An enhanced recovery after surgery (ERAS) pathway for laparoscopic gastrostomy insertion facilitates 23-h discharge.

Background: Enhanced recovery after surgery (ERAS) pathways has become well established for operations as diverse as hip replacement and coronary artery bypass. We designed an ERAS gastrostomy pathway in children based on best practice to facilitate 23-h discharge.

Methods: An ERAS pathway for laparoscopic Seldinger gastrostomy insertion was developed in 2018 with standardisation of all phases from first pre-operative visit to discharge.

Thoracoscopic external traction suture elongation for the management of long-gap oesophageal atresia: a two-centre experience.

Aim: Van der Zee (VdZ) described a technique to elongate the oesophagus in long-gap oesophageal atresia (LGOA) by thoracoscopic placement of external traction sutures (TPETS). Here, we describe our experience of using this technique.

Method: Retrospective review of all LGOA + / - distal tracheo-oesophageal fistula (dTOF) cases where TPETS was used in our institutions.

Outcomes of patients with exomphalos and associated congenital heart diseases.

Introduction: Exomphalos is an anterior abdominal wall defect resulting in herniation of contents into the umbilical cord. Severe associated chromosomal anomalies and congenital heart disease (CHD) are known to influence mortality, but it is not clear which cardiac anomalies have the greatest impact on survival.

Methods: We performed a retrospective review of the treatment and outcome of patients with exomphalos over a 30-year period (1990-2020), with a focus on those with the combination of exomphalos major and major CHD (EMCHD).

Fluorescence-guided lymph node sampling is feasible during up-front or delayed nephrectomy for Wilms tumor.

Background: Lymph node sampling is critical to surgical staging in Wilms tumor; failure to sample lymph nodes is associated with under-staging and an increased incidence of local relapse. However, no standard lymphatic mapping method is currently being utilized for Wilms tumor to aid identification of regional draining lymph nodes. Herein, we describe the use of fluorescence-guided lymphatic mapping for Wilms tumor.

A single centre experience using internal traction sutures in managing long gap oesophageal atresia.

Aim: Thoracoscopically placed internal traction sutures (ITS) for the initial management of long gap oesophageal atresia (LGOA), not amenable to primary anastomosis, was first described in 2015. Here we describe our experience using ITS both thoracoscopically and at thoracotomy where the gap between upper and lower oesophagus is too wide for primary anastomosis.

Method: The case notes of all infants treated with ITS for oesophageal atresia (01/10/2015 to 01/12/2019) were reviewed.

Ultrasound-guided percutaneous insertion of Broviac lines in infants less than 5kg: Prospective study of 100 consecutive procedures.

Aim: Ultrasound-guided (USG) percutaneous insertion of Broviac lines (cuffed tunnelled silastic central venous catheters, TCVC) has increasingly been adopted throughout the UK. However, vascular access remains a challenge in small babies and in some units is still performed by open cutdown. Our vascular access team, established in 2004, consists of consultant surgeons, anaesthetists and interventional radiologists, who provide all permanent vascular access by the USG technique.

Paediatric major incident triage: UK military tool offers best performance in predicting the need for time-critical major surgical and resuscitative intervention.

Background: Children are frequently injured during major incidents (MI), including terrorist attacks, conflict and natural disasters. Triage facilitates healthcare resource allocation in order to maximise overall survival. A critical function of MI triage tools is to identify patients needing time-critical major resuscitative and surgical intervention (Priority 1 (P1) status).

Controlled aspiration of large paediatric ovarian cystic tumours.

Aim: Cystic ovarian masses in children may be physiological or neoplastic. It is mandatory that suspected neoplastic lesions are resected without tumour spillage. However, a large midline incision is cosmetically unappealing incision to young women.

Getting it right first time: implementation of laparoscopic pyloromyotomy without a learning curve.

Introduction: Laparoscopic pyloromyotomy is now an accepted procedure for the treatment of pyloric stenosis. However, it is clear that during the implementation period there are significantly higher incidences of mucosal perforation and incomplete pyloromyotomy. We describe how we introduced a new laparoscopic procedure without the complications associated with the learning curve.

Exomphalos major: Conservative management using Manuka honey dressings and an outreach surgical nursing team.

Introduction: Controversy exists over the best dressing for conservative management of exomphalos major. Here we describe our experience of using Manuka Honey.

Methods: Our regimen involved covering the sac with Manuka honey (Advancis Medical™) wrapped with gauze and crepe bandage.

A single centre matched pair series comparing minimally invasive and open surgery for the resection of pediatric renal tumours.

Introduction: Minimally invasive nephrectomy (MIN)for the resection of pediatric renal tumors is controversial. We compared patients who underwent laparoscopic MIN according to our unit protocol with matched patients who underwent open surgery (ON).

Method: A single centre retrospective analysis of prospectively collected data for MIN.

Biodegradable Stents in the Management of Refractory Esophageal Strictures in Children.

Management of refractory esophageal strictures in children is challenging and mostly involves frequent and prolonged dilatations that are associated with significant physical and psychological complications. Biodegradable stents (BDS) have recently been used and it is particularly attractive in children as stent removal is avoided due to their dissolution. We report our experience with BDS use in 3 children with severe refractory esophageal strictures.

Congenital mesoblastic nephroma: a single-centre series.

Background: Congenital mesoblastic nephroma is a rare disease. Treatment is surgical in the first instance. Chemotherapy has traditionally been thought not to have a role.

Damage control surgery in neonates: Lessons learned from the battlefield.

Introduction: Mortality for neonates requiring surgery for serious pathology such as NEC, remains high. Damage control surgery (DCS) has evolved as an operative strategy in battlefield trauma that sacrifices the completeness of the initial surgery to address the deadly triad of acidosis, hypothermia and coagulopathy. This approach is now used routinely in sick adults with nontrauma surgical emergencies.

Risks of long-term port use in enzyme replacement therapy for lysosomal storage disorders.

Totally implantable vascular access devices (TIVADs) are commonly used in conjunction with enzyme replacement therapy (ERT) for lysosomal storage disorders (LSDs). This case series describes potential complications associated with long-term TIVAD use, such as compromise of skin integrity, infection, or port failures. Best practices and skilled specialists are essential for minimizing complications from long-term TIVAD use for ERT.

Characterization of the upper pouch tracheo-oesophageal fistula in oesophageal atresia.

Aim: A small proportion of infants with oesophageal atresia (OA) are thought to have a proximal tracheoesophageal fistula (TOF). Failure to recognize these can hamper mobilization of the upper pouch and lead to life-threatening episodes of aspiration once oral feeding starts. We reviewed our experience of upper pouch fistulae to identify characteristic features of proximal TOF.

Pediatric and Adolescent Extracranial Germ Cell Tumors: The Road to Collaboration.

During the past 35 years, survival rates for children with extracranial malignant germ cell tumors (GCTs) have increased significantly. Success has been achieved primarily through the application of platinum-based chemotherapy regimens; however, clinical challenges in GCTs remain. Excellent outcomes are not distributed uniformly across the heterogeneous distribution of age, histologic features, and primary tumor site.

Human factors in decision making in major trauma in Camp Bastion, Afghanistan.

Introduction: The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements.

Influence of Triazine Herbicide Exposure on Guppies (Poecilia sphenops) Aromatase Activities, Altered Sex Steroid Concentration and Vitellogenin Induction.

Atrazine, a herbicide is one the most toxic and sustaining pollutants in aquatic environment. It is detectable in surface water and in underground sources of drinking water. Many studies indicate that atrazine might be a potent endocrine disrupting xenobiotic.