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Glenisson M, Bonnard A, Berrebi D, Belarbi N, Viala J, Martinez-Vinson C. Complications and Disease Recurrence After Ileocecal Resection in Pediatric Crohn's Disease: A Retrospective Study. Eur J Pediatr Surg 2024; 34:253-260. [PMID: 36882155 PMCID: PMC11076103 DOI: 10.1055/a-2048-7407] [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: 09/28/2022] [Accepted: 12/15/2022] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aim of this retrospective study was to describe the risk of postoperative recurrence (POR) after ileocecal resection, the occurrence of surgical complications, and identify predictors of these adverse postoperative outcomes in pediatric Crohn's disease (CD). PATIENTS AND METHODS All the children less than 18 years of age with a diagnosis of CD, who underwent primary ileocecal resection for CD between January 2006 and December 2016 in our tertiary center, were considered for inclusion. Factors related to POR were investigated. RESULTS A total of 377 children were followed for CD between 2006 and 2016. During this period, 45 (12%) children needed an ileocecal resection. POR was diagnosed in 16% (n = 7) at 1 year and 35% (n = 15) at the end of the follow-up, with a median follow-up of 2.3 years (Q1-Q3 1.8-3.3). Median duration of the postoperative clinical remission was 1.5 years (range 0.5-2). Multivariate Cox regression analysis identified only young age at diagnosis as a risk factor for POR.In total, 7 of the 43 patients (16%) developed severe postoperative complications, defined as requiring surgical, endoscopic, or radiological intervention. The only risk factor was intraoperative abscess. CONCLUSION Only young age at diagnosis was associated with POR. This information could be useful to develop targeted therapeutic strategies for young CD children. At the end of follow-up with a median follow-up of 2.3 years (Q1-Q3 1.8-3.3), there was no surgical POR: endoscopic dilatation for POR should be considered in order to delay or prevent surgery.
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Affiliation(s)
- M Glenisson
- Department of Pediatric Surgery, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - A Bonnard
- Department of Pediatric Surgery, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - D Berrebi
- Department of Pediatric Pathology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Belarbi
- Department of Pediatric Radiology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - J Viala
- Department of Pediatric Gastroenterology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - C Martinez-Vinson
- Department of Pediatric Gastroenterology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
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Garabedian C, Bonnard A, Rousseau V, Sfeir R, Drumez E, Michaud L, Gottrand F, Houfflin-Debarge V. Management and outcome of neonates with a prenatal diagnosis of esophageal atresia type A: A population-based study. Prenat Diagn 2018; 38:517-522. [DOI: 10.1002/pd.5273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023]
Affiliation(s)
- C. Garabedian
- Department of Obstetrics; CHU Lille; Lille France
- EA 4489-Perinatal Environment and Health; Univ. Lille; Lille France
- CHU Lille, CRACMO Reference Center for Rare Esophageal Diseases, Univ. Lille, LIRIC UMR 995; Lille France
| | - A. Bonnard
- Department of Paediatric Surgery; University Hospital Robert Debré; Paris France
| | - V. Rousseau
- Department of Paediatric Surgery; University Hospital Necker-Enfants Malades; Paris France
| | - R. Sfeir
- Department of Paediatric Surgery; CHU Lille; Lille France
| | - E. Drumez
- Department of Biostatistics, EA 2694-Santé Publique : épidémiologie et qualité des soins; Univ. Lille, CHU Lille; Lille France
| | - L. Michaud
- CHU Lille, CRACMO Reference Center for Rare Esophageal Diseases, Univ. Lille, LIRIC UMR 995; Lille France
| | - F. Gottrand
- CHU Lille, CRACMO Reference Center for Rare Esophageal Diseases, Univ. Lille, LIRIC UMR 995; Lille France
| | - V. Houfflin-Debarge
- Department of Obstetrics; CHU Lille; Lille France
- EA 4489-Perinatal Environment and Health; Univ. Lille; Lille France
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Creuzé M, Afchain P, Munck A, Viala J, Bonnard A, Bertrand V. [Desmoid tumors in an adolescent girl with familial adenomatous polyposis]. Arch Pediatr 2016; 23:1141-1145. [PMID: 27692552 DOI: 10.1016/j.arcped.2016.08.009] [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] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 07/04/2016] [Accepted: 08/25/2016] [Indexed: 10/20/2022]
Abstract
Desmoid tumors (DT) are rare and nonmetastasizing fibroblastic neoplasms, characterized by local invasiveness. They occur sporadically or arise in the context of familial adenomatous polyposis (FAP; 5-10% of cases). Most cases develop sporadically in young adults, but some cases also occur in children. We report the case of an adolescent girl with FAP and DT, and we discuss the therapeutic strategies. An adolescent girl with FAP underwent surgery at the age of 14 years with total proctocolectomy. She had a neo-mutation in the APC gene at codon 1068, which is not usually associated with DT. Three years later, she had painful defecations. Imaging showed two abdominal DT. After a multidisciplinary team meeting, the patient was refused for surgery, and medical treatment with antihormonal agents and nonsteroidal anti-inflammatory drugs was started. Imaging 18 months later showed DT stabilization, but the patient had difficulties to control chronic pains, which required morphine treatment, hypnotic sessions, and transcutaneous electric nerve stimulation. This case highlights the importance of DT screening in patients with FAP, mainly after surgery, regardless of their age and genetic mutation. Progress remains to be made in determining DT risk factors and in developing treatment. DT are still difficult to cure because of their potential for local invasion and local recurrence, and need to be managed by a multidisciplinary team.
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Affiliation(s)
- M Creuzé
- Service de pédiatrie, centre hospitalier Jacques-Monod, 29, avenue Pierre-Mendès, 76600 Le Havre, France
| | - P Afchain
- Service d'oncologie médecine interne, hôpital St-Antoine, 184, rue du Faubourg-St-Antoine, 75571 Paris cedex 12, France
| | - A Munck
- Service de gastroentérologie et nutrition pédiatrique, hôpital Robert-Debré, 7019 université Paris 7, Assistance publique-Hôpitaux de Paris, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - J Viala
- Service de gastroentérologie et nutrition pédiatrique, hôpital Robert-Debré, 7019 université Paris 7, Assistance publique-Hôpitaux de Paris, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - A Bonnard
- Service de chirurgie pédiatrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - V Bertrand
- Service de pédiatrie, centre hospitalier Jacques-Monod, 29, avenue Pierre-Mendès, 76600 Le Havre, France.
