Pub Date : 2024-04-01DOI: 10.1136/wjps-2023-000752
Daniel B Gehle, Logan C Meyer, Tim Jancelewicz
Extracorporeal life support (ECLS) serves as a rescue therapy for patients with congenital diaphragmatic hernia (CDH) and severe cardiopulmonary failure, and only half of these patients survive to discharge. This costly intervention has a significant complication risk and is reserved for patients with the most severe disease physiology refractory to maximal cardiopulmonary support. Some contraindications to ECLS do exist such as coagulopathy, lethal chromosomal or congenital anomaly, very preterm birth, or very low birth weight, but many of these limits are being evaluated through further research. Consensus guidelines from the past decade vary in recommendations for ECLS use in patients with CDH but this therapy appears to have a survival benefit in the most severe subset of patients. Improved outcomes have been observed for patients treated at high-volume centers. This review details the evolving literature surrounding management paradigms for timing of CDH repair for patients receiving preoperative ECLS. Most recent data support early repair following cannulation to avoid non-repair which is uniformly fatal in this population. Longer ECLS runs are associated with decreased survival, and patient physiology should guide ECLS weaning and eventual decannulation rather than limiting patients to arbitrary run lengths. Standardization of care across centers is a major focus to limit unnecessary costs and improve short-term and long-term outcomes for these complex patients. No data are available.
{"title":"The role of extracorporeal life support and timing of repair in infants with congenital diaphragmatic hernia","authors":"Daniel B Gehle, Logan C Meyer, Tim Jancelewicz","doi":"10.1136/wjps-2023-000752","DOIUrl":"https://doi.org/10.1136/wjps-2023-000752","url":null,"abstract":"Extracorporeal life support (ECLS) serves as a rescue therapy for patients with congenital diaphragmatic hernia (CDH) and severe cardiopulmonary failure, and only half of these patients survive to discharge. This costly intervention has a significant complication risk and is reserved for patients with the most severe disease physiology refractory to maximal cardiopulmonary support. Some contraindications to ECLS do exist such as coagulopathy, lethal chromosomal or congenital anomaly, very preterm birth, or very low birth weight, but many of these limits are being evaluated through further research. Consensus guidelines from the past decade vary in recommendations for ECLS use in patients with CDH but this therapy appears to have a survival benefit in the most severe subset of patients. Improved outcomes have been observed for patients treated at high-volume centers. This review details the evolving literature surrounding management paradigms for timing of CDH repair for patients receiving preoperative ECLS. Most recent data support early repair following cannulation to avoid non-repair which is uniformly fatal in this population. Longer ECLS runs are associated with decreased survival, and patient physiology should guide ECLS weaning and eventual decannulation rather than limiting patients to arbitrary run lengths. Standardization of care across centers is a major focus to limit unnecessary costs and improve short-term and long-term outcomes for these complex patients. No data are available.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/wjps-2023-000703
Stephanie Y Chen, Iris Garcia, Shadassa Ourshalimian, Chantel Lowery, Pradip P Chaudhari, Ryan G Spurrier
Objectives Safety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study in pediatric trauma is limited. We hypothesized that MVC patients from low-opportunity neighborhoods are less likely to be appropriately restrained. Methods A retrospective cross-sectional study was performed on children/adolescents ≤18 years old in MVCs between January 1, 2011 and December 31, 2021. Patients were identified from the Children’s Hospital Los Angeles trauma registry. The outcome was safety restraint use (appropriately restrained, not appropriately restrained). COI levels by home zip codes were stratified as very low, low, moderate, high, and very high. Multivariable regression controlling for age identified factors associated with safety restraint use. Results Of 337 patients, 73.9% were appropriately restrained and 26.1% were not appropriately restrained. Compared with appropriately restrained patients, more not appropriately restrained patients were from low-COI (26.1% vs 20.9%), high-COI (14.8% vs 10.8%) and very high-COI (10.2% vs 3.6%) neighborhoods. Multivariable analysis demonstrated no significant associations in appropriate restraint use and COI. There was a non-significant trend that children/adolescents from moderate-COI neighborhoods were more likely than those from very low-COI neighborhoods to be appropriately restrained (OR=1.82, 95% CI 0.78, 4.28). Conclusion Injury prevention initiatives focused on safety restraints should target families of children from all neighborhood types. Level of evidence III. Data are available upon reasonable request.
