Pub Date : 2024-07-01DOI: 10.4103/jiaps.jiaps_16_24
M. Vathulya, Arush Pasricha, B. Sree
ABSTRACT The latissimus dorsi muscle flap is a robust option for reconstructing defects over the back, but the use of this flap in infants is not widely documented. We did this flap to cover a defect that was created after wide local excision of a rhabdomyosarcoma on the back of a 2-month-old infant. Reconstructive surgery was completed successfully, and postoperative recovery was uneventful.
{"title":"Use of Pedicled Latissimus Dorsi Muscle Flap for Reconstruction of Soft-tissue Defect in a 2-month-old Infant with Rhabdomyosarcoma on Back","authors":"M. Vathulya, Arush Pasricha, B. Sree","doi":"10.4103/jiaps.jiaps_16_24","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_16_24","url":null,"abstract":"ABSTRACT\u0000 \u0000 The latissimus dorsi muscle flap is a robust option for reconstructing defects over the back, but the use of this flap in infants is not widely documented. We did this flap to cover a defect that was created after wide local excision of a rhabdomyosarcoma on the back of a 2-month-old infant. Reconstructive surgery was completed successfully, and postoperative recovery was uneventful.","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"32 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.4103/jiaps.jiaps_239_23
A. Basu, K. Basu, K. Bhaumik, Jyotsna Basu, Abhishek Aanad
ABSTRACT Reconstruction of a cloacal defect in a girl is often difficult and complicated.[1] This is most often done either by the sacro-perineal route or through the posterior sagittal route.[2] The procedures may involve total mobilization of the cloaca with or without the creation of a lower vagina with the help of a loop of vascularized bowel.[3] In our approach, such defects can be corrected using the lower anorectum for the creation of a lower vagina and abdominoperineal pull-through of the proximal divided bowel. This method can be used both in short and long common channel cloaca. We have used this procedure in one patient of posterior cloaca and four patients of anterior cloaca. These operations were done in patients of 1 year and 6 months to 4 years. Only one patient is waiting for the closure of the colostomy. In all the cases, the urethra, the vagina, and the anus were successfully separated. This operation restores normal pelvic anatomy and physiology with minimal mutilation of the pelvic floor.
{"title":"Reconstruction of Cloacal Defect: Switch Operation – A New Approach","authors":"A. Basu, K. Basu, K. Bhaumik, Jyotsna Basu, Abhishek Aanad","doi":"10.4103/jiaps.jiaps_239_23","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_239_23","url":null,"abstract":"ABSTRACT\u0000 \u0000 \u0000 \u0000 Reconstruction of a cloacal defect in a girl is often difficult and complicated.[1] This is most often done either by the sacro-perineal route or through the posterior sagittal route.[2] The procedures may involve total mobilization of the cloaca with or without the creation of a lower vagina with the help of a loop of vascularized bowel.[3] In our approach, such defects can be corrected using the lower anorectum for the creation of a lower vagina and abdominoperineal pull-through of the proximal divided bowel. This method can be used both in short and long common channel cloaca.\u0000 \u0000 \u0000 \u0000 We have used this procedure in one patient of posterior cloaca and four patients of anterior cloaca. These operations were done in patients of 1 year and 6 months to 4 years. Only one patient is waiting for the closure of the colostomy.\u0000 \u0000 \u0000 \u0000 In all the cases, the urethra, the vagina, and the anus were successfully separated.\u0000 \u0000 \u0000 \u0000 This operation restores normal pelvic anatomy and physiology with minimal mutilation of the pelvic floor.\u0000","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-07-06DOI: 10.4103/jiaps.jiaps_7_24
Ashish Sam Samuel, Deepthi Boddu, S Patricia, Thomas Alex Kodiatte, Kanjiyil Thamarapilli Sreekanth, Priyanka Hegde, Susan Jehangir
Background: Solid pseudopapillary neoplasm (SPN) of the pancreas in children is a rare tumor with low malignant potential. Some tumors, however, behave aggressively. There is very little literature on managing these variants, especially in children. We share our experience of managing large and recurrent SPN and explore the clinicopathological findings correlating to the risk of recurrence.
