Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia

Abstract Background Severe jejunoileal atresia is associated with prolonged parenteral nutrition, higher mortality and secondary surgery. However, the ideal surgical management of this condition remains controversial. This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures. Methods From January 2007 to December 2016, 105 neonates with severe jejunoileal atresia were retrospectively reviewed. Of these, 42 patients (40.0%) underwent the Bishop–Koop procedure (BK group), 49 (46.7%) underwent primary anastomosis (PA group) and 14 (13.3%) underwent Mikulicz double-barreled ileostomy (DB group). Demographics, treatment and outcomes including mortality, morbidity and nutrition status were reviewed and were compared among the three groups. Results The total mortality rate was 6.7%, showing no statistical difference among the three groups (P = 0.164). The BK group had the lowest post-operative complication rate (33.3% vs 65.3% for the PA group and 71.4% for the DB group, P = 0.003) and re-operation rate (4.8% vs 38.8% for the PA group and 14.3% for the DB group, P < 0.001). Compared with the BK group, the PA group showed a positive correlation with the complication rate and re-operation rate, with an odds ratio of 4.15 [95% confidence interval (CI): 1.57, 10.96] and 12.78 (95% CI: 2.58, 63.29), respectively. The DB group showed a positive correlation with the complication rate when compared with the BK group, with an odds ratio of 7.73 (95% CI: 1.67, 35.72). The weight-for-age Z-score at stoma closure was –1.22 (95% CI: –1.91, –0.54) in the BK group and –2.84 (95% CI: –4.28, –1.40) in the DB group (P = 0.039). Conclusions The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate, and the nutrition status at stoma closure was superior to double-barreled enterostomy. The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.

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A comparative study of surgical procedures in neonatal intestinal atresia - resection and anastomosis, Bishop Koop, Santulli and Mikulicz procedure

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20210653 ◽

2021 ◽

Vol 8 (3) ◽

pp. 495

Author(s):

Aniruddha Basak

Keyword(s):

Primary Anastomosis ◽

Perioperative Period ◽

Intestinal Atresia ◽

Anastomosis Group ◽

Nutrition Status ◽

Group 4 ◽

Jejunoileal Atresia ◽

Operation Rate ◽

Common Causes ◽

Resection And Anastomosis

Background: The aim of this work was to assess the outcome for patients with jejunoileal atresia who underwent primary anastomosis, Bishop–Koop, Santulli procedure and Mikulicz procedure. Intestinal atresia is one of the most common causes of intestinal obstruction in neonates. But ideal surgical management of this condition remains controversial.Methods: During the period from January 2017 to January 2019, 112 neonates (62 males and 50 females) suspected to have intestinal atresia were operated in NRSMCH, Kolkata. 30 patients were treated with primary resection/ anastomosis, 30 patients underwent Bishop-koop (BK) technique, 27 patients who were treated with Santulli technique and 25 patients who were treated with Mikulicz procedure. Demographics, treatment and outcomes including mortality, morbidity and nutrition status were reviewed and were compared among the four groups.Results: 20 patients (17.86%) died during the perioperative period. Among them, 10 died due to uncontrolled sepsis and 10 due to malnutrition. Mortality was highest in Primary anastomosis group (33.33%) followed by BK group (13.3%), Santulli group (11.1%) and lowest in Mikulicz group (4%). The Mikulicz group experienced the lowest re-operation rate (4%) and Primary anastomosis group experienced highest re-operation (26.7%). This difference was statistically significant (P<0.003).Conclusions: Using Mikulicz procedure in the current study has improved the survival of these patients and minimized the post-operative complications.

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Treatment of jejunoileal atresia by primary anastomosis or enterostomy: Double the operations, double the risk of complications

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2021.07.021 ◽

2021 ◽

Author(s):

Laurens D. Eeftinck Schattenkerk ◽

Manouk Backes ◽

Wouter J. de Jonge ◽

LW Ernest van Heurn ◽

Joep PM. Derikx

Keyword(s):

Primary Anastomosis ◽

Jejunoileal Atresia

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Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

Orthopedic Reviews ◽

10.4081/or.2016.6211 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 5

Author(s):

Andreas Panagopoulos ◽

Irini Tatani ◽

Dimitrios Ntourantonis ◽

Ioannis Seferlis ◽

Antonis Kouzelis ◽

...