目标 安全约束装置可减少机动车碰撞（MVC）造成的伤害，但往往使用不当或未使用。儿童机会指数（COI）反映了健康的社会决定因素，但其对儿科创伤的研究却很有限。我们假设，来自机会较少社区的 MVC 患者不太可能得到适当的约束。方法 我们对 2011 年 1 月 1 日至 2021 年 12 月 31 日期间发生 MVC 的 18 岁以下儿童/青少年进行了一项回顾性横断面研究。患者身份来自洛杉矶儿童医院创伤登记处。结果是安全约束的使用情况（适当约束、未适当约束）。按家庭邮政编码划分的 COI 水平分为极低、低、中、高和极高。控制年龄的多变量回归确定了与使用安全约束相关的因素。结果 在 337 名患者中，73.9% 得到了适当的约束，26.1% 没有得到适当的约束。与受到适当约束的患者相比，更多未受到适当约束的患者来自低感染率（26.1% 对 20.9%）、高感染率（14.8% 对 10.8%）和极高感染率（10.2% 对 3.6%）社区。多变量分析表明，适当限制措施的使用与 COI 之间无明显关联。中度 COI 社区的儿童/青少年比 COI 非常低的社区的儿童/青少年更有可能得到适当的约束，但这一趋势并不明显（OR=1.82，95% CI 0.78，4.28）。结论 以安全约束为重点的伤害预防措施应针对所有社区类型的儿童家庭。证据等级 III。如有合理要求，可提供数据。
{"title":"Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions","authors":"Stephanie Y Chen, Iris Garcia, Shadassa Ourshalimian, Chantel Lowery, Pradip P Chaudhari, Ryan G Spurrier","doi":"10.1136/wjps-2023-000703","DOIUrl":"https://doi.org/10.1136/wjps-2023-000703","url":null,"abstract":"Objectives Safety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study in pediatric trauma is limited. We hypothesized that MVC patients from low-opportunity neighborhoods are less likely to be appropriately restrained. Methods A retrospective cross-sectional study was performed on children/adolescents ≤18 years old in MVCs between January 1, 2011 and December 31, 2021. Patients were identified from the Children’s Hospital Los Angeles trauma registry. The outcome was safety restraint use (appropriately restrained, not appropriately restrained). COI levels by home zip codes were stratified as very low, low, moderate, high, and very high. Multivariable regression controlling for age identified factors associated with safety restraint use. Results Of 337 patients, 73.9% were appropriately restrained and 26.1% were not appropriately restrained. Compared with appropriately restrained patients, more not appropriately restrained patients were from low-COI (26.1% vs 20.9%), high-COI (14.8% vs 10.8%) and very high-COI (10.2% vs 3.6%) neighborhoods. Multivariable analysis demonstrated no significant associations in appropriate restraint use and COI. There was a non-significant trend that children/adolescents from moderate-COI neighborhoods were more likely than those from very low-COI neighborhoods to be appropriately restrained (OR=1.82, 95% CI 0.78, 4.28). Conclusion Injury prevention initiatives focused on safety restraints should target families of children from all neighborhood types. Level of evidence III. Data are available upon reasonable request.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/wjps-2023-000758
Nicole Cimbak, Terry L Buchmiller
Neonates with congenital diaphragmatic hernia encounter a number of surgical and medical morbidities that persist into adulthood. As mortality improves for this population, these survivors warrant specialized follow-up for their unique disease-specific morbidities. Multidisciplinary congenital diaphragmatic hernia clinics are best positioned to address these complex long-term morbidities, provide long-term research outcomes, and help inform standardization of best practices in this cohort of patients. This review outlines long-term morbidities experienced by congenital diaphragmatic hernia survivors that can be addressed in a comprehensive follow-up clinic. No data are available.