Methods: This is a retrospective study of children treated for SPN between 2012 and 2022 at a tertiary care center in India. The clinicopathological features and management strategies in these children were evaluated.
Results: Sixteen children with SPN were treated during this period (88% of girls). The median age of presentation was 12 years (interquartile range [IQR]: 9-14). All children presented with abdominal pain. Computed tomography gave a definitive diagnosis in 81% of cases. The tumor predominantly involved the head of the pancreas (n = 9, 56%). Eight of nine children classified as high-grade (HG) malignant had a benign course. One child had a recurrence of the tumor 4 years after the initial resection and further recurrence on chemotherapy. She required radiation therapy in addition to reoperation following which she was disease free for 77 months. The overall median follow-up was 46 months (IQR: 18-72 months).
Conclusion: Complete resection of the tumor provides a cure in most patients with SPN. Recurrent tumors require a multi-modality approach. Long-term survival is good. There is a need for clear definitions of the components within the WHO criteria for HG malignancy.
{"title":"Pediatric Solid Pseudopapillary Neoplasm of the Pancreas.","authors":"Ashish Sam Samuel, Deepthi Boddu, S Patricia, Thomas Alex Kodiatte, Kanjiyil Thamarapilli Sreekanth, Priyanka Hegde, Susan Jehangir","doi":"10.4103/jiaps.jiaps_7_24","DOIUrl":"10.4103/jiaps.jiaps_7_24","url":null,"abstract":"<p><strong>Background: </strong>Solid pseudopapillary neoplasm (SPN) of the pancreas in children is a rare tumor with low malignant potential. Some tumors, however, behave aggressively. There is very little literature on managing these variants, especially in children. We share our experience of managing large and recurrent SPN and explore the clinicopathological findings correlating to the risk of recurrence.</p><p><strong>Methods: </strong>This is a retrospective study of children treated for SPN between 2012 and 2022 at a tertiary care center in India. The clinicopathological features and management strategies in these children were evaluated.</p><p><strong>Results: </strong>Sixteen children with SPN were treated during this period (88% of girls). The median age of presentation was 12 years (interquartile range [IQR]: 9-14). All children presented with abdominal pain. Computed tomography gave a definitive diagnosis in 81% of cases. The tumor predominantly involved the head of the pancreas (<i>n</i> = 9, 56%). Eight of nine children classified as high-grade (HG) malignant had a benign course. One child had a recurrence of the tumor 4 years after the initial resection and further recurrence on chemotherapy. She required radiation therapy in addition to reoperation following which she was disease free for 77 months. The overall median follow-up was 46 months (IQR: 18-72 months).</p><p><strong>Conclusion: </strong>Complete resection of the tumor provides a cure in most patients with SPN. Recurrent tumors require a multi-modality approach. Long-term survival is good. There is a need for clear definitions of the components within the WHO criteria for HG malignancy.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"29 4","pages":"345-350"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.4103/jiaps.jiaps_50_24
P. Mishra, Tanushree Sahoo, T. Som, S. Sahoo
{"title":"Biliary Perforation in a Neonate – A Rare Cause of Infantile Cholestasis","authors":"P. Mishra, Tanushree Sahoo, T. Som, S. Sahoo","doi":"10.4103/jiaps.jiaps_50_24","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_50_24","url":null,"abstract":"","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"341 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.4103/jiaps.jiaps_70_24
Emine Burcu Cigsar Kuzu
{"title":"Hard End of a Guide wire: An Easy Way to Untangle knotted Urethral Catheters","authors":"Emine Burcu Cigsar Kuzu","doi":"10.4103/jiaps.jiaps_70_24","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_70_24","url":null,"abstract":"","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"20 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141698749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.4103/jiaps.jiaps_262_23
Amar A. Shah, Devesh N. Joshi, A. Shah
ABSTRACT Atypical or nontuberculous mycobacteria (NTM) are an environmental organism responsible for opportunistic infection. Rapid-growing NTM are more commonly associated with hospital-acquired infections. Many of the organisms responsible for diseases in immunocompromised patients and hospital-acquired infections originate from tap water, such as Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium gordonae, Mycobacterium simiae, Mycobacterium mucogenicum, Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus. NTM is a rare organism responsible for the injection abscess. Considering low incidents, not much clinical data are available for this condition. Here, we discuss such cases which can be helpful to spread awareness and provide data for future policy makers. This was a retrospective study. Data on patients with injection abscess were collected from the last 6 years. Detailed history and clinical examination findings were analyzed. Children with injection abscess were operated and their further management and outcome were studied. A total of 13 cases with confirmed culture of NTM were treated over 6 years. The age ranged from 2½ months to 5¾ years with male:female ratio of 7:6. All patients hailed from the same geographical area. All children were healthy