DOZ047.103: Learning curve and long-term outcomes for jejunal replacement of the esophagus: a single-center experience in the pediatric population

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
W J Svetanoff ◽  
B Zendejas ◽  
S Bairdain ◽  
K Hernandez ◽  
K Davidson ◽  
...  
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Pediatric Population ◽  
Oral Intake ◽  
Feeding Tube ◽  
Jejunal Interposition ◽  
Long Term Outcomes ◽  
Single Center Experience

Abstract Introduction Patients with complex esophageal atresia (EA) may require replacement; jejunal interposition is an option that is uncommon in children. This study aimed to identify the procedural learning curve and outcomes of patients undergoing jejunal interposition. Methods In a retrospective analysis, patients were divided into those who had surgery between 2010 and 2015 (incipient cohort–previously reported) and those who underwent surgery between 2016 and 2018 (contemporary cohort). Outcomes included length of paralysis (LOP), time to extubation, length of stay (LOS), and complication rate. Current feeding status and time to full oral intake were recorded. Mann–Whitney U and Fisher's exact tests were used for analysis. Results The cohort included 13 in the incipient group and 40 in the contemporary group. LOP (5.33 vs 1.88 days, P = 0.002), time to extubation (9.50 vs 6.34 days, P = 0.05), ICU stay (54 vs 12.65 days, P = 0.04), and LOS (86.77 vs 32.90 days, P = 0.003) were shorter in the contemporary cohort. The complication rate was similar between the incipient and contemporary cohorts, respectively (69.23% vs 50%, P = 0.231). Fourteen patients (incipient–6, contemporary–8) reached full oral intake by a median follow-up of 6.35 months (0.36–26.63 months); another 23 have consistent oral intake but require some use of a feeding tube. All can handle secretions. Patients who had oral intake preoperatively, even with an esophagostomy, were more likely to be eating all consistencies postoperatively (67.74% vs 27.30%, P = 0.004). Conclusion As our experience has improved, LOP, intubation time, and LOS have decreased. Preoperative oral intake, even if sham feeding, was a significant determinant for consistent oral intake postoperatively.

scholarly journals 1158 Autograft degeneration, clinical outcomes and predictors after 21 years follow up in Ross procedure. A single center experience

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Pericet Rodriguez ◽  
L Pardo Gonzalez ◽  
A Fernandez Ruiz ◽  
R Gonzalez Manzanares ◽  
M Ruiz Ortiz ◽  
...  
Keyword(s):  
Learning Curve ◽  
Valvular Disease ◽  
Ross Procedure ◽  
Aortic Lesion ◽  
Probability Of Survival ◽  
Single Center Experience ◽  
Echocardiographic Evaluation ◽  
Long Term Follow Up

Abstract Background Autograft regurgitation and the need of autograft reintervention are possible complications of Ross procedure. Purpose Our Aim was to identify rates of autograft degeneration, reintervention and predictive factors valvular disease in a prospective series of a reference cardiovascular surgery hospital. Methods Since November 1997 to July 2009, a total of 107 patients diagnosed of aortic valvular disease requiring surgical treatment underwent Ross surgery (mean age 30 ± 11 years, 69% male, 21 patients <18 years). In all of them, a comprehensive clinical and echocardiographic evaluation was performed before the intervention and at discharge, at 6, 12 months and annually after surgery. Results At the end of follow-up (21 years, median: 17 years, interquartile rank 12-19 years), echocardiographic and clinical data were available in 95 (89%) and 105 (98%) patients, respectively. 30 patients (32%) developed at least moderate aortic regurgitation and 18 of them (17%) required autograft reintervention. Probability of survival free from at least moderate autograft regurgitation and reintervention at the end of follow up was 71% and 83% respectively. Two patients died because of reintervention related complications. A larger native pulmonary annulus size was the only factor, associated to autograft reintervention (HR 1.24 95% [CI] 1.04-1.48, p = 0.01) and at least moderate autograft regurgitation (HR 1.19 95% [CI] 1.03-1.37, p = 0.02). Autograft reintervention was also associated to intervention in the learning curve period (first 12 cases, HR 3.78, [CI] 95% 1.42-10.08, p = 0.008). We found no significant association of these outcomes with previous cardiac surgery, age, sex, aetiology of aortic lesion or native aortic annulus diameter. Conclusion At long term follow-up after Ross procedure, 32% of patients developed at least moderate autograft regurgitation and 17% required autograft reintervention. A larger size of the native pulmonary annulus and intervention in the learning curve period were associated with the need of autograft surgery in the long term follow up.