Keyword(s):

Systematic Review ◽

Avascular Necrosis ◽

Proximal Humerus ◽

Constant Score ◽

Surgical Techniques ◽

Case Series ◽

Cochrane Library ◽

Operation Rate ◽

Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

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Results of the Surgical Treatment in Children with Hirschprung Disease: A 12-Year Experience

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2021.49092 ◽

2021 ◽

Author(s):

Ceren Cesur ◽

Ayşenur Celayir

Keyword(s):

Surgical Treatment ◽

Complication Rate ◽

Operative Procedure ◽

Surgical Techniques ◽

Hirschsprung Disease ◽

Rectal Biopsy ◽

X Rays ◽

Surgical Methods ◽

Pull Through ◽

Subacute Intestinal Obstruction

Objective: In the treatment of Hirschsprung’s disease, many surgical techniques have been developed and modified including laparotomy, resection of the affected colon segment, and pull-through of the functional bowel segment to the anus. Conventional surgical methods have many early and late postoperative complications, albeit at a reduced rate today. In this study, it was aimed to compare the treatment results of children with Hirschsprung Disease who were operated with single or two-stage techniques in our department. Method: Hospital records of the patients operated for Hirschsprung disease were retrospectively evaluated. Demografic characteristics, findings of physical and rectal examinations, X-rays findings, rectal biopsy results, surgical treatment methods and outcomes were analyzed. Results: Fifty-two children including 41-male (78.8%) and 11-female (21.2%) patients with age ranging from 1-day to 5-year and mean age of 6.8-day in neonates and 6.3-month in others were enrolled in the study. All patients presented with acute or subacute intestinal obstruction. Levels were observed on supine abdominal radiographs in all; transition zone and retention of opaque material were observed on opaque enema or retention radiographs.In patients whose rectal biopsies revealed aganglionic megacolon two staged procedures were performed including initial colostomy followed by definitive procedure of Duhamel with stapler in 30, and Soave in 12, and Swenson in 1 patient. Nine patients were operated with one-stage endorectal pull-through technique. The complication rate in 43 patients with Hirschsprung disease managed by two staged operative procedure was (78.8%), and it was 11.1% in 9 cases that underwent transanal endorectal pullthrough procedure. It was learned that effective anal dilatation was not performed in 22-patients who had postoperative enterocolitis attacks. Conclusion: In addition to the low complication rate, the morbidity rates in the transanal endorectal pull-through method, which achieved successful results with only one procedure, were very low compared to multiple-stage operations.

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The Utility of Preoperative HbA1c as a Standardized Protocol in Elective Carpal Tunnel Release: A Retrospective Review of Clinical Outcomes

Hand ◽

10.1177/1558944720919181 ◽

2020 ◽

pp. 155894472091918

Author(s):

Patrick S. Collins ◽

Peter J. Apel ◽

Albert Y. Truong ◽

Melika Zarei ◽

Alicia J. Lozano ◽

...

Keyword(s):

Carpal Tunnel ◽

Complication Rate ◽

Outpatient Treatment ◽

Odds Ratio ◽

Retrospective Cohort ◽

Hemoglobin A1c ◽

Carpal Tunnel Release ◽

Wound Dehiscence ◽

Standardized Protocol ◽

Major Complications

Background: In an effort to reduce surgical complications, some institutions have implemented universal hemoglobin A1c (HbA1c) screening for all preoperative patients. However, the value of HbA1c screening for predicting clinically meaningful complications after elective carpal tunnel release (CTR) remains unclear. The purpose of this study was to investigate the clinically meaningful predicative value of HbA1c screening on postoperative complications following elective CTR. Methods: A retrospective cohort study of 790 patients who underwent CTR was performed. All patients had an HbA1c screening performed, regardless of whether they underwent the diagnosis for diabetes or not. Primary outcomes were overall complication rate, rates of major complications (readmission or reoperation), and rates of minor complications (surgical site infection and wound dehiscence). Patients were stratified into 3 groups based on HbA1c: HbA1c <7, HbA1c 7-8, and HbA1c >8. Results: The overall complication rate for all groups was 4.8%. Rates of major complications were 0.4% for readmission and 0.1% for reoperation. For minor complications, the odds ratio (OR) for the HbA1c 7-8 group was 0.6 (95% confidence interval [CI], 0.14-1.77), and for the HbA1c >8 group, the OR was 1.6 (95% CI, 0.66-3.60). All minor complications resolved with outpatient treatment. There were no statistically significant differences between the groups for any comparisons. Conclusions: Elective CTR has a low complication rate. Routine preoperative screening of HbA1c is of little value in predicting clinically meaningful complications.

