Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

Abstract Backgrounds: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Methods: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Results: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05). Conclusions: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery.　Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

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Surgical treatment of 125 cases with congenital diaphragmatic eventration in a single institution

10.21203/rs.3.rs-35679/v2 ◽

2020 ◽

Author(s):

Shengliang Zhao ◽

Zhengxia Pan ◽

Yonggang Li ◽

Yong An ◽

Lu Zhao ◽

...

Keyword(s):

Surgical Treatment ◽

Open Surgery ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Operation Time ◽

Diaphragmatic Eventration ◽

Diaphragmatic Plication ◽

Paradoxical Movement ◽

First Choice ◽

Surgical Methods

Abstract Backgrounds This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacy of thoracoscopy and traditional open surgery in infants with congenital diaphragmatic eventration. Methods We retrospectively analyzed the clinical data of 125 children with CDE(90 boys, 35girls; median age:12.2 months, range 1h-7years;body weight1.99-28.5kg,median body weight 7.87±4.40kg) admitted to our hospital in recent 10years,　and statistically analyzed their clinical manifestations and surgical methods. Results 108 children in this group underwent surgery, of which 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication.107 patients recovered well postoperatively, except for 1 patient died of respiratory distress after surgery.Followed up for 1-9.5 years,107 patients had significantly improved preoperative symptoms.During follow-up, the location of the diaphragm was normal and no paradoxical movement was observed.Eleven of the 17 children who did not undergo surgical treatment did not see a decrease in diaphragm position after 1-6 years of follow-up.In the thoracoscopy group, the index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better than those in the open group.The difference between the two groups was statistically significant (P＜0.05). Conclusions Clinical symptoms of congenital diaphragmatic eventration varied in severity. Patients with severe symptoms should be operated.Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration,but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of short operation time, less trauma, rapid recovery,　so it should be the first choice for children with congenital diaphragmatic eventration.

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Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

BMC Surgery ◽

10.1186/s12893-020-00928-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shengliang Zhao ◽

Zhengxia Pan ◽

Yonggang Li ◽

Yong An ◽

Lu Zhao ◽

...

Keyword(s):

Body Weight ◽

Surgical Treatment ◽

Open Surgery ◽

Clinical Manifestations ◽

Operation Time ◽

Diaphragmatic Eventration ◽

Diaphragmatic Plication ◽

First Choice ◽

Surgical Methods

Abstract Background This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Methods We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99–28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods. Results A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1–9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1–6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). Conclusions The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

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Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

10.21203/rs.3.rs-35679/v4 ◽

2020 ◽

Author(s):

Shengliang Zhao ◽

Zhengxia Pan ◽

Yonggang Li ◽

Yong An ◽

Lu Zhao ◽

...

Keyword(s):

Body Weight ◽

Surgical Treatment ◽

Open Surgery ◽

Clinical Manifestations ◽

Operation Time ◽

Diaphragmatic Eventration ◽

Diaphragmatic Plication ◽

First Choice ◽

Surgical Methods

Abstract Background: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE.Methods: We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87±4.40 kg) admitted to our hospital in the previous 10 years,　and we statistically analyzed their clinical manifestations and surgical methods.Results: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05).Conclusions: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery.　Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

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Surgical treatment of 125 cases with congenital diaphragmatic eventration in a single institution

10.21203/rs.3.rs-35679/v1 ◽

2020 ◽

Author(s):

Shengliang Zhao ◽

Zhengxia Pan ◽

Yonggang Li ◽

Yong An ◽

Lu Zhao ◽

...

Keyword(s):

Surgical Treatment ◽

Open Surgery ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Operation Time ◽

Treatment Method ◽

Diaphragmatic Eventration ◽

Time To Peak ◽

Surgical Methods ◽

Better Than

Abstract Background:This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacy of thoracoscopy and traditional open surgery in infants with congenital diaphragmatic eventration.Methods: We retrospectively analyzed the clinical data of 125 children with CDE(90 boys, 35girls; median age:12.2 months, range 1h-7years;body mass1.99-28.5kg,median body mass 7.87±4.40kg) admitted to our hospital in recent 10years,and statistically analyzed their clinical manifestations and surgical methods. Results:108 children in this group underwent surgery, of which 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic Plication.107 patients recovered well postoperatively, except for 1 patient with hiatal hernia died of respiratory distress after surgery.Followed up for 1-9.5 years,107 patients had significantly improved preoperative symptoms.Eleven of the 17 children who did not undergo surgical treatment did not see a significant decrease in diaphragm position after 1-6 years of follow-up.In the thoracoscopy group, the lung function values of 13 children before operation and 3 year after operation was compared. The difference in percent of expiratory time to peak tidal time (tPTEF%tE) and percentage of tidal volume to peak tidal expiratory flow(VPEF%VE) was significant (P<0.05).In the thoracoscopy group, the index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better than those in the open group.The difference between the two groups was statistically significant (P＜0.05). Conclusions: Clinical symptoms of congenital diaphragmatic eventration varied in severity. Patients with severe symptoms should be operated early. All kinds of surgical methods can achieve better results.The clinical symptoms of children after diaphragm Plication operation are better than those before operation.We believe that the continuous suture of barbed wire thread applied to thoracoscopy diaphragm Plication surgery has quick operation time, less trauma, and quick recovery should be the preferred treatment method for infants with congenital diaphragmatic eventration.

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Clinical and sonographic evaluation of the diaphragm after plication in adults with unilateral eventration: a retrospective study

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00108-4 ◽

2022 ◽

Vol 16 (1) ◽

Author(s):

Mohamed Abdel-Bary ◽

Alaa Rashad ◽

Hamed Elgendy ◽

Mohammed Zaki ◽

Mahmoud Youssef Abdelhamid ◽

...

Keyword(s):

Fluid Collection ◽

Safe Procedure ◽

Diaphragmatic Eventration ◽

Diaphragmatic Plication ◽

Paradoxical Movement ◽

Bedside Test ◽

The Mean ◽

Eventration Diaphragm

Abstract Background We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration. Results Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P < 0.001), and 6 months 2.6 ± 0.9 cm (P < 0.001), compared to preoperative values (10.1 ± 2.8 cm). diaphragm ultrasonography showed normal motility of the plicated cupola in all cases, and there was a highly significant decrease in the mean height of eventration at 1 week (3.1 ± 1.1 cm, P < 0.001), and 6 months (2.3 ± 0.5 cm, P < 0.001) compared to preoperative values (10.3 ± 2.2 cm). There was a highly significant increase in the diaphragm thickness at 1 week (2.7 ± 0.3 mm, P < 0.001), and 6 months (2.9 ± 0.2 mm, P < 0.001), compared to the preoperative value. There was a highly significant improvement in the degree of excursion 1 week (25 ± 4.3 mm, P < 0.001), and 6 months (28 ± 5.2 mm, P < 0.001), compared to the preoperative value (15 ± 6.2 mm). No fluid collection or surroundings organ injuries were detected. The mean FVC and FEV1 showed a highly significant improvement at 1 week (66.7 ± 6%, 78.2 ± 9.8%), and 6 months (68.8 ± 5.7%, 80.4 ± 10.3%), compared to the preoperative value (58.8 ± 8% and 70.9 ± 10.3%). Conclusions Surgical diaphragmatic plication is an effective and safe procedure that can be performed to treat symptomatic adults with unilateral diaphragmatic eventration. Diaphragm ultrasonography can be used as a simple bedside test to evaluate unilateral diaphragmatic eventration cases and their postoperative follow-up.

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MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00021 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0002

Author(s):

Brendon C. Mitchell ◽

Matthew Y. Siow ◽

Alyssa Carrol ◽

Andrew T. Pennock ◽

Eric W. Edmonds

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Shoulder Instability ◽

Surgical Intervention ◽

Operation Time ◽

Demographic Variables ◽

Return To Sports ◽

Suture Anchors ◽

Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

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Surgical Correction of Penoscrotal Web: A Case Series With Literature Review

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2020.62134 ◽

2020 ◽

Author(s):

Volkan Sarper Erikçi

Keyword(s):

Surgical Treatment ◽

Clinical Characteristics ◽

Surgical Techniques ◽

Case Series ◽

Scrotal Skin ◽

Penile Skin ◽

Surgical Experience ◽

Postoperative Results ◽

Pediatric Urologist

INTRODUCTION: Penoscrotal webbing (PSW) is an anomaly of penis and it includes penile and scrotal skin aberration. There are various surgical techniques for repairing PSW with different terminologies. Herein we present our surgical experience of Z-plasty procedure in these cases. METHODS: In this retrospective study, 5 patients with an average age of 46 months who were diagnosed and under follow-up for PSW, between June 2017 and May 2019 were included. Along with demographic and clinical characteristics, treatment and follow-up records were collected. RESULTS: Isolated PSW was observed in 4 patients and one patient had an associated megameatus intact prepuce (MMIP) of a hypospadias variant in addition to PSW. Circumcision and ventral prepuce reconstruction of the penis with the aid of "Z-plasty" solved problem and acceptable postoperative results were obtained. DISCUSSION AND CONCLUSION: PSW is a condition that warrants surgical treatment. During the management of these children, in the case of suspicion of penile skin abnormality at the time of circumcision, it should be deferred and should be consulted to a pediatric surgeon or a pediatric urologist. Gentle surgical treatment is recommended for a favourable surgical and psychological result

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Clinical Characteristics and Surgical Outcomes of Sinonasal Lesions Associated With Tumor-Induced Osteomalacia

Otolaryngology ◽

10.1177/0194599820975432 ◽

2020 ◽

pp. 019459982097543

Author(s):

Zhenzhen Zhu ◽

Weibo Xia ◽

Fang Qi ◽

Weiqing Wang ◽

Xiaowei Wang ◽

...

Keyword(s):

Skull Base ◽

Surgical Outcomes ◽

Recovery Rate ◽

Open Surgery ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Case Series ◽

Ethmoid Sinus ◽

Tertiary Center ◽

Significant Difference

Objective To investigate the clinical characteristics and surgical outcomes of sinonasal tumors associated with tumor-induced osteomalacia (TIO). Study Design Retrospective case series. Setting Single tertiary center. Methods We studied the clinical characteristics and surgical outcomes of 43 patients (22 male, 21 female) who had lesions in the nasal cavity and paranasal sinus associated with TIO and underwent surgery between August 2006 and November 2019. Results The mean ± SD duration between the onset of symptoms and surgery was 3.9 ± 2.6 years. The most common tumor site was the ethmoid sinus (76.7%), and the skull base was involved in 12 cases. Phosphaturic mesenchymal tumors were diagnosed in 41 patients, among whom there was 1 multifocal case. Another 2 cases involved odontogenic fibroma and hemangiofibroma, respectively. Serum phosphorus normalized in 39 cases within 4.4 ± 2.3 days, and serum fibroblastic growth factor 23 normalized within 1 day; clinical symptoms, however, gradually improved within several months after the first operation. There was no significant difference in the recovery rate between endoscopic and open surgery ( P = 0.639). Two patients with recurrent cases and 2 with nonremission cases recovered after a sinonasal reoperation. The patient with a multifocal case recovered after the resection of the tumors in the ethmoid sinus and mandible. The overall recovery rate was 97.7%. Conclusion Most sinonasal tumors associated with TIO are located in the ethmoid sinus, and the skull base is involved in some cases. Complete excision of the tumor leads to recovery, and endoscopic surgery could achieve recovery rates similar to those of open surgery.

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Clinical symptoms and sonographic follow-up after surgical treatment of nonparasitic liver cysts

BMC Surgery ◽

10.1186/1471-2482-13-42 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 7

Author(s):

Hubert Scheuerlein ◽

Falk Rauchfuss ◽

Julia Franke ◽

Karin Jandt ◽

Yves Dittmar ◽

...

Keyword(s):

Surgical Treatment ◽

Clinical Symptoms ◽

Liver Cysts

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Clinical Characteristics And Prognosis of Vasovagal Syncope With Sinus Arrest In Children

10.21203/rs.3.rs-1103825/v1 ◽

2021 ◽

Author(s):

Rui Sun ◽

Yingying Kang ◽

Yeshi Chen ◽

Xiaohui Li ◽

Mingming Zhang ◽

...

Keyword(s):

Clinical Characteristics ◽

Clinical Symptoms ◽

Vasovagal Syncope ◽

Interquartile Range ◽

Autonomic Nerve ◽

Sinus Arrest ◽

Oral Rehydration ◽

Autonomic Nerve Function ◽

Oral Rehydration Salts

Abstract The aim of this study was to analyze the clinical characteristics and prognosis of vasovagal syncope(VVS) with sinus arrest in children. From July 2017 to October 2020, cases of VVS with sinus arrest were recruited from patients diagnosed as VVS in our department. The clinical data, the results of the head-up tilt testing (HUTT), and follow-up information were analyzed. 223 patients were diagnosed as VVS during the time, and 10 cases of VVS with sinus arrest were recruited, who had a median age of 9.5 years（interquartile range: 6.8 to 10.4 years), a gender ratio of 1:1, and median sinus arrest time of 7.7s(range: 3.39 to 19s). These patients were given oral rehydration salts and orthostatic training, as well as 2 children treated with metoprolol and 5 children with sertraline hydrochloride. No child was implanted with pacemakers. During a median of 26 months of follow-up (interquartile range: 21 to 33 months), only one of the children had once syncope episode, three children had 1~4 times of prodromal symptoms. Conclusion The present research most crucial finding was that VVS patients with sinus arrest in children were younger than ordinary pediatric VVS patients. Oral rehydration salts(ORS) and autonomic nerve function exercise may improve clinical symptoms in children with VVS accompanied by sinus arrest. Pacemakers for VVS with sinus arrest in children should be cautious.

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