with no history of any long-term or chronic illness, without additional symptoms and had received Bacillus Calmette-Guérin vaccination at birth. The total duration of illness varied from 1 to 5 months, with a mean of 3 months. All patients had a history of intramuscular age-appropriate vaccination as per the national immunization schedule. All patients were followed up to 6 months after intervention and none of our patients developed relapse. Patient who does not respond with optimum treatment should have a high suspicion of such opportunistic infection, which is crucial to their management. Hospital-acquired NTM infections often result from contaminated instruments or fluids. Adherence to strict aseptic precautions, hand hygiene and environmental precautions are the key to preventing these infections. In case of skin and soft tissue infections / abscesses, surgical intervention plays a significant role for managing the patient.
{"title":"Beyond the Needle: Unmasking Atypical Mycobacteria in Postvaccination Abscesses in Children","authors":"Amar A. Shah, Devesh N. Joshi, A. Shah","doi":"10.4103/jiaps.jiaps_262_23","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_262_23","url":null,"abstract":"ABSTRACT\u0000 \u0000 \u0000 \u0000 Atypical or nontuberculous mycobacteria (NTM) are an environmental organism responsible for opportunistic infection. Rapid-growing NTM are more commonly associated with hospital-acquired infections. Many of the organisms responsible for diseases in immunocompromised patients and hospital-acquired infections originate from tap water, such as Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium gordonae, Mycobacterium simiae, Mycobacterium mucogenicum, Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus. NTM is a rare organism responsible for the injection abscess. Considering low incidents, not much clinical data are available for this condition. Here, we discuss such cases which can be helpful to spread awareness and provide data for future policy makers.\u0000 \u0000 \u0000 \u0000 This was a retrospective study. Data on patients with injection abscess were collected from the last 6 years. Detailed history and clinical examination findings were analyzed. Children with injection abscess were operated and their further management and outcome were studied.\u0000 \u0000 \u0000 \u0000 A total of 13 cases with confirmed culture of NTM were treated over 6 years. The age ranged from 2½ months to 5¾ years with male:female ratio of 7:6. All patients hailed from the same geographical area. All children were healthy with no history of any long-term or chronic illness, without additional symptoms and had received Bacillus Calmette-Guérin vaccination at birth. The total duration of illness varied from 1 to 5 months, with a mean of 3 months. All patients had a history of intramuscular age-appropriate vaccination as per the national immunization schedule. All patients were followed up to 6 months after intervention and none of our patients developed relapse.\u0000 \u0000 \u0000 \u0000 Patient who does not respond with optimum treatment should have a high suspicion of such opportunistic infection, which is crucial to their management. Hospital-acquired NTM infections often result from contaminated instruments or fluids. Adherence to strict aseptic precautions, hand hygiene and environmental precautions are the key to preventing these infections. In case of skin and soft tissue infections / abscesses, surgical intervention plays a significant role for managing the patient.\u0000","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"43 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.4103/jiaps.jiaps_27_24
Gali Divya, V. Kundal, Rajasekhar Addagatla, Ritesh Kumar, Sandeep Kumar Jaglan, P. Debnath, A. Meena, Shalu Shah
ABSTRACT Posterior urethral valves (PUV) are the most common obstructive anomaly of the lower urinary tract in children. End-stage renal disease (ESRD) in 17% of the children is due to PUV. The present study helps know the spectrum of the disease, management options, and the outcome in these children. The present study is a descriptive type of study by review of medical records of all the children presented to the hospital from 2015 to 2019. Profile of PUV includes any abnormality in antenatal ultrasonography (USG), age at presentation, presenting complaints, general condition at the time of presentation, biochemical investigations like serum creatinine and electrolytes at admission, clinical progression during hospital stay and the type of intervention. Outcome variables studied were improvement in the stream and overall well-being of the child, renal function, recurrent urinary tract infections (UTIs). Follow-up period varied from 1 to 6 years. A total of 73 patients were included in the study. The mean age of presentation was 3.4 years. The most common presenting complaints were poor urinary stream and dribbling of urine. Antenatal USG showed abnormality in 23 patients. Renal function was abnormal in 28 patients. Out of 73 patients, 51 underwent endoscopic ablation of valves, 19 underwent vesicostomy, and three patients underwent supravesical diversion. During the follow-up recurrent UTI was observed in 11 patients, 15 patients progressed to chronic kidney disease, and 15% of patients were hypertensive. Mortality in the present study was 4%. PUV includes a spectrum of diseases from mild form to lethal conditions. Early intervention by relieving obstruction may prevent or delay the ESRD; hence, timely intervention is necessary in these children.