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Maesani M, Pares F, Michelet D, Abdat R, Hilly J, Diallo T, Greff B, Malbezin S, Bonnard A, Dahmani S. Haemodynamic and cerebral oxygenation during paediatric laparoscopy in fluid optimized patients. Br J Anaesth 2016; 116:564-6. [PMID: 26994241 DOI: 10.1093/bja/aew041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Garabedian C, Sfeir R, Langlois C, Bonnard A, Khen-Dunlop N, Gelas T, Michaud L, Auber F, Piolat C, Lemelle JL, Fouquet V, Habonima É, Becmeur F, Polimerol ML, Breton A, Petit T, Podevin G, Lavrand F, Allal H, Lopez M, Elbaz F, Merrot T, Michel JL, Buisson P, Sapin E, Delagausie P, Pelatan C, Gaudin J, Weil D, de Vries P, Jaby O, Lardy H, Aubert D, Borderon C, Fourcade L, Geiss S, Breaud J, Pouzac M, Echaieb A, Laplace C, Gottrand F, Houfflin-Debarge V. Le diagnostic anténatal modifie-t-il la prise en charge néonatale et le devenir à 1 an des enfants suivis pour atrésie de l’œsophage de type III ? ACTA ACUST UNITED AC 2015; 44:848-54. [DOI: 10.1016/j.jgyn.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 11/09/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
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Bonnard A, Masmoudi M, Boimond B, Capito C, Holvoet L, Skhiri A, El Ghoneimi A. Acute chest syndrome after laparoscopic splenectomy in children with sickle cell disease: operative time dependent? Pediatr Surg Int 2014; 30:1117-20. [PMID: 25245325 DOI: 10.1007/s00383-014-3600-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Accepted: 09/17/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Laparoscopic splenectomy remains a technically demanding procedure. On patients with sickle cell disease (SCD), a post operative acute chest syndrome (ACS) can occur. The aim of the study was to look for predictive factors of post operative ACS. PATIENTS AND METHOD It's a retrospective study on patients with SCD, who underwent a laparoscopic splenectomy in Robert Debré hospital, Paris, France, between March 2008 and December 2013. Diagnosis of ACS was done if the patient developed hypoxemia associated with fever above 38.5 °C and an infiltrate on chest x ray during the post operative course. Pre-, post- and operative factors were studied. Descriptive statistics were compared using the Mann-Whitney test or the exact Fisher test. A p inferior to 0.05 was considered as significant. RESULTS 52 patients with SCD underwent a laparoscopic splenectomy. Twelve patients presented a post operative ACS (23%) (mean age at surgery 4 years old) while forty did not (mean age 5.25 years old). Neither previous episode of ACS nor any factors reflecting SCD severity were significant. The shorter the operative time was, the greater the risk of developing an ACS (p < 0.05). CONCLUSION ACS is an important complication following laparoscopic splenectomy in patients with SCD. The immediate post operative management, in the absence of predictive factors for ACS, should be carefully followed in a high dependency unit at least for 48 h for all patients.
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Affiliation(s)
- A Bonnard
- Department of General Pediatric Surgery and Pediatric Urology, Robert Debré Hospital and Paris VII University, APHP, 48 Boulevard Serurier, 75019, Paris, France,
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Muller C, Berrebi D, Malbezin S, Rega A, El Ghoneimi A, Bonnard A. SFCP CO-09 - Variation de marquage par la calrétinine dans les formes courtes de Maladie de Hirschsprung : un facteur pronostic ? Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71647-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Muller CO, Bonnard A. Apport de la thoracoscopie dans le traitement de l’atrésie de l’œsophage. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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de Lagausie P, Hery G, Guys J, Bonnard A. SFCP P-057 - Une reconnection après Bianchi déconnection est possible. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muller C, Viala J, De Lagausie P, Berrebi D, Hilly J, El Ghoneimi A, Bonnard A. SFCP CO-10 - Lésions Crohn-like et entérocolites tardives dans les formes longues de maladie de Hirschsprung. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maignan A, Bonnard A, Hery G, Guys JM, de Lagausie P. Oesophagogastric reconnection is possible. Pediatr Surg Int 2014; 30:511-4. [PMID: 24531651 DOI: 10.1007/s00383-014-3483-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The first oesophagogastric dissociation was described by Bianchi in 1997 for the treatment of severe gastro-oesophageal reflux (GOR) in neurological patients to avoid serious respiratory complications. The dissociation leads to malabsorption and growth problems. We describe the first two cases of oesophagogastric reconnection long after lung growth. PATIENTS Case no. 1 was a 12.7-year-old child with a history of type I oesophageal atresia. He required oesophagocoloplasty and gastric dissociation by the Bianchi procedure at the age of 3 months. He has oesophagogastric reconnection at 11 years old because he had a several macrocytic anaemia. Case no. 2 was also a 12-year-old boy, with an unlabelled multiple malformation syndrome with type I oesophageal atresia. He had an oesophagocoloplasty with gastric dissociation at the age of 3 months to protect his lungs. The reconnection was proposed at 10 years old because he developed multiple nutritional deficiencies and growth retardation. RESULTS The two cases have no clinical symptom of reflux and their post-operative digestive contrasts are normal. Reconnection appears possible with or without preserving the Roux-en-Y loop. It improves absorption and corrects any vitamin deficiencies, allows the reconnected stomach to be monitored in terms of reflux and malignancy and enables enteral nutrition supplementation to be stopped. The possibility of reconnection after the Bianchi procedure therefore extends its indications, mostly in the case of oesophageal atresia complicated by severe GOR with pulmonary repercussions or tracheoesophageal cleft.