Encephaloduroarteriosynangiosis for Pediatric Moyamoya Disease: A Single-Center Experience With 67 Cases in China

2018 ◽  
Vol 33 (14) ◽  
pp. 901-908 ◽  
Author(s):  
Chengjun Wang ◽  
Meng Zhao ◽  
Jia Wang ◽  
Shuo Wang ◽  
Dong Zhang ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Positive Impact ◽  
Case Series ◽  
Stroke Recurrence ◽  
Long Term Outcomes ◽  
Single Center Experience ◽  
The Mean

The purpose of this study is to investigate the surgical results and long-term outcomes of encephaloduroarteriosynangiosis for moyamoya disease in pediatric patients. We performed a retrospective analysis of 67 pediatric patients with moyamoya disease who underwent encephaloduroarteriosynangiosis in Beijing Tiantan Hospital. The case series included 36 boys and 31 girls. All the patients underwent surgical revascularization, and a total of 93 encephaloduroarteriosynangiosis procedures were performed (41 unilateral, 26 bilateral). The mean follow-up period after surgery was 30 months. During follow-up, ischemic stroke events were detected in 5 patients and the stroke rate for pediatric patients who underwent encephaloduroarteriosynangiosis procedure was 7.1% per patient-years. At the last follow-up, favorable outcomes (modified Rankin Scale score ≤ 2) were observed in 65 cases (97.0%). Our study suggests that long-term surgical outcome of encephaloduroarteriosynangiosis in pediatric moyamoya disease patients is satisfactory, and this technique has a positive impact on the prevention of stroke recurrence.

scholarly journals Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Micheloni Gian Mario ◽  
Tarallo Luigi ◽  
Negri Alberto ◽  
Giorgini Andrea ◽  
Merolla Giovanni ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Outcome Measures ◽  
Complication Rate ◽  
Pediatric Population ◽  
Invasive Technique ◽  
Safe Procedure ◽  
Elbow Arthroscopy ◽  
Long Term Follow Up

Abstract Background Elbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up. Materials and methods In this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated. Results In the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected. Conclusions Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries. Level of evidence Level IV—case series.

scholarly journals Alveolar Echinococcosis—A Challenging Task for the Hepatobiliary Surgeon

Pathogens ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 40
Author(s):  
Jens Strohaeker ◽  
Mihaly Sulyok ◽  
Alfred Koenigsrainer ◽  
Silvio Nadalin
Keyword(s):  
Liver Resection ◽  
Alveolar Echinococcosis ◽  
Extrahepatic Bile Duct ◽  
High Volume ◽  
Late Presentation ◽  
Long Term Outcomes ◽  
Single Center Experience ◽  
Resected Patient

(1) Background: Alveolar echinococcosis (AE) is an ultimately fatal disease, whose only curative treatment is surgery. Due to its late presentation extended liver resections are often necessary. The true benefit of extensive surgery has yet to be established; (2) Methods: We present a single center experience of 33 cases of Echinococcus multilocularis that have been treated at a high-volume hepatobiliary surgery center between 2004 and 2021. (3) Results: Of the 33 patients 24 patients underwent major liver resection (73%). In addition to the liver resection patients frequently underwent complex extrahepatic procedures such as lymphadenectomy (n = 21, 61%), vascular resections and reconstructions (n = 9, 27%) or resections and reconstruction of the extrahepatic bile duct (n = 11, 33%). Seven patients suffered from ≥ grade III complications (21%). Complete resection was achieved in 17 patients. Fourteen patients had R1 resections and two had macroscopic parasitic remnant (R2). Progressive disease was reported in three patients (The two R2 patients and one R1 resected patient). At a median follow-up of 54 months no mortality has occurred in our cohort; (4) Conclusions: Liver resection remains the gold standard for AE. Even in extensive disease the combination of complex resection and perioperative benzimidazoles can achieve favorable long-term outcomes.