{"title":"Clinical Profile, Management, and Outcome of Posterior Urethral Valves in Children – Experience from a Tertiary Care Hospital","authors":"Gali Divya, V. Kundal, Rajasekhar Addagatla, Ritesh Kumar, Sandeep Kumar Jaglan, P. Debnath, A. Meena, Shalu Shah","doi":"10.4103/jiaps.jiaps_27_24","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_27_24","url":null,"abstract":"ABSTRACT\u0000 \u0000 \u0000 \u0000 Posterior urethral valves (PUV) are the most common obstructive anomaly of the lower urinary tract in children. End-stage renal disease (ESRD) in 17% of the children is due to PUV. The present study helps know the spectrum of the disease, management options, and the outcome in these children.\u0000 \u0000 \u0000 \u0000 The present study is a descriptive type of study by review of medical records of all the children presented to the hospital from 2015 to 2019. Profile of PUV includes any abnormality in antenatal ultrasonography (USG), age at presentation, presenting complaints, general condition at the time of presentation, biochemical investigations like serum creatinine and electrolytes at admission, clinical progression during hospital stay and the type of intervention. Outcome variables studied were improvement in the stream and overall well-being of the child, renal function, recurrent urinary tract infections (UTIs). Follow-up period varied from 1 to 6 years.\u0000 \u0000 \u0000 \u0000 A total of 73 patients were included in the study. The mean age of presentation was 3.4 years. The most common presenting complaints were poor urinary stream and dribbling of urine. Antenatal USG showed abnormality in 23 patients. Renal function was abnormal in 28 patients. Out of 73 patients, 51 underwent endoscopic ablation of valves, 19 underwent vesicostomy, and three patients underwent supravesical diversion. During the follow-up recurrent UTI was observed in 11 patients, 15 patients progressed to chronic kidney disease, and 15% of patients were hypertensive. Mortality in the present study was 4%.\u0000 \u0000 \u0000 \u0000 PUV includes a spectrum of diseases from mild form to lethal conditions. Early intervention by relieving obstruction may prevent or delay the ESRD; hence, timely intervention is necessary in these children.\u0000","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"2016 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.4103/jiaps.jiaps_261_23
Vidhya Gunasekaran, Gaurav Chaturvedi, S. K. Thanneeru, Amit Gupta, Reyaz Ahmad
ABSTRACT Chest wall reconstruction poses significant challenges. One of those challenges is choosing the correct material for reconstruction. There is debate on using prosthetic materials versus autologous tissues and rigid versus nonrigid materials. This article showcases the novel use of fascia lata for chest wall reconstruction in children.