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Affiliation(s)
- A Maignan
- Paediatric Surgery Department, Timone-Enfants, Aix-Marseille University, 13005, Marseille, France,
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Parmentier B, Müller C, Bonnard A. Modèle animal d’atrésie de l’œsophage. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Edjo Nkilly G, Michelet D, Hilly J, Diallo T, Greff B, Mangalsuren N, Lira E, Bounadja I, Brasher C, Bonnard A, Malbezin S, Nivoche Y, Dahmani S. Postoperative decrease in plasma sodium concentration after infusion of hypotonic intravenous solutions in neonatal surgery. Br J Anaesth 2013; 112:540-5. [PMID: 24193323 DOI: 10.1093/bja/aet374] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypotonic i.v. solutions can cause hyponatraemia in the context of paediatric surgery. However, this has not been demonstrated in neonatal surgery. The goal of this study was to define the relationship between infused perioperative free water and plasma sodium in neonates. METHODS Newborns up to 7 days old undergoing abdominal or thoracic surgery were included in this prospective, observational study. Collected data included type and duration of surgery, calculated i.v. free water intake, and pre- and postoperative plasma sodium. Statistical analyses were performed using the Pearson correlation, Mann-Whitney test, and receiver operating characteristic analysis with a 1000 time bootstrap procedure. RESULTS Thirty-four subjects were included. Postoperative hyponatraemia occurred in four subjects (11.9%). The difference between preoperative and postoperative plasma sodium measurements (ΔNaP) correlated with calculated free water intake during surgery (r=0.37, P=0.03), but not with preoperative free water intake. Calculated operative free water intake exceeding 6.5 ml kg(-1) h(-1) was associated with ΔNaP≥4 mM with a sensitivity and specificity [median (95% confidence interval)] of 0.7 (0.9-1) and 0.5 (0.3-0.7), respectively. CONCLUSIONS Hypotonic solutions and i.v. free water intake of more than 6.5 ml kg(-1) h(-1) are associated with reductions in postoperative plasma sodium measurements ≥4 mM. In the context of neonatal surgery, close monitoring of plasma sodium is mandatory. Routine use of hypotonic i.v. solutions during neonatal surgery should be questioned as they are likely to reduce plasma sodium.
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Affiliation(s)
- G Edjo Nkilly
- Department of Anaesthesia, Intensive Care and Pain Management
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Fischerauer EE, Zötsch S, Capito C, Bonnard A, Sárközy S, Berndt J, Hosie S, Beltra Pico R, Steinau G, Wiejek A, Czauderna P, Çelik A, Lain Fernandez A, Ibanez VM, Esposito C, Saxena AK. Paediatric and adolescent traumatic gastrointestinal injuries: results of a European multicentre analysis. Acta Paediatr 2013; 102:977-81. [PMID: 23815746 DOI: 10.1111/apa.12337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/31/2013] [Revised: 06/18/2013] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Abstract
AIM Paediatric gastrointestinal injuries (GIIs) are rare, and the aim of this multicentre study was to evaluate their outcomes in a large cohort. METHODS Hospital databases of 10 European paediatric surgical centres were reviewed for paediatric traumatic GIIs managed between 2000-2010. RESULTS Ninety-seven patients with a median age of 9 years (0-17 years) were identified, with 72 blunt and 25 penetrating GIIs. Initial diagnostics in 90 patients led to correct diagnosis in 71%. Diagnostics were delayed in 26 patients (median 24 h). Eighty-two patients required surgery (67 laparotomy, 12 laparoscopy and three other approaches). There was a 50% conversion in the laparoscopic group. Median hospital stay was 10 days (range 1-137 days), with longer duration influenced by associated injuries (n = 41). Diagnosis <24 h was associated with significantly shorter hospital stay compared to more than 24 h (p = 0.011). In one-third of patients, morbidities were not related to a diagnostic delay or type of injury. There were five lethal outcomes, four due to associated injuries. CONCLUSION Initial diagnostics in traumatic paediatric GIIs provide false negatives in one-third of patients. Diagnostic delay <24 h is associated with a significantly shorter hospital stay. Although laparoscopy is associated with a conversion rate of 50%, it can be used for diagnosis in suspected cases to avoid nontherapeutic laparotomy.
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Affiliation(s)
- EE Fischerauer
- Department of Pediatric- and Adolescent Surgery; Medical University of Graz; Graz; Austria
| | - S Zötsch
- Department of Pediatric- and Adolescent Surgery; Medical University of Graz; Graz; Austria
| | - C Capito
- General Pediatric Surgery; Robert Debre Hospital and Paris VII Denis Diderot University; Paris; France
| | - A Bonnard
- General Pediatric Surgery; Robert Debre Hospital and Paris VII Denis Diderot University; Paris; France
| | - S Sárközy
- Surgical Department; Heim Pál Children's Hospital; Budapest; Hungary
| | - J Berndt
- Department of Pediatric Surgery; München Schwabing, Munich; Germany
| | - S Hosie
- Department of Pediatric Surgery; München Schwabing, Munich; Germany
| | - R Beltra Pico
- Pediatric Surgery Unit; Hospital Univsersitario Materno-Infantil de Canarias; Las Palmas de Gran Canaria; Spain
| | - G Steinau
- Department of Surgery; University Hospital Aachen; Aachen; Germany
| | - A Wiejek
- Department of Surgery and Urology for Children and Adolescents; Medical University of Gdansk; Gdansk; Poland
| | - P Czauderna
- Department of Surgery and Urology for Children and Adolescents; Medical University of Gdansk; Gdansk; Poland
| | - A Çelik
- Department of Pediatric Surgery; Ege University Faculty of Medicine; Izmir; Turkey
| | - A Lain Fernandez
- Pediatric Surgery Department; Hospital Universitari Vall d'Hebron; Barcelona; Spain
| | - VM Ibanez
- Pediatric Surgery Department; Hospital Universitari Vall d'Hebron; Barcelona; Spain
| | - C Esposito
- Department of Pediatric Surgery; “Federico II” University of Naples; School of Medicine; Naples; Italy
| | - AK Saxena
- Department of Pediatric- and Adolescent Surgery; Medical University of Graz; Graz; Austria
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Chaillou E, Bonnard A, Sfeir R, Podevin G, Arnaud A, Bellaiche M. Étude multicentrique rétrospective du traitement de l’hypertonie du sphincter anal interne après chirurgie de la maladie de Hirschsprung par injection de toxine botulique. Arch Pediatr 2013. [DOI: 10.1016/j.arcped.2013.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bonnard A, Paye-Jaouen A, Ilharborde B, Brasher C, Aizenfisz S, Sebag G, El Ghoneimi A. Lessons learnt from two pediatric motor vehicle accidents resulting in anal canal, rectal and gluteal muscle wrenching. Pediatr Surg Int 2011; 27:1135-9. [PMID: 21437699 DOI: 10.1007/s00383-011-2887-3] [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] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
Abstract
Ano-rectal trauma is common in motor vehicle accidents involving children. Inadequate initial assessment of the extent of lesions may be life threatening. We describe two cases where children were struck by buses that subsequently rolled over them in the prone position, resulting in ano-rectal and gluteal muscle wrenching. The first patient was inadequately assessed. Initial management did not include a diverting stoma, leading to life-threatening necrosis and septic shock. The second benefitted from our previous experience and recovery was uneventful. The distinctive mechanism of trauma in true gluteal muscle and anal canal wrenching is discussed. Gluteal muscle, anal canal and rectal wrenching as a result of rolling force from a motor vehicle is a very serious condition requiring immediate intestinal diversion with a stoma. Immediate repair may be attempted at the same time as stoma creation if the patient is stable. Broad-spectrum antibiotics and close wound monitoring are necessary to avoid muscle necrosis and serious complications.
