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McNevin K, Nicassio L, Rice-Townsend SE, Katz CB, Goldin A, Avansino J, Calkins CM, Durham MM, Page K, Ralls MW, Reeder RW, Rentea RM, Rollins MD, Saadai P, Wood RJ, van Leeuwen KD, Smith CA. Comparison of the PCPLC Database to NSQIP-P: A Patient Matched Comparison of Surgical Complications Following Repair of Anorectal Malformation. J Pediatr Surg 2024; 59:997-1002. [PMID: 38365475 DOI: 10.1016/j.jpedsurg.2024.01.004] [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: 06/21/2023] [Revised: 11/27/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Anorectal malformations (ARM) are rare and heterogenous which creates a challenge in conducting research and offering recommendations for best practice. The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) was formed in 2016 to address this challenge and created a shared national data registry to collect information about pediatric colorectal patients. There has been no external validation of the data collected. We sought to evaluate the database by performing a patient matched analysis comparing 30-day outcomes identified in the PCPLC registry with the NSQIP-P database for patients undergoing surgical repair of ARM. METHODS Patients captured in the PCPLC database from 2016 to 2021 at institutions also participating in NSQIP-P who underwent ARM repair younger than 12 months old were reviewed for 30-day complications. These patients were matched to their NSQIP-P record using their hospital identification number, and records were compared for concordance in identified complications. RESULTS A total of 591 patient records met inclusion criteria in the PCPLC database. Of these, 180 patients were also reviewed by NSQIP-P. One hundred and fifty-six patient records had no complications recorded. Twenty-four patient records had a complication listed in one or both databases. There was a 91 % concordance rate between databases. When excluding complications not tracked in the PCPLC registry, this agreement improved to 93 %. CONCLUSION Including all patients evaluated for this subpopulation, a 91 % concordance rate was observed when comparing PCPLC collected complications to NSQIP-P. Future efforts can focus on further validating the data within the PCPLC for other patient populations. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Kathryn McNevin
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Lauren Nicassio
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Samuel E Rice-Townsend
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Cindy B Katz
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Adam Goldin
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Jeffrey Avansino
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, 999 N 92 St Suite 320, Milwaukee, WI 53226, USA
| | - Megan M Durham
- Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Kent Page
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Matthew W Ralls
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 E Hospital Drive Level 4, Ann Arbor, MI 48109, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Dr., Ste 3800 Salt Lake City, UT 84112, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, 2521 Stockton Blvd, 4th Floor Suite 4100, Sacramento, CA 95817, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
| | - Kathleen D van Leeuwen
- Department of Surgery, Phoenix Children's Hospital, University of Arizona, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Caitlin A Smith
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
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2
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Saenz ZM, Austin K, Avansino JR, Badillo A, Calkins CM, Durham MM, Fuller MK, Rana A, Reeder RW, Rentea RM, Rollins MD, Speck KE, Wood RJ, Harris JC, Anderson J, Hassan M, Saadai P. Can Anorectal Stenosis be Managed With Dilations Alone? A PCPLC Review. J Pediatr Surg 2024:S0022-3468(24)00258-6. [PMID: 38735806 DOI: 10.1016/j.jpedsurg.2024.04.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Congenital anorectal stenosis is managed by dilations or operative repair. Recent studies now propose use of dilations as the primary treatment modality to potentially defer or eliminate the need for surgical repair. We aim to characterize the management and outcomes of these patients via a multi-institutional review using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry. METHODS A retrospective database review was performed using the PCPLC registry. The patients were evaluated for demographics, co-morbidities, diagnostic work-up, surgical intervention, current bowel management, and complications. RESULTS 64 patients with anal or rectal stenosis were identified (57 anal, 7 rectal) from a total of 14 hospital centers. 59.6% (anal) and 42.9% (rectal) were male. The median age was 3.2 (anal) and 1.9 years (rectal). 11 patients with anal stenosis also had Currarino Syndrome with 10 of the 11 patients diagnosed with a presacral mass compared to only one rectal stenosis with Currarino Syndrome and a presacral mass. 13 patients (22.8%, anal) and one (14.3%, rectal) underwent surgical correction. Nine patients (8 anal, 1 rectal) underwent PSARP. Other procedures performed were cutback anoplasty and anterior anorectoplasty. The median age at repair was 8.4 months (anal) and 10 days old (rectal). One patient had a wound complication in the anal stenosis group. Bowel management at last visit showed little differences between groups or treatment approach. CONCLUSION The PCPLC registry demonstrated that these patients can often be managed successfully with dilations alone. PSARP is the most common surgical repair chosen for those who undergo surgical repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zoe M Saenz
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA
| | - Kelly Austin
- Department of Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey R Avansino
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Megan M Durham
- Department of Surgery, Emory + Childrens Pediatric Institute Atlanta, GA, USA
| | - Megan K Fuller
- Department of Surgery, Boys Town National Research Hospital, University of Nebraska Medical Center, Boys Town, NE, USA
| | - Ankur Rana
- Department of Surgery and Perioperative Care, Dell Children's Medical Center, University of Texas Austin, Austin, TX, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - K Elizabeth Speck
- Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Jamie C Harris
- Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA
| | - Jamie Anderson
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA
| | - Maheen Hassan
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA.
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3
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Kwon EG, Kreiss J, Nicassio L, Austin K, Avansino JR, Badillo A, Calkins CM, Crady RC, Dickie B, Durham MM, Frischer J, Fuller MK, Speck KE, Reeder RW, Rentea R, Rollins MD, Saadai P, Wood RJ, van Leeuwen KD, Smith CA, Rice-Townsend SE. Variation in Practice Surrounding Antegrade Colonic Enema Channel Placement. J Pediatr Surg 2024:S0022-3468(24)00260-4. [PMID: 38760309 DOI: 10.1016/j.jpedsurg.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE Antegrade colonic enemas (ACE) can be an effective management option for defecation disorders and improve quality of life. Best practice regarding channel placement is unclear and variation may exist around preferred initial type of channel, age at placement, and underlying diagnoses. We aimed to describe practice patterns and patient characteristics around ACE channel placement. METHODS We conducted a multicenter retrospective study of children with an ACE channel cared for at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) from 2017 to 2022. Kruskal-Wallis test was utilized to test the age at surgery by site with significance level of 0.05. RESULTS 500 patients with ACE channel were included. 293 (58.6%) patients had their ACE procedure at a PCPLC center. The median age at surgery was 7.6 [IQR 5.3-11.0] years for the overall cohort and 8.1 [IQR 5.3-11.5] years for placement at PCPLC centers. For PCPLC centers, median age at placement varied significantly across centers (p = 0.009). 371 (74.2%) patients received Malone appendicostomy, 116 (23.2%) received cecostomy, and 13 (2.6%) received Neo-Malone appendicostomy. Median age of patients by channel type was 7.7 [IQR 5.3-11.0], 7.5 [IQR 5.7-11.0], and 9.8 [IQR 4.2-11.6] years, respectively. The most common indication for cecostomy was idiopathic/refractory constipation (52.6%), whereas anorectal malformation was the most common indication for Malone (47.2%) and Neo-Malone (61.5%). Among ACE channels placed at PCPLC centers, there was variation across institutions in preferred initial channel type. The 4 highest volume centers favored Malone appendicostomy over cecostomy. CONCLUSION There is variation in practice of ACE channel placement. At specialty pediatric colorectal centers, age at time of placement and type of channel placed varied across institutions. Further work is needed to better characterize diagnosis- and age-focused patient centered outcomes to clarify recommendations for our patients who benefit from these procedures. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Eustina G Kwon
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
| | - Jenny Kreiss
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Lauren Nicassio
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Kelly Austin
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey R Avansino
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Casey M Calkins
- Department of Surgery, Wisconsin Children's Hospital, Milwaukee, WI, USA
| | - Rachel C Crady
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Belinda Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Megan M Durham
- Department of Surgery, Children's Hospital of Atlanta, Atlanta, GA, USA
| | - Jason Frischer
- Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Megan K Fuller
- Department of Surgery, Boys Town Research Hospital-Children's of Omaha, Boys Town, NE, USA
| | - K Elizabeth Speck
- Division of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rebecca Rentea
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Payam Saadai
- Department of Surgery, University of California Davis, Davis, CA, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Caitlin A Smith
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Samuel E Rice-Townsend
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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4
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Ullrich S, Austin K, Avansino JR, Badillo A, Calkins CM, Crady RC, Durham MM, Fuller MK, Rana A, Reeder RW, Rentea RM, Rollins MD, Saadai P, Speck KE, Wood RJ, van Leeuwen K, Frischer JS. Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium. J Pediatr Surg 2024:S0022-3468(24)00186-6. [PMID: 38677965 DOI: 10.1016/j.jpedsurg.2024.03.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Hirschsprung Disease (HD) is a rare cause of functional bowel obstruction in children. Patients are typically diagnosed in the neonatal period and undergo pull-through (PT) soon after diagnosis. The optimal management and post-operative outcomes of children who present in a delayed fashion are unknown. METHODS A multi-center retrospective review of children with HD was performed at participating Pediatric Colorectal and Pelvic Learning Consortium sites. Children were stratified by age at diagnosis (neonates <29 days; infants 29 days-12 months; toddler 1 year-5 years and child >5 years). RESULTS 679 patients with HD from 14 sites were included; Most (69%) were diagnosed in the neonatal period. Age at diagnosis was not associated with differences in 30-day complication rates or need for PT revision. Older age at diagnosis was associated with a greater likelihood of undergoing fecal diversion after PT (neonate 10%, infant 12%, toddler 26%, child 28%, P < 0.001) and a greater need for intervention for constipation or incontinence postoperatively (neonate 56%, infant 62%, toddler 78%, child 69%, P < 0.001). CONCLUSION Delayed diagnosis of HD does not impact 30-day post-operative outcomes or need for revision surgery but, delayed diagnosis is associated with increased need for fecal diversion after pull-through. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sarah Ullrich
- Colorectal Center, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
| | - Kelly Austin
- Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey R Avansino
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel C Crady
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Megan M Durham
- Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Megan K Fuller
- Department of Surgery, Boys Town National Research Hospital, University of Nebraska Medical Center, Boys Town, NE, USA
| | - Ankur Rana
- Department of Surgery and Perioperative Care, Dell Children's Medical Center, University of Texas Austin, Austin, TX, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Davis, CA, USA
| | - K Elizabeth Speck
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Kathleen van Leeuwen
- Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA
| | - Jason S Frischer
- Colorectal Center, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA.
