems, and a larger proportion of complications was classified as high-grade complications (61.8% vs. 31.0% p =0.002). CONCLUSION A high complication rate after enterostomy formation was detected. Children with gastrointestinal motility disorders had more and more severe complications as compared to children without motility disorders. LEVEL OF EVIDENCE Level III TYPE OF STUDY: Retrospective comparative study.
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Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Najia Noor
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilan J Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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17
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Musters GD, Oomen MWN, Zwaveling S, de Jong JR, de Beer SA. [Dynamic compression brace for pectus carinatum: 5 years on]. Ned Tijdschr Geneeskd 2019; 163:D3557. [PMID: 30638003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pectus carinatum is a congenital chest-wall deformity with a prevalence of 0.3-0.7%. This chest-wall deformity can lead to functional, cosmetic and psychosocial problems. For many years, the only available treatment was an invasive surgical procedure. A less-invasive treatment, namely external compression of the sternum with a brace, showed disappointing results due to discomfort, a high percentage of skin complications and low compliance. The introduction of the dynamic compression brace has meant that the pressure of sternal compression can be measured and adjusted, which has improved comfort and compliance and resulted in an increased success rate of 92% and a decrease in the percentage of skin complications to just 8%. Despite the fact that wearing a compression brace for a longer period of time is not an easy undertaking for an adolescent, the use of the dynamic compression brace results in a high success rate, and is a safe and an efficient treatment.
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Affiliation(s)
| | | | | | | | - Sjoerd A de Beer
- Amsterdam UMC, locatie AMC-UvA, afd. Kinderchirurgie
- Contact: S.A. de Beer
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Abstract
BACKGROUND Patients with pectus carinatum have been treated with orthotic braces since the 1970s. By applying external pressure to the anterior chest wall, a normal chest shape can be restored. However, high patient treatment dropout rates were reported because of the subjectively high pressures applied to the patient´s skin. Measured dynamic compression allows measurement and adjustments of the brace's pressure on the thoracic wall, leading to a controlled correction. METHODS We performed an electronic database search (Pubmed and Cochrane) of the medical literature on measured dynamic compression. A total of 14 studies were found and eight studies between 2008 and 2018 were included. Study designs ranged from retrospective chart reviews to cross-sectional cohort studies. RESULTS From the 8 studies, 1185 patients were included. The median age was 14 years (range 2-28) and 87% were male. The mean study follow up period was 16 months; 44% of patients were still under treatment, 29% of patients successfully completed treatment. 6% dropped out and 21% were lost to follow-up. Dropout was mainly caused social discomfort (7.2%) and failure of treatment (5.8%). Complications were infrequent. Mild chest discomfort or tightness was reported in 12% and skin lesions occurred in 5.1%. The overall recurrence rate was 2.6%. CONCLUSIONS Several studies are available on measured dynamic compression. Dynamic compression appears to be a safe, non-invasive and efficient treatment to correct pectus carinatum in patients with a non-rigid thorax. Patients experience less discomfort, which in turn results in better compliance. However, accurate selection of patients based on age, pressure of initial correction and motivation is important and an objective scoring system to assess the esthetic and long-term physical and psychological results of the treatment is needed.
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Affiliation(s)
- Sjoerd A de Beer
- Department of Pediatric Surgery, Academic Medical Center (AMC), Amsterdam, the Netherlands .
| | - Yael E Blom
- Department of Pediatric Surgery, Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Manuel Lopez
- Department of Pediatric Surgery and urology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Justin R de Jong
- Department of Pediatric Surgery, Academic Medical Center (AMC), Amsterdam, the Netherlands
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19
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de Beer SA, Gritter M, de Jong JR, van Heurn ELW. The Dynamic Compression Brace for Pectus Carinatum: Intermediate Results in 286 Patients. Ann Thorac Surg 2017; 103:1742-1749. [PMID: 28274516 DOI: 10.1016/j.athoracsur.2016.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/29/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dynamic brace compression is a novel treatment for patients with pectus carinatum. The dynamic compression system contains a device to measure the flexibility of the thoracic wall and regulate the pressure of the brace. METHODS Patients referred to our pediatric surgical center were screened for treatment with the dynamic compression brace. Patients with a pressure of initial correction (PIC) of 10.0 pounds per square inch or less were offered treatment with the brace. Patients with a PIC above 10.0 pounds per square inch were offered surgical correction. Between March 2013 and April 2016, 286 patients were treated with the brace; 260 were male (91%) and 26 were female (9%). Their mean age was 14 years (range, 4 to 21 years). RESULTS Seventy-eight patients completed brace treatment; the mean treatment time was 14 months. Twenty-seven patients abandoned treatment because of lack of motivation, loss to follow-up, persistent protrusion of the sternal bone or flaring that required surgical correction, failure of treatment because of a bifid rib, fear of locking the brace, and delayed correction. One hundred eighty-one patients are still wearing the brace, either in the active or in the retainer phase. Patients with a high PIC also showed improvement when they were compliant. Adverse events were minor and included skin lesions (n = 4, 1%) and vasovagal reactions at the start of therapy (n = 3, 1%). CONCLUSIONS These data show that brace therapy can be considered a valuable treatment option to correct pectus carinatum in patients with a flexible thorax.