{"title":"Long-term follow-up of patients with congenital diaphragmatic hernia","authors":"Nicole Cimbak, Terry L Buchmiller","doi":"10.1136/wjps-2023-000758","DOIUrl":"https://doi.org/10.1136/wjps-2023-000758","url":null,"abstract":"Neonates with congenital diaphragmatic hernia encounter a number of surgical and medical morbidities that persist into adulthood. As mortality improves for this population, these survivors warrant specialized follow-up for their unique disease-specific morbidities. Multidisciplinary congenital diaphragmatic hernia clinics are best positioned to address these complex long-term morbidities, provide long-term research outcomes, and help inform standardization of best practices in this cohort of patients. This review outlines long-term morbidities experienced by congenital diaphragmatic hernia survivors that can be addressed in a comprehensive follow-up clinic. No data are available.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/wjps-2024-000783
Alexandra Dimmer, Robert Baird, Pramod Puligandla
Standardization of care seeks to improve patient outcomes and healthcare delivery by reducing unwanted variations in care as well as promoting the efficient and effective use of healthcare resources. There are many types of standardization, with clinical practice guidelines (CPGs), based on a stringent assessment of evidence and expert consensus, being the hallmark of high-quality care. This article outlines the history of CPGs, their benefits and shortcomings, with a specific focus on standardization efforts as it relates to congenital diaphragmatic hernia management.
{"title":"Role of practice standardization in outcome optimization for CDH","authors":"Alexandra Dimmer, Robert Baird, Pramod Puligandla","doi":"10.1136/wjps-2024-000783","DOIUrl":"https://doi.org/10.1136/wjps-2024-000783","url":null,"abstract":"Standardization of care seeks to improve patient outcomes and healthcare delivery by reducing unwanted variations in care as well as promoting the efficient and effective use of healthcare resources. There are many types of standardization, with clinical practice guidelines (CPGs), based on a stringent assessment of evidence and expert consensus, being the hallmark of high-quality care. This article outlines the history of CPGs, their benefits and shortcomings, with a specific focus on standardization efforts as it relates to congenital diaphragmatic hernia management.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140198954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/wjps-2024-reviewers
BMJ Publishing Group Ltd
The editors would like to publicly acknowledge the people listed below who served as reviewers on the journal during 2023.Without their efforts,the quality of the journal could not be sustained. Allison Aguado Gehad Ahmed Zeynep Alp Unkar Belen Aneiros Castro Kyle J Van Arendonk Einar Arnbjornsson Jugpal S.Arneja Yatin Arora Robert Baird Adam Bajinting Quentin Ballouhey Garrett Barfoot Sylvie Beaudoin Asaad G.Beshish George Bethell Arnaud Bonnard Fabio Botelho Terry L.Buchmiller Danilo Buonsenso Vito Andrea Capozzi Neil K.Chadha V.V.S.Chandrasekharam Aswin Chari Anthony Chin Chan Chui Kenneth L.Y.Chung Patrick Ho Yu Chung Jennifer N Cooper Philip Crispin Alessandro Crocoli Kanishka Das Sumit Dave …
编辑们在此公开感谢在 2023 年期间担任本刊审稿人的下列人员，没有他们的努力，本刊的质量就无法维持。Allison Aguado Gehad Ahmed Zeynep Alp Unkar Belen Aneiros Castro Kyle J Van Arendonk Einar Arnbjornsson Jugpal S.Arneja Yatin Arora Robert Baird Adam Bajinting Quentin Ballouhey Garrett Barfoot Sylvie Beaudoin Asaad G.Beshish George Bethell Arnaud Bonnard Fabio Botelho Terry L. Buchmiller Danilo Buonsenso V. Capt.Buchmiller Danilo Buonsenso Vito Andrea Capozzi Neil K.Chadha V.V.S.Chandrasekharam Aswin Chari Anthony Chin Chan Chui Kenneth L.Y.Chung Patrick Ho Yu Chung Jennifer N Cooper Philip Crispin Alessandro Crocoli Kanishka Das Sumit Dave ...
