Gallbladder disease is one of the most common abdominal conditions requiring the attention of the pediatric surgeon. In this chapter, we review the etiology of stone disease and types of presentation from inflammatory conditions of the gallbladder and biliary tree. We outline the phenomenon of biliary disease and explore the diagnostic algorithms for patients with biliary symptoms. In addition, we compare the treatment options and examine the published outcomes to date.

Introduction: We previously conducted a randomized trial that showed a lack of need for esophagocrural (EC) sutures during fundoplication when no esophageal dissection was performed. There was no difference in wrap herniation or other complications in the group without EC sutures at a median 1.5 years of follow-up. In this follow-up study, we aim to evaluate long-term symptom control and complication profiles in these patients. Methods: 106 patients were randomized and participated in the original trial. We were primarily concerned with identification of late complications and persistence of symptoms. Presently, we conducted a retrospective chart review and a telephone follow-up survey at a minimum of 6.5 years after fundoplication. Results: 100 patients were alive at late follow-up and 70% of caregivers responded to the telephone survey. 53% of patients were male; 76% were Caucasian. Of these children, 39 (56%) received four EC sutures, while 31 (44%) did not. Follow-up was conducted at a median of 8.7 years [IQR 8.2,9.7] post-fundoplication. Late wrap herniation was not demonstrated radiographically on chart review or caregiver report in either group. The rate of residual reflux symptoms, post-operative hospitalizations for pneumonia, failure to thrive (FTT), and brief resolved unexplained event (BRUE) were also similar between groups. Conclusion: Long-term follow-up in children who underwent fundoplication without esophagocrural sutures demonstrates no difference in symptom management or subsequent hospitalizations at a minimum of 6.5-year follow-up. (C) 2021 Elsevier Inc. All rights reserved.

The incidence of gallbladder disease in children is rising due to an increase in the development of nonhemolytic cholelithiasis in this age group. Laparoscopic cholecystectomy is the gold standard for treatment for gallbladder disease in adults and, with the technique's widespread adoption, it has now become the mainstay of treatment for gallbladder disease in children as well. Complications are infrequent and is now often performed as an outpatient surgery. Although the standard approach is through a 4-port technique, it can also be performed using a single-site technique. We describe our thoughts on laparoscopic cholecystectomy in children with a focus on the standard approach.

Gastroesophageal reflux (GER) is common in infants generally resolving in early childhood. However, gastroesophageal reflux disease (GERD) is diagnosed when persistent troublesome symptoms and/or complications of GER develop. These symptoms and complications can significantly affect the quality of life, thus requiring medical or surgical treatment. Medical management is typically trialed, but operative treatment is indicated with severe symptoms such as aspiration pneumonia, apneic episodes, bradycardia, apparent life-threatening events, severe vomiting, failure to thrive, esophagitis, stricture, and failed medical therapy. We review the recent literature on the indications and outcomes for laparoscopic fundoplication in the management of pediatric GERD.

Ashcraft's Pediatric Surgery, 6th Edition - Libros de Medicina - Cirugia pediatrica - 229,00

This is the first Journal of Pediatric Surgery lecture at the Pacific Association of Pediatric Surgeons (PAPS) meeting.

Introduction: Children with pectus carinatum (PC) are particularly vulnerable to psychosocial effects of poor body image, even though they may not experience physical symptoms. Nonoperative treatment with orthotic bracing is effective in PC correction. We describe our experience with dynamic compression bracing (DCB) for PC patients and their satisfaction with bracing. Materials and Methods: Prospective institutional data of patients undergoing DCB from July 2011 to June 2018 were reviewed and analyzed for those who entered the retainer mode after correction, defined by a correction pressure of <1 psi. A telephone survey was conducted regarding their bracing experience and satisfaction with the outcome on a scale of 1-10. Results: Of 460 PC patients, 144 reached the retainer mode. Median time to retainer mode was 5.5 months. There was no statistically significant relationship between initial correction pressure or carinatum height and time to retainer mode (P = .08 and P = .10, respectively). Fifty-seven percent were compliant with brace use, and median time to retainer mode in this subset was significantly shorter than noncompliant patients (3.5 months versus 10 months, P < .001). Fifty-three percent responded to the survey 13 months [interquartile ratios 3, 33] after the last clinic visit. The main barrier to compliance with wearing the brace was discomfort (37%), while the main motivation for compliance was appearance (58%). All endorsed bracing as worthwhile, with 94% reporting a satisfaction rating of 8 or greater for the correction outcome. Conclusion: DCB is effective in achieving correction of PC in compliant patients. Regardless of time to retainer mode, patients reported high satisfaction with bracing.

Quality and safety have come to the forefront of the current healthcare environment over the past 10 years. Although all surgeons feel they perform safe operations with quality outcomes, these variables are being increasingly measured in today's healthcare world. The purpose of this article is to describe our thoughts about the error traps and safety steps when performing a laparoscopic Nissen fundoplication. Hopefully, adherence to these technical points will help prevent the need for a second operative procedure due to transmigration of the fundoplication wrap or the need for esophageal dilation postoperatively.