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OUTCOMES OF SILASTIC TRAPEZIUM REPLACEMENTS

Hand Surgery ◽

10.1142/s0218810411005588 ◽

2011 ◽

Vol 16 (03) ◽

pp. 301-305 ◽

Cited By ~ 2

Author(s):

D. P. A. Jewell ◽

M. B. S. Brewster ◽

M. A. Arafa

Keyword(s):

Patient Satisfaction ◽

Pain Relief ◽

Complication Rate ◽

Surgical Techniques ◽

The Other ◽

Dash Score ◽

Power Grip ◽

Effective Operation ◽

Good Pain Relief ◽

Joint Arthritis

Trapezio-metacarpal joint arthritis is common, affecting 7% of men and 15% of women. Numerous surgical techniques are described for this condition but it is not clear which is best. Eighty-six silicone trapezium replacements were assessed at an average of 46 months (six to 156 months) postoperatively for patient satisfaction, pain, key and power grip strength, range of motion, complications and disability with DASH score. Patient satisfaction was 92%. There was excellent pain reduction from 4.2 to 0.6 on a scale of 0 to 5. Strength was 72% and 84% of age-sex-matched normal data for key and power grips, respectively. The complication rate was low, with two cases of persistent pain. One resolved spontaneously, the other resolved following revision of the silicone implant. The average DASH score was 30. Silicone trapezium replacement is an effective operation that offers the patient good pain relief, strength and good function with few complications.

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Role of Bishop–Koop Procedure for Jejunal and Proximal Ileal Atresia

Journal of Neonatal Surgery ◽

10.47338/jns.v8.356 ◽

2020 ◽

Vol 8 (4) ◽

pp. 31

Author(s):

Anand Pandey ◽

Gurmeet Singh ◽

Gaurav Shandilya ◽

Archika Gupta ◽

Jiledar Rawat ◽

...

Keyword(s):

Complication Rate ◽

Adverse Outcomes ◽

Proximal Segment ◽

Type Ii ◽

Ileal Atresia ◽

Type Iii ◽

Jejunoileal Atresia ◽

Operation Techniques ◽

The Mean ◽

Medical University

Background: This study was undertaken to review the Bishop–Koop procedure as a treatment option with a grossly dilated proximal segment in jejunal and proximal ileal atresia.Materials and Methods: This was a retrospective cohort study conducted from January 2012 to June 2018 in the Department of Pediatric Surgery at King George's Medical University, Lucknow, India. The outcome, complication rate, and the follow-up study for postoperative adverse outcomes were assessed.Results: Thirty-two neonates underwent Bishop–Koop procedure. The mean age at presentation was 4.37  2.3 days. The male (n=22) to female (n=10) ratio was 2.2:1. Sixteeen had jejunal (type II-9, type III- 7), and 16 (type II-6, type III-10) had proximal ileal atresia. The mean duration of the hospital stay was 13.03  5.7 days. Oral feeds were initiated by the 7th postoperative day. In our study, the complication rate was 31.25% (n=10) and mortality rate was 37.5% (n=12).Conclusions: Bishop–Koop procedure appears to be a technically efficient method in desperate cases of jejunoileal atresia with a grossly dilated proximal segment, although more extensive studies may be needed to compare Bishop–Koop procedure and other operation techniques.

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The outcome of limited urethral mobilization urethroplasty for anterior hypospadias.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.01.4055 ◽

2020 ◽

Vol 27 (01) ◽

pp. 210-216

Author(s):

Shafiq-ur- Rehman ◽

Yasir Makki ◽

Fareena Ishtiaq ◽

Waleeja Shami Khan ◽

Nauman Aziz ◽

...

Keyword(s):

Wound Infection ◽

Functional Outcome ◽

Study Design ◽

Complication Rate ◽

Surgical Techniques ◽

Significant Risk ◽

Paediatric Surgery ◽

Urethrocutaneous Fistula ◽

Cosmetic Appearance ◽

Minimum Age

Objectives: Hypospadias, one of the most common genital anomalies, is characterized by an abnormal meatal opening on the ventral aspect of penis. Anterior hypospadias are the most common. Most of the surgical techniques involves the construction of neourethra with significant risk of urethrocutaneous fistula. Limited urethral mobilization technique involves the advancement of native urethra. Study Design: The objective of this study was to evaluate the outcome of Limited Urethral Mobilization Urethroplasty for Anterior Hypospadias. Setting: The study was conducted in the Department of Paediatric Surgery, DHQ teaching Hospital Sahiwal. Period: From January 2016 to December 2018. Material & Methods: A total number of 187 patients were included in this study. Limited urethral mobilization technique was used in all patients. Minimum age was 2.5 Years and maximum age was 12 years. Cosmetic appearance, functional outcome and complication rate were assessed. Results: Wound infection developed in 3.20 %( n=6) patients. Complete glanular disruption was seen in 2.13 %( n=4) patients. Partial disruption of glans with meatal retraction was observed in 1.60 %( n=3) patients. Post-operative haematoma was seen in 1.60 %( n=3) patients. Meatal stenosis in 1.06 %( n=2) patients. Post-operative bleeding and diverticula was observed in 0.5 %( n=1) patients each. Vertical oriented, slit like meatus at the tip of glans was achieved in 95.72 %( n=179) patients. Conclusion: Limited urethral mobilization urethroplasty is a technique with proven benefits and effectiveness in the terms of cosmesis and functional outcome with a minimal number of complications because of the usage of native elastic urethra.

