Cost analysis of laparoscopic appendectomy in a large integrated healthcare system.

Introduction: Healthcare expenditure is on the rise placing greater emphasis on operational excellence, cost containment, and high quality of care. Significant variation is seen in operating room (OR) costs with common surgical procedures such as laparoscopic appendectomy. Surgeons can influence cost through the selection of instrumentation for common surgical procedures such as laparoscopic appendectomy.

Regional cost analysis for laparoscopic cholecystectomy.

Background: Laparoscopic cholecystectomy is the most common procedure performed by general surgeons in the United States, with approximately 600,000 procedures performed annually. As the cost of care rises, there is increasing emphasis on utilization and quality. Our objective was to evaluate the cost of laparoscopic cholecystectomy in our health system and to compare the operative times and outcomes at high- and low-cost centers.

Congenital H-type tracheoesophageal fistula: A multicenter review of outcomes in a rare disease.

Objective: To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications.

Background: H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications.

Infant head injury in falls and nonaccidental trauma: does injury pattern correlate with mechanism?

Objectives: Nonaccidental trauma (NAT) is most common and most lethal in infants. Falls are the most frequently given explanation for NAT, and head injuries can result from both mechanisms. We hypothesized that infant head injuries from NAT have a distinct injury profile compared to falls.

Low doses of celecoxib attenuate gut barrier failure during experimental peritonitis.

The intestinal barrier becomes compromised during systemic inflammation, leading to the entry of luminal bacteria into the host and gut origin sepsis. Pathogenesis and treatment of inflammatory gut barrier failure is an important problem in critical care. In this study, we examined the role of cyclooxygenase-2 (COX-2), a key enzyme in the production of inflammatory prostanoids, in gut barrier failure during experimental peritonitis in mice.

On-Q ® pain pump versus epidural for postoperative analgesia in children.

Purpose: The On-Q(®) pain pump provides a continuous infusion of local anesthesia for management of postoperative pain. The objective of this study was to assess the efficacy and outcomes of the On-Q(®) pump compared to continuous epidural in children postoperatively.

Methods: We performed a retrospective review of patients in our hospital who received a postoperative epidural or On-Q(®) pump from 2005 to 2008.

Recent developments in Hirschsprung's-associated enterocolitis.

Hirschsprung's-associated enterocolitis (HAEC) continues to be a significant source of morbidity for patients with Hirschsprung's disease (HD). New clinical and histologic classification systems for HAEC will improve consistency between reports and increase the ability to compare outcomes. A complete understanding of disease pathogenesis is lacking, but evidence suggests that the intestinal microbiota may play a role in the development of HD and HAEC.

Single-incision laparoscopic resection of ovarian masses in children: a preliminary report.

Purpose: Ovarian masses in the pediatric population are commonly resected with a three or four port laparoscopic approach. Single-incision laparoscopic (SIL) resection is an alternative approach. However, there is limited experience with this modality in ovarian mass resection.

Laparoscopic versus open distal pancreatectomy in the management of traumatic pancreatic disruption.

Purpose: Traumatic pancreatic transection is uncommon. The role of laparoscopy in the setting of this injury has not been well described.

Patients And Methods: Six large-volume pediatric trauma centers contributed patients <18 years of age who underwent a distal pancreatectomy for traumatic pancreatic transection from 2000 to 2010.

P-glycoprotein induction by breast milk attenuates intestinal inflammation in experimental necrotizing enterocolitis.

P-glycoprotein (Pgp), a product of the multi-drug resistance gene MDR1a, is a broad specificity efflux ATP cassette transmembrane transporter that is predominantly expressed in epithelial tissues. Because mdr1a(-/-) mice tend to develop spontaneous colitis in bacteria-dependent manner, Pgp is believed to have a role in protection of the intestinal epithelium from luminal bacteria. Here we demonstrate that levels of Pgp in the small intestine of newborn rodents dramatically increase during breastfeeding, but not during formula feeding (FF).

Laparoscopic adrenalectomy in children: a multicenter experience.

Introduction: Laparoscopic adrenalectomy is now being recognized as the standard approach for adrenalectomy for benign lesions in adults. The published experience in children and adolescents has been limited to sporadic small case series. Therefore, we conducted a large multicenter review of children who have undergone laparoscopic adrenalectomy.