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5
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Srinivas S, Knaus ME, Avansino JR, Badillo A, Calkins CM, Dickie BH, Durham MM, Fuller MK, Ralls MW, Reeder RW, Rentea RM, Rollins MD, van Leeuwen K, Wood RJ. Outcomes From Colonic Pull-Through for Cloacal Exstrophy Differ by Colon Length: A Multi-Institutional Study. J Pediatr Surg 2024; 59:225-229. [PMID: 37968156 DOI: 10.1016/j.jpedsurg.2023.10.019] [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: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Cloacal exstrophy (CE) represents a rare sub-group of anorectal malformations. Traditionally managed with a permanent colostomy, colonic pull-through (PT) has emerged to allow cleanliness without a life-long stoma. We sought to understand outcomes of PT in a large multi-center CE population. METHODS We performed a retrospective study involving eleven pediatric hospitals. We gathered data on demographics, outcomes, and anatomical factors including colon length. Continuous variables were analyzed with Wilcoxon rank-sum tests and categorial variables with Fisher's exact tests. RESULTS There were 98 patients, of which the majority (n = 70, 71.4 %) never underwent PT. There were no differences in exstrophy type, demographics, or associated anomalies. Median age at PT was 1.3 years (IQR 0.3-3.7). Of the cohort that continue to use their PT, the majority (n = 16, 69.6 %) are not clean. In total, 7.1 % (n = 7) of the cohort is clean with a PT, and only one patient is continent. Clean patients have a longer colon length than those who are not clean or opt for re-do ostomy (64.0 cm [IQR 46.0-82.0] vs 26.5 cm [IQR 11.6-41.2], p = 0.005). CONCLUSION Overall, we demonstrate that most children born with CE will keep their stoma. Only a small percentage who elect to undergo colonic PT are clean for stool. Greater colon length correlates with success. This suggests that multiple factors, including colon length, are important when considering PT in a child with CE. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shruthi Srinivas
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
| | - Maria E Knaus
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Jeffrey R Avansino
- Department of Surgery, Seattle Children's, University of Washington, Seattle, WA, USA
| | - Andrea Badillo
- Department of Surgery, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Belinda H Dickie
- Department of Surgery, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Megan M Durham
- Department of Surgery, Emory + Children's Pediatric Institute, Atlanta, GA, USA
| | - Megan K Fuller
- Department of Surgery, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Matthew W Ralls
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Michael D Rollins
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah Health, Salt Lake City, UT, USA
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
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6
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Garvey EM, Fuller M, Frischer J, Calkins CM, Rentea RM, Ralls M, Wood R, Rollins MD, Avansino J, Reeder RW, Durham MM. Multi-Institutional Review From the Pediatric Colorectal and Pelvic Learning Consortium of Minor Spinal Cord Dysraphism in the Setting of Anorectal Malformations: Diagnosis, Treatment, and Outcomes. J Pediatr Surg 2023:S0022-3468(23)00251-8. [PMID: 37248140 DOI: 10.1016/j.jpedsurg.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/RATIONALE Anorectal malformations (ARM) are associated with congenital anomalies of the spine, but the impact of a minor spinal cord dysraphism (mSCD) on fecal continence in the setting of ARM remains unclear. MATERIALS/METHODS A retrospective review was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry. The patient cohort was reviewed for ARM type, mSCD screening/incidence/neurosurgical intervention and age-based BMP utilization. RESULTS 987 patients with ARM were categorized into mild (38%), moderate (32%) or complex (19%). 694 (70%) had normal spinal (NS) status. 271 (27.5%) patients had mSCD. MRI alone (49%) was the most common screening test for mSCD. US screening had a positive predictive value of 86.3% and a negative predictive value of 67.1%. Surgical intervention rates for mSCD ranged between 13% and 77% at a median age of 0.6-5.2 years. 726 (73.6%) patients were prescribed BMP (74.4% NS, 77.5% mSCD). Laxatives were most utilized BMP in all groups <5yo. ≥5yo, enema utilization increased with ARM complexity independent of spine status (with or without neurosurgical intervention). Neurosurgical intervention did not affect BMP utilization at any age or with any ARM when mSCD was identified. CONCLUSIONS MSCD influence on bowel function in the setting ARM remains unclear. No significant impact of mSCD was noted on ARM patient bowel management program utilization. Variability exists within PCPLC site with screening and intervention for mSCD in patients with ARM. Future studies with standardized care may be needed to elucidate the true impact of mSCD on long term patient outcomes in ARM patients. TYPE OF STUDY Retrospective Comparative Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Erin M Garvey
- Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85106, USA
| | - Megan Fuller
- Boys Town National Research Hospital, 14040 Boys Town Hospital Rd, Omaha, NE, 68010, USA
| | | | - Casey M Calkins
- Children's Hospital of Wisconsin, 999 N. 92nd Street, Milwaukee, WI, 53226, USA
| | - Rebecca M Rentea
- Children's Mercy Kansas City, University of Missouri- Kansas City, Kansas City, MO, 64108, USA
| | - Matthew Ralls
- C.S. Mott Children's Michigan University of Michigan, 1540 E. Hospital Drive, Ann Arbor, MI, 48109, USA
| | - Richard Wood
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Michael D Rollins
- Primary Children's Hospital, University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA
| | - Jeffrey Avansino
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Ron W Reeder
- Data Coordinating Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Megan M Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, 1405 Clifton Road NE, 3rd Floor, Tower 1, Pediatric Surgical Suite, Atlanta, GA, 30322, USA.
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7
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Iantorno SE, Rollins MD, Austin K, Avansino JR, Badillo A, Calkins CM, Crady RC, Dickie BH, Durham MM, Frischer JS, Fuller MK, Grabowski JE, Ralls MW, Reeder RW, Rentea RM, Saadai P, Wood RJ, van Leeuwen KD, Short SS. Rectal Prolapse Following Repair of Anorectal Malformation: Incidence, Risk Factors, and Management. J Pediatr Surg 2023:S0022-3468(23)00252-X. [PMID: 37173214 DOI: 10.1016/j.jpedsurg.2023.04.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The incidence and optimal management of rectal prolapse following repair of an anorectal malformation (ARM) has not been well-defined. METHODS A retrospective cohort study was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium registry. All children with a history of ARM repair were included. Our primary outcome was rectal prolapse. Secondary outcomes included operative management of prolapse and anoplasty stricture following operative management of prolapse. Univariate analyses were performed to identify patient factors associated with our primary and secondary outcomes. A multivariable logistic regression was developed to assess the association between laparoscopic ARM repair and rectal prolapse. RESULTS A total of 1140 patients met inclusion criteria; 163 (14.3%) developed rectal prolapse. On univariate analysis, prolapse was significantly associated with male sex, sacral abnormalities, ARM type, ARM complexity, and laparoscopic ARM repairs (p < 0.001). ARM types with the highest rates of prolapse included rectourethral-prostatic fistula (29.2%), rectovesical/bladder neck fistula (28.8%), and cloaca (25.0%). Of those who developed prolapse, 110 (67.5%) underwent operative management. Anoplasty strictures developed in 27 (24.5%) patients after prolapse repair. After controlling for ARM type and hospital, laparoscopic ARM repair was not significantly associated with prolapse (adjusted odds ratio (95% CI): 1.50 (0.84, 2.66), p = 0.17). CONCLUSION Rectal prolapse develops in a significant subset of patients following ARM repair. Risk factors for prolapse include male sex, complex ARM type, and sacral abnormalities. Further research investigating the indications for operative management of prolapse and operative techniques for prolapse repair are needed to define optimal treatment. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Stephanie E Iantorno
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Kelly Austin
- Department of Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey R Avansino
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel C Crady
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Belinda H Dickie
- Department of Surgery, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Megan M Durham
- Emory + Children's Pediatric Institute, Atlanta, GA, USA
| | - Jason S Frischer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Megan K Fuller
- Department of Surgery, Boys Town Research Hospital-Children's of Omaha, University of Nebraska Medical Center, Boys Town, NE, USA
| | - Julia E Grabowski
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Matthew W Ralls
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Davis, CA, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Kathleen D van Leeuwen
- Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA
| | - Scott S Short
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
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8
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Ahmad H, Wood RJ, Avansino JR, Calkins CM, Dickie BH, Durham MM, Frischer J, Fuller M, Ralls M, Reeder RW, Rentea RM, Rollins MD, Saadai P, Oelschlager AMEA, Breech LL, Hewitt GD, Kluivers K, van Leeuwen KD, McCracken KA. Does presence of a VACTERL anomaly predict an associated gynecologic anomaly in females with anorectal malformations?: A Pediatric Colorectal and Pelvic Learning Consortium Study. J Pediatr Surg 2023; 58:471-477. [PMID: 35879143 DOI: 10.1016/j.jpedsurg.2022.06.006] [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: 03/19/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND VACTERL association is defined by the presence of 3 or more anomalies in any of the following systems: vertebral, anorectal, cardiac, trachea-esophageal, renal, or limb. This study hypothesized that the presence of VACTERL association would correlate with an increased risk of gynecologic anomalies in patients with anorectal malformation (ARM). METHODS This study is a cross-sectional, retrospective analysis from the prospectively collected, multicenter registry of the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). The 834 female patients with ARM who were enrolled in the registry by January 1, 2020 were included in this study. The relationship of VACTERL association with presence of a gynecologic anomaly was evaluated with Fisher's exact test. The relationship of each VACTERL system with presence of a gynecologic anomaly was assessed in patients with cloaca, rectovestibular fistulas and rectoperineal fistulas. P-values reported were based on a 2-sided alternative and considered significant when less than 0.05. RESULTS 834 patients with ARM underwent VACTERL screening and gynecologic evaluation with the three most common subtypes being cloaca (n = 215, 25.8%), rectovestibular fistula (n = 191, 22.9%) and rectoperineal fistula (n = 194, 23.3%). A total of 223 (26.7%) patients with ARM had gynecologic anomalies. VACTERL association was seen in 380 (45.6%) of patients with ARM. Gynecologic anomalies were present in 149 (39.1%) vs. 74 (16.3%) of subjects with vs. without VACTERL association (p < 0.001). VACTERL association did not significantly increase the risk of gynecologic anomaly in patients with cloaca and VACTERL (n = 88, 61.5%) vs. cloaca without VACTERL (n = 39, 54.2% p = 0.308). VACTERL association increased the risk of gynecologic anomalies in patients with rectoperineal fistulas (n = 7, 14.9% vs n = 9, 6.1% p = 0.014) and rectovestibular fistulas (n = 19, 31.1% vs. n = 13, 10.0% p<0.001). In patients with ARM who had a VACTERL association, when one of the associated anomalies was renal, there was an even higher risk of having an associated gynecologic anomaly (n = 138, 44.2% vs. n = 85, 16.3% p<0.001). CONCLUSIONS VACTERL association in patients with rectoperineal and rectovestibular fistulas correlates with an increased risk of gynecologic anomalies. The presence of VACTERL associated findings, especially renal, should prompt a thorough evaluation of the gynecologic system. LEVEL OF EVIDENCE III. Retrospective comparative study.
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Affiliation(s)
- Hira Ahmad
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States; Seattle Children's Hospital, Seattle, WA, United States.
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States
| | | | - Casey M Calkins
- Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | | | - Megan M Durham
- Emory-CHOA Pediatric Institute, Atlanta, GA, United States
| | - Jason Frischer
- Cincinnati Children's Hospital, Cincinnati, OH, United States
| | | | - Matt Ralls
- University of Michigan, Ann Arbor, MI, United States
| | - Ron W Reeder
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | | | - Michael D Rollins
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Payam Saadai
- University of California Davis, Davis, CA, United States
| | | | - Lesley L Breech
- Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Geri D Hewitt
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States
| | - Kirsten Kluivers
- Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | | | - Katherine A McCracken
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States
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Slater BJ, Kashyap MV, Calkins CM, Powell D, Rothstein DH, Clifton M, Pandya S. Global dissemination of knowledge through virtual platforms: Reflections and recommendations from APSA/IPEG. J Pediatr Surg 2022; 57:124-129. [PMID: 35086680 PMCID: PMC8760846 DOI: 10.1016/j.jpedsurg.2022.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/04/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic forced the cancelation of conventional in-person academic conferences due to the risk of virus transmission and limited ability to travel. Both the American Pediatric Surgical Association (APSA) and International Pediatric Endosurgery Group (IPEG) converted to a virtual format for their 2020 annual meetings. The purpose of this article is to review the successful implementation of the APSA and IPEG virtual meetings and reflect upon lessons learned for future virtual conferences. METHODS Logistics, structure, and attendance statistics were reviewed. Informal interviews were conducted with key stakeholders and the number of presenters and participants were analyzed. Finally, post-meeting attendee surveys were conducted to elicit feedback after both virtual meetings. RESULTS The meetings were organized in different ways, with APSA spreading a mix of scientific and clinical educational content over several months and IPEG keeping the meeting compressed, similar to previous in-person versions. Both meetings were free and therefore attracted a high proportion of participants (720 for APSA and 834 for IPEG). The meetings were felt to be educationally appropriate by most, although timing and lack of Continuing Medical Education (CME) opportunities were detractors. Most attendees said they would be willing to pay fees similar to in-person amounts. IPEG compressed presentations into four 2-hour sessions spread over 4 weeks, but also made material available on-line through a proprietary application. There was a broad range of international attendees. IPEG attracted a larger percentage of non-members than did APSA (3:1 nonmember to member ratio). Both societies reported net losses, largely due to lost registration revenue and non-refundable costs from having to switch from an in-person meeting. CONCLUSIONS The main advantage of the virtual meeting was increased participation while disadvantages included the lack of networking. The key lessons learned from the meetings include methods to increase interactivity, adjustments of technical logistics, and creation of enduring material. In the future, hybrid conferences will likely become more prevalent with advantages of both platforms. LEVEL-OF-EVIDENCE Level V - Expert Opinion.