Autoaugmentation: A Feasible Option before Ileal Augmentation in Selected Cases

2021 ◽  
Author(s):  
Mesut Altan ◽  
Ali Cansu Bozacı ◽  
Ahmet Asci ◽  
Hasan Serkan Dogan ◽  
Serdar Tekgul
Keyword(s):  
Pediatric Population ◽  
Functional Results ◽  
Bladder Capacity ◽  
Upper Urinary Tract ◽  
Anticholinergic Medication ◽  
Long Term Outcomes ◽  
Feasible Option ◽  
The Mean

Abstract Purpose To evaluate the long-term outcomes of autoaugmentation (AA) in pediatric population. Materials and Methods The data of 59 patients (32 females and 27 males) who underwent AA between 1993 and 2018 were analyzed retrospectively. During postoperative follow-up, deterioration on renal scan and/or nonimproved hydronephrosis (HN) were described as upper urinary tract (UUT) impairment. Incontinence was described as use of diaper or pad. Preoperative urodynamic volume was divided into two as less than 50 and more than or equal to 50% expected bladder capacity (EBC). The effect of preoperative clinical factors on reaugmentation, incontinence, and UUT impairment was evaluated. Results The mean age and the median follow-up were 8.9 ± 3.6 years and 64 (12–218) months, respectively. Ten (16.9%) patients underwent reaugmentation (ureteral or ileal). UUT impairment and incontinence rates were 13.6% (8/59) and 30.5% (18/59), respectively. On multivariate analysis, less than 50% EBC was the only predictor of reaugmentation and incontinence (p = 0.013, odds ratio [OR]: 17.546 and p = 0.035, OR: 3.750, respectively). Preoperative HN was predictor of UUT impairment (p = 0.041, OR: 10.168). After AA, 51 patients used clean intermittent catheter and 27 (45.8%) patients discontinued the use of anticholinergic medication. At follow-up, eight (13.5%) patients underwent surgery after AA due to long-term complications, dissatisfaction, or poor functional results (bladder neck injection, cystolithotripsy, Mitrofanoff revision, dilatation, and injection). Conclusion AA is a viable option in selected cases with high pressure and low compliant bladders. Preoperative bladder capacity is significant for reaugmentation rate and continence. UUT impairment is related to preoperative HN.

scholarly journals Long-term Outcomes of Augmentation Cystoplasty in a Pediatric Population With Refractory Bladder Dysfunction: A 12-Year Follow-up Experience at Single Center

2018 ◽  
Vol 22 (4) ◽  
pp. 287-294 ◽  
Author(s):  
Shahbaz Mehmood ◽  
Hamdan Alhazmi ◽  
Mohammed Al-Shayie ◽  
Ahmed Althobity ◽  
Ahmed Alshammari ◽  
...  
Keyword(s):  
Bladder Dysfunction ◽  
Pediatric Population ◽  
Augmentation Cystoplasty ◽  
Single Center ◽  
Long Term Outcomes

Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience

2017 ◽  
Vol 35 (6) ◽  
pp. 532-538 ◽  
Author(s):  
Ang Lv ◽  
Hong-Gang Qian ◽  
Hui Qiu ◽  
Jian-Hui Wu ◽  
Chun-Yi Hao
Keyword(s):  
Endocrine Function ◽  
Low Grade ◽  
Central Pancreatectomy ◽  
Long Term Outcomes ◽  
Exocrine Insufficiency ◽  
Severe Diarrhea ◽  
Single Center Experience ◽  
Short And Long Term

Aims: To compare the short- and long-term outcomes in patients with pancreatic benign or borderline neoplasm who underwent central pancreatectomy (CP) and distal pancreatectomy (DP). Methods: The inclusion criteria were as follows: (1) single benign or low-grade malignant tumor; (2) tumor confined to the pancreatic neck or proximal body; and (3) tumor amenable to either CP or DP. Short and long-term outcomes, including complications, pancreatic exocrine and endocrine function, and quality of life (QoL) were analyzed retrospectively. Results: Sixteen patients who underwent CP and 26 patients who underwent DP were included. The median follow-up period was 53 months (range 21–117 months). Patients undergoing CP were significantly more likely to experience complications (68.7 vs. 23%, p = 0.003) especially grade B/C postoperative pancreatic fistula (62.5 vs. 23%, p = 0.011) than those undergoing DP. During the long-term follow-up, 2 patients in the DP group developed new-onset diabetes mellitus, but no patient in CP group developed this condition (8 vs. 0%, p = 0.382). Evidence of exocrine insufficiency, including severe diarrhea or steatorrhea, was not observed in either group. Both groups were equally satisfied with the overall health status and overall QoL. Conclusion: CP is associated with excellent pancreatic function but a significantly increased postoperative morbidity and risk compared to DP. Therefore, the indication of CP should be chosen strictly.

Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽  
2013 ◽  
Vol 42 (4) ◽  
pp. 264-274
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Miroslav Lojík ◽  
Martina Mulačová ◽  
Martin Vališ
Keyword(s):  
Death Rate ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Angioplasty And Stenting ◽  
Aggressive Medical Management ◽  
Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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