{"title":"Thank you to our reviewers","authors":"BMJ Publishing Group Ltd","doi":"10.1136/wjps-2024-reviewers","DOIUrl":"https://doi.org/10.1136/wjps-2024-reviewers","url":null,"abstract":"The editors would like to publicly acknowledge the people listed below who served as reviewers on the journal during 2023.Without their efforts,the quality of the journal could not be sustained. Allison Aguado Gehad Ahmed Zeynep Alp Unkar Belen Aneiros Castro Kyle J Van Arendonk Einar Arnbjornsson Jugpal S.Arneja Yatin Arora Robert Baird Adam Bajinting Quentin Ballouhey Garrett Barfoot Sylvie Beaudoin Asaad G.Beshish George Bethell Arnaud Bonnard Fabio Botelho Terry L.Buchmiller Danilo Buonsenso Vito Andrea Capozzi Neil K.Chadha V.V.S.Chandrasekharam Aswin Chari Anthony Chin Chan Chui Kenneth L.Y.Chung Patrick Ho Yu Chung Jennifer N Cooper Philip Crispin Alessandro Crocoli Kanishka Das Sumit Dave …","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To review postoperative necrotizing enterocolitis (NEC) in patients with jejunoileal atresia (JIA) and to explore the potential risk factors related to the concurrence of NEC. Methods Patients diagnosed with JIA who received surgical treatment from January 2016 to June 2021 were enrolled. Demographics, viral infection of the fetus, transfusion within 48 hours before NEC, sepsis before JIA repair, pathological and anatomical classification of JIA, combined malformation, occurrence time of NEC after the operation, treatment, and prognosis of patients were analyzed. Patients were divided into NEC group and non-NEC group, and all patients were followed up for 3–6 months to observe for complications. Results A total of 180 patients with JIA were included, of whom 12 were diagnosed with NEC after surgery and 1 patient with NEC died during follow-up. The average age, birth weight, gestational age, proportion of premature infants, proportion of preoperative infections, and pathological classification of JIA did not significantly differ between the two groups. The probability of patients with proximal jejunal atresia (PJA) in the NEC group (58.3%) was higher than that in the non-NEC group (22.6%) ( p =0.011), and patients with PJA had longer parenteral nutrition time than patients without PJA (26.64±9.21 days vs 15.11±6.58 days, p <0.001). Conclusion PJA was more likely to be associated with concurrent NEC after surgery, which is a highly NEC-related risk factor inherent in JIA. All data relevant to the study are included in the article or uploaded as supplementary information.
