The Impact of Pediatric Laparoscopic Inguinal Hernia Repair in a Community Based Children's Ambulatory Surgery Center - It's Safe and Effective.

Purpose: Pediatric surgery in a free-standing children's ambulatory surgery center (C-ASC) is a common practice. The implementation of minimally invasive surgery in this setting may be associated with unique challenges. The purpose of this study was to compare a cohort of children who underwent laparoscopic (LHR) and open inguinal hernia repairs (OHR) at the C-ASC as part of a quality assurance initiative to assess safety and efficacy.

Simultaneous Bilateral Thoracoscopy During the Nuss Procedure is Safe, Effective, and Allows for Optimal Visualization of the Bar Passer Throughout the Substernal Dissection.

Purpose: Cardiac injury during the Nuss procedure is a rare risk that can lead to a catastrophic outcome. The specific aim of this pilot study was to evaluate the safety and efficacy of simultaneous bilateral thoracoscopy (SBT) compared to standard unilateral right thoracoscopy (RT) in children undergoing the Nuss procedure in order to mitigate that risk.

Methods: IRB approval was obtained to analyze data on children who underwent SBT and RT during the Nuss procedure.

The Novel Use of Rare Earth Magnets for the Extraction of Metallic Soft Tissue Foreign Bodies in Children.

Introduction: Metallic foreign bodies (mFB) are common following penetrating injuries in children. The mFB commonly occur in the head and neck region and extremity soft tissues. Removal may be indicated due to morbidity related to pain or migration.

A novel low cost minimally invasive surgical system allows for the translation of modern pediatric surgical technology to low- and middle-income nations.

Background: There is a critical need for pediatric surgical humanitarian care. The role of minimally invasive surgery (MIS) in these environments with its reduction in pain and wound care, operative time, length of hospitalization, and morbidity is logical. However, the costs, logistics and feasibility of MIS in Low- and Middle-Income Countries (LMIC) can be challenging.

Mini thoracic CT adequately determines Haller index and decreases radiation exposure in children with pectus excavatum.

Introduction: The preoperative assessment of Pectus Excavatum (PE) is resource intensive. CT chest for the purpose of calculating a Haller index (HI) remains a central component and is necessary for third-party reimbursment for surgical correction. With the goal of minimizing radiation exposure, a strategy was introduced to perform a mini-Thoracic CT (mini-CT) for the calculation of HI.

Ovarian tissue cryopreservation in young females with cancer and its impact on ovarian follicle density.

Background: Cancer therapy in young females results in irreversible damage to their ovaries potentially leading to premature ovarian failure (POF) and infertility. Ovarian follicle density (FD) serves as a key predictor of reproductive potential for a woman. FD is significantly reduced after cryopreservation in adult women with cancer.

Laparoscopic assisted extracorporeal ovarian harvest: A novel technique to optimize ovarian tissue for cryopreservation in young females with cancer.

Background: Advances in pediatric cancer therapy have improved the long-term survival for many children with cancer. The awareness of quality of life aspects, specifically fertility preservation, has become a reality for many of these families and children. Ovarian tissue cryopreservation has emerged as an available fertility option for young females with cancer.

Microdeformational wound therapy: A novel option to salvage complex wounds associated with the Nuss procedure.

Background: Complex wounds associated with the Nuss procedure are a resource intensive complication that may lead to significant morbidity with potential removal of the implanted device and abandonment of the repair. We report our management technique of this complication utilizing microdeformational wound therapy (MDWT) that is safe, is efficacious and allows for salvage of the repair.

Operative Technique: We defined a complex wound as a wound that became suppurative and drained in the postoperative period and failed to resolve with a trial of conventional wound management and antibiotics.

Minimally Invasive Pediatric Surgery During Remote Humanitarian Missions Is Feasible, Safe, and Effective.

Purpose: There remains a critical need for the provision for pediatric humanitarian aid worldwide. Historically, the emphasis of global pediatric health needs has been focused on infectious diseases. Today, we are witnessing a shift in this paradigm, with growing attention being paid toward the surgical needs of children.

Minimally Invasive Patent Ductus Arteriosus Ligation.

A patent ductus arteriosus is a common condition, particularly in premature infants. Many spontaneously resolve but those that lead to clinical instability require closure. Conservative measures can be highly successful in selected groups.

Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial.

Purpose: Laparoscopy is being increasingly applied to pediatric inguinal hernia repair. In younger children, however, open repair remains preferred due to concerns related to anesthesia and technical challenges. We sought to assess outcomes after laparoscopic and open inguinal hernia repair in children less than or equal to 3 years.

Intraluminal Meckel's Duplication Cyst Causing Bowel Obstruction in an Infant: A Role for Laparotomy.

This report describes a two-month-old girl who presented with signs and symptoms of a distal small bowel obstruction. She underwent an abdominal ultrasound that revealed a right lower quadrant cystic mass. A Technetium-99 scan revealed increased activity in the right lower quadrant consistent with a Meckel's diverticulum.

Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates.

Background/purpose: Premature neonates can develop intraabdominal conditions requiring emergent bowel resection and enterostomy. Parenteral nutrition (PN) is often required, but results in cholestasis. Mucous fistula refeeding allows for functional restoration of continuity.

Pancreatic surgery for tumors in children and adolescents.

Purpose: Pancreatic neoplasms are uncommon in children. This study sought to analyze the clinical and pathological features of surgically resected pancreatic tumors in children and discuss management strategies.

Methods: We conducted a retrospective review of patients ≤21 years with pancreatic neoplasms who underwent surgery at a single institution between 1995 and 2015.

Ultrasound-Guided Percutaneous Central Venous Access in Low Birth Weight Infants: Feasibility in the Smallest of Patients.

Purpose: The insertion of tunneled central venous access catheters (CVCs) in infants can be challenging. The use of the ultrasound-guided (UG) approach to CVC placement has been reported in adults and children, but the technique is not well studied in infants.

Subjects And Methods: A retrospective review was performed of infants under 3.

Secondary overtriage in pediatric trauma: can unnecessary patient transfers be avoided?

Background: In an era of wide regionalization of pediatric trauma systems, interhospital patient transfer is common. Decisions regarding the location of definitive trauma care depend on prehospital destination criteria (primary triage) and interfacility transfers (secondary triage). Secondary overtriage can occur in any resource-limited setting but is not well characterized in pediatric trauma.

A novel continuous stitch fundoplication utilizing knotless barbed suture in children with gastroesophageal reflux disease: a pilot study.

Introduction: The intracorporeal placement and tying of suture (IT) can be challenging leading to prolonged CO2 insufflation, anesthesia, and potential morbidity. The unidirectional barbed knotless suture (V-LOC) has emerged as an innovative technology that has been shown to reduce the time associated with IT. Therefore, we conducted a retrospective analysis comparing our initial experience utilizing V-LOC to perform a novel continuous stitch laparoscopic fundoplication (CF) to standard laparoscopic Nissen fundoplication (NF).

Age at presentation of common pediatric surgical conditions: Reexamining dogma.

Purpose: The commonly cited ages at presentation of many pediatric conditions have been based largely on single center or outdated epidemiologic evidence. Thus, we sought to examine the ages at presentation of common pediatric surgical conditions using cases from large national databases.

Methods: A retrospective analysis was performed on Healthcare Cost and Utilization Project databases from 1988 to 2009.

Utilization of a novel unidirectional knotless suture during minimal access procedures in pediatric surgery.

Background: The application of minimally invasive surgery (MIS) