Predictors of radiolucent foreign body aspiration.

Background: Children frequently present for suspected foreign body aspiration, many have mild symptoms and/or negative radiographs raising the question of a radiolucent foreign body aspiration.

Method: Retrospective review of patients having bronchoscopy for suspected radiolucent foreign body aspiration from 2000 to 2010 collecting demographics, history, hospital presentation, radiographic, and operative details. Pearson's correlation was used between event history, presentation, radiographic details and bronchoscopically identified foreign body with P value <0.

Multi-institutional analysis of long-term symptom resolution after cholecystectomy for biliary dyskinesia in children.

Purpose: Current literature for resolution of abdominal pain after cholecystectomy in children with biliary dyskinesia shows variable outcomes. We sought to compare early outcomes with long-term symptom resolution in children.

Methods: Telephone surveys were conducted on children who underwent cholecystectomy for biliary dyskinesia between January 2000 and January 2011 at two centers.

Ghost publications in the pediatric surgery match.

Introduction: Pediatric surgery fellowship is considered one of the most competitive subspecialties in medicine. With fierce competition increasing the stakes, publications and first authorship are paramount to the success rate of matching. We analyzed Electronic Residency Application Service applications for verification of authorship to determine rate of misrepresentation.

Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial.

Background: The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic appendectomy in children.

Predictors of failed enema reduction in childhood intussusception.

Background: Initial management of intussusception is enema reduction. Data are scarce on predicting which patients are unlikely to have a successful reduction. Therefore, we reviewed our experience to identify factors predictive of enema failure.

Operative findings in antenatal abdominal masses of unknown etiology in females.

Background: Perinatal findings of abdominal masses pose a diagnostic challenge to clinicians. This study presents the operative findings of patients who underwent exploration for perinatally identified abdominal masses of unknown etiology.

Methods: Retrospective review of all patients with abdominal masses of unknown etiology identified in the antenatal period was conducted from January 1, 2000 to July 1, 2010.

Utility of pH/multichannel intraluminal impedance probe in identifying operative patients in infants with gastroesophageal reflux disease.

Introduction: Gastroesophageal reflux is a common clinical problem in infants, but identifying which infants may benefit from a fundoplication remains a conundrum. Esophageal pH and multichannel intraluminal impedance (MII) measurements are useful diagnostic tools in adults and older children, but their diagnostic efficacy in infants is unclear. Therefore, we reviewed our experience with the combined pH/MII probe in this population.

Experience with a simple technique for pectus bar removal.

Background: There have been numerous reports of techniques used for pectus bar removal after correction of pectus excavatum. We use 2 operating tables positioned perpendicular to each other in a T-shaped configuration with the patients thorax circumferentially exposed so the bar is removed in 1 motion without bending the bar. In this study, we report the results of this procedure.

The use of high-frequency oscillating ventilation to facilitate stability during neonatal thoracoscopic operations.

Background: Thoracoscopy has become a surgical option for the repair of esophageal atresia (EA) and congenital diaphragmatic hernia (CDH). Insufflation of carbon dioxide combined with one lung ventilation creates an anesthetic challenge to control acidosis and maintain oxygenation while allowing optimal operative exposure. We have overcome these issues by utilizing the high-frequency oscillating ventilator (HFOV) and report our early experience.

Diagnosis of gastroesophageal reflux disease in infants.

Gastroesophageal reflux is commonly encountered in the infant population. Most children will outgrow their reflux but some develop pervasive disease and require medical or surgical treatment. Many tools exist for use in the workup of pediatric gastroesophageal reflux disease; however, the most effective method of diagnosis is not clear.

The impact of postoperative abscess formation in perforated appendicitis.

Background: Abscess after appendectomy for perforated appendicitis is the most common complication. We have completed three prospective trials and are conducting a fourth in which the included patients had either a hole in the appendix or a fecalith in the abdomen identified at the time of operation. The abscess rate in each of these trials was 20%.

Treatment of appendicitis in neutropenic children.

Background: Appendicitis in the neutropenic patient places the clinician in a precarious position; balancing the timing and risks of surgery and the risk of an uncontrolled infectious source in the abdomen.

Methods: Multi-center retrospective review from 2000 to 2010 of appendicitis occurring in patients with neutropenia secondary to chemotherapy. Patient demographics and surgical outcomes were tracked.

Occurrence of Crohn's disease in children after total colectomy for ulcerative colitis.

Background: Colectomy is the definitive treatment for ulcerative colitis (UC) to remove the inflammatory burden. Crohn's disease, however, can affect any portion of the bowel with a propensity to involve the terminal ileum. In some patients with fulminant colitis, distinction between the two is imperfect.

Treadmill injuries in the pediatric population.

Background: Exercise equipment such as treadmills are becoming commonplace in residential homes, placing small children at risk for injury. These injuries can be severe and may require surgical intervention. While it is our clinical perception that these injuries are on the rise, they remain largely unreported in the literature.

The predictive value of Haller index in patients undergoing pectus bar repair for pectus excavatum.

Background: The Haller index (HI) remains the standard metric to quantify the severity of pectus excavatum deformity. However, little data exist to determine how well this parameter correlates with the difficulty or early outcomes of repair.

Methods: The study population was comprised of all patients who underwent pectus bar repair for pectus excavatum on whom adequate preoperative images on computed tomography allowed for Haller index calculation, from December 1999 to February 2010.

Experience with pilonidal disease in children.

Background: Controversy exists regarding the optimum treatment for pediatric pilonidal disease. It is a complex disease process with a high rate of recurrence. A spectrum of surgical strategies exists, including drainage, cyst marsupialization, complete cyst and sinus tract excision with primary versus secondary closure, and excision utilizing flap closure.

The lack of efficacy for oral contrast in the diagnosis of appendicitis by computed tomography.

Background: Oral contrast is often used with computed tomography (CT) for the diagnosis of appendicitis. This adjunct adds time to evaluation, not all patients can tolerate enteric bolus, and the diagnostic advantages have not been well defined. Therefore, we reviewed our experience to evaluate the impact of oral contrast on diagnostic efficiency and its impact on the patient.

Neutropenic colitis in children.

Background: Neutropenic colitis (NC) or typhlitis has an incidence of approximately 5% in patients receiving chemotherapy for malignancy. The precise cause is unknown, but almost all patients are neutropenic; most profoundly so. We reviewed our experience with neutropenic colitis over the past 10 y to assess the incidence, management, and outcome.

Review of the evidence on the closure of abdominal wall defects.

Infants with congenital abdominal wall defects pose an interesting and challenging management issue for surgeons. We attempt to review the literature to define the current treatment modalities and their application in practice. In gastroschisis, the overall strategies for repair include immediate closure or delayed operative repair.