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Affiliation(s)
- Bethany J Slater
- Department of Surgery, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, Illinois, United States 60637.
| | - Meghana V. Kashyap
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, United States 68198
| | - Casey M. Calkins
- Department of Pediatric Surgery, Children's Wisconsin/Medical College of Wisconsin, 999 N 92nd Street, Suite 320, Milwaukee, WI 53226, United States
| | - David Powell
- Division of Pediatric Surgery, Stanford School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - David H. Rothstein
- Department of Pediatric Surgery, Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, WA, United States
| | - Matthew Clifton
- Department of Surgery, Emory University/Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - Samir Pandya
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
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Short SS, Reeder RW, Lewis KE, Dickie B, Grabowski J, Sepuha T, Durham MM, Frischer J, Badillo A, Calkins CM, Rentea RM, Ralls M, Wood RJ, Fuller MK, van Leeuwen K, Avansino JR, Austin K, Rollins MD. The presence of a neurodiverse disorder is associated with increased use of antegrade enema therapy in children with severe constipation: A study from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). J Pediatr Surg 2022; 57:1676-1680. [PMID: 35597676 DOI: 10.1016/j.jpedsurg.2022.04.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Children with severe constipation and a neurodiverse disorder (Autism and/or developmental delay) represent a challenging bowel management group. Treatment outcomes with laxative or enema therapy remain limited and are often complicated by patient/caregiver compliance. We hypothesized that children with neurodiverse disorders and severe constipation would benefit from a bowel management program (BMP) that includes early use of antegrade enemas. MATERIALS AND METHODS Children requiring BMP in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry with diagnosis of constipation and/or constipation with pseudo-incontinence were reviewed. Those with Hirschsprung disease and/or Anorectal Malformation were excluded. BMP needs in patients with a neurodiverse diagnosis were compared to those without to evaluate differences in BMP's. RESULTS 372 patients requiring a BMP were identified. 95 patients (58 autism spectrum, 54 developmental delay) were neurodiverse, and 277 patients were not. Neurodiverse patients had a higher prevalence of enema therapy 62.1% (59/95) vs. 54.9% (152/273) and use of antegrade enema therapy 33.7% (32/95) vs. 21.2% (58/273), p = 0.126. Neurodiverse patients were older 37.9% (36/95) > 12 years vs. 23.1% (63/273), p = 0.001 and 47.6% (10/21) were changed from laxative to enema therapy over time. 80% (8/10) of those changed from laxatives to enemas used antegrade therapy. 67.3% (35/52) of neurodiverse patients followed over time were on enema therapy at the most recent visit with 80% (28/35) requiring antegrade therapy. CONCLUSION A large portion of patients with a neurodiverse disorder who fail laxative therapy use antegrade enemas to achieve effective bowel management. Early consideration of an antegrade conduit may simplify treatment in this group of children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Scott S Short
- Primary Children's Hospital, 100 N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, USA.
| | | | | | | | | | | | | | | | | | | | | | - Matt Ralls
- C.S. Mott Children's Hospital/Univ. of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | | | - Michael D Rollins
- Primary Children's Hospital, 100 N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, USA
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11
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Tham SW, Rollins MD, Reeder RW, Lewis KE, Calkins CM, Avansino JR, Palermo TM. Health-related quality of life in children with Hirschsprung disease and children with functional constipation: Parent-child variability. J Pediatr Surg 2022; 57:1694-1700. [PMID: 35491270 PMCID: PMC9296600 DOI: 10.1016/j.jpedsurg.2022.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is an important outcome among children with Hirschsprung Disease (HD), but there are challenges in interpreting findings in previous studies owing to the choice of a comparator group and informant. We compared parent-proxy versus child self-report HRQOL in children with HD to children with functional constipation (FC) and examined predictors of HRQOL. METHODS Data of 126 children (5-18 years, 60.3% male, HD: n = 52, FC: n = 74) were acquired from the Pediatric Colorectal and Pelvic Learning Consortium. Demographics, clinical variables, HRQOL (Pediatric Quality of Life Inventory parent-proxy; child self-report) and functional outcomes (Baylor Continence Scale, Cleveland Clinic Constipation Scoring System) were collected. RESULTS Parent and child HRQOL was similar for both cohorts, with higher scores on physical functioning and lower scores on emotional and school functioning. For children with HD, demographics and clinical variables did not predict HRQOL in multivariable regression models. For children with FC, greater severity of constipation predicted lower HRQOL (parent-proxy: B = -2.14, p < 0.001; child: B = -1.75, p = 0.001). Parent-child agreement on HRQOL scores was poor to moderate in the HD group (intraclass correlations (ICC)=0.38-0.74), but moderate to excellent in the FC group (ICC=0.63-0.84). Furthermore, parents of children with FC and ≤10 years overestimated children's HRQOL (proportional OR 4.59 (1.63, 13.85); p = 0.004). CONCLUSION Clinical symptoms and demographic factors did not predict HRQOL among children with HD, highlighting the need to examine other biopsychosocial factors to understand long term HRQOL. Low parent-child HRQOL agreement in children with HD demonstrates the importance of obtaining parent and child perspectives. LEVEL OF EVIDENCE III. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- See Wan Tham
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA; Seattle Children's Research Institute, M/S CURE-3, PO Box 5371, Seattle, WA 98145, USA.
| | - Michael D Rollins
- University of Utah Health, Salt Lake City, UT, USA,Division of Pediatric Surgery, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Ron W Reeder
- Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Katelyn E Lewis
- Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Casey M Calkins
- Division of Pediatric Surgery, Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey R Avansino
- Department of Surgery, University of Washington School of Medicine, Division of Pediatric General and Thoracic Surgery, Seattle Children’s, Seattle, WA USA
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA,Seattle Children’s Research Institute, Seattle, WA, USA
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12
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Ahn JJ, Rice-Townsend SE, Nicassio L, Glazer D, Avansino JR, Lewis KE, Durham MM, Frischer J, Calkins CM, Rentea RM, Ralls M, Fuller M, Wood RJ, Rollins MD, Lee J, Reeder RW, Dickie BH, Saadai P, Cain MP, Merguerian P, Smith CA. Urinary continence disparities in patients with anorectal malformations. J Pediatr Surg 2022; 57:74-79. [PMID: 34688492 DOI: 10.1016/j.jpedsurg.2021.09.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM. METHODS We performed a multicenter retrospective study of ARM patients evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent accidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes included bladder management strategies such as clean intermittent catheterization and continence surgery. P-value < 0.05 was considered significant. RESULTS A total of 525 patients with ARM were included. Overall, 48% reported complete urinary continence, and continence was associated with greater age. For school-aged children (age ≥ 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were associated with decreased likelihood of incontinence. CONCLUSIONS We observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes.
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Affiliation(s)
- Jennifer J Ahn
- Department of Urology, Seattle Children's, University of Washington, 4800 Sand Point Way NE, M/S OA.9.220, Seattle, WA 98105, United States.
| | - Samuel E Rice-Townsend
- Department of General Surgery, Seattle Children's, University of Washington, Seattle, WA, United States
| | - Lauren Nicassio
- Department of General Surgery, Seattle Children's, University of Washington, Seattle, WA, United States
| | - Debra Glazer
- Department of General Surgery, Seattle Children's, University of Washington, Seattle, WA, United States
| | - Jeffrey R Avansino
- Department of General Surgery, Seattle Children's, University of Washington, Seattle, WA, United States
| | - Katelyn E Lewis
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Megan M Durham
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Jason Frischer
- Cinncinati Children's Hospital, Cincinnati, OH, United States
| | - Casey M Calkins
- Children's Hospital of Wisconsin, The Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Matthew Ralls
- C.S. Mott Children's Michigan, Ann Arbor, MI, United States
| | - Megan Fuller
- Boys Town National Research Hospital, Boys Town, NE, United States
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Justin Lee
- Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | | | - Payam Saadai
- University of California Davis, Sacramento, CA, United States
| | - Mark P Cain
- Department of Urology, Seattle Children's, University of Washington, 4800 Sand Point Way NE, M/S OA.9.220, Seattle, WA 98105, United States
| | - Paul Merguerian
- Department of Urology, Seattle Children's, University of Washington, 4800 Sand Point Way NE, M/S OA.9.220, Seattle, WA 98105, United States
| | - Caitlin A Smith
- Department of General Surgery, Seattle Children's, University of Washington, Seattle, WA, United States
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13
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Calkins CM. The pediatric vascular system and surgical considerations - A preface: Seminars in pediatric surgery. Semin Pediatr Surg 2021; 30:151117. [PMID: 34930592 DOI: 10.1016/j.sempedsurg.2021.151117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Casey M Calkins
- The Medical College of Wisconsin, The Children's Hospital of Wisconsin, 999 North 92nd Street, Suite C320, Milwaukee, WI 53226, USA.
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14
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Kastenberg ZJ, Taylor MA, Durham MM, Calkins CM, Rentea RM, Wood RJ, Avansino JR, Levitt MA, van Leeuwen KD, Lewis KE, Reeder RW, Rollins MD. Perioperative and long-term functional outcomes of neonatal versus delayed primary endorectal pull-through for children with Hirschsprung disease: A pediatric colorectal and pelvic learning consortium study. J Pediatr Surg 2021; 56:1465-1469. [PMID: 34052005 DOI: 10.1016/j.jpedsurg.2021.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE the timing of endorectal pull-through for Hirschsprung disease (HD) is controversial. Neonatal primary endorectal pull-through theoretically prevents preoperative enterocolitis. Delayed primary endorectal pull-through offers the surgeon the benefit of more robust perineal anatomy and allows primary caregivers the time to emotionally process the diagnosis and to gain experience with rectal irrigations. We hypothesized that delayed primary endorectal pull-through would be associated with equivalent perioperative morbidity compared to the neonatal repair and would lead to improved long-term functional outcomes. METHODS we analyzed all patients in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry who had a primary endorectal pull-through for HD and at least three-and-one-half years of follow up in a specialty colorectal clinic. We evaluated patient demographics, operative outcomes, perioperative episodes of enterocolitis, and long-term functional outcomes for the neonatal (<31 days) and delayed (≥31 days) pull-through cohorts. RESULTS eighty-two patients were identified of whom 49 were operated upon in the neonatal period and 33 in a delayed fashion. The median age at operation was 11 days [IQR 7 - 19 days] for the neonatal cohort and 98 days [IQR 61 - 188 days] for the delayed cohort. Thirty-four (69.4%) of the neonatal and 22 (66.7%) of the delayed cohort patients had rectosigmoid transition zones. Four of 49 patients (8.1%) in the neonatal cohort were diagnosed with enterocolitis preoperatively compared to two of 33 (6.0%) in the delayed cohort (p = 0.89). Eighteen of 49 patients (36.7%) in the neonatal cohort and 16 of 33 (48.5%) in the delayed cohort had at least one postoperative episode of enterocolitis (p = 0.38). Fifteen of 49 patients (30.6%) in the neonatal cohort were receiving bowel management for fecal incontinence at most recent follow up compared to five of 33 (15.2%) in the delayed cohort (p = 0.13). CONCLUSION delayed primary endorectal pull-through offers a safe alternative to operation in the neonatal period and appears to have, at least, equivalent functional outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Zachary J Kastenberg
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Primary Children's Hospital, 100N. Mario Cappecchi Dr., Suite 3800, Salt Lake City, UT 84113, United States.