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Affiliation(s)
- Sjoerd A de Beer
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands.
| | - Martin Gritter
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands
| | - Justin R de Jong
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands
| | - Ernst L W van Heurn
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands
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20
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Wille J, de Jong JR, Moll FL, Hammacher ER, van der Zwan A, Fick TE, Ugahary F. Endofibrosis of the External Iliac Artery in Sportsmen Clinical Review and Four New Cases. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449803200405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endofibrosis of the external iliac artery is an unusual condition associated with competition cyclists. There seems to be a good prognosis after surgical therapy, consisting of endarterectomy and vein patching in combination with resection if the artery is lengthened. However, absence of well-documented long-term follow-up studies makes surgical treatment controversial. The authors describe four new patients with endofibrosis of the external iliac artery (EIA) with a review of relevant literature.
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Affiliation(s)
- Jan Wille
- Department of Surgery, St. Antonius Hospital, Nieuwegein
| | | | - Frans L. Moll
- Department of Surgery, St. Antonius Hospital, Nieuwegein
| | | | | | - Tom E. Fick
- Department of Surgery, University Hospital Utrect
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21
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van Poll D, de Beer SA, de Jong JR, Heij HA. [Mechanical ileus in children with no prior history of abdominal surgery]. Ned Tijdschr Geneeskd 2015; 159:A8911. [PMID: 26443112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In children with no prior history of abdominal surgery and no signs of intussusception or incarcerated inguinal hernia, mechanical ileus may have a congenital cause such as malrotation with volvulus or a persistent omphalomesenteric duct. Acquired causes include sigmoid volvulus. We present two cases of mechanical ileus in children. The first case involved a 6-year-old boy who presented with acute abdominal pain and vomiting. An emergency laparotomy was performed, with resection of the omphalomesenteric duct. Recovery was uneventful. The other case concerned a 9-year-old boy who presented with increasing abdominal pain, bilious vomiting and general clinical deterioration. An emergency laparotomy was performed, revealing malrotation with volvulus and intestinal ischaemia. Children with no prior abdominal history who present with symptoms that may be caused by mechanical obstruction should be managed with a view to surgery and without delay, in order to prevent a catastrophic outcome resulting from a congenital or acquired mechanical obstruction.
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Affiliation(s)
- Daan van Poll
- Academisch Medisch Centrum en VUmc, Kinderchirurgisch Centrum Amsterdam, Amsterdam
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22
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Versteegh HP, Sloots CEJ, Wolffenbuttel KP, de Jong JR, Sleeboom C, Feitz WF, van Heurn LWE, van der Zee DC, Wijnen RMH, de Blaauw I. Urogenital function after cloacal reconstruction, two techniques evaluated. J Pediatr Urol 2014; 10:1160-4. [PMID: 24957462 DOI: 10.1016/j.jpurol.2014.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Current surgical techniques for cloacal reconstruction are posterior sagittal anorecto vagino urethroplasty (PSARVUP) and posterior sagittal anorectoplasty (PSARP) with total urogenital mobilization (TUM). The aim of this study was to explore the results of reconstructive cloaca surgery in the Netherlands and evaluate urogenital function after PSARVUP and TUM. PATIENTS AND METHODS Medical records from five pediatric surgical departments in the Netherlands were studied for patients with cloacal malformations treated between 1985 and 2009. Forty-two patients were eligible, and patients with short common channels were categorized into PSARVUP and TUM groups. Groups were compared using Fisher's exact test. RESULTS Median age at time of surgery was 9 months (range 1-121). In 24 patients (57%) a PSARVUP was done, in 18 patients (43%) TUM. Median follow-up was 142 months (range 15-289). At follow-up spontaneous voiding was seen in 29 patients (69%). Clean intermittent catheterization (CIC) was needed in 14 patients (33%); a urinary diversion was created in 10 patients (24%). In total 32 patients (76%) were dry with no involuntary loss of urine per urethra. Recurrent urinary tract infections were seen in 23 patients (55%). When comparing PSARVUP and TUM groups in our series of patients with short common channels, there were no differences in urological outcome. Normal menstruation was present in 11 of the 20 patients who reached puberty (55%). CONCLUSION Urogenital functional outcome after reconstructive surgery for cloacal malformations was similar in PSARVUP and TUM groups in patients with short common channels. A thorough urological follow-up is needed to establish the long-term bladder function and urinary incontinence results to prevent long-term risks of recurrent UTI. Albeit without differences between PSARVUP and TUM groups, 45% of the patients present with abnormal or absent menstruations. Gynecological follow-up is mandatory in all patients with cloacal malformations 6 months after the first sign of puberty.
