Early CDH repair on ECMO: Improved survival but no decrease in ECMO duration (A CDH Study Group Investigation).

Purpose: "Early on-ECMO" repair of CDH entails repair within 48-72 h of cannulation in an effort to optimize pulmonary physiology, shorten ECMO duration, and, ultimately, improve survival. This study evaluated the effect of early on-ECMO repair as compared to leaving patients unrepaired during ECMO.

Methods: The CDH Study Group database was queried for CDH patients requiring ECMO who either underwent repair within the first 72 h after cannulation or remained unrepaired on ECMO.

Evaluating the utility of the "late ECMO repair": a congenital diaphragmatic hernia study group investigation.

Purpose: Optimal timing of congenital diaphragmatic hernia (CDH) repair in patients requiring extracorporeal membrane oxygenation (ECMO) remains controversial. The "late ECMO repair" is an approach where the patient, once deemed stable for decannulation, is repaired while still on ECMO to enable expeditious return to ECMO if surgery induces instability. The goal of this study was to investigate the potential benefit of this approach by evaluating the rate of return to ECMO after repair.

Thoracoscopic Repair of Congenital Diaphragmatic Hernia After Extracorporeal Membrane Oxygenation: Feasibility and Outcomes.

Introduction: Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has been associated with faster recovery, earlier extubation, and decreased morbidity. Nevertheless, thoracoscopic repair is rarely attempted in the post-extracorporeal membrane oxygenation (ECMO) patient. Commonly cited reasons for not attempting thoracoscopy include concerns that the patients' respiratory status is too tenuous to tolerate insufflation pressures or that presumed defect size is so large that it precludes thoracoscopic repair.

The "Flat Diaphragm": Does the Degree of Curvature of the Diaphragm on Postoperative X-Ray Predict Congenital Diaphragmatic Hernia Recurrence?

Purpose: The appearance of the diaphragmatic curvature and the rib insertion level of the diaphragm on postoperative chest X-ray (CXR) may predict recurrence. Our purpose was to examine the relationship between the curvature of the diaphragm on postoperative CXR and recurrence.

Methods: We performed a retrospective review of left-sided, Bochdalek congenital diaphragmatic hernia (CDH) surgical repairs from 2004 to 2015 at a single institution.

Current Practices in the Management of Congenital Diaphragmatic Hernia Patients Requiring Extracorporeal Membrane Oxygenation: Results of an International Survey of Pediatric Surgeons.

Introduction: There is little consensus on optimal management for congenital diaphragmatic hernia extracorporeal membrane oxygenation (CDH ECMO) patients. Meaningful comparisons of the various approaches have been limited due to the low number of cases in institutions. In addition, the multidisciplinary reliance and rigid institutional framework of ECMO serve to further limit exposure to alternative practices.

Tube Thoracostomy at the Time of Congenital Diaphragmatic Hernia Repair: Reassessing the Risks and Benefits.

Purpose: Postoperative pneumothorax and effusion remain a concern following congenital diaphragmatic hernia (CDH) repair. Despite a recent trend away from intraoperative thoracostomy, few studies have actually compared outcomes with and without a chest tube. Rationale commonly cited for the more minimalistic approach include the presumed low likelihood of postoperative complications, potential risk of patch infection, and prolonged intubation.

Approach to Recurrent Congenital Diaphragmatic Hernia: Results of an International Survey.

Purpose: Although recurrence remains one of the most feared complications following congenital diaphragmatic hernia (CDH) repair, there are minimal data on the optimal surgical approach to these complex situations. The purpose of this study was to survey the international pediatric surgery community to ascertain practice patterns for both minimally invasive (MIS) and open approaches for recurrent CDH.

Materials And Methods: A survey was e-mailed to members of an online community of pediatric surgeons.

The "omega" jejunostomy tube: A preferred alternative for postpyloric feeding access.

Aim: We present our technique for construction of the "Omega Jejunostomy" (OJ), a novel method of postpyloric feeding using a pouched-jejunal loop capable of accommodating a balloon gastrostomy button. We describe potential indications for the procedure and outcomes in a complex patient population.

Materials And Methods: We retrospectively reviewed records of patients who underwent an OJ at our institution between 2005 and 2014.

Single-Incision Total Proctocolectomy and Ileal Pouch Anal Anastomosis in Pediatric Patients: Lessons Learned.

Background: Total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) have become the standard of care for patients with ulcerative colitis refractory to medical management. The purpose of our study is to show our single-site approach and to identify maneuvers that improve efficiency.

Materials And Methods: We retrospectively reviewed patients who underwent single-site three-stage TPC-IPAA for ulcerative colitis at our institution.

Laparoscopic sleeve gastrectomy with transgastric visualization: another step toward totally NOTES procedures.

