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Di Mitri M, Parente G, Bisanti C, Thomas E, Cravano SM, Cordola C, Vastano M, Collautti E, Di Carmine A, Maffi M, D’Antonio S, Libri M, Gargano T, Lima M. Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children. Diagnostics (Basel) 2023; 13:3285. [PMID: 37892106 PMCID: PMC10606892 DOI: 10.3390/diagnostics13203285] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI's management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. MATERIALS AND METHODS The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. RESULTS An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. CONCLUSION We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way.
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Affiliation(s)
- Marco Di Mitri
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (G.P.); (C.B.); (E.T.); (S.M.C.); (C.C.); (M.V.); (E.C.); (A.D.C.); (M.M.); (S.D.); (M.L.); (T.G.); (M.L.)
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Di Mitri M, Thomas E, Di Carmine A, Manghi I, Cravano SM, Bisanti C, Collautti E, Ruspi F, Cordola C, Vastano M, D'Antonio S, Libri M, Gargano T, Lima M. Intraoperative Ultrasound in Minimally Invasive Laparoscopic and Robotic Pediatric Surgery: Our Experiences and Literature Review. Children (Basel) 2023; 10:1153. [PMID: 37508649 PMCID: PMC10378675 DOI: 10.3390/children10071153] [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: 04/22/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
Ultrasound (US) is a non-invasive imaging technique frequently used to examine internal organs and superficial tissues, and invaluable in pediatric patients. In a surgical setting, intraoperative ultrasound allows to highlight anatomical structures in detail during traditional open and minimally invasive surgery, thanks to the use of specific probes. In fact, laparoscopic and robotic ultrasonography requires the development of specialized transducers that fit through laparoscopic trocars. In adults, laparoscopic ultrasound is used during cholecystectomy before dissection of the triangle of Calot, to guide liver biopsies and ablation procedures and for the staging of patients with pancreas adenocarcinoma. However, the applications in the pediatric field are still limited. This paper aims to share our preliminary experience with ultra-sound in minimally invasive laparoscopic and robotic pediatric surgery, describing two cases in which intra-operative ultrasound was applied, and to present a review of the literature on the state of the art of the actual uses in pediatric surgery.
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Affiliation(s)
- Marco Di Mitri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Eduje Thomas
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Annalisa Di Carmine
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Ilaria Manghi
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Sara Maria Cravano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Cristian Bisanti
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Edoardo Collautti
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Francesca Ruspi
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Chiara Cordola
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Marzia Vastano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Simone D'Antonio
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Michele Libri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
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Parente G, Ruspi F, Thomas E, Di Mitri M, Cravano SM, D'Antonio S, Gargano T, Lima M. Endoscopic Pilonidal Sinus Treatment: Preliminary Results, Learning Curve and Comparison with Standard Open Approach. Children (Basel) 2023; 10:1063. [PMID: 37371294 DOI: 10.3390/children10061063] [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: 05/12/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Background: Pilonidal sinus (PNS) is a common disease which can lead to complications including infection and abscess formation. Different surgical approaches have been suggested, based on primary or secondary wound closure intention healing or endoscopic treatment (EPSiT). The aim of this study is to verify the superior outcomes of EPSiT, especially in comparison with the traditional open approach, and discuss the operators' learning curve. Methods: A retrospective study was conducted identifying all the patients who underwent surgical treatment for PNS with EPSiT technique between 2019 and 2022 and with open technique between 2002 and 2022. We divided patients in two groups: open procedure (group 1) and EPSiT (group 2). We considered a p value < 0.05 as statistically significant. Results: The mean operative time was 58.6 ± 23.7 min for group 1 and 42.8 ± 17.4 min for group 2 (p < 0.01). The mean hospital stay was 2.6 ± 1.7 days for group 1 patients and of 0.8 ± 0.4 days for group 2 (p < 0.01). Complete healing was obtained in 18.7 ± 5.6 days for group 1 and 38.3 ± 23.5 days for group 2 (p < 0.01). Recurrences were of 23.4% for group 1 and 5.4% for group 2 (p = 0.03). Conclusions: EPSiT is a minimally invasive and effective approach for the treatment of pilonidal cyst that can be safely performed in pediatric patients with promising results concerning aesthetic outcome and pain control, and with a rapid and less complicated recovery compared to traditional open procedures.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Francesca Ruspi
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Eduje Thomas
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Marco Di Mitri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Sara Maria Cravano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Simone D'Antonio
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
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Parente G, Di Mitri M, Thomas E, Cravano SM, D’Antonio S, Gargano T, Libri M, Lima M. A case of massive subcutaneous emphysema and transient ischemic attack due to argon plasma coagulation following endoscopic pilonidal sinus treatment. J Surg Case Rep 2023; 2023:rjad324. [PMID: 37305345 PMCID: PMC10256626 DOI: 10.1093/jscr/rjad324] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023] Open
Abstract
Pilonidal sinus is a small hole affecting the skin and subcutaneous tissue, which usually contains hair and skin debris, resulting in the creation of the so-called pilonidal cyst. The endoscopic pilonidal sinus treatment (EPSiT) is a minimally invasive procedure consisting of the removal of hairs and cauterization of the cavity under direct endoscopic vision. In our institution, we used to end this procedure with argon plasma coagulation (APC). Here, we discuss a case of 22-year-old man affected by pilonidal disease, who developed a massive subcutaneous emphysema and suspected transient ischemic attack secondary to gas reabsorption after an EPSiT in which APC was used for the coagulation.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Di Mitri
- Correspondence address. Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna (IT), Via Massarenti 11, 40138, Bologna, Italy. Tel: +39-051/214.4656; Fax: +39-051/214.4619; E-mail:
| | - Eduje Thomas
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Maria Cravano
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Simone D’Antonio
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Michele Libri
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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