| | - Mark A Taylor
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Primary Children's Hospital, 100N. Mario Cappecchi Dr., Suite 3800, Salt Lake City, UT 84113, United States
| | - Megan M Durham
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Casey M Calkins
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - Rebecca M Rentea
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Richard J Wood
- Division of Pediatric Surgery, Department of Surgery, Ohio State College of Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Jeffrey R Avansino
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle Children's, WA, United States
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington DC, United States
| | | | - Katelyn E Lewis
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, United States
| | - Ron W Reeder
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, United States
| | - Michael D Rollins
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Primary Children's Hospital, 100N. Mario Cappecchi Dr., Suite 3800, Salt Lake City, UT 84113, United States
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15
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Taylor MA, Bucher BT, Reeder RW, Avansino JR, Durham M, Calkins CM, Wood RJ, Levitt MA, Drake K, Rollins MD. Comparison of Hirschsprung Disease Characteristics between Those with a History of Postoperative Enterocolitis and Those without: Results from the Pediatric Colorectal and Pelvic Learning Consortium. Eur J Pediatr Surg 2021; 31:207-213. [PMID: 32947626 DOI: 10.1055/s-0040-1716876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/29/2022]
Abstract
INTRODUCTION The current understanding of Hirschsprung-associated enterocolitis (HAEC) is based mainly on single-center, retrospective studies. The aims of this study are to determine risk factors for postoperative HAEC using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) database. MATERIALS AND METHODS We performed a multicenter, retrospective, case-control study of children with Hirschsprung disease (HD) who had undergone a pull-through procedure and were evaluated at a PCPLC member site between February 2017 and March 2020. The cohort with a history of postoperative HAEC was compared with that without postoperative episodes of HAEC to determine relevant associations with postoperative HAEC. RESULTS One-hundred forty of 299 (46.8%) patients enrolled had a history of postoperative HAEC. Patients with a rectosigmoid transition zone had a lower association with postoperative HAEC as compared with those with a more proximal transition zone (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.26, 0.84, p < 0.01). Private insurance was protective against postoperative HAEC on univariate analysis (OR: 0.62, 95% CI: 0.38, 0.99, p = 0.047), but not on multivariate analysis (OR: 0.62, 95% CI: 0.37, 1.04, p = 0.07). Preoperative HAEC was not associated with the development of postoperative HAEC. CONCLUSION Patients with a rectosigmoid transition zone have less postoperative HAEC compared with patients with a more proximal transition zone. Multi-institutional collection of clinical information in patients with HD may allow for the identification of additional risk factors for HAEC and afford the opportunity to improve care.
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Affiliation(s)
- Mark A Taylor
- Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Brian T Bucher
- Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Ron W Reeder
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Jeffrey R Avansino
- Department of Pediatric Surgery, Seattle Children's, Seattle, Washington, United States
| | - Megan Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Casey M Calkins
- Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, Wisconsin, United States
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Marc A Levitt
- Department Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, Washington, United States
| | - Kaylea Drake
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Michael D Rollins
- Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
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Lane VA, Calisto J, deBlaauw I, Calkins CM, Samuk I, Avansino JR. Assessing the previously repaired patient with an anorectal malformation who is not doing well. Semin Pediatr Surg 2020; 29:150995. [PMID: 33288142 DOI: 10.1016/j.sempedsurg.2020.150995] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this review, the care of children with a previously repaired anorectal malformation is explored. We know that the surgical care of children with anorectal malformations is complex; however, despite an increased understanding of the congenital anomaly and significant technical advances in the operative repair, many of these children continue to have poor functional outcomes. In this article we focus on the common surgical complications, discuss typical presentations, consider appropriate investigations, and review the risks and benefits of revisional surgery in those patients that are 'not doing well' following their primary reconstruction.
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Affiliation(s)
- Victoria A Lane
- Department of Paediatric Surgery, Great North Children's Hospital, Newcastle-Upon-Tyne, UK.
| | - Juan Calisto
- Colorectal Center, Nicklaus Children's Hospital, Miami, FL, USA
| | - Ivo deBlaauw
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Casey M Calkins
- The Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Inbal Samuk
- Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Jeffrey R Avansino
- Reconstructive Pelvic Medicine Program, Seattle Children's Hospital, Seattle, WA, USA; Department of Surgery, University of Washington, USA
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17
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Baxter KJ, Garza JM, Rollins MD, Drake K, Reeder RW, Wood R, Avansino J, Calkins CM, Ralls M, Garvey EM, Durham MM. Multi-institutional review of bowel management strategies in children with anorectal malformations. J Pediatr Surg 2020; 55:2752-2757. [PMID: 32616413 DOI: 10.1016/j.jpedsurg.2020.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/27/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/RATIONALE To describe current bowel management program (BMP) strategies in anorectal malformation (ARM) patients based on patient-level predictors using data from a multi-institutional consortium. MATERIALS/METHODS Patient bowel function and BMP were reviewed from Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) data. The PCPLC is comprised of multidisciplinary specialists researching colorectal and pelvic disorders. Seven US institutions submitted de-identified clinical data on ARM patients into a centralized patient registry. RESULTS The primary ARM of 624 patients was categorized into Mild (45.2%), Moderate (40.4%) or Complex (14.2%) anomaly classifications. Patient-specific BMP were examined based on age and on the presence of spinal cord/sacral anomalies. 418 (67%) enrolled patients were prescribed BMP (<5 yo 56.4%; ≥5-<12 yo 86.7%; ≥12 81.5%). Constipation was the primary chief complaint (80.2%). Forty percent of patients on a BMP were toilet trained and approximately one-half (48.5%) reported daytime stool accidents. Secondary surgical interventions for antegrade continence enemas (ACE) were examined; 14.5% of patients employed ACE strategies and utilization increased with age and varied based on anatomic anomalies. CONCLUSIONS This is the first report on BMP strategies for patients with ARM from the Pediatric Colorectal and Pelvic Learning Consortium. Individual patient characteristics are explored for their impact on bowel management strategy utilization. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Katherine J Baxter
- Emory University School of Medicine, Office of Surgical Education, H100 Emory University Hospital1364 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Jose M Garza
- Children's Healthcare of Atlanta, 1400 Tullie Road NE 6th Floor, Atlanta, GA 30329, USA
| | - Michael D Rollins
- Primary Children's Hospital, University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Kaylea Drake
- Data Coordinating Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Ron W Reeder
- Data Coordinating Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Richard Wood
- Nationwide Children's Hospital, 700 Children's Drive Columbus, OH 43205, USA
| | - Jeffrey Avansino
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Casey M Calkins
- Children's Hospital of Wisconsin, 999 N. 92(nd) Street, Milwaukee, WI 53226, USA
| | - Matt Ralls
- University of Michigan, 1540 E. Hospital Drive, Ann Arbor, MI 48109, USA
| | - Erin M Garvey
- Phoenix Children's Hospital , 1919 E. Thomas Road, Phoenix, AZ 85106, USA
| | - Megan M Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, 1405 Clifton Road NE, 3rd Floor, Tower 1, Pediatric Surgical Suite, Atlanta, Ga 30322, USA.
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18
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Suchi M, Calkins CM, Chogle A, Bond JS, Kapur RP. Submucosal Supernumerary Smooth Muscle Coat: A Common Histologic Finding in Mowat-Wilson Syndrome With or Without Hirschsprung Disease. Pediatr Dev Pathol 2020; 23:372-379. [PMID: 32469269 DOI: 10.1177/1093526620925960] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mowat-Wilson syndrome (MWS) is a multiorgan system disorder caused by ZEB2 (zinc finger E-box-binding homeobox 2) mutations or deletions. One common manifestation is constipation, and approximately half of the patients have Hirschsprung disease (HSCR). In addition to classic histologic features of HSCR, an unusual supernumerary intestinal muscle coat was recently reported in a patient of MWS with HSCR. A similar smooth muscle alteration, segmental additional circular muscle coat, had been described in the specimens from patients with intestinal pseudo-obstruction without MWS or HSCR. METHOD Rectal biopsies and rectosigmoidectomy specimens from MWS patients were identified by retrospective reviews of surgical pathology records. Routinely prepared glass slides were examined to determine whether any smooth muscle structural alteration was present. Clinical information was obtained by chart review. RESULTS Six MWS patients were identified. A supernumerary smooth muscle coat in the submucosa was present in 3 of them, including 2 of the 4 patients with HSCR. CONCLUSION The structural anomaly, termed submucosal supernumerary smooth muscle coat, is not a syndrome-specific pathological feature. However, it appears to be more common than expected in MWS and is consistent with contemporary models for the roles of ZEB2 and related cell signaling pathways in the patterning of intestinal musculature during embryonic development.
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Affiliation(s)
- Mariko Suchi
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Casey M Calkins
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ashish Chogle
- Department of Pediatric Ganstroenterology, Children's Hospital of Orange County, Orange, California
| | - Jesse Steffan Bond
- Department of Pathology, Providence Alaska Medical Center, Anchorage, Alaska
| | - Raj P Kapur
- Department of Pathology, Seattle Children's Hospital and University of Washington, Seattle, Washington
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19
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Taylor MA, Bucher BT, Reeder RW, Levitt M, Avansino J, Durham MM, Calkins CM, Wood R, Drake K, Rollins M. Comparison of Maternal Histories and Exposures in Children With Isolated Anorectal Malformation Versus Anorectal Malformation With Genitourinary Anomalies. Cureus 2020; 12:e8762. [PMID: 32714700 PMCID: PMC7377652 DOI: 10.7759/cureus.8762] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction To our knowledge, there are no studies to date that have compared patients with isolated anorectal malformation (ARM) to patients with ARM and an associated genitourinary (GU) malformation despite a possible etiological difference between these two entities. We examined the differences in maternal and prenatal exposures and comorbidities between patients with isolated ARM and patients with ARM and associated GU malformations. Materials and methods A retrospective cohort study of children with ARM, enrolled in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) between February 2017 and October 2019, was performed comparing those with isolated ARM to those with ARM and associated GU anomalies (GU +/- additional anomalies) as well as to those with ARM and a GU anomaly with no anomaly of any other system (GU-only). We compared the prevalence of prematurity, family history of colorectal disorders, as well as maternal and prenatal comorbidities and exposures between these two cohorts and the isolated ARM cohort. Results A total of 505 patients (117 with isolated ARM and 388 with ARM and associated GU anomalies) were enrolled. Of the 388 patients with ARM and associated GU anomalies, 48 had an ARM with a GU anomaly without an anomaly in any other system. There was an increased prevalence of premature births in the GU +/- additional anomalies cohort compared to the isolated ARM cohort (27 vs 14%, p=0.003). This difference was not seen in the GU-only cohort. There was no difference between the cohorts regarding prevalence of family history of ARM or maternal and prenatal comorbidities or exposures. Conclusions Patients with an ARM and an associated GU anomaly with or without other congenital anomalies are more likely to be born prematurely compared to patients with an isolated ARM. Parents of these children should be counseled on this increased risk.