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Affiliation(s)
- A Bonnard
- Department of General and Urology Pediatric Surgery, Paris VII University, Robert Debré Hospital, APHP, 48, boulevard Sérurier, 75019, Paris, France.
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Boubnova J, Peycelon M, Garbi O, David M, Bonnard A, De Lagausie P. CL160 - Résection thoracoscopique des lésions congénitales pulmonaires. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Naudin J, Katsahian S, Aizenfisz S, Vitoux C, Beydon N, Belarbi N, Nivoche Y, Dauger S, Bonnard A. CL044 - Atrésie de l’œsophage : facteurs précoces en réanimation prédictifs de complications oesophagiennes durant la 1re année post opératoire. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Guerin F, Podevin G, Petit T, Lopez M, Erpicum P, Delagausie P, Lardy H, Bonnard A, Thollot A, Philippe P, Larroquet M, Sapin E, Kurzenne J, Le Mandat A, Francois-Fiquet C, Gaudin J, Valioulis I, Morisson-Lacombe G, Motupet P, Demarche M. CL039 - Étude rétrospective multicentrique du GECI sur 114 duplications digestives opérées par thoracoscopie ou laparoscopie. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Madre C, Serhal L, Bonnevalle M, De Lagausie P, Gottrand F, Hugot J, Bonnard A. SFCP-034 – Chirurgie viscérale – Statut nutritionnel et métabolique après déconnexion oesogastrique totale (intervention de Bianchi) : plaidoyer pour une nutrition entérale prolongée. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)71986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Irtan S, Maisin A, Jacqz-Aigrain E, Bonnard A, Philippe-Chomette P, El Ghoneimi A, Aigrain Y. SFCP-023 – Urologie – Analyse rétrospective des complications chirurgicales de 203 greffes rénales pédiatriques. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)71975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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de Lagausie P, Bonnard A, Berrebi D, Lepretre O, Statopoulos L, Delarue A, Guys JM. Abdominal lymphangiomas in children: interest of the laparoscopic approach. Surg Endosc 2006; 21:1153-7. [PMID: 17177082 DOI: 10.1007/s00464-006-9091-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 07/11/2006] [Accepted: 08/02/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lymphangiomas are rare benign lesions of the lymphatic system. The most common symptoms are abdominal tumor or "acute abdomen" in children. The treatment of choice is complete surgical resection, but the recurrence rate with incomplete resection is high, and laparotomy exposes the patient to adhesions. The authors report their experience with the lymphangioma laparoscopic approach. METHODS This retrospective study examined 15 consecutive operations for lymphangiomas in children, ages 5 months to 14 years, treated during the 5-year period from 1999 to 2004. RESULTS Six patients were treated using the primary laparotomy approach, and nine patients underwent the laparoscopic procedure, six successfully. Three conversions were necessary (1 case requiring partial colectomy, 1 retroperitoneal case with adherence on the aorta and vena cava, 1 case with partial volvulus). Morbidity included two cases of acute occlusion caused by adhesions after laparotomy. There was no recurrence of lymphangioma during a mean follow-up period of 35 months. CONCLUSION The laparoscopy procedure could be used successfully for abdominal lymphangioma, even in an emergency. When the laparoscopic resection is impossible, laparotomy or sclerotherapy can be discussed.
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Affiliation(s)
- P de Lagausie
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
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Dauger S, Benhayoun M, Touzot F, Bonnard A. Images in neonatal medicine. Abdominal cellulitis due to Escherichia coli in a two month old premature newborn. Arch Dis Child Fetal Neonatal Ed 2006; 91:F442. [PMID: 17056840 PMCID: PMC2672754 DOI: 10.1136/adc.2006.094201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Dauger
- Pediatric Intensive Care Unit, Hôpital Robert Debré, Université Paris VII-Denis Diderot, Paris, France.