目的 回顾性分析空肠闭锁（JIA）患者术后坏死性小肠结肠炎（NEC）的情况，并探讨与NEC并发症相关的潜在风险因素。方法 纳入2016年1月至2021年6月期间接受手术治疗的确诊为JIA的患者。对患者的人口统计学、胎儿病毒感染、NEC发生前48小时内输血、JIA修复前败血症、JIA的病理解剖分类、合并畸形、术后NEC发生时间、治疗和预后进行分析。将患者分为 NEC 组和非 NEC 组，对所有患者进行 3-6 个月的随访，观察并发症的发生情况。结果 共纳入180例JIA患者，其中12例术后确诊为NEC，1例NEC患者在随访期间死亡。两组 JIA 患者的平均年龄、出生体重、胎龄、早产儿比例、术前感染比例和病理分类无显著差异。NEC 组近端空肠闭锁（PJA）患者的概率（58.3%）高于非 NEC 组（22.6%）（P =0.011），PJA 患者的肠外营养时间长于无 PJA 患者（26.64±9.21 天 vs 15.11±6.58 天，P <0.001）。结论 PJA 更有可能与术后并发 NEC 相关，这是 JIA 中固有的与 NEC 高度相关的风险因素。与该研究相关的所有数据均包含在文章中或作为补充信息上传。
{"title":"Clinical characteristics of postoperative necrotizing enterocolitis in patients with congenital jejunoileal atresia and its risk factors","authors":"Xiaofeng Xiong, Wei Lu, Fuzhong Xing, Yuan Cai, Jixin Yang, Yuhang Yuan, Jiexiong Feng, Xuyong Chen","doi":"10.1136/wjps-2023-000622","DOIUrl":"https://doi.org/10.1136/wjps-2023-000622","url":null,"abstract":"Objective To review postoperative necrotizing enterocolitis (NEC) in patients with jejunoileal atresia (JIA) and to explore the potential risk factors related to the concurrence of NEC. Methods Patients diagnosed with JIA who received surgical treatment from January 2016 to June 2021 were enrolled. Demographics, viral infection of the fetus, transfusion within 48 hours before NEC, sepsis before JIA repair, pathological and anatomical classification of JIA, combined malformation, occurrence time of NEC after the operation, treatment, and prognosis of patients were analyzed. Patients were divided into NEC group and non-NEC group, and all patients were followed up for 3–6 months to observe for complications. Results A total of 180 patients with JIA were included, of whom 12 were diagnosed with NEC after surgery and 1 patient with NEC died during follow-up. The average age, birth weight, gestational age, proportion of premature infants, proportion of preoperative infections, and pathological classification of JIA did not significantly differ between the two groups. The probability of patients with proximal jejunal atresia (PJA) in the NEC group (58.3%) was higher than that in the non-NEC group (22.6%) ( p =0.011), and patients with PJA had longer parenteral nutrition time than patients without PJA (26.64±9.21 days vs 15.11±6.58 days, p <0.001). Conclusion PJA was more likely to be associated with concurrent NEC after surgery, which is a highly NEC-related risk factor inherent in JIA. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140168259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/wjps-2023-000659
Nitinkumar Borkar, Charu Tiwari, Debajyoti Mohanty, Tridip Dutta Baruah, Manoj Mohanty, C K Sinha
Background Polyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon’s preference. The development of post-reconstruction urethrocutaneous fistula (UCF) is variably attributed to the choice of suture material for urethroplasty. This meta-analysis compares complications of hypospadias repair using PG and PDS sutures. Methods The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors conducted thorough searches in databases including MEDLINE, EMBASE, CENTRAL, Scopus, Google Scholar, and clinical trial registries. Outcome measures included UCF, meatal stenosis, wound infection, urethral stricture, glans dehiscence, and overall complications. Quantitative analysis was used with fixed or random-effect models to find the pooled risk ratio and I2 heterogeneity. Results The criteria for inclusion were met by five comparative studies with the inclusion of 1244 children altogether. Pooled analysis failed to show a statistically significant difference in the incidence of meatal stenosis, urethral stricture, wound infection, and total complications using PG and PDS sutures. However, it showed a reduction in the incidence of UCF with PDS suture hypospadias repairs (risk ratio=0.66, 95% CI 0.48 to 0.92). Conclusions PDS sutures are associated with decreased incidence of UCF than PG after hypospadias repair. The incidence of meatal stenosis, urethral stricture, wound infection, and total complications was not affected by the type of suture material used for repair. Clinical implications This meta-analysis suggests decreased incidence of UCF when PDS sutures are used for hypospadias repair which may impact the choice of suture material for repair. PROSPERO registration number CRD42023409710. All data relevant to the study are included in the article or uploaded as supplemental information.