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Affiliation(s)
- Mark A Taylor
- Department of Surgery, University of Utah, Salt Lake City, USA
| | - Brian T Bucher
- Department of Surgery, University of Utah, Salt Lake City, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Marc Levitt
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, USA
| | - Jeffrey Avansino
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, USA
| | - Megan M Durham
- Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, USA
| | - Casey M Calkins
- Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, USA
| | - Richard Wood
- Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, USA
| | - Kaylea Drake
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Michael Rollins
- Department of Surgery, University of Utah, Salt Lake City, USA.,Department of Surgery, Primary Children's Hospital, Salt Lake City, USA
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20
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Calkins CM, Scasta JD, Smith T, Stayton MM, Lake SL. Haematobia irritans parasitism of F1 yak × beef cattle (Bos grunniens × Bos taurus) hybrids. Med Vet Entomol 2019; 33:546-551. [PMID: 31106462 DOI: 10.1111/mve.12382] [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] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Abstract
The horn fly Haematobia irritans (Diptera: Muscidae) is a blood obligate ectoparasite of bovids that causes annual losses to the U.S. beef cattle industry of over US$1.75 billion. Climate warming, the anthropogenic dispersion of bovids and the cross-breeding of beef cattle with other bovid species may facilitate novel horn fly-host interactions. In particular, hybridizing yaks [Bos grunniens (Artiodactyla: Bovidae)] with beef cows (Bos taurus) for heterosis and carcass improvements may increase the exposure of yak × beef hybrids to horn flies. The present paper reports on the collection of digital images of commingled beef heifers (n = 12) and F1 yak × beef hybrid bovids (heifers, n = 7; steers, n = 5) near Laramie, Wyoming (∼ 2200 m a.s.l.) in 2018. The total numbers of horn flies on beef heifers and F1 yak × beef heifers [mean ± standard error (SE): 88 ± 13 and 70 ± 17, respectively] did not differ significantly; however, F1 yak × beef steers had greater total horn fly abundance (mean ± SE: 159 ± 39) than female bovids. The present report of this experiment is the first such report in the literature and suggests that F1 yak × beef bovids are as susceptible as cattle to horn fly parasitism. Therefore, similar monitoring and treatment practices should be adopted by veterinarians, entomologists and producers.
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Affiliation(s)
- C M Calkins
- United States Army Veterinary Corps, Fort Sam, Houston, TX, U.S.A
- Department of Ecosystem Science and Management, University of Wyoming, Laramie, WY, U.S.A
| | - J D Scasta
- Department of Ecosystem Science and Management, University of Wyoming, Laramie, WY, U.S.A
| | - T Smith
- Beef Unit, Agriculture Experiment Station, University of Wyoming, Laramie, WY, U.S.A
| | - M M Stayton
- Department of Molecular Biology, University of Wyoming, Laramie, WY, U.S.A
| | - S L Lake
- Department of Animal Science, University of Wyoming, Laramie, WY, U.S.A
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21
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Jamshidi R, Densmore JC, Gourlay DM, Lal DR, Calkins CM. Esophagojejunal Anastomosis by Circular Stapler in Pediatric Patients: Size Minima Defined by Experience and Geometry. J Laparoendosc Adv Surg Tech A 2019; 29:1311-1314. [PMID: 31549898 DOI: 10.1089/lap.2019.0092] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Esophagojejunostomy is facilitated by use of a circular stapler, particularly when performed laparoscopically. The minimum patient size that will allow use of circular staplers in the small intestine is unknown. Materials and Methods: Retrospective review of esophagogastric dissociations performed at a single tertiary care institution for 48 months. This was combined with a geometric derivation of a size-estimation formula. Results: From the 7 cases identified, patients weighing >16 kg easily accommodated the 21 mm stapler. There was a narrow fit in the patient weighing 13.6 kg, and the 6 kg patient was too small for the stapler. Conclusions: Through a combination of clinical observation and physical reasoning, circular stapler applicability in small intestine is predicted by patient weight or intestinal measurement. Patients weighing >16 kg will accept the stapler, whereas patients <13 kg are likely too small. Alternately, on the basis of a geometric derivation, if the width of the flat intestine is >1.6 × the device diameter, the device will fit. This calculation can be applied broadly (e.g., incision length for laparoscopic ports or single-port access devices).
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Affiliation(s)
- Ramin Jamshidi
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - John C Densmore
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - David M Gourlay
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Dave R Lal
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Casey M Calkins
- Pediatric General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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22
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Minneci PC, Kabre RS, Mak GZ, Halleran DR, Cooper JN, Afrazi A, Calkins CM, Corkum K, Downard CD, Ehrlich P, Fraser JD, Gadepalli SK, Helmrath MA, Kohler JE, Landisch R, Landman MP, Lee C, Leys CM, Lodwick DL, McLeod J, Mon R, McClure B, Rymeski B, Saito JM, Sato TT, St Peter SD, Wood R, Levitt MA, Deans KJ. Can fecal continence be predicted in patients born with anorectal malformations? J Pediatr Surg 2019; 54:1159-1163. [PMID: 30898398 DOI: 10.1016/j.jpedsurg.2019.02.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 02/09/2019] [Accepted: 02/21/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to identify factors associated with attaining fecal continence in children with anorectal malformations (ARM). METHODS We performed a multi-institutional cohort study of children born with ARM in 2007-2011 who had spinal and sacral imaging. Questions from the Baylor Social Continence Scale were used to assess fecal continence at the age of ≥4 years. Factors present at birth that predicted continence were identified using multivariable logistic regression. RESULTS Among 144 ARM patients with a median age of 7 years (IQR 6-8), 58 (40%) were continent. The rate of fecal continence varied by ARM subtype (p = 0.002) with the highest rate of continence in patients with perineal fistula (60%). Spinal anomalies and the lateral sacral ratio were not associated with continence. On multivariable analysis, patients with less severe ARM subtypes (perineal fistula, recto-bulbar fistula, recto-vestibular fistula, no fistula, rectal stenosis) were more likely to be continent (OR = 7.4, p = 0.001). CONCLUSION Type of ARM was the only factor that predicted fecal continence in children with ARM. The high degree of incontinence, even in the least severe subtypes, highlights that predicting fecal continence is difficult at birth and supports the need for long-term follow-up and bowel management programs for children with ARM. TYPE OF STUDY Prospective Cohort Study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Peter C Minneci
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.
| | - Rashmi S Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - Devin R Halleran
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer N Cooper
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Amin Afrazi
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Casey M Calkins
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kristine Corkum
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Peter Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rachel Landisch
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Constance Lee
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Daniel L Lodwick
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer McLeod
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Rodrigo Mon
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Beth McClure
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Beth Rymeski
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Richard Wood
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
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23
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Jen HC, Raval MV, Langham MR, Calkins CM, Dasgupta R, Shah SR, Stafford SD, Bernstein IH, Chen LE. Attitudes and Beliefs of Pediatric Surgical Specialists on Costs of Care and High Deductible Health Plans. Am Surg 2018; 84:1410-1414. [PMID: 30268167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Health care consumers are burdened with rising out-of-pocket medical expenses. Surgical specialists' experience and attitude towards patients' out-of-pocket costs and the influence of these factors on healthcare utilization are unknown. Our aim was to define the pediatric surgeons' experience with the financial concerns of their patients. Members from the American Academy of Pediatrics Sections on Plastic Surgery, Surgery and Urology were surveyed. Analysis of variance was used to investigate practice differences. Two hundred and eighteen out of 973 surgeons representing 38 states completed the survey. Nearly half of the surveyed surgeons did not know if cost was a determinant for their patients' choice in surgical facility, or if parents compared costs prior to the visit. Eighty four per cent of the surgeons would consider patient costs if medically appropriate, to entertain less costly alternatives, and adjust surgical scheduling to decrease economic burden. Most pediatric surgical specialists are unaware if out-of-pocket costs influenced patients' preoperative decisions. Nonetheless, they are sympathetic to the issue. As the financial burden of health care shifts to consumers, our survey indicates that surgeons are open to candid discussion surrounding finances and may alter recommendations accordingly if appropriate.
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24
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Jen HC, Raval MV, Langham MR, Calkins CM, Dasgupta R, Shah SR, Stafford SD, Bernstein IH, Chen LE. Attitudes and Beliefs of Pediatric Surgical Specialists on Costs of Care and High Deductible Health Plans. Am Surg 2018. [DOI: 10.1177/000313481808400941] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Health care consumers are burdened with rising out-of-pocket medical expenses. Surgical specialists’ experience and attitude towards patients’ out-of-pocket costs and the influence of these factors on healthcare utilization are unknown. Our aim was to define the pediatric surgeons’ experience with the financial concerns of their patients. Members from the American Academy of Pediatrics Sections on Plastic Surgery, Surgery and Urology were surveyed. Analysis of variance was used to investigate practice differences. Two hundred and eighteen out of 973 surgeons representing 38 states completed the survey. Nearly half of the surveyed surgeons did not know if cost was a determinant for their patients’ choice in surgical facility, or if parents compared costs prior to the visit. Eighty four per cent of the surgeons would consider patient costs if medically appropriate, to entertain less costly alternatives, and adjust surgical scheduling to decrease economic burden. Most pediatric surgical specialists are unaware if out-of-pocket costs influenced patients’ preoperative decisions. Nonetheless, they are sympathetic to the issue. As the financial burden of health care shifts to consumers, our survey indicates that surgeons are open to candid discussion surrounding finances and may alter recommendations accordingly if appropriate.
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Affiliation(s)
| | - Howard C. Jen
- From the Mattel Children's Hospital at UCLA, Los Angeles, California
| | | | - Max R. Langham
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Roshni Dasgupta
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Shawn D. Stafford
- From the Mattel Children's Hospital at UCLA, Los Angeles, California
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25
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Baird R, Pandya K, Lal DR, Calkins CM, Oldham KT, Tsai A, Naik-Mathuria B, St-Louis E, Luc MK, LaRusso K, Petroze R, Lofberg KM, Biller CK, Villalona GA, Gourlay DM, Klein M, DeUgarte D, Cleary M, Berdan EA, Siddiqui S, Lo A, Langer M, Duffy D, Blair G, Beres A, Laberge JM, Berdan EA, Radulescu A, Holterman A, Hoover JD, Fitzgerald T, Ganey M, Krishnaswami S, Ozgediz D. Regarding global pediatric surgery training opportunities. J Pediatr Surg 2018; 53:1256-1258. [PMID: 29605263 DOI: 10.1016/j.jpedsurg.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Robert Baird
- Department of Pediatric General and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, 4480 Oak, British Columbia, Vancouver V6H3V4, Canada.