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Bonnard A, Fouquet V, Berrebi D, Hugot JP, Belarbi N, Bruneau B, Aigrain Y, de Lagausie P. Crohn's disease in children. Preliminary experience with a laparoscopic approach. Eur J Pediatr Surg 2006; 16:90-3. [PMID: 16685613 DOI: 10.1055/s-2006-924048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Laparoscopic surgery in patients with Crohn's disease (CD) has been demonstrated to have advantages over a conventional approach in children. The aim of this study was to review the children treated for CD with a laparoscopic approach, to report our indications, the surgical procedure, the complications, and to compare the children with pancolitis or ileocaecal (segmental) Crohn's disease. PATIENTS AND METHOD We reviewed the files of 11 children treated for CD in a single institution between 1999 and 2004 for a retrospective study of clinical and surgical data. Mann-Whitney U-test was used for statistical analysis of nonparametric data. RESULTS Eleven children were operated. The average age when initial clinical symptoms became apparent was 12.1 years (range 6.6 - 15), and surgery was performed after an average of 3.4 years of disease (range 1 - 7.6). The surgical indications were stenosis in 6 cases, failure to thrive in 1 case (segmental CD, SCD group) and pancolitis refractory to medical treatment in 4 cases (pancolitis group, PCD group). Mean operative time was 207 minutes (range 140 - 270) for the SCD group and 285 minutes (range 260 - 300) for the PCD group (p < 0.05). Three cases needed a conversion to open surgery (2 in PCD group, one in SCD group), mainly in relation to anastomosis performed with an EEA stapler. The average length of surgical unit stay was 6.5 days (range 4 - 8) for the PCD group and 6.4 days (range 4 - 8) for the SCD group; average follow-up was 16 months (range 3 - 38). Two patients had a relapse of CD (stenosis of the anastomosis in one, skin fistula in the other). CONCLUSION A laparoscopic approach for ileocolic resection in Crohn's disease is a feasible procedure, even in cases of pancolitis. We recommend an extra-corporeal anastomosis because, in relation to the inflammatory bowel, the mechanical anastomosis is not a safe procedure in cases of pancolitis.
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Affiliation(s)
- A Bonnard
- Department of Paediatric Surgery, Hôpital Robert Debré, Paris, France.
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25
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Abstract
Pyelo-ureteral junction abnormalities in children are most frequently discovered by prenatal ultrasound investigation. Most pyeloplasties by resection-anastomosis of the pyelo-ureteral junction are performed in young infants, usually with a posterior approach, patient prone. The indication and type of urinary pyelic drain remain debated: simple nephrostomy or double J drain. Ureteral-caliceal anastomosis is an interesting approach to rare surgical reoperations, particularly with major pyelo-ureteral dilatation. Laparoscopic surgery may prove usefulness in less small children. Endopyelotomy gives good results for post-operative stenoses.
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Affiliation(s)
- G Audry
- Service de chirurgie viscérale infantile, Hôpital d'enfants Armand Trousseau, 26, avenue du Docteur Arnold-Netter, 75571 Paris 12, France.
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Abstract
Meckel's diverticulum is an evolution of omphalomesentric channel one of the most frequent embryologic abnormality of digestive tract. It is observed in two circumstances: during a routine exploration or after a complication: intestinal obstruction, peritonitis, recurrent abdominal pain. Only open or laparoscopic explorations allow a diagnosis. Resection of the diverticulum is recommended in children because the complications are frequent and serious. The preferred therapeutic method is the bowel resection with immediate anastomosis.
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Affiliation(s)
- C Grapin
- Service de Chirurgie Viscérale Pédiatrique, Hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France.
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Auber F, Larroquet M, Bonnard A, Boudjemaa S, Landman-Parker J, Ducou Le Pointe H, Boccon-Gibod L, Lefebvre G, Uzan S, Hélardot P, Audry G. [Prenatal ultrasound diagnosis of neuroblastoma]. ACTA ACUST UNITED AC 2005; 33:228-31. [PMID: 15894207 DOI: 10.1016/j.gyobfe.2005.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Accepted: 03/09/2005] [Indexed: 11/19/2022]
Abstract
With the progress of foetal ultrasonography, diagnosis of foetal tumors can be made before birth. We report five cases of prenatally detected neuroblastoma of the adrenal glands. Diagnosis was made during the third trimester in all cases. At birth no clinical sign related to the tumor was present, and urinary catecholamines were within normal ranges. On ultrasound scans the tumor was cystic in 1 case, solid in 2 cases and of mixed echogenicity in 2 cases. All children were operated on without pre or postoperative chemotherapy. In each setting the tumor was a stage I neuroblastoma according to the Evans classification. All children are alive and disease-free with a follow-up of 32 months at 14 years.
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Affiliation(s)
- F Auber
- Service de chirurgie pédiatrique, hôpital d'enfants Armand-Trousseau (AP-HP), université Pierre et Marie Curie - Paris VI, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Seguier-Lipszyc E, Bonnard A, Evrard P, Garel C, De Ribier A, Aigrain Y, de Lagausie P. Left thoracoscopic thymectomy in children. Surg Endosc 2005; 19:140-2. [PMID: 15772877 DOI: 10.1007/s00464-004-9039-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 06/17/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the management of autoimmune myasthenia, thymectomy is recognized as effective surgical therapy. The necessity of complete radical thymectomy to achieve maximal improvement has been emphasized. Video-assisted thoracoscopic surgery has been successfully used for thymectomy in adults, and more recently in children, and has been described as achieving the same radicality and functional improvement as median sternotomy or as transcervical thymectomy. The aim of this work is to report our first thoracoscopic experience in this indication. METHODS Patients with myasthenia gravis on anticholinesterase drugs and/or steroids are discussed for surgery in case of clinical deterioration despite increasing doses of medication or in case of no improvement. We decided to perform thoracoscopic thymectomies by a left-sided approach. Preoperative localization of thymic tissue is done by a thoracic CT exam. Patients are placed on their right side with a thoracic tilt under the thorax. Four thoracoscopic ports are used, a 10-mm for the camera and three 5-mm operating ports. The left lung was collapsed by selective intubation (double-lumen endotrachial intubation). RESULTS Two boys, 7.5 and 14 years old, were addressed by the department of neurology for radical thymectomy. They presented an ocular myasthenia gravis for 2 years and a mild general myasthenia gravis for 7 years. The operative times were 120 and 240 min. There was no intraoperative or postoperative complication. Duration of thoracic drainage was 2 days. The children were discharged on the third postoperative day. For the second procedure, an ultrasound exam during surgery was necessary to localize the thymus exactly, thus enabling its complete resection without the need for a conversion. The follow-up is 19 and 7 months with a clinical improvement enabling the diminution of medication for both children, the end of ptosis for the first child, and the general improvement of muscle strength for the second. CONCLUSIONS Thoracoscopic thymectomy in children with juvenile myasthenia gravis seems to offer a complete surgical resection, as do open techniques. In case of difficulties in finding the thymus, an ultrasound exam is feasible to enable complete resection. The left-sided thoracoscopic approach gives a good mediastinal and cervical exposition. Furthermore, being less painful in the postoperative period, it presents a less pronounced impairment of pulmonary function, and it presents good cosmetic effect.