{"title":"Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing polydioxanone and polyglactin sutures","authors":"Nitinkumar Borkar, Charu Tiwari, Debajyoti Mohanty, Tridip Dutta Baruah, Manoj Mohanty, C K Sinha","doi":"10.1136/wjps-2023-000659","DOIUrl":"https://doi.org/10.1136/wjps-2023-000659","url":null,"abstract":"Background Polyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon’s preference. The development of post-reconstruction urethrocutaneous fistula (UCF) is variably attributed to the choice of suture material for urethroplasty. This meta-analysis compares complications of hypospadias repair using PG and PDS sutures. Methods The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors conducted thorough searches in databases including MEDLINE, EMBASE, CENTRAL, Scopus, Google Scholar, and clinical trial registries. Outcome measures included UCF, meatal stenosis, wound infection, urethral stricture, glans dehiscence, and overall complications. Quantitative analysis was used with fixed or random-effect models to find the pooled risk ratio and I2 heterogeneity. Results The criteria for inclusion were met by five comparative studies with the inclusion of 1244 children altogether. Pooled analysis failed to show a statistically significant difference in the incidence of meatal stenosis, urethral stricture, wound infection, and total complications using PG and PDS sutures. However, it showed a reduction in the incidence of UCF with PDS suture hypospadias repairs (risk ratio=0.66, 95% CI 0.48 to 0.92). Conclusions PDS sutures are associated with decreased incidence of UCF than PG after hypospadias repair. The incidence of meatal stenosis, urethral stricture, wound infection, and total complications was not affected by the type of suture material used for repair. Clinical implications This meta-analysis suggests decreased incidence of UCF when PDS sutures are used for hypospadias repair which may impact the choice of suture material for repair. PROSPERO registration number CRD42023409710. All data relevant to the study are included in the article or uploaded as supplemental information.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1136/wjps-2023-000641
Yuxin Wu, ZaiYu Zhang, Ping Liang, Lusheng Li, Bin Zou, Difei Wang, Xinyu Dong, Haotian Tang, Hanli Qiu, Xuan Zhai
Objective The study aimed to explore the association between the site of interictal epileptic discharges (IEDs) on postoperative electroencephalogram (EEG) and seizure recurrence after antiepileptic drug (AED) withdrawal. The study hypothesizes that the concordance of IED sites with surgical sites indicates incomplete resection of epileptic focus, while non-concordance of IED sites with surgical sites indicates postoperative changes or cortical stimulation. The former has a higher risk of seizure recurrence. Methods We retrospectively analyzed the postoperative EEG pattern of 182 consecutive children who underwent resection surgery. To identify the risk factors for seizure recurrence, we compared the attributes of seizure recurred and seizure-free groups by univariate and multivariate analyses. AED tapering was standardized, involving a 25% reduction in the dose of a single type of AED every 2 weeks, independent of the presurgical AED load. Results We attempted AED withdrawal in 116 (63.7%) children. Twenty-eight (24.1%) children experienced seizure recurrence during or after AED withdrawal. A greater number of AEDs used at the time of surgery ( p =0.005), incomplete resection ( p =0.001), and presence of IED on postoperative EEG ( p =0.011) are predictors of seizure recurrence. The completeness of resection and seizure recurrence after AED withdrawal were related to the presence of IED on the EEG, but not to the concordance of IED with surgical sites. Conclusion For children with abnormal EEG, the decision to discontinue AED should be made more cautiously, regardless of the relative location of the discharge site and the surgical site. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Postoperative interictal epileptiform discharges predict seizure recurrence after antiepileptic drug withdrawal regardless of concordance with surgical site","authors":"Yuxin Wu, ZaiYu Zhang, Ping Liang, Lusheng Li, Bin Zou, Difei Wang, Xinyu Dong, Haotian Tang, Hanli Qiu, Xuan Zhai","doi":"10.1136/wjps-2023-000641","DOIUrl":"https://doi.org/10.1136/wjps-2023-000641","url":null,"abstract":"Objective The study aimed to explore the association between the site of interictal epileptic discharges (IEDs) on postoperative electroencephalogram (EEG) and seizure recurrence after antiepileptic drug (AED) withdrawal. The study hypothesizes that the concordance of IED sites with surgical sites indicates incomplete resection of epileptic focus, while non-concordance of IED sites with surgical sites