| | - Kartik Pandya
- Tuft's University, Maine Medical Center, Portland, ME
| | - Dave R Lal
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | | | | | | | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Etienne St-Louis
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Malemo Kalisya Luc
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University; HEAL Africa Hospital, Goma, D.R., Congo
| | - Kathryn LaRusso
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Robin Petroze
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | | | | | - Gustavo A Villalona
- SSM Heath Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO
| | | | - Michael Klein
- Wayne State University, Children's Hospital of Michigan, Detroit, MI
| | - Daniel DeUgarte
- Division of Pediatric Surgery, UCLA and Harbor-UCLA, Los Angeles, CA
| | - Muriel Cleary
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | | | - Sabina Siddiqui
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Andrea Lo
- University of Calgary, Calgary, Alberta, Canada
| | | | - Damain Duffy
- Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC, Canada
| | - Geoffrey Blair
- Division of Pediatric Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Alana Beres
- Division of Pediatric Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Jean-Martin Laberge
- Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | | | | | | | | | | | - Michael Ganey
- Loma Linda University School of Medicine, Tenwek Hospital, Bomet, Kenya
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR
| | - Doruk Ozgediz
- Yale Institute for Global Health, Yale University, New Haven, CT
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26
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Minneci PC, Kabre RS, Mak GZ, Halleran DR, Cooper JN, Afrazi A, Calkins CM, Downard CD, Ehrlich P, Fraser J, Gadepalli SK, Helmrath MA, Kohler JE, Landisch R, Landman MP, Lee C, Leys CM, Lodwick DL, Mon R, McClure B, Rymeski B, Saito JM, Sato TT, St Peter SD, Wood R, Levitt MA, Deans KJ. Screening practices and associated anomalies in infants with anorectal malformations: Results from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2018; 53:1163-1167. [PMID: 29602552 DOI: 10.1016/j.jpedsurg.2018.02.079] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluates screening practices and the incidence of associated anomalies in infants with anorectal malformations (ARM). METHODS We performed a multi-institutional retrospective cohort study of children born between 2007 and 2011 who underwent surgery for ARM at 10 children's hospitals. ARM type was classified based on the location of the distal rectum, and all screening studies were reviewed. RESULTS Among 506 patients, the most common ARM subtypes were perineal fistula (40.7%), no fistula (11.5%), and vestibular fistula (10.1%). At least 1 screening test was performed in 96.6% of patients, and 11.3% of patients underwent all. The proportion of patients with ≥1 abnormal finding on any screening test varied by type of ARM (p<0.001). Screening rates varied from 15.2% for limb anomalies to 89.7% for renal anomalies. The most commonly identified anomalies by screening category were: spinal: tethered cord (20.6%); vertebral: sacral dysplasia/hemisacrum (17.8%); cardiac: patent foramen ovale (58.0%); renal: hydronephrosis (22.7%); limb: absent radius (7.9%). CONCLUSION Screening practices and the incidence of associated anomalies varied by type of ARM. The rate of identifying at least one associated anomaly was high across all ARM subtypes. Screening for associated anomalies should be considered standard of care for all ARM patients. TYPE OF STUDY Multi-institutional retrospective cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peter C Minneci
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.
| | - Rashmi S Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - Devin R Halleran
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer N Cooper
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Amin Afrazi
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Casey M Calkins
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Peter Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jason Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rachel Landisch
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Constance Lee
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Daniel L Lodwick
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Rodrigo Mon
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Beth McClure
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, University of Louisville, Louisville, KY
| | - Beth Rymeski
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Richard Wood
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
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Reeder RW, Wood RJ, Avansino JR, Levitt MA, Durham MM, Sutcliffe J, Midrio P, Calkins CM, de Blaauw I, Dickie BH, Rollins MD. The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC): rationale, infrastructure, and initial steps. Tech Coloproctol 2018; 22:395-399. [DOI: 10.1007/s10151-018-1782-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
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Abstract
Hirschsprung disease (HD) is a common cause of neonatal intestinal obstruction in which a variable segment of the distal intestinal tract lacks the normal enteric nervous system elements. Affected individuals present with varying degrees of obstructive symptoms, but today most patients are diagnosed within the first several months of life owing to the well-recognized symptoms and the ease of making the diagnosis by way of the bedside suction rectal biopsy. Thus, for the adult general or colorectal surgeon, the vast majority of patients who present for evaluation will have already undergone surgical treatment within the first year of life by a pediatric surgeon. Despite several safe operative interventions to treat patients with HD, the long-term results are far from perfect. These patients may reach adult life with ongoing defecation disorders that require a systematic evaluation by a multidisciplinary group that should be led by a surgeon with a thorough knowledge of HD operations and the potential problems. The evaluation of these patients will form the basis for the majority of this review-however, some patients manage to escape diagnosis beyond the infant and childhood period-and a section herein will briefly address the case of an older patient who is suspected of having HD.
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Affiliation(s)
- Casey M. Calkins
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Calkins CM, Bensard DD, Shames BD, Pulido EJ, Abraham E, Fernandez N, Xianzhong Meng, Dinarello CA, McIntyre RC. IL-1 regulates in vivo C—X—C chemokine induction and neutrophil sequestration following endotoxemia. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/09680519020080010601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The influx of neutrophils into tissues in response to inflammatory stimuli involves C—X—C chemokines. Interleukin-1 (IL-1) stimulates chemokine production in vitro , but its role in vivo on chemokine production is not as clearly understood. We hypothesized that IL-1 mediates in vivo tissue C—X—C chemokine production induced by systemic lipopolysaccharide (LPS). IL-1 activity was blockedbyIL-1 receptor antagonist (IL-1Ra). Rats were injected with Salmonella typhi LPS (0.5 mg/kg) with and without prior administration of IL-1Ra. Cytokine-induced neutrophil chemoattractant-1 (CINC-1) and macrophage inflammatory protein-2 (MIP-2) protein and mRNA levels, tissue neutrophil accumulation, and indices of organ injury were measured. LPS administration resulted in increased plasma, lung, and liver IL-1β that was decreased by IL-1Ra. LPS also induced an increase in plasma, lung, and liver CINC-1 and MIP-2 protein and mRNA. However, IL-1Ra had no effect on LPS-induced plasma or lung tissue CINC-1 levels. In contrast, IL-1Ra pretreatment did significantly decrease CINC-1 protein expression in the liver (45% decrease) and MIP-2 protein expression in plasma (100% decrease), lung (72% decrease) and liver (100% decrease) compared to LPS-treated controls. Steady-state mRNA levels by Northern blot analysis of both CINC-1 and MIP-2 in lung and liver were similar to the protein findings. Pretreatment with IL-1Ra also resulted in a 47% and 59% decrease in lung and liver neutrophil accumulation, respectively, following LPS. In addition, indices of both lung and liver injury were decreased in animals pretreated with IL-1Ra. In summary, LPS induces IL-1β and MIP-2 expression in the lung and liver, both of which are IL-1 dependent. Although lung neutrophil accumulation in both lung and liver after LPS is also IL-1 mediated, lung CINC-1 levels were unaffected by IL-1Ra. These data suggest that IL-1 regulates tissue chemokine expression and neutrophil accumulation after LPS.
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Affiliation(s)
- Casey M. Calkins
- Department of Surgery, University of Colorado Health Sciences Center and Veterans Affairs Hospital,
| | - Denis D. Bensard
- Department of Surgery, University of Colorado Health Sciences Center and Veterans Affairs Hospital,, Division of Pediatric Surgery, The Children's Hospital, and Department of Medicine,
| | - Brian D. Shames
- Department of Surgery, University of Colorado Health Sciences Center and Veterans Affairs Hospital,
| | - Edward J. Pulido
- Department of Surgery, University of Colorado Health Sciences Center and Veterans Affairs Hospital,
| | | | - Nathan Fernandez
- Department of Surgery, University of Colorado Health Sciences Center and Veterans Affairs Hospital,
| | - Xianzhong Meng
- Department of Surgery, University of Colorado Health Sciences Center and Veterans Affairs Hospital,
| | - Charles A. Dinarello
- Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado, USA
| | - Robert C. McIntyre
- Department of Surgery, University of Colorado Health Sciences Center and Veterans Affairs Hospital,
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Yu J, Maheshwari M, Foy AB, Calkins CM, Drolet BA. Neonatal Lumbosacral Ulceration Masking Lumbosacral and Intraspinal Hemangiomas Associated with Occult Spinal Dysraphism. J Pediatr 2016; 175:211-5. [PMID: 27215780 DOI: 10.1016/j.jpeds.2016.04.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 03/30/2016] [Accepted: 04/20/2016] [Indexed: 11/25/2022]
Affiliation(s)
- JiaDe Yu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI.
| | - Mohit Maheshwari
- Division of Neuroradiology, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Andrew B Foy
- Division of Neurosurgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Casey M Calkins
- Department of Pediatric, General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
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Putnam LR, Levy SM, Blakely ML, Lally KP, Wyrick DL, Dassinger MS, Russell RT, Huang EY, Vogel AM, Streck CJ, Kawaguchi AL, Calkins CM, St Peter SD, Abbas PI, Lopez ME, Tsao K. A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough? J Pediatr Surg 2016; 51:639-44. [PMID: 26590473 DOI: 10.1016/j.jpedsurg.2015.10.046] [Citation(s) in RCA: 8] [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: 06/07/2015] [Revised: 08/21/2015] [Accepted: 10/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Surgical wound classification (SWC) is widely utilized for surgical site infection (SSI) risk stratification and hospital comparisons. We previously demonstrated that nearly half of common pediatric operations are incorrectly classified in eleven hospitals. We aimed to improve multicenter, intraoperative SWC assignment through targeted quality improvement (QI) interventions. METHODS A before-and-after study from 2011-2014 at eleven children's hospitals was conducted. The SWC recorded in the hospital's intraoperative record (hospital-based SWC) was compared to the SWC assigned by a surgeon reviewer utilizing a standardized algorithm. Study centers independently performed QI interventions. Agreement between the hospital-based and surgeon SWC was analyzed with Cohen's weighted kappa and chi square. RESULTS Surgeons reviewed 2034 cases from 2011 (Period 1) and 1998 cases from 2013 (Period 2). Overall SWC agreement improved from 56% to 76% (p<0.01) and weighted kappa from 0.45 (95% CI 0.42-0.48) to 0.73 (95% CI 0.70-0.75). Median (range) improvement per institution was 23% (7-35%). A dose-response-like pattern was found between the number of interventions implemented and the amount of improvement in SWC agreement at each institution. CONCLUSIONS Intraoperative SWC assignment significantly improved after resource-intensive, multifaceted interventions. However, inaccurate wound classification still commonly occurred. SWC used in SSI risk-stratification models for hospital comparisons should be carefully evaluated.
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Affiliation(s)
- Luke R Putnam
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA
| | - Shauna M Levy
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA
| | - Martin L Blakely
- Vanderbilt Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin P Lally
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA
| | - Deidre L Wyrick
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Melvin S Dassinger
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert T Russell
- Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - Eunice Y Huang
- Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adam M Vogel
- St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christian J Streck
- MUSC Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Akemi L Kawaguchi
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA; Children's Hospital Los Angeles, Keck Medical Center of USC, Los Angeles, CA, USA
| | - Casey M Calkins
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shawn D St Peter
- Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Paulette I Abbas
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Monica E Lopez
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - KuoJen Tsao
- Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX, USA.
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Levy SM, Lally KP, Blakely ML, Calkins CM, Dassinger MS, Duggan E, Huang EY, Kawaguchi AL, Lopez ME, Russell RT, St Peter SD, Streck CJ, Vogel AM, Tsao K. Surgical Wound Misclassification: A Multicenter Evaluation. J Am Coll Surg 2015; 220:323-9. [DOI: 10.1016/j.jamcollsurg.2014.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022]
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Rangel SJ, Islam S, St Peter SD, Goldin AB, Abdullah F, Downard CD, Saito JM, Blakely ML, Puligandla PS, Dasgupta R, Austin M, Chen LE, Renaud E, Arca MJ, Calkins CM. Prevention of infectious complications after elective colorectal surgery in children: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee comprehensive review. J Pediatr Surg 2015; 50:192-200. [PMID: 25598122 DOI: 10.1016/j.jpedsurg.2014.11.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 06/09/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This goal of this review was to examine the clinical evidence in support of commonly utilized measures intended to reduce complications following elective colorectal surgery. DATA SOURCE Literature searches were performed to identify relevant studies from Medline, PubMed, and Cochrane databases. STUDY SELECTION The American Pediatric Surgery Association Outcomes and Clinical Trials Committee selected eight questions to address this topic systematically in the context of three management areas: 1) appropriate utilization of systemic antibiotics for colorectal procedures, 2) reduction of stool burden through mechanical bowel preparation, and 3) intraluminal gut decontamination through use of enteral nonabsorbable antibiotics. Primary outcomes of interest included the occurrence of infectious and mechanical complications related to stool burden and intraluminal bacterial concentration (incisional surgical site infection, anastomotic leakage, and intraabdominal abscess). RESULTS The evidence in support of each management category was systematically reviewed, graded, and summarized in the context of the review's primary outcomes. Practice recommendations were made as deemed appropriate by the committee. CONCLUSIONS Clinical evidence in support of interventions to reduce infectious complications following colorectal surgery is derived almost exclusively from the adult literature. High-quality evidence to guide clinical practice in children is sorely needed, as the available data may have only limited relevance to pediatric colorectal diseases.
