Selective anterior annuloplasty during inguinal herniotomy in boys: an approach to further reduce hernia recurrence.

Background: Hernia recurrence is one of the most common complications after inguinal herniotomy (IH) in children. We describe a novel approach that involves adding anterior annuloplasty (AAP) during IH for selective high recurrence-risk children.

Objectives: Evaluate the initial safety and effectiveness of selective AAP during IH in boys.

Enhanced fluid drainage using a novel multi-pod drainage catheter: An in vitro evaluation.

Background: A multi-pod catheter (MPC) is a large drainage catheter that can house multiple smaller retractable (MPC-R) and deployable catheters (MPC-D) within the body.

Objective: The drainage capabilities and resistance to clogging of a novel MPC have been assessed.

Methods: The drainage capabilities are evaluated by placing the MPC in a bag of either a non-clogging (H2O) or clogging medium.

A prospective, double-blind, randomized, placebo-controlled trial comparing the efficacy of polyethylene glycol versus polyethylene glycol combined with topical diltiazem for treating anal fissure in children.

Background: Anal fissure (AF) in children is usually treated with laxatives and/or topical agents such as calcium channel blockers. We hypothesize that owing to the superior efficacy of Polyethylene glycol (PEG) in treating constipation in children, adding diltiazem (DTZ) might not improve healing of AF.

Methods: Children ≤14 years with anal fissure presented to the pediatric surgery clinic between November 2014 and March 2016 were recruited.

Ambu AuraOnce versus i-gel laryngeal mask airway in infants and children undergoing surgical procedures. A randomized controlled trial.

To compare the efficacy and performance of the pediatric Ambu AuraOnce (Ambu AO) mask (Ambu, Copenhagen, Denmark) and i-gel mask (Intersurgical Ltd., Wokingham, United Kingdom). Methods: From May 2015 to September 2016, 112 patients, 0-14 years old, underwent elective surgery at a tertiary university hospital (Riyadh, Saudi Arabia).

The Impact of Healthcare Privatization on Access to Surgical Care: Cholecystectomy as a Model.

Background: Privatization is widely perceived as a tool to improve healthcare access; however, its impact on the access of surgical care has not been quantified. We used cholecystectomy as a model to assess the variation in access between coexisting public (PB) and private providers (PVs).

Methods: We performed cross-sectional analysis of patients who underwent cholecystectomy at two major PB and PV groups serving Riyadh, Saudi Arabia.

Spatial relationship of i-gel® and Ambu® AuraOnceTM on pediatric airway: a randomized comparison based on three dimensional magnetic resonance imaging.

Background: Gross morphological differences exist among different brands of pediatric supraglottic devices (SGDs). The aim of this study is to compare the spatial relationship of i-gel® and Ambu® AuraOnce (AO)TM on pediatric airway based on three dimensional (3-D) magnetic resonance imaging (MRI) measurements.

Methods: Sixty patients up to 12 years of age were enrolled and assigned in two groups, i-gel® or Ambu® AOTM.

Guided Transabdominal U-Stitches Gastropexy: A Simplified Technique for Secure Laparoscopic Gastrostomy Tube Insertion.

Insecure gastropexy, gastric mucosa overgrowth, granulation tissue formation, and a nonhealing gastrostomy are unwanted consequences encountered in the current minimally invasive gastrostomy tube (GT) placement techniques. Aiming to overcome these problems we have developed a simplified laparoscopic-assisted GT insertion (LAG) procedure using guided transabdominal U-stitches (GTU) gastropexy. We retrospectively reviewed all LAG cases performed in our institute using the GTU technique.

Repair of congenital diaphragmatic hernia under high-frequency oscillatory ventilation in high-risk patients: an opportunity for earlier repair while minimizing lung injury.

Background: Repair of congenital diaphragmatic hernia (CDH) is ideally delayed until ventilatory parameters are stabilized and patients are switched to conventional ventilation. However, in selected high-risk patients, repair can be performed earlier while they are still on high-frequency oscillatory ventilation (HFOV).

Design And Settings: A retrospective review of all CDH cases treated in our tertiary referral center between 1997 and 2013.

Ultrasound-guided rectus sheath block in children with umbilical hernia: Case series.

Background: Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital.

Percutaneous obliteration of patent processus vaginalis: a rat model for future inguinal hernia repair in children.

Purpose: Inguinal hernia repair is one of the most common procedures performed by pediatric surgeons. A percutaneous technique could be the next advance in inguinal hernia repair in children. We used a rat model to study the utility of percutaneous inguinal hernia repair (PHR) using 2-octyl-cyanoacrylate (OCT).

The role of seating position in determining the injury pattern among unrestrained children involved in motor vehicle collisions presenting to a level I trauma center.