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Cranioplasty following decompressive craniectomy – Analysis of complication rates and neurological outcomes: A single center study

Surgical Neurology International ◽

10.25259/sni_29_2019 ◽

2019 ◽

Vol 10 ◽

pp. 142 ◽

Cited By ~ 2

Author(s):

Saraj Singh ◽

Rakesh Singh ◽

Kapil Jain ◽

Bipin Walia

Keyword(s):

Decompressive Craniectomy ◽

Complication Rate ◽

Neurological Outcome ◽

Simple Procedure ◽

Surgical Techniques ◽

Bone Flap ◽

Intracerebral Hematoma ◽

Complication Rates ◽

Good Neurological Outcome ◽

Second Surgery

Background:Cranioplasty is the surgical intervention to repair cranial defects in both cosmetic and functional ways. Despite the fact that cranioplasty is a simple procedure, it is still associated with a relatively high complication rate, ranging between series from 12% to 50%.Methods:The author did a prospective cohort study of patients from August 2015 to December 2017, who had undergone decompressive craniectomy followed by cranioplasty after 6 weeks at our institution. All patients were followed up to 6 months after cranioplasty and complications were recorded both by imaging and clinically. The complications were classified as minor (subgaleal collection, seizures) who did not require the second surgery and major (hydrocephalus, bone flap infection) who required the second surgery. To find out neurological outcome, Glasgow coma score (GCS) and Glasgow outcome scale extended (GOSE) were recorded at 1 month, 3 months, and 6 months.Results:Overall complication rate in this study was 22.4% (16/72). Subgaleal collection was the most common complication (5.6%), followed by hydrocephalus (4.2%), seizure (4.2%), bone flap infection (2.8%), intracerebral hematoma (2.8%), empyema (1.4%), and subdural hematoma (SDH) (1.4%). Of these, 8.4% (n= 6/72) were major complication (hydrocephalusn= 3, bone flap infectionn= 2, and SDHn= 1) which required the second surgery. GCS and GOSE were assessed preoperatively and in postoperative period at 1 month, 3 months, and 6 months. Both mean values of GCS and GOSE showed a significant improvement at 3 and 6 months after cranioplasty.Conclusion:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications.Key Message:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications. However, complications rate can be brought down by meticulous timing of cranioplasty in a patient of well-controlled comorbidities and precise surgical techniques. However, storing bone in bone bank is not an additional factor for any postcranioplasty complications which was considered previously.

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Early extubation after congenital heart surgery

Journal of Health Sciences ◽

10.17532/jhsci.2014.165 ◽

2014 ◽

Vol 4 (3) ◽

pp. 156-161 ◽

Cited By ~ 1

Author(s):

Mirza Halimić ◽

Senka Mesihović Dinarević ◽

Zijo Begić ◽

Almira Kadić ◽

Sanko Pandur ◽

...

Keyword(s):

Heart Disease ◽

Blood Transfusion ◽

Odds Ratio ◽

Congenital Heart ◽

Heart Surgery ◽

Prolonged Mechanical Ventilation ◽

Surgical Techniques ◽

Congenital Heart Surgery ◽

Early Extubation ◽

Group I

Introduction: Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation. Early extubation was definedas ventilation shorter than 12 hours. Aim of this study is to identify factors associated with successful early extubation after pediatric cardiac surgery.Methods: The study was performed during period from January 2006 to January 2011 at Pediatric Clinic and Heart Center University Clinical center Sarajevo. One hundred children up to 5 years of age, who have had congenital heart disease, with left–right shunt and obstructive heart disease were included in the study. Patients were divided into two groups: Group I - patients extubated within 12 hours after surgery and Group II - patients extubated 12 or more hours after surgery. Results: The most frequently encountered preoperative variables were age with odds ratio 4% 95%CI (1-7%), Down's syndrome 8.5 95%CI (1.6-43.15), failure to thrive 4.3 95%CI( 1-18). Statistically significant postoperative data included lung disease (reactive airways, pneumonia, atelectasis, pneumothorax) and with odds ratio 35.1 95 %CI (4-286) and blood transfusion with odds ratio 4.6 95%CI (2-12). Blood transfusion (p=0.002) (Wald=9.2) 95%CI (2-12), during as well as after operation procedure has statistically significant influence on prediction time of extubation. Proven markers were age with cut of 21.5 months (sensitivity 74% and specificity 70%) and extracorporeal circulation (ECC) with cut-of 45.5 minutes (sensitivity 71% and specificity 65%).Conclusion: Early extubation is possible in many children undergoing congenital heart surgery. Younger age and prolonged ECC time are markers associated with prolonged mechanical ventilation.

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