{"title":"Innovative Approach to Chest Wall Reconstruction Using Autologous Tissue – The Fascia Lata in Pediatric Patients","authors":"Vidhya Gunasekaran, Gaurav Chaturvedi, S. K. Thanneeru, Amit Gupta, Reyaz Ahmad","doi":"10.4103/jiaps.jiaps_261_23","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_261_23","url":null,"abstract":"ABSTRACT\u0000 \u0000 Chest wall reconstruction poses significant challenges. One of those challenges is choosing the correct material for reconstruction. There is debate on using prosthetic materials versus autologous tissues and rigid versus nonrigid materials. This article showcases the novel use of fascia lata for chest wall reconstruction in children.","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"27 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.4103/jiaps.jiaps_233_23
Ayeza Ali, Muhammad Azeem Khan, Nabiha Ali, Sher Wali Khan, Syed Rehan Ali
{"title":"Ileo Ileal Intussusception in a Preterm Neonate: A Letter to the Editor","authors":"Ayeza Ali, Muhammad Azeem Khan, Nabiha Ali, Sher Wali Khan, Syed Rehan Ali","doi":"10.4103/jiaps.jiaps_233_23","DOIUrl":"https://doi.org/10.4103/jiaps.jiaps_233_23","url":null,"abstract":"","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"100 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141045152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.4103/jiaps.jiaps_250_23
Sravanthi Vutukuru, Shailesh Solanki, R. Kanojia
ABSTRACT Extrahepatic biliary atresia (BA) is seen in infants, with an incidence of 1 in 15,000 live births. The presentation is progressive jaundice, dark-colored urine, and clay-colored stools. Kasai portoenterostomy (KPE) is the commonly performed surgical procedure in these patients. Postoperatively, phenobarbitone, ursodeoxycholic acid (UDCA), steroids, and other drugs are given to improve bile drainage and prevent inflammation and fibrosis. However, a definitive protocol regarding the need for different drugs, dosage, and duration varies across individual surgeons and centers. No universally accepted protocol exists for postoperative management after KPE. The aim of this study was to know the prevailing postoperative management of BA by subject experts and use the Delphi process to know if the experts want to change their practice based on the results from the survey. A questionnaire was made after discussing with two experts in the field of BA. The questionnaire was mailed to 25 subject experts. The first survey data were analyzed and shared with all responders. In the second survey, change in the management based on the results from the first survey was assessed. The Delphi questionnaire was answered by 17 experts. Postoperatively, prophylactic antibiotics are prescribed for 6–12 weeks by around 40% and >12 weeks by 30% of respondents. Phenobarbitone is prescribed for <3 months by nearly 50%. UDCA is prescribed for <3 months, ≤6 months, and 6 months–1 year by 47.1%, 23.5%, and 23.5% responders, respectively. Nearly 50% prescribe steroids (mostly prednisolone), and among them, two-thirds prescribe it for 6–12 weeks. Approximately 60% give antiviral drugs to children who are cytomegalovirus immunoglobulin M positive. In our survey, 50% of experts perform 5–10 KPE per year, and 25% each perform 10–15 and >15 KPE per year. The second survey noted that a significant percentage of responders want to change their practice according to consensus. From our Delphi survey, an overview of the postoperative management of BA could be made. However, multicentric studies are required for uniform protocol on the postoperative management of BA.
摘要 肝外胆道闭锁（BA）多见于婴儿，其发病率为活产婴儿的1/15,000。表现为进行性黄疸、深色尿液和粘土色粪便。葛西肠管造口术（KPE）是此类患者常用的手术方法。术后给予苯巴比妥、熊去氧胆酸（UDCA）、类固醇和其他药物，以改善胆汁引流，防止炎症和纤维化。然而，关于不同药物的需求、剂量和持续时间，不同的外科医生和中心有不同的明确方案。对于 KPE 的术后管理，目前还没有公认的方案。 本研究的目的是了解学科专家对 BA 术后管理的普遍做法，并使用德尔菲法了解专家是否希望根据调查结果改变他们的做法。 在与 BA 领域的两位专家讨论后，制作了一份调查问卷。问卷邮寄给了 25 位学科专家。对第一次调查的数据进行了分析，并与所有答复者分享。在第二次调查中，根据第一次调查的结果对管理层的变化进行了评估。 17 位专家回答了德尔菲问卷。约 40% 的受访者在术后 6-12 周内使用预防性抗生素，30% 的受访者在术后 12 周以上使用预防性抗生素。苯巴比妥的处方量为每年 15 KPE。第二次调查显示，相当大比例的受访者希望根据共识改变他们的做法。 通过德尔菲调查，我们可以对 BA 的术后管理有一个大致的了解。不过，还需要进行多中心研究，以制定统一的 BA 术后管理方案。
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