Background And Objectives: Seating position in motor vehicle collisions (MVC) plays a major role in determining the injury pattern in mainly restrained children. However, compliance with child seating and restraint laws is still suboptimal. The role of seating position in predicting injury patterns among unrestrained children has not been previously studied.

The impact of variation in access to care on the management of Hirschsprung disease.

Introduction: Variation in access to care has a significant impact on the disease management process and outcomes. Variable access to care might have similar effects on the management of Hirschsprung disease (HD). However, such variation has not been highlighted.

Simplified technique for minimally invasive repair of congenital diaphragmatic hernia using hollow-needle snare and transthoracic traction stitches.

Background: Minimally invasive (MI) congenital diaphragmatic hernia (CDH) repair can be challenging. Placing rib-anchoring stitches without creating skin incisions and closing wider defects are some of the difficulties. In Bochdaleck hernia repair, maintaining visceral reduction and minimizing pneumothorax use are additional obstacles.

Mini-scar inguinal herniotomy in selected children: comparative analysis of safety, effectiveness, and parents' satisfaction.

Introduction: Inguinal herniotomy in children is still dominated by conventional open inguinal herniotomy (COIH) as laparoscopic techniques have yet to demonstrate clear advantages. A technical modification that minimizes the incision of COIH in selected children can offer another minimally invasive alternative. A comparative analysis of safety, efficacy, and parental attitudes between mini-scar inguinal herniotomy (MSIH) and COIH was performed.

Can the duration of vomiting predict postoperative outcomes in hypertrophic pyloric stenosis?

Background And Objectives: Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction (GOO) in infants. Prolonged GOO is believed to result in acid and electrolyte disturbances, gastric atony, and delayed postoperative recovery. We studied the impact of prolonged vomiting as an indicator of GOO symptoms on the post-operative outcomes in HPS.

Short hospitalization after early intervention in managing grade III pancreatic injuries in children: a possible new trend.

The presence of ductal disruption in pancreatic trauma is a major indicator of severity leading to higher morbidities and prolonged hospital stay. However, the adoption of early interventional approach in selected cases of documented grade III pancreatic trauma could result in shorter hospitalization and early recovery. We are describing our approach of early presentation-tailored interventions in managing two consecutive children diagnosed with grade III pancreatic injuries, which constitute the two main ends of the presentations' spectrum.

Johanson-Blizzard syndrome: report of a novel mutation and severe liver involvement.

Johanson-Blizzard syndrome (JBS) is a rare autosomal recessive condition characterized by pathognomonic facies and a constellation of other features most notably exocrine pancreatic insufficiency, oligodontia, growth retardation, hearing loss, mental retardation, scalp defects, hypothyroidism and imperforate anus. We report on an infant with classical JBS who also has unusually severe neonatal cholestatic liver disease that progressed to liver fibrosis and portal hypertension. Sequencing of UBR1 revealed a previously unreported homozygous missense mutation in a consensus splice acceptor site (IVS12-1G > A).

Prophylactic thyroidectomy in pediatric carriers of multiple endocrine neoplasia type 2A or familial medullary thyroid carcinoma: mutation in C620 is associated with Hirschsprung's disease.

Purpose: Prophylactic total thyroidectomy is now recommended after having confirmed RET mutations in children of parents with multiple endocrine neoplasia type 2 or familial medullary thyroid carcinoma. We reviewed our experience to determine the incidence of medullary thyroid carcinoma with respect to age at surgery, the location of the mutation, and its association with Hirschsprung's disease (HD).

Methods: A retrospective review from 1996 to 2005 revealed 20 children with genetic screening for multiple endocrine neoplasia type 2A or familial medullary thyroid carcinoma who underwent a prophylactic total thyroidectomy with parathyroid gland preservation.

Utility of hospital admission after successful enema reduction of ileocolic intussusception.

Background: In-hospital observation of 24 to 48 hours has been the standard practice after successful enema reduction (ER) of ileocolic intussusceptions, but this practice has not been validated. We evaluated retrospectively the safety of short-term emergency department observation.

Methods: Between April 2000 and October 2004, 121 patients presented to the emergency department with ileocolic intussusception, and all had ER attempts.

Alcoholic solution of zein (Ethibloc) sclerotherapy for treatment of lymphangiomas in children.

Purpose: The aim of this study was to report the experience and efficacy of Ethibloc sclerotherapy as treatment of lymphangiomas.

Methods: Between 1992 and 2004, 63 patients had Ethibloc sclerotherapy for lymphangiomas at our institution. Computed tomographic scan or magnetic resonance imaging and clinical evaluation determined efficacy of the treatment.

Vacuum-assisted closure for wound management in the pediatric population.

Background/purpose: Wound management in children has traditionally consisted of daily dressings. Although vacuum-assisted closure (VAC) is well described in the adult literature, there are few reports about children. We reviewed our experience with VAC.