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Affiliation(s)
- Hendt P Versteegh
- Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
| | - Cornelius E J Sloots
- Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
| | - Katja P Wolffenbuttel
- Dept. of Pediatric Urology, Erasmus MC-Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
| | - Justin R de Jong
- Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Christien Sleeboom
- Pediatric Surgical Center Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Wout F Feitz
- Dept. of Pediatric Urology, Radboud University Medical Center - Amalia Children's Hospital, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - L W Ernest van Heurn
- Dept. of Pediatric Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - David C van der Zee
- Dept. of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Rene M H Wijnen
- Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
| | - Ivo de Blaauw
- Dept. of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands; Dept. of Surgery - Pediatric Surgery, Radboud University Medical Center - Amalia Children's Hospital, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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23
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de Beer SA, de Jong JR, Heij HA. [Dynamic compression brace for pectus carinatum]. Ned Tijdschr Geneeskd 2013; 157:A6796. [PMID: 24220182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pectus carinatum occurs in one of 1500-1700 people and may lead to physical, cosmetic and psychosocial problems. Surgical treatment of pectus carinatum is performed using the 'Ravitch procedure'. An alternative and less invasive treatment consists of external compression with a brace. Results are often disappointing because of skin complications, a low level of comfort of the brace and low compliance. Nowadays a new brace (dynamic compression brace) exists with which the comfort and thus the compliance can be increased by measuring and regulating the pressure of correction during the treatment. This leads to better results and fewer complications. In 80-90% of patients the results are good to excellent and an operation can be avoided. This new brace is therefore a less invasive, cheap and safe alternative to the Ravitch procedure in the treatment of pectus carinatum in children.
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Affiliation(s)
- Sjoerd A de Beer
- Kinderchirurgisch Centrum Amsterdam, Emma Kinderziekenhuis, AMC en VUmc, Amsterdam
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24
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de Jong JR. Surgical treatment of the obese adolescent. J Pediatr Gastroenterol Nutr 2011; 53 Suppl 2:S28-30. [PMID: 22235461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Justin R de Jong
- Department of Pediatric Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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25
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Kuiper RJL, de Jong JR, Kneepkens CMF. [There is something coming out of the anus of my child]. Ned Tijdschr Geneeskd 2011; 155:A2735. [PMID: 21291582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The diagnosis of anal protrusions in children may be difficult, because the protrusion often occurs only after defaecation, and is usually invisible during the consultation. We present three cases of children with rectal prolapse (4-year-old boy), polyp (4-year-old boy), and external haemorrhoids (3-year-old boy), respectively. In each case, the diagnosis could be made after parents had sent a picture of the phenomenon. The first patient recovered after laxative therapy, the second after polypectomy, and in the third patient, the haemorrhoid persisted, despite laxative therapy and physiotherapy.
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de Betue CT, Boersma D, Oomen MW, Benninga MA, de Jong JR. Volvulus as a complication of chronic intestinal pseudo-obstruction syndrome. Eur J Pediatr 2011; 170:1591-5. [PMID: 21947197 PMCID: PMC3221853 DOI: 10.1007/s00431-011-1554-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 08/04/2011] [Indexed: 01/21/2023]
Abstract
UNLABELLED Chronic intestinal pseudo-obstruction syndrome (CIPS) is a severe motility disorder of the gastrointestinal tract that presents with continuous or recurrent symptoms and signs of intestinal obstruction without evidence of a structural lesion occluding the intestinal lumen. Mechanical obstruction might occur in these patients as well but is typically difficult to distinguish from an exacerbation of CIPS. We report two pediatric cases in which mechanical obstruction by volvulus mimicked an exacerbation of CIPS, requiring surgical intervention. CONCLUSION Awareness of the possibility of true mechanical obstruction in CIPS patients during an exacerbation episode is needed, as this is a severe condition and usually requires surgical intervention.
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Affiliation(s)
- Carlijn T. de Betue
- Department of Pediatric Surgery, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Department of Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children’s Hospital, University Medical Center, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
| | - Doeke Boersma
- Department of Pediatric Surgery, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Matthijs W. Oomen
- Department of Pediatric Surgery, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Justin R. de Jong
- Department of Pediatric Surgery, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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27
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Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) influences gastroesophageal reflux. METHODS 26 patients undergoing gastric banding were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy and barium swallows, preoperatively, at 6 weeks and at 6 months after operation. RESULTS Gastric banding had minimal effect on heartburn scores, but regurgitation and belching scores increased significantly during follow-up. Use of acid-reducing drugs decreased significantly at 6 weeks and increased significantly at 6 months. Pathological reflux was present in 13 of the 26 patients preoperatively. At 6 months pathological reflux was found in only 6 of these 13 patients, but 4 of the 13 patients with preoperative normal reflux patterns had developed pathological reflux. 6 months after the operation esophagitis had disappeared in 6 patients and was increased in 9 patients. In 9 patients, a pouch was found at 6 months. Pouch formation was significantly correlated with the presence of pathological reflux, esophagitis and the use of acid-reducing medication. Preoperative presence of a hiatal hernia did not influence pouch formation or pathological reflux. CONCLUSION LAGB decreases gastroesophageal reflux if there is no pouch formation during follow-up.
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Affiliation(s)
- Justin R de Jong
- Department of Surgery, University Medical Center, Heidelberglaan 100, CX-3584 Utrecht, The Netherlands.
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