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Affiliation(s)
- Shawn J Rangel
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Saleem Islam
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Shawn D St Peter
- Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA
| | - Adam B Goldin
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | | | - Jacqueline M Saito
- St. Louis Children's Hospital, Washington University, St. Louis, MO, USA
| | | | | | - Roshni Dasgupta
- Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Mary Austin
- Children's Memorial Hermann Hospital, University of Texas, Houston, TX, USA
| | - Li Ern Chen
- Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Marjorie J Arca
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Casey M Calkins
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
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Hall NJ, Eaton S, Seims A, Leys CM, Densmore JC, Calkins CM, Ostlie DJ, St Peter SD, Azizkhan RG, von Allmen D, Langer JC, Lapidus-Krol E, Bouchard S, Piché N, Bruch S, Drongowski R, MacKinlay GA, Clark C, Pierro A. Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy. J Pediatr Surg 2014; 49:1083-6. [PMID: 24952793 DOI: 10.1016/j.jpedsurg.2013.10.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 07/04/2013] [Revised: 10/07/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite randomized controlled trials and meta-analyses, it remains unclear whether laparoscopic pyloromyotomy (LP) carries a higher risk of incomplete pyloromyotomy and mucosal perforation compared with open pyloromyotomy (OP). METHODS Multicenter study of all pyloromyotomies (May 2007-December 2010) at nine high-volume institutions. The effect of laparoscopy on the procedure-related complications of incomplete pyloromyotomy and mucosal perforation was determined using binomial logistic regression adjusting for differences among centers. RESULTS Data relating to 2830 pyloromyotomies (1802 [64%] LP) were analyzed. There were 24 cases of incomplete pyloromyotomy; 3 in the open group (0.29%) and 21 in the laparoscopic group (1.16%). There were 18 cases of mucosal perforation; 3 in the open group (0.29%) and 15 in the laparoscopic group (0.83%). The regression model demonstrated that LP was a marginally significant predictor of incomplete pyloromyotomy (adjusted difference 0.87% [95% CI 0.006-4.083]; P=0.046) but not of mucosal perforation (adjusted difference 0.56% [95% CI -0.096 to 3.365]; P=0.153). Trainees performed a similar proportion of each procedure (laparoscopic 82.6% vs. open 80.3%; P=0.2) and grade of primary operator did not affect the rate of either complication. CONCLUSIONS This is one of the largest series of pyloromyotomy ever reported. Although laparoscopy is associated with a statistically significant increase in the risk of incomplete pyloromyotomy, the effect size is small and of questionable clinical relevance. Both OP and LP are associated with low rates of mucosal perforation and incomplete pyloromyotomy in specialist centers, whether trainee or consultant surgeons perform the procedure.
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Affiliation(s)
- Nigel J Hall
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK.
| | - Simon Eaton
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | - Aaron Seims
- Riley Hospital for Children, Indianapolis, IN
| | | | - John C Densmore
- The Children's Hospital of Wisconsin, Medical College ofWisconsin, Milwaukee, WI
| | - Casey M Calkins
- The Children's Hospital of Wisconsin, Medical College ofWisconsin, Milwaukee, WI
| | | | | | | | | | - Jacob C Langer
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | | - Agostino Pierro
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK; Hospital for Sick Children and University of Toronto, Toronto, Canada
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Goldin AB, Dasgupta R, Chen LE, Blakely ML, Islam S, Downard CD, Rangel SJ, St Peter SD, Calkins CM, Arca MJ, Barnhart DC, Saito JM, Oldham KT, Abdullah F. Optimizing resources for the surgical care of children: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee consensus statement. J Pediatr Surg 2014; 49:818-22. [PMID: 24851778 DOI: 10.1016/j.jpedsurg.2014.02.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/20/2013] [Revised: 02/16/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
The United States' healthcare system is facing unprecedented pressures: the healthcare cost curve is not sustainable while the bar of standards and expectations for the quality of care continues to rise. Systems committed to the surgical treatment of children will likely require changes and reorganization. Regardless of these mounting pressures, hospitals must remain focused on providing the best possible care to each child at every encounter. Available clinical expertise and hospital resources should be optimized to match the complexity of the treated condition. Although precise criteria are lacking, there is a growing consensus that the optimal combination of clinical experience and hospital resources must be defined, and efforts toward this goal have been supported by the Regents of the American College of Surgeons, the members of the American Pediatric Surgical Association, and the Society for Pediatric Anesthesia (SPA) Board of Directors. The topic of optimizing outcomes and the discussion of the concepts involved have unfortunately become divisive. Our goals, therefore, are 1) to provide a review of the literature that can provide context for the discussion of regionalization, volume, and optimal resources and promote mutual understanding of these important terms, 2) to review the evidence that has been published to date in pediatric surgery associated with regionalization, volume, and resource, 3) to focus on a specific resource (anesthesia), and the association that this may have with outcomes, and 4) to provide a framework for future research and policy efforts.
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Affiliation(s)
- Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105.
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039
| | - Li Ern Chen
- Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX 75235
| | - Martin L Blakely
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Saleem Islam
- Division of Pediatric Surgery, University of Florida College of Medicine, Gainesville, FL 32610
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr. M.D. Department of Surgery, University of Louisville, Louisville, KY 40202
| | - Shawn J Rangel
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108
| | - Casey M Calkins
- Department of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI 53226
| | - Marjorie J Arca
- Department of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI 53226
| | - Douglas C Barnhart
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT 84113
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Washington University, St. Louis, MO 63110
| | - Keith T Oldham
- Department of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI 53226
| | - Fizan Abdullah
- Division of Pediatric Surgery, Johns Hopkins University, Baltimore, MD 21287
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Nghiem-Rao TH, Cassidy LD, Polzin EM, Calkins CM, Arca MJ, Goday PS. Risks and benefits of prophylactic cyclic parenteral nutrition in surgical neonates. Nutr Clin Pract 2013; 28:745-52. [PMID: 24107391 DOI: 10.1177/0884533613502813] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 01/08/2023] Open
Abstract
BACKGROUND Cyclic parenteral nutrition (PN) is used for both the treatment and prevention of parenteral nutrition-associated liver disease (PNALD). Early initiation of prophylactic cyclic PN may not be well tolerated in young neonates. Our objective was to test the hypothesis that prophylactic cyclic PN initiated prior to the onset of hyperbilirubinemia is associated with younger age at initiation, lower bilirubin levels, and similar rates of adverse events compared to therapeutic cyclic PN initiated after established cholestasis in surgical neonates. METHODS A retrospective review of infants with gastrointestinal disorders requiring surgical intervention who received cyclic PN 2006-2011 was performed. RESULTS Of the 43 infants eligible for analysis, 23 received prophylactic and 20 received therapeutic cyclic PN. Infants in both groups were comparable in demographics, surgical diagnoses, and illness severity. At initiation of cyclic PN, infants with prophylactic cyclic PN were significantly younger in chronologic (P = .003) and postmenstrual age (P = .029). Prophylactic cyclic PN was associated with a significantly lower incidence of hyperbilirubinemia (P = .001), lower maximum conjugated bilirubin (P < .0001), and lower last checked conjugated bilirubin (P = .032) compared to the therapeutic cyclic PN. The incidence of hypoglycemia, hyperglycemia, and hypertriglyceridemia was similar for the 2 groups. CONCLUSIONS There may be a potential benefit to initiating cyclic PN prior to the development of hyperbilirubinemia in surgical neonates. Early initiation of prophylactic cyclic PN does not appear to increase the risk for adverse events.
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Affiliation(s)
- T Hang Nghiem-Rao
- T. Hang Nghiem-Rao, Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, PO Box 1997, 999 N 92 St, Milwaukee, WI 53226, USA.
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Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY, Cassidy L, Saito J, Blakely ML, Rangel SJ, Arca MJ, Abdullah F, St Peter SD. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg 2012; 47:2101-10. [PMID: 23164006 DOI: 10.1016/j.jpedsurg.2012.07.047] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [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: 04/06/2012] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 11/16/2022]
Abstract
The aim of this study is to review the current evidence on the diagnosis and management of empyema. The American Pediatric Surgical Association Outcomes and Clinical Trials Committee compiled 8 questions to address. A comprehensive review was performed on each topic. Topics included the distinction between parapneumonic effusion and empyema, the optimal imaging modality in evaluating pleural space disease, when and how pleural fluid should be managed, the first treatment option and optimal timing in the management of empyema, the optimal chemical debridement agent for empyema, therapeutic options if chemical debridement fails, therapy for parenchymal abscess or necrotizing pneumonia and duration of antibiotic therapy after an intervention. The evidence was graded for each topic to provide grade of recommendation where appropriate.
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Affiliation(s)
- Saleem Islam
- University of Florida College of Medicine, Gainesville, FL, USA
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Rangel SJ, Calkins CM, Cowles RA, Barnhart DC, Huang EY, Abdullah F, Arca MJ, Teitelbaum DH. Parenteral nutrition-associated cholestasis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2012; 47:225-40. [PMID: 22244423 DOI: 10.1016/j.jpedsurg.2011.10.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [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: 07/20/2011] [Revised: 10/05/2011] [Accepted: 10/06/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to review evidence-based data addressing key clinical questions regarding parenteral nutrition-associated cholestasis (PNAC) and parenteral nutrition-associated liver disease (PNALD) in children. DATA SOURCE Data were obtained from PubMed, Medicine databases of the English literature (up to October 2010), and the Cochrane Database of Systematic Reviews. STUDY SELECTION The review of PNAC/PNALD has been divided into 4 areas to simplify one's understanding of the current knowledge regarding the pathogenesis and treatment of this disease: (1) nonnutrient risk factors associated with PNAC, (2) PNAC and lipid emulsions, (3) nutritional (nonlipid) considerations in the prevention of PNAC, and (4) supplemental medications in the prevention and treatment of PNAC. RESULTS The data for each topic area relevant to the clinical practice of pediatric surgery were reviewed, evaluated, graded, and summarized. CONCLUSIONS Although the conditions of PNAC and PNALD have been well recognized for more than 30 years, only a few concrete associations and treatment protocols have been established.
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Huang EY, Chen C, Abdullah F, Aspelund G, Barnhart DC, Calkins CM, Cowles RA, Downard CD, Goldin AB, Lee SL, St Peter SD, Arca MJ. Strategies for the prevention of central venous catheter infections: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2011; 46:2000-11. [PMID: 22008341 DOI: 10.1016/j.jpedsurg.2011.06.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [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: 04/27/2011] [Revised: 06/13/2011] [Accepted: 06/15/2011] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study is to review the current evidence-based data regarding strategies for prevention of central venous catheter (CVC) infections at the time of catheter insertion and as a part of routine care. METHODS We conducted a PubMed search from January 1990 to November 2010 using the following keywords: central venous catheter, clinical trials, pediatric, infection, prevention, antibiotic, chlorhexidine, dressing, antiseptic impregnated catheters, ethanol lock, impregnated cuff, insertion site infection, and Cochrane systematic review. Seven questions, selected by the American Pediatric Surgical Association Outcomes and Clinical Trials Committee, were addressed. RESULTS Thirty-six studies were selected for detailed review based on the strength of their study design and relevance to our 7 questions. These studies provide evidence that (1) chlorhexidine skin prep and chlorhexidine-impregnated dressing can decrease CVC colonization and bloodstream infection, (2) use of heparin and antibiotic-impregnated CVCs can decrease CVC colonization and bloodstream infection, and (3) ethanol and vancomycin lock therapy can reduce the incidence of catheter-associated bloodstream infections. CONCLUSION Grade A and B recommendations can be made based on available evidence in adult and limited pediatric studies for multiple components of proper CVC insertion practices and subsequent management. These strategies can minimize the risk of CVC infections in pediatric patients.