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Affiliation(s)
- E Seguier-Lipszyc
- Department of Pediatric Surgery, Hospital Robert Debré, 48 bd Sérurier, 75019, Paris, France
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Bacry A, Bonnard A. [III--Differed emergencies. 6/ Ovarian cysts--testicular torsion]. Soins Pediatr Pueric 2004:41-2. [PMID: 15456238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Bonnard A, Malbezin S, Ferkdadji L, Luton D, Aigrain Y, de Lagauise P. Pulmonary sequestration children: is the thoracoscopic approach a good option? Surg Endosc 2004; 18:1364-7. [PMID: 15803237 DOI: 10.1007/s00464-003-9247-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 02/17/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The thoracoscopic approach for pulmonary sequestration in children seems to be feasible and reproducible. To date, there have been no studies comparing the thoracoscopic approach with the conventional technique in this indication. Therefore, the aim of this study was to compare these two approachs. METHODS We performed a retrospective study in patients treated surgically for a prenatal diagnosis of pulmonary sequestration between 2000 and 2003. Three or five ports were used, and single-lung ventilation was required. The clinical, operative, and postoperative data were compared with those for patients operated on during the same period via thoracotomy. For statistical purposes, the children who required conversion to the open proecedure were grouped with those who underwent thoracotomy. The following data were compared: age, and weight, operating time, duration of postoperative drainage via chest tube, duration of postoperative narcotic use, pain scores on the 1(st) and 2(nd) days after the procedure, and length of hospital stay. The Mann-Whitney test was used for statistical analysis. RESULTS Five infants were operated on via a thoracoscopic approach. Two required conversion to an open procedure. There were four intralobar sequestrations (ILS) and one extralobar sequestration (ELS). The mean age at surgery was 6.2 months (range, 4-9). The mean operating time, excluding the patients who were converted to open, was 155 min (range, 120-190). In the thoracotomy group, there were one ELS and one ILS. Two groups were defined: the exclusively laparoscopy group (EL) (n = 3) and the thoracotomy and conversion group (TC) (n = 4). The duration of postoperative drainage, duration of postoperative narcotic use, and hospital stay seemed to be shorter in the group EL. These times, respectively, were 3.4 vs 2.75 days, 4.1 vs 3.3 days, and 7.5 vs 4.3 days = (p = 0.03). There were two complications in the TC group (one wound abcess and one pleural leak that required a chest tube). CONCLUSION The thoracoscopic approach for pulmonary sequestration is feasible. It seems to reduce the duration of postoperative drainage, postoperative narcotic use, hospital and stay. These results need to be confirmed by a prospective and more detailed study.
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Affiliation(s)
- A Bonnard
- Department of Pediatric Surgery, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France.
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Bacry A, Bonnard A. [III--Differed emergencies. 5/ Persistence of the arterial canal]. Soins Pediatr Pueric 2004:43-4. [PMID: 15327078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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32
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Abstract
An 11-month-old boy presented with an intrahepatic foreign body after ingestion of a sewing needle. Surgical management using an exclusive laparoscopic extraction was successful.
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Affiliation(s)
- A Le Mandat-Schultz
- Department of Visceral Surgery, Hôpital Robert Debré, 48 Boulevard Serrurier, 75019 Paris, France
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Bacry A, Bonnard A. [III--differed emergencies. 4/. Upper anorectal abnormalities]. Soins Pediatr Pueric 2004:43-4. [PMID: 15141518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Bacry A, Bonnard A. [III--differed emergencies. 3/ Lower anorectal abnormality]. Soins Pediatr Pueric 2004:45-6. [PMID: 15027259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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35
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Bacry A, Bonnard A. [Differed emergencies. 2/ Hirschsprung's disease]. Soins Pediatr Pueric 2003:45-6. [PMID: 14740381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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36
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de Lagausie P, Bonnard A, Benkerrou M, Rorlich P, de Ribier A, Aigrain Y. Pediatric laparoscopic splenectomy: benefits of the anterior approach. Surg Endosc 2003; 18:80-2. [PMID: 14625739 DOI: 10.1007/s00464-003-9048-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Accepted: 05/31/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Splenectomy is frequently performed in children for various hematologic and autoimmune disorders. We reviewed our indication for splenectomy, our technique of laparoscopic, splenectomy, and our results. The aim of this study was to show if an anterior approach with elective vessel endoligature in a patient in decubitus position was a better and safer approach than the other techniques previously published. PATIENTS AND METHODS Between January 1996 and December 2002, 54 children underwent laparoscopic splenectomy. We use the anterior pedicle approach and elective vessel endoligature in order to prevent persistence of any exogenous material. Sixteen children also had a concomitant cholecystectomy. Their age ranged between 1 and 18 years (mean 7.5 years). Twenty children had hereditary spherocytosis, 15 were affected by sickle cell disease, six had an idiopathic thrombocytopenia, four had beta-thalassemia, and nine another hemolytic disease. RESULTS Mean operative time was 150 min (range, 115-230 min). Hospital stays ranged from 3 to 15 days (mean: 5.4). Seven patients had complications (four pneumonia and three deep abscess with successful antibiotic treatment). Median follow-up was 42 months (2 months-6 years) without problems regarding procedure. DISCUSSION With this technique consisting in first elective arterial and secondary venal ligature, we preserved blood splenic sequestration and pancreatic tail lesion. The procedure is safer. For us, considering the low complication rate for this type of patient, and the advantages of a small abdominal trauma in the postoperative period, laparoscopy with anterior approach for elective splenectomy and eventual cholecystectomy in hematologic disorders is the best technique.