indicates postoperative changes or cortical stimulation. The former has a higher risk of seizure recurrence. Methods We retrospectively analyzed the postoperative EEG pattern of 182 consecutive children who underwent resection surgery. To identify the risk factors for seizure recurrence, we compared the attributes of seizure recurred and seizure-free groups by univariate and multivariate analyses. AED tapering was standardized, involving a 25% reduction in the dose of a single type of AED every 2 weeks, independent of the presurgical AED load. Results We attempted AED withdrawal in 116 (63.7%) children. Twenty-eight (24.1%) children experienced seizure recurrence during or after AED withdrawal. A greater number of AEDs used at the time of surgery ( p =0.005), incomplete resection ( p =0.001), and presence of IED on postoperative EEG ( p =0.011) are predictors of seizure recurrence. The completeness of resection and seizure recurrence after AED withdrawal were related to the presence of IED on the EEG, but not to the concordance of IED with surgical sites. Conclusion For children with abnormal EEG, the decision to discontinue AED should be made more cautiously, regardless of the relative location of the discharge site and the surgical site. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139766998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1136/wjps-2023-000719
Abirami Muthumani
Pediatric surgical interventions may represent more than one-third of the surgical caseload in humanitarian settings.1 The humanitarian crisis in Gaza has taken a devastating toll on children, many of whom have suffered injuries due to indiscriminate and heavy bombardment, resulting in severe polytraumatic injuries necessitating immediate and specialized pediatric surgical intervention. The conflict has strained the region’s fragile healthcare system, resulting in a significant number of casualties, a substantial proportion of which are children. This exacerbates the demand for specialized pediatric surgical care, especially when the existing healthcare system and infrastructure has nearly collapsed and is under-resourced to handle the influx of pediatric patients.2 The urgency for specialized pediatric surgical care and support for children in Gaza cannot be overstated. Access to healthcare in Palestine has been an ongoing challenge.3 Before the recent hostilities, 1.1 million children in Gaza and the West Bank were already in need of humanitarian aid, constituting approximately half of the child population.4 The current war in Gaza, as per a recent UNICEF report, has exacerbated the situation, with hundreds of thousands of children in desperate need of humanitarian assistance and protection.5 Team members of Médecins Sans Frontières (MSF) who are currently provding medical care in Gaza, have expressed deep concern regarding the critical medical and humanitarian crisis facing children in the region. Nearly half of the consultations MSF staff provided in the Martyrs and Beni Suheila clinics, in which they have now been forced to suspend operations in, were for children under the age of five.6 The conflict has resulted in a significant number of casualties, with a substantial proportion being children who require specialized pediatric surgical care. One child in Gaza has been killed every 10 min on average.7 Thousands more have been injured in the region. There is …
{"title":"Safeguarding children through pediatric surgical care in war and humanitarian settings: a call to action for pediatric patients in Gaza","authors":"Abirami Muthumani","doi":"10.1136/wjps-2023-000719","DOIUrl":"https://doi.org/10.1136/wjps-2023-000719","url":null,"abstract":"Pediatric surgical interventions may represent more than one-third of the surgical caseload in humanitarian settings.1 The humanitarian crisis in Gaza has taken a devastating toll on children, many of whom have suffered injuries due to indiscriminate and heavy bombardment, resulting in severe polytraumatic injuries necessitating immediate and specialized pediatric surgical intervention. The conflict has strained the region’s fragile healthcare system, resulting in a significant number of casualties, a substantial proportion of which are children. This exacerbates the demand for specialized pediatric surgical care, especially when the existing healthcare system and infrastructure has nearly collapsed and is under-resourced to handle the influx of pediatric patients.2 The urgency for specialized pediatric surgical care and support for children in Gaza cannot be overstated. Access to healthcare in Palestine has been an ongoing challenge.3 Before the recent hostilities, 1.1 million children in Gaza and the West Bank were already in need of humanitarian aid, constituting approximately half of the child population.4 The