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Affiliation(s)
- Eunice Y Huang
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
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Peter SDS, Valusek PA, Hill S, Wulkan ML, Shah SS, Ferro MM, Laje P, Mattei PA, Graziano KD, Muensterer OJ, Pontarelli EM, Nguyen NX, Kane TD, Qureshi FG, Calkins CM, Leys CM, Baerg JE, Holcomb GW. Laparoscopic Adrenalectomy in Children: A Multicenter Experience. J Laparoendosc Adv Surg Tech A 2011; 21:647-9. [DOI: 10.1089/lap.2011.0141] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | - Sarah Hill
- Department of Surgery, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Mark L. Wulkan
- Department of Surgery, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Sohail S. Shah
- Department of Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marcello Martinez Ferro
- Department of Surgery, Fundacion Hospitalaria Children's Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pablo Laje
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter A. Mattei
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Nam X. Nguyen
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - Timothy D. Kane
- Department of Surgery, National Children's Hospital, Washington, District of Columbia
| | - Faisal G. Qureshi
- Department of Surgery, National Children's Hospital, Washington, District of Columbia
| | - Casey M. Calkins
- Department of Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Charles M. Leys
- Department of Surgery, Riley Children's Hospital, Indianapolis, Indiana
| | - Joanne E. Baerg
- Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - George W. Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Cassidy LD, Jensen JN, Durkee CT, Calkins CM, Sato T, Tassone C, Kerschner J, Theilke RJ, Mitchell ME, Hoffman GM, Oldham KT. Creation and implementation of a prospective pediatric clinical outcomes registry. J Registry Manag 2011; 38:138-143. [PMID: 22223056] [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: 05/31/2023]
Abstract
OBJECTIVE To build a pediatric clinical outcomes registry (COR) using a contemporary information system designed to support research and outcome studies and to improve patient care and quality of life. PATIENTS AND METHODS In response to physician needs, this process was implemented: 1) database needs assessment survey, 2) evaluate existing systems and vendors, 3) pilot test a COR tool, and 4) build a COR. The COR was designed to include patients with the following conditions: scoliosis, neonatal surgery, urologic surgery, cleft palate, pain management, otitis media, and voice and airway problems. Agency for Healthcare Research and Quality methodology was followed to create the infrastructure and registry. RESULTS The database needs assessment survey was completed by 99 individuals and most respondents wanted to collect more standardized data than currently available in existing systems. Satisfaction with the existing systems was rated low. The COR was created and a pilot test was successful. The COR was implemented and has been functioning for more than 2 years. CONCLUSIONS By identifying physicians needs, evaluating existing technology and incorporating a multidisciplinary team, the COR was created and implemented to maintain clinical data on a variety of patient diagnoses and outcomes using a single technology platform that enhances potential research collaborations and minimizes redundant data entry and data collection, such as quality of life assessments for the patients.
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St Peter SD, Little DC, Barsness KA, Copeland DR, Calkins CM, Yoder S, Rothenberg SS, Islam S, Tsao K, Ostlie DJ. Should we be concerned about jejunoileal atresia during repair of duodenal atresia? J Laparoendosc Adv Surg Tech A 2010; 20:773-5. [PMID: 20701544 DOI: 10.1089/lap.2010.0173] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION During repair for duodenal atresia, it has been emphasized that inspection of the small bowel to identify a second atresia is required. The laparoscopic approach for repair of duodenal atresia has been criticized for its limitation to perform this step. Given that duodenal atresia and jejunoileal atresias do not share common embryologic origins, we question the validity of this concern. Therefore, we conducted a multicenter retrospective review of duodenal atresia patients to quantify the incidence of jejunoileal atresia in this population. METHODS After institutional review board approval (IRB #07-12-187X), a retrospective review was conducted on all patients who have undergone duodenal atresia repair at seven institutions over the past 7-12 years. Demographics and the presence or absence of a jejunoileal atresia were recorded. RESULTS Four hundred eight patients with duodenal atresia were identified. The mean gestaational age was 36.3 ± 2.9 weeks, and the mean weight was 2.5 ± 0.8 kg. Mean age at operation was 19 days (range, 1-1314). There was a 28% incidence of trisomy 21. Two patients (0.5%) were identified as having a second intestinal atresia, and both were type IIIb. One patient was diagnosed at the time of duodenal atresia repair; the other was a delayed diagnosis. Both patients did well after repair. CONCLUSIONS In this, the largest series of duodenal atresia patients compiled to date, the rate of a concomitant jejunoileal atresia is less than 1%. This low incidence is not high enough to mandate extensive inspection of the entire bowel in these patients, and a second atresia should not be a concern during laparoscopic repair of duodenal atresia.
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Affiliation(s)
- Shawn D St Peter
- Children's Mercy Hospital and Clinics, Kansas City, Missouri 64108, USA
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Whitehouse JS, Gourlay DM, Masonbrink AR, Aiken JJ, Calkins CM, Sato TT, Arca MJ. Conservative management of giant omphalocele with topical povidone-iodine and its effect on thyroid function. J Pediatr Surg 2010; 45:1192-7. [PMID: 20620319 DOI: 10.1016/j.jpedsurg.2010.02.091] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [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: 02/13/2010] [Accepted: 02/22/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was to evaluate topical povidone-iodine as a bridge to delayed fascial closure of giant omphaloceles with emphasis on its effect on thyroid function. METHODS Newborns from a single institution with giant omphaloceles treated with topical povidone-iodine for a 10-year period were reviewed. Recorded data included sex, associated anomalies, length of stay, frequency of povidone-iodine application, thyroid function tests, frequency of laboratory draws, and thyroid supplementation administration. RESULTS Six neonates with giant omphaloceles were treated with povidone-iodine. Thyroid function testing occurred weekly as inpatients and monthly as outpatients, with abnormal values normalized by the subsequent laboratory draw. One patient demonstrated persistent hypothyroidism and subsequently died secondary to cardiac complications, but this infant's newborn thyroid screening suggested congenital hypothyroidism. Five patients remained euthyroid and ultimately achieved fascial closure without the need for a prosthetic implant. None of these patients had abnormal outpatient thyroid tests nor did they require thyroid hormone supplementation. CONCLUSION Topical povidone-iodine promotes escharification and epithelialization of the omphalocele sac. Because transient hypothyroidism may occur, thyroid function studies may guide inpatient therapy. After sac desiccation, systemic effects of iodine are minimal and thyroid supplementation is not necessary. Topical povidone-iodine is an effective initial strategy for giant omphaloceles and does not produce clinically significant hypothyroidism.
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Greenup R, Calkins CM. Urgent surgical issues in children with special health care needs: A brief report. J Pediatr Rehabil Med 2009; 2:101-6. [PMID: 21791801 DOI: 10.3233/prm-2009-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rachel Greenup
- The Medical College of Wisconsin, Children's Hospital of Wisconsin, Department of Pediatric Surgery, Milwaukee, WI, USA
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Keckler SJ, St. Peter SD, Calkins CM, Holcomb GW. Occlusion of a Recurrent Tracheoesophageal Fistula with Surgisis. J Laparoendosc Adv Surg Tech A 2008; 18:465-8. [DOI: 10.1089/lap.2007.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Scott J. Keckler
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D. St. Peter
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Casey M. Calkins
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - George W. Holcomb
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
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Abstract
Outcomes are, simply put, why a surgeon comes to work each day. For decades, surgeons have insisted on a regular self-examination of outcomes to ensure the optimal treatment of our patients. Clinical research in pediatric surgery has largely subsisted on outcome analysis as it relates to the rudimentary end-result of an operation, utilizing variables such as mortality, operative time, specific complication rates, and hospital length of stay to name a few. Recently, outcomes research has become a more complex endeavor. This issue of Seminars in Pediatric Surgery addresses a wide array of these newfound complexities in contemporary outcomes research. The purpose of this review is to assist the pediatric surgeon in understanding the tools that are used in contemporary outcomes research and to be able to use this information to ask new questions of our patients and ourselves as we continue to strive for excellence in caring for sick infants and children.
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Affiliation(s)
- Casey M Calkins
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Gilstrap JN, Calkins CM. QS180. Duration of Hospital Stay in Pediatric Blunt Spleen and/or Liver Injuries: Can APSA Mandated Guidelines for Length of In-Patient Stay Be Safely Reduced? J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.424] [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: 11/24/2022]
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Calkins CM, Brown SP, Oldham KT. Training pediatric surgeons to care for children with special health care needs. J Pediatr Rehabil Med 2008; 1:75-80. [PMID: 21791746] [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: 03/08/2023] Open
Affiliation(s)
- Casey M Calkins
- Departments of Pediatric Surgery and Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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St Peter SD, Calkins CM, Holcomb GW. The use of biosynthetic mesh to separate the anastomoses during the thoracoscopic repair of esophageal atresia and tracheoesophageal fistula. J Laparoendosc Adv Surg Tech A 2007; 17:380-2. [PMID: 17570793 DOI: 10.1089/lap.2006.0138] [Citation(s) in RCA: 10] [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] [Indexed: 11/13/2022] Open
Abstract
Recurrent tracheoesophageal fistula following the repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) is a difficult complication to manage, which makes prevention the dominant concern of surgeons performing the primary repair. To this end, the surrounding pleural tissues are usually brought over the tracheal closure to prevent the development of a recurrence during the open repair. This maneuver is not usually feasible when using the thoracoscopic approach. Therefore, in this paper, we describe a case in which we interposed a biosynthetic mesh between the esophageal and tracheal suture lines during the thoracoscopic repair of EA/TEF on a 2.9-kg newborn girl.
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Affiliation(s)
- Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri 64108, USA
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St Peter SD, Little DC, Calkins CM, Holcomb GW, Snyder CL, Ostlie DJ. The initial experience of antithrombin III in the management of neonates with necrotizing enterocolitis. J Pediatr Surg 2007; 42:704-8. [PMID: 17448770 DOI: 10.1016/j.jpedsurg.2006.12.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC), the devastating enteric process of premature neonates, is marked by severe intravascular abnormalities and disseminated intravascular coagulation. Treatment to date remains historical and continues to be merely supportive without attempts to ameliorate progress within the inflammatory or coagulation cascades. Antithrombin III (ATIII) supplementation has been shown to favorably alter the process of disseminated intravascular coagulation and sepsis in adults. However, no reported use of this treatment exists in neonates. Therefore, we analyze the efficacy of our recent experience with ATIII replacement therapy in neonates with NEC. METHODS Age and diseased-matched controls with NEC were identified before the introduction of ATIII in our institution and compared against neonates with NEC undergoing ATIII replacement for diminished ATIII levels. Data collected included demographics, course of treatment parameters, and outcomes. Course of treatment parameters included hemoglobin, platelet count, prothrombin time, and partial thromboplastin time over the first 10 consecutive days of treatment. Outcome variables included packed red blood cell, platelet, fresh frozen plasma, and cryoprecipitate transfusions, as well as transfusion cost, length of stay, and survival. RESULTS Over a 5-year period, 19 neonates with NEC received ATIII and were compared to 17 historical controls. Treatment hematologic profiles were not worsened in the ATIII-treated patients. The control patients received less overall transfusions and had a shorter length of stay. CONCLUSION Antithrombin III appears to be safe in neonates with NEC, and its impact on reversing intravascular pathology in these patients warrants more thorough investigation.
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Affiliation(s)
- Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
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