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Affiliation(s)
- P de Lagausie
- Department of Pediatric Surgery, Hospital Robert Debré, Paris XIX, France.
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37
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Carricaburu E, Enezian G, Bonnard A, Berrebi D, Belarbi N, Huot O, Aigrain Y, de Lagausie P. Laparoscopic distal pancreatectomy for Frantz's tumor in a child. Surg Endosc 2003; 17:2028-31. [PMID: 14598158 DOI: 10.1007/s00464-003-4222-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Accepted: 04/21/2003] [Indexed: 12/17/2022]
Abstract
Solid pseudopapillary tumor of the pancreas is a rare pathologic entity. Although the role of laparoscopy in surgery of the pancreas is still controversial, laparoscopic distal pancreatectomy has been reported with good results in adults. We report a laparoscopic spleen-preserving distal pancreatectomy in a 9-year-old boy who presented with a low-grade malignant tumor. Needle biopsy was impossible. A laparoscopic spleen-preserving distal pancreatectomy was performed. We used four trocars, and the operative time was 240 min. Conversion to open surgery was not necessary. The boy's postoperative recovery was uneventful, and he was discharged on the 6th day. CT-scan control at 6 months was normal. This case shows that even in advanced surgical cases, such as spleen-preserving distal pancreatectomy, laparoscopic procedures can be done safely, within a reasonable operative time, in children.
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Affiliation(s)
- E Carricaburu
- Department of Pediatric Surgery, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 48, Boulevard Sérurier, 75019 Paris, France.
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Bonnard A, Mougenot JP, Ferkdadji L, Huot O, Aigrain Y, De Lagausie P. Laparoscopic rectopexy for solitary ulcer of rectum syndrome in a child. Surg Endosc 2003; 17:1156-7. [PMID: 12728388 DOI: 10.1007/s00464-002-4285-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 12/12/2002] [Indexed: 12/17/2022]
Abstract
BACKGROUND Solitary ulcer of rectum syndrome occurs rarely in children, and the diagnosis may be difficult. Rectopexy has already been reported with good results in adults and children. We report the first laparoscopic rectopexy in children. METHODS We report the first case of rectopexy performed according to the Orr-Loygue technique using a laparoscopic approach in children. Three trocars were used. A polypropylene mesh was sutured on each side of the rectum and fixed to the promontary with a nonabsorbable suture. The operative time was 150 min. RESULTS The postoperative course was uneventful. The boy was discharged on postoperative day 3. The rectoscopy at 4 months was normal. The rectal bleeding and pain had disappeared by the 18-month follow-up assessment. CONCLUSION We report a successful laparoscopic rectopexy for solitary ulcer of rectum syndrome in a child. The procedure is simple, safe, and reproductible, giving good results in the reported case.
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Affiliation(s)
- A Bonnard
- Department of Pediatric Surgery, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France.
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Abstract
BACKGROUND The authors analyzed clinical signs of vascular ring anomalies together with appropriate complementary examinations and factors predictive of outcome after surgical treatment. METHODS The authors reviewed the files of 62 patients with vascular ring abnormalities treated at Necker-Enfants Malades Hospital between January 1990 and January 2000, to analyze age at symptom onset, results of paraclinical examinations, the type of vascular ring abnormality, the surgical indications and type of surgery, and postoperative outcome. Outcomes were divided into 3 categories: cure, partial improvement, and no improvement. The chi2 test corrected with Fischer's Exact test was used for statistical analysis. RESULTS Vascular ring abnormalities were diagnosed at birth in 28% of cases and during the first year of life in 68%. Sixteen percent of patients had associated abnormalities. Recurrent pulmonary and bronchial infections occurred after one year of age. An esophagogram was done in 76% of cases and showed impression images. Endoscopy was done in 63% of cases and showed malacia in 41% of patients and stenosis in 51%. Fifty-eight children were treated surgically. The average hospital stay was 7.4 days. The average follow-up was 37.4 months (12 to 159 months). Complete improvement was obtained in 68% of cases, partial improvement in 17%, and no improvement in 15%. Preoperative malacia was more frequent in patients with partial improvement or no improvement. CONCLUSIONS Surgical treatment of congenital vascular ring abnormalities is effective and safe. Complications are rare. Prognostic factors include the quality of preoperative preparation of respiratory function, the type of abnormality, and the degree of malacia.
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Affiliation(s)
- A Bonnard
- Pediatric Surgery Unit, Necker Enfants-Malades, Paris, France
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Bonnard A, de Lagausie P, Leclair MD, Marwan K, Languepin J, Bruneau B, Berribi D, Aigrain Y. Definitive treatment of extended Hirschsprung's disease or total colonic form. Surg Endosc 2001; 15:1301-4. [PMID: 11727138 DOI: 10.1007/s004640090092] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2000] [Accepted: 02/22/2001] [Indexed: 12/15/2022]
Abstract
BACKGROUND Between December 1990 and March 1999, five laparoscopic Duhamel pull-through procedures for extended or total aganglionosis were performed in our department, one of which had a rectosigmoid form with a short bowel and a colonic resection due to a volvulus. METHODS The aim of this study was to show that even when the extended form of Hirschprung's disease or anatomic difficulties such as a short bowel and anterior colonic resection are encountered, the laparoscopic approach is possible and total colectomy is feasible. The procedure has been described previously. We used one camera port and three working ports. The sigmoid, transverse, and right colon up to the last ileal cove were mobilized laparoscopically. A standard posterior ileo-anal anastomosis was performed, and an endo-GIA stapler was used for the anterior anastomosis. RESULTS A total of five patients underwent laparoscopic surgery for Hirschprung's disease. There were three total colonic forms, one rectosigmoid form with a short bowel and colon resection attributed to a volvulus, and one transverse variant that required a Deloyers' maneuver for the pull-through. Three of the infants required total parenteral nutrition (TPN) for an average of 49 days (range, 28-60) from diversion until the time of the definitive procedure. Only one patient did not receive TPN. Postoperatively, there were two complications-one wound infection and one hectic fever. The clinical results were good, with no soiling or stool incontinence and no constipation. CONCLUSION The laparoscopic procedure for total aganglionosis or the extended form of Hirschprung's disease is safe, feasible, and reproducible.
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Affiliation(s)
- A Bonnard
- Department of Pediatric Surgery, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
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41
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Bonnard A, Lagausie P, Malbezin S, Sauvat E, Lemaitre AI, Aigrain Y. Mediastinal pancreatic pseudocyst in a child. A thoracoscopic approach. Surg Endosc 2001; 15:760. [PMID: 11591994 DOI: 10.1007/s004640042015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2000] [Accepted: 09/28/2000] [Indexed: 11/27/2022]
Abstract
Mediastinal pancreatic pseudocyst is a rare occurrence in children and may be difficult to diagnose. Internal drainage via a cystenterostomy and a simple external drainage are two of the treatment options that are currently employed. We describe the case of an 11-year-old boy with a mediastinal pseudocyst who was treated via a thoracoscopic approach using an original pulmonary exclusion. The pseudocyst disappeared in 15 days and there has been no recurrence. No adjuvant treatment was necessary. Endoscopic retrograde cholangiopancreatography (ERCP) was useful in establishing the etiology (pancreas divisum). We believe that the thoracoscopic approach is a reproducible, simple, and safe procedure for the treatment of mediastinal pseudocysts. The technique may represent a valid alternative to cystogastrostomy.
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Affiliation(s)
- A Bonnard
- Department of Pediatric Surgery, Hôpital Robert Debré, 48, boulevard Sérusier, 75020 Paris, France
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42
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Abstract
BACKGROUND Premature infants are particularly at risk of iatrogenic pharyngoesophageal perforation. It is a rare occurrence but when it does occur it often mimics esophageal atresia. In the light of 10 patients treated in our service and those reported in the literature we have highlighted the diagnostic difficulties and discussed the appropriate management. PATIENTS Between 1980 and 1995, we treated 10 premature neonates for pharyngoesophageal perforation. Six of these neonates weighed less than 1500 g. Esophageal atresia was the primary diagnosis in 4 cases. The pharyngoesophageal perforation was caused by repeated airway intubation in 3 cases and by overenthusiastic routine postpartum suctioning or nasogastric tube (NGT) insertion in 7 others. Severe respiratory distress occurred in 7 neonates. A plain chest x-ray revealed a large right pneumothorax in 3 cases and an aberrant NGT in 3 other cases. Four neonates had a contrast esophagography and 4 neonates underwent endoscopy. Five cases were treated surgically. In 3 of these, esophageal atresia was the presumptive diagnosis and the perforation was only diagnosed intraoperatively via a right thoracotomy. One neonate required suturing of the perforation and another had a gastrostomy. In all 5 cases a mediastinal drain was left in situ. The 5 remaining neonates were treated conservatively with broad spectrum antibiotics, total parenteral nutrition, a silastic NGT and pharyngeal aspiration. One of these neonates had previously had a laparotomy for a colonic perforation. There was a good outcome in 4 neonates, one of whom required instrumental dilatation for an esophageal stricture. Bronchopulmonary dysplasia developed in 3 cases and necrotizing enterocolitis in 1 other case. Two neonates died. CONCLUSION An iatrogenic perforation is often difficult to diagnose and can easily be confused with esophageal atresia. Clinical findings, a plain chest x-ray, an esophagography and endoscopy are helpful. Surgery can be avoided in most instances. The outcome is not always favorable especially as premature neonates are at risk of severe concomitant pathology.
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Affiliation(s)
- E Sapin
- Department of Pediatric Surgery, Hôpital Saint-Vincent-de-Paul, University School of Medicine René Descartes, Paris, France
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Abstract
BACKGROUND Neonatal perforation of the esophagus appears to occur rarely and often can mimic esophageal atresia. This report presents 12 cases of pharyngoesophageal perforation with a review of the literature. PATIENTS From 1980 to 1995, we treated 12 infants for pharyngo-esophageal perforation. Ten infants were pre-term, seven of them weighing less than 1,500 g. Five infants had severe respiratory distress. Four infants had repeated attempt on intubation of the airway and eight infants had a routine postpartum suctioning and gastric aspiration. On plain X-ray, a large right pneumothorax was observed in three cases and the nasogastric tube deviated widely from its expected course in three cases. Four infants underwent contrast esophagography and three infants esophagoscopy. In five cases esophageal atresia was the initial diagnosis. Five infants underwent a thoracotomy. A gastrostomy was performed in one case. The six remaining neonates were treated non-operatively: broad spectrum antibiotics, total parenteral nutrition, and silastic nasogastric tube. Follow-up was uneventful in five cases. One infant with an esophageal stricture underwent instrumental dilatation. Bronchopulmonary dysplasia occurred in two cases and necrotizing enterocolitis in one. Two infants died. CONCLUSION Iatrogenic perforation remains a difficult diagnosis. Clinical findings, plain chest x-ray and oesophagography are helpful. Surgery can be completely avoided in most instances. Infants with low birthweight and prematurity are most at risk.
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Affiliation(s)
- A Bonnard
- Service de chirurgie pédiatrique, hôpital Saint-Vincent-de-Paul, Paris, France
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Gaillare F, Hocquaux H, Bonnard A. Study of epoxy-bounded galvanized steels: Applications of FTIRin situ analysis and microspectrometry. SURF INTERFACE ANAL 1991. [DOI: 10.1002/sia.740170725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rivier J-L, Bonnard A, Sadeghi H. [The syndrome of unstable angina justifying an urgent coronary arteriography (author's transl)]. Ther Umsch 1976; 33:70-4. [PMID: 1085497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bonnard A. POINTS FROM LETTERS: Shush! West J Med 1961. [DOI: 10.1136/bmj.2.5264.1436-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bonnard A. Tongue Swallowing. Proc R Soc Med 1960; 53:784-785. [PMID: 19994068 PMCID: PMC1871264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Bonnard A, Morris D. Tongue Swallowing. Proc R Soc Med 1960. [DOI: 10.1177/003591576005300915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bonnard A. Supplement to Breast-feed. West J Med 1944. [DOI: 10.1136/bmj.2.4377.707-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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