Robotic Surgery for Pediatric Choledochal Cysts: An American Case Series and Literature Review

INTRODUCTION

Choledochal cysts are rare congenital biliary cystic dilations. The US incidence rate varies between 5 and 15 cases per 1,000,000 people. In contrast, Asians, which are a large subset of the population of Hawaii, have an incidence of approximately one in every 1000 births. We report our experience with robot-assisted laparoscopic surgical management with biliary reconstruction of choledochal cysts which to date is the largest American case series to be reported.

MATERIALS AND METHODS

From 2006 to 2021, patients diagnosed with a choledochal cyst(s) at a tertiary children's hospital were retrospectively reviewed. Perioperative analysis was performed. Complications were defined as immediate, early, or late. The data underwent simple descriptive statistics.

RESULTS

Nineteen patients underwent choledochal cystectomy and hepaticoduodenostomy. Thirteen underwent a robotic approach while the rest were planned laparoscopic. Eighteen of 19 were female with 15/19 of Asian descent. The ages ranged from 5 mo to 21 y. Presenting diagnoses included jaundice, primary abdominal pain, pancreatitis, and cholangitis. Sixty eight percent had type 1 fusiform cysts while the rest were type 4a. Operative time and length of stay for robotic versus laparoscopic were 321 versus 267 min and 8.2 versus 17.3 d, respectively. For the robotic group, there was one immediate complication due to peritonitis. One-year follow-up revealed two patients requiring endoscopic retrograde cholangiopancreatography with dilation/stenting for an anastomotic stricture. There were no anastomotic leaks.

CONCLUSIONS

Robot-assisted laparoscopic choledochal cystectomy with hepaticoduodenostomy is associated with overall good outcomes with the most common long-term complication being anastomotic stenosis.

High Rates of Pediatric Venous Thromboembolism After Elective Laparoscopic Splenectomy Suggest Need for Perioperative Prophylaxis

INTRODUCTION

In adult populations, postoperative venous thromboembolism (VTE) is a reported complication of up to 8% of elective laparoscopic splenectomy (LS) cases. VTE is a rare event in the pediatric population, affecting less than 1% of all pediatric surgical patients. We hypothesized that pediatric patients are at a higher risk of postoperative VTE after undergoing elective LS relative to other laparoscopic procedures and may warrant prophylactic treatment.

MATERIALS AND METHODS

We queried the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2012 to 2020. Patients were identified using the Current Procedural Terminology code 38120 and only elective cases were analyzed.

RESULTS

The incidence of VTE in all pediatric patients undergoing surgery in the American College of Surgeons NSQIP-P database was 0.13%. The incidence of VTE in pediatric patients undergoing elective laparoscopic abdominopelvic procedures was 0.17%. There were seven total cases of VTE (0.41%) in pediatric patients undergoing elective LS, more than twice the rate of the general population (P = 0.001). Eighty percent of pediatric patients undergoing elective LS had an underlying hematological disorder.

CONCLUSIONS

By analyzing the NSQIP-P database, we evaluated the largest cohort of pediatric patients undergoing elective LS to date. We identified a higher incidence of VTE following this procedure relative to the rate of VTE in the overall population in the NSQIP-P database, as well as those undergoing elective laparoscopic abdominopelvic operations. The relatively higher incidence of VTE after elective LS is likely due to the presence of underlying hematological conditions. Given the low incidence of complications associated with pharmacologic VTE prophylaxis, the results of this study suggest that further research is warranted to establish the efficacy of perioperative pharmacological VTE prophylaxis in pediatric patients undergoing elective LS.

Efficacy of Telehealth in Preoperative Pediatric Surgery Consultations

INTRODUCTION

The Coronavirus disease 2019 pandemic created a sudden need to transition outpatient pediatric surgical care to a telehealth platform, allotting little time to study the efficacy of these changes. In particular, the accuracy of telehealth preoperative assessment remains unclear. Therefore, we sought to study the prevalence of errors in diagnosis and procedure cancellations between preoperative in-person evaluations and telehealth evaluations.

METHODS

We conducted a single institution, retrospective chart review of perioperative medical records at a tertiary children's hospital over a 2-year period. Data included patient demographics (age, sex, county, primary language, and insurance), preoperative diagnosis, postoperative diagnosis, and surgical cancellation rates. Data were analyzed using Fisher's exact and chi-square tests. Alpha was set at 0.05.

RESULTS

A total of 523 patients were analyzed, with 445 in-person visits and 78 telehealth visits. There were no demographic differences between the in-person and telehealth cohorts. The frequency of changes from the preoperative to the postoperative diagnosis was not significantly different between in-person preoperative visits and telehealth preoperative visits (0.99% versus 1.41%, P = 0.557). The frequency of case cancellations between the two consultation modalities was not significantly different (9.44% versus 8.97%, P = 0.899).

CONCLUSIONS

Our results demonstrate that preoperative pediatric surgical consultations held via telehealth were neither associated with a decrease in the accuracy of preoperative diagnosis, nor an increased rate of surgery cancellations, compared to those held in-person. Further study is needed to better determine the advantages, disadvantages, and limitations of telehealth in the delivery of pediatric surgical care.

Parsing social motivation: Development and validation of a self-report measure of social effort.. [DOI: 10.31234/osf.io/y4p8s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Reduced efforts to form and maintain social bonds can exist in the context of sufficient desire for social connection. Thus, social impairment common across many psychiatric conditions may often reflect failures in social effort exertion, despite normative levels of social liking and wanting. Although there are many questionnaires available that assess sociability, desire or lack thereof for connection, and perceived social support, there is no current self-report assessment of the behavioral outputs of social motivation. Aims: We aimed to develop and validate a measure of social effort in college students and in the general population.Methods: College students (n = 981) and a broader sample of adults via Amazon’s Mechanical Turk (MTurk; n = 506) participated in the study. Results: We identified two factors that represented content related to general social effort and social effort in adherence with social norms; we named the measure the Social Effort and Conscientiousness Scale (SEACS). Results suggest the SEACS is a reliable and valid measure of social effort. Conclusions: Lower scores on the SEACS were associated with symptoms of depression and anxiety, highlighting the scale’s potential utility in clinical populations. We include discussion of possible applications of the SEACS, including its further use and application in psychopathology research.

Novel use of porcine extracellular matrix in recurrent stricture following repair of tracheoesophageal fistula

Anastomotic stricture is a common complication following repair of esophageal atresia (EA). Many factors are thought to contribute to stricture formation and a variety of management techniques have been developed. In this case report, we describe the treatment of a recurrent anastomotic stricture following repair of long-gap esophageal atresia. Porcine bladder extracellular matrix (ECM) was mounted on a stent and delivered endoscopically to the site of recurrent stricture. An appropriate positioning was confirmed using direct endoscopic visualization and intra-operative fluoroscopy. The patient recovered well with persistent radiographic and functional improvements in previous stricture.

Transthoracic echocardiography visualization of bicaval dual lumen catheters for veno-venous extracorporeal membrane oxygenation

Bicaval dual lumen catheters improve the efficiency of veno-venous extracorporeal membrane oxygenation by minimizing recirculation with an innovative design, which requires precise placement of three catheter ports in the superior vena cava, right atrium, and inferior vena cava, respectively. However, the exact position of these catheter ports is usually not known during placement because they cannot be visualized with conventional radiography. We performed a retrospective review of our experience over the past year using transthoracic echocardiography to evaluate the position of the catheter ports. From a subcostal, sagittal imaging approach, we were able to identify all three catheter ports in 11 of 11 studies. At least one of the catheter ports was incorrectly positioned in 5 of 11 studies. Further prospective evaluation is necessary to determine if catheter repositioning based on transthoracic echocardiography findings can further improve the clinical efficiency of veno-venous extracorporeal membrane oxygenation.

Metatarsal-slide lengthening without bone grafting

Brachymetatarsia is a condition of premature closure of the epiphyseal plate of a metatarsal. The authors present a case of brachymetatarsia of the second metatarsal. Utilizing a review of the literature, various surgical procedures are discussed. Treatment in this case consisted of a metatarsal-slide lengthening osteotomy, a modification of the Giannestras step-down procedure.