The American Pediatric Surgical Association (APSA) held its 50th meeting this past year. In this January issue, the papers that were accepted by the APSA Publications Committee are published. The APSA Publications Committee did a wonderful job in determining which papers were appropriate and suitable for publication. In addition, Elsevier is publishing a supplemental to this APSA issue. The supplement contains the historical vignettes by Dr. Don Nakayama about the development of pediatric surgery and the formation of APSA. These had previously been circulated as individual vignettes, but are now combined into one article. In addition, other articles by Drs. Jim O′ Neil, Kristen Zeller, James Wall and Tom Krummel, and Katherine Deans and Jordan Apfeld describe APSA's past and project what the field of pediatric surgery may look like in the future. The JPS Editorial Board hopes that you enjoy this supplement.

Background: Pain following bar placement for pectus excavatum is the dominant factor post-operatively and determines length of stay (LOS). Werecently adopted intercostal cryoablation as our preferred method of pain control following minimally invasive pectus excavatumrepair. Wecompared the outcomes of cryoablation to results of a recently concluded trial of epidural (EPI) and patient-controlled analgesia (PCA) protocols. Methods: We conducted a prospective observational study of patients undergoing bar placement for pectus excavatum using intercostal cryoablation. Results are reported and compared with those of a randomized trial comparing EPI with PCA. Comparisons of medians were performed using Kruskal-Wallis H tests with alpha 0.05. Results: Thirty-five patients were treated with cryoablation compared to 32 epidural and 33 PCA patients from the trial. Cryoablation was associated with longer operating time (101 min, versus 58 and 57 min for epidural and PCA groups, p < 0.01), resulted in less time to pain control with oral medication (21 h, versus 72 and 67 h, p < 0.01), and decreased LOS (1 day, versus 4.3 and 4.2 days, p < 0.01). Conclusion: Intercostal cryoablation during minimally invasive pectus excavatumrepair reduces LOS and perioperative opioid consumption compared with both EPI and PCA. Level of Evidence: II. (c) 2019 Elsevier Inc. All rights reserved.

Purpose: Historically, fundoplication has been performed with extensive dissection of the esophageal attachments to the diaphragm. Previously, we conducted a randomized trial demonstrating that minimal esophageal dissection and mobilization reduce the rate of wrap herniation and the need for reoperation. In that study, four esophagocrural (EC) sutures were placed in both groups to help obliterate the space between the esophagus and diaphragmatic crura. In this current study, we evaluate the need for these EC sutures. Methods: Children less than age 7 undergoing laparoscopic fundoplication were randomized to receive four EC sutures or none. Exclusion criteria included an existing hiatal hernia. The primary outcome was transmigration of the fundoplication wrap through the esophageal hiatus into the mediastinum. A contrast study was performed around 1 year postoperatively. Telephone follow-up was performed at a minimum of 1.5 years. Results: 120 patients were enrolled from 2/2010 to 2/2014, and 13 did not survive. One patient was excluded because a hiatal hernia was found at laparoscopy, leaving 52 patients with EC sutures (S) and 54 without EC sutures (NS). Operative time was 20 min longer in the S group (P < 0.01). Contrast studies were obtained in 62% of S and 68% of NS patients, and there were no wrap herniations in either group. There was one reoperation for wrap loosening in the NS group, none in the S group. Final telephone and clinic follow up was at a median of 4 years (IQR 3-4.7). Reflux symptoms and medications were not different at one month, one year, and final follow-up. Conclusion: When minimal phrenoesophageal dissection is performed, EC sutures offer no advantages and increase operating time. (c) 2017 Elsevier Inc. All rights reserved.

There is a limited and conflicting evidence about the most appropriate method for appendiceal stump closure during laparoscopic appendectomy (LA). We aimed to compare endoloop (EL) versus endostapler (ES) for stump closure during LA for complicated perforated appendicitis in children.

Background: Analyzing the recent literature, it seems that the use of irrigation increases the incidence of intra-abdominal abscesses (IAAs) and infectious complications in perforated appendicitis. The aim of this study was to compare peritoneal irrigation and suction versus suction only during laparoscopic appendectomy (LA) for perforated appendicitis in children. Materials and Methods: We retrospectively reviewed the records of 699 patients (460 boys and 239 girls, average age 9.8 years) who underwent LA for complicated appendicitis in six international centers of pediatric surgery over a 5-year period. The appendix was perforated with localized peritonitis in 465 cases and diffuse peritonitis in 234 patients. Irrigation + suction was used in 488 cases (group 1 [G1]), whereas suction only was used in 211 cases (group 2 [G2]). Results: No significant difference between the two groups was found in regard to average operative time (P = .23), average time of resumption of oral diet (P=.55), average reprise of gastrointestinal transit (P = .55), and average length of hospital stay (P = .41). As for postoperative complications, the incidence of IAAs was significantly higher in G2 (41/211; 19.4%) compared with G1 (38/488; 7.7%) (P = .0000), whereas no significant difference was found between the two groups in regard to wound infection (G1: n = 2 or 0.4%; G2: n = 4 or 1.8%; P = .05) and small bowel obstruction rates (G1: n = 8 or 1.6%; G2: n = 2 or 0.9%; P = .47). Conclusions: In contrast with the most recent literature on this topic, our results demonstrated that peritoneal irrigation and suction were associated with a lower rate of postoperative IAA formation compared with the suction-only approach in children with perforated appendicitis. In such cases, peritoneal irrigation and abdominal drainage should be the preferred methods for peritoneal toilette, with no increase in operative time and postoperative morbidity.