current war in Gaza, as per a recent UNICEF report, has exacerbated the situation, with hundreds of thousands of children in desperate need of humanitarian assistance and protection.5 Team members of Médecins Sans Frontières (MSF) who are currently provding medical care in Gaza, have expressed deep concern regarding the critical medical and humanitarian crisis facing children in the region. Nearly half of the consultations MSF staff provided in the Martyrs and Beni Suheila clinics, in which they have now been forced to suspend operations in, were for children under the age of five.6 The conflict has resulted in a significant number of casualties, with a substantial proportion being children who require specialized pediatric surgical care. One child in Gaza has been killed every 10 min on average.7 Thousands more have been injured in the region. There is …","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140008372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1136/wjps-2023-000707
Nitinkumar Borkar, Charu Tiwari, Abhijit Nair, Debajyoti Mohanty, C K Sinha, Jai Kumar Mahajan
Background Hypospadias is one of the most common genital birth defects. There are around 300 various techniques available for the repair of hypospadias. This study aims to compare the reported outcomes of Tubularized incised plate urethroplasty (TIP) and Grafted TIP (GTIP) repair in children undergoing primary hypospadias repair. Methods This meta-analysisadhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and we framed our research question using the population, intervention, control and outcomes format. We conducted comprehensive electronic searches across various databases, employing a Boolean search strategy with predefined search terms. Only randomized controlled trials (RCTs) were included for quantitative analysis. Results Totally, 10 RCTs met our inclusion criteria for quantitative analysis. The results indicated that urethrocutaneous fistula, glans dehiscence, and stricture rates were comparable between the two groups. The incidence of meatal stenosis was found to be significantly lower in the GTIP group with a relative risk (RR) of 0.32 (95% confidence interval (CI) 0.15 to 0.67). Conclusion The coucomes UCF, glans dehiscence, and stricture rates were comparable between the two groups. Notably, the incidence of meatal stenosis was found to be significantly lower in the grafted TIP group. In terms of operative time, our quantitative synthesis demonstrated that the TIP group had a shorter operative time than the GTIP group with significant heterogeneity. All data relevant to the study are included in the article or uploaded as supplemental information.
{"title":"Tubularized incised plate urethroplasty and grafted tubularized incised plate urethroplasty: systematic review, meta-analysis and trial sequential analysis","authors":"Nitinkumar Borkar, Charu Tiwari, Abhijit Nair, Debajyoti Mohanty, C K Sinha, Jai Kumar Mahajan","doi":"10.1136/wjps-2023-000707","DOIUrl":"https://doi.org/10.1136/wjps-2023-000707","url":null,"abstract":"Background Hypospadias is one of the most common genital birth defects. There are around 300 various techniques available for the repair of hypospadias. This study aims to compare the reported outcomes of Tubularized incised plate urethroplasty (TIP) and Grafted TIP (GTIP) repair in children undergoing primary hypospadias repair. Methods This meta-analysisadhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and we framed our research question using the population, intervention, control and outcomes format. We conducted comprehensive electronic searches across various databases, employing a Boolean search strategy with predefined search terms. Only randomized controlled trials (RCTs) were included for quantitative analysis. Results Totally, 10 RCTs met our inclusion criteria for quantitative analysis. The results indicated that urethrocutaneous fistula, glans dehiscence, and stricture rates were comparable between the two groups. The incidence of meatal stenosis was found to be significantly lower in the GTIP group with a relative risk (RR) of 0.32 (95% confidence interval (CI) 0.15 to 0.67). Conclusion The coucomes UCF, glans dehiscence, and stricture rates were comparable between the two groups. Notably, the incidence of meatal stenosis was found to be significantly lower in the grafted TIP group. In terms of operative time, our quantitative synthesis demonstrated that the TIP group had a shorter operative time than the GTIP group with significant heterogeneity. All data relevant to the study are included in the article or uploaded as supplemental information.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139918545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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