Background: Laparoendoscopic single-site sleeve gastrectomy is gaining acceptance. However, totally natural orifice translumenal endoscopic surgery (NOTES) in morbidly obese patients is still controversial due to safety and technical issues. To this end, we have developed a technique for sleeve gastrectomy in which the surgical field view is achieved through transgastric approach and the operating channel will eventually be through the vagina to form a dual lumen totally NOTES procedure for sleeve gastrectomy.

Miniature camera for enhanced visualization for single-port surgery and NOTES.

Objective: Natural orifice translumenal endoscopic surgery (NOTES) and single-port surgery (SPS) have maximized the enhanced aesthetic profile of laparoscopic surgery. Nevertheless, these modalities also accentuate the inherent limitations of subvisibility and decreased instrument dexterity of motion. The goal of this study was to evaluate the utility of a miniature laparoscopic camera to alleviate these obstacles.

Laparoscopic infrared imaging--the future vascular map.

Objective: One of the most significant limitations of laparoscopic surgery is the inability to achieve tactile assessment of structures during surgical dissection. Because blood vessels are naturally warmer than their surroundings, infrared (IR) detection can be highly effective in identifying and mapping out their course. In recent years, IR detection has been used successfully for this purpose in open surgery.

[Surgery without incisions--the third generation of surgery].

In the past, abdominal surgery mandated a large abdominal wall incision. The minimal invasive surgery techniques including Laparoscopy, created an option for performing intraabdominal surgery through small incisions. In this article, the authors present new surgical techniques: the natural orifice trans-luminal endoscopic surgery (NOTES], and the singLe incision laparoscopic surgery (SILS).

A mouse model for sleeve gastrectomy: applications for diabetes research.

Introduction: Discovery of enhanced glucose tolerance following bariatric surgery has sparked renewed interest in the investigation of unchartered underlying pathways of glucose homeostasis. Delineation of this pathway may ultimately be the first step in the creation of a novel therapy for type II diabetes. Nevertheless, the technical complexity and formidable nature of these surgeries coupled with the fragile nature of small rodents has made the creation of a mouse model to study these effects incredibly challenging.

Plasma factor in red blood cells adhesion to endothelial cells: humans and rats.

Erythrocyte adhesion to the vascular endothelium is one of the key determinants of microcirculatory blood flow. Adhesion is a complex process determined by the intricate interaction among red blood cells (RBC), plasma factors, and the vascular endothelium. Rats are commonly used as disease models to investigate the pathophysiology of various hematological disease processes occurring in humans and their response to prospective treatments.

An endoscopic repair option for acquired esophagorespiratory fistulas.

Benign acquired esophagorespiratory fistulas (BERFs) represent a broad spectrum of anatomic pathology presenting in a wide variety of clinical settings. These fistulas can lead to severe respiratory compromise and rarely close spontaneously. Surgical fistula closure has been the traditional therapeutic approach, but is associated with significant morbidity and mortality.

Revascularization of the celiac and superior mesenteric arteries after operative injury using both splenic artery and saphenous graft.

We report a case of iatrogenic resection of both the superior mesenteric artery (SMA) and celiac artery during left nephrectomy and adrenalectomy. A 47-year-old woman was diagnosed with a large adrenal tumor and underwent a laparoscopic left adrenalectomy that was converted to open adrenalectomy and nephrectomy as a result of a bulky tumor. Both the SMA and celiac artery were inadvertently cut at their origin because of adherence of the tumor to the aorta.

Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm.

We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastro-duodenal artery (GDA) pseudoaneurysm.

Left laparoscopic paraduodenal hernia repair.

Background: An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Paraduodenal hernia is by far the most common form of congenital internal hernia, making up 53% of all reported cases. In recent years, as surgeons have become more comfortable with laparoscopic techniques, they are performing an increasing number of these procedures laparoscopically.

Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy.

Background: As the field of minimally invasive surgery continues to develop, surgeons are confronted with the challenge of performing conventional laparoscopic surgeries through fewer incisions while maintaining the same degree of safety and surgical efficiency. Most of these methods involve elimination of the ports previously designated for retraction. As a result, minimally invasive surgeons have been forced to develop minimally invasive and ingenious methods for providing adequate retraction for these procedures.

Malignant appendiceal GIST: case report and review of the literature.

Introduction: Gastro-intestinal stromal tumors (GISTs) of the appendix are a rare entity. To date, only a handful has been described in the literature, all of which have been of the benign type.

Case Report: We present the first reported case of a malignant appendiceal GIST.

Renal clear cell carcinoma emerging in a transplanted kidney 3 years after return to dialysis. Case report and review of the literature.

We present a female patient with end-stage renal disease who was referred to the emergency department with sudden, excruciating pain over the right lower abdomen and flank. Radiologic evaluation following admission revealed a mass, solid in nature, located at the upper pole of the transplanted kidney. The patient was treated with empiric antibiotics and analgesics, and her symptoms subsided over the course of the week.

Internal hernias: clinical findings, management, and outcomes in 49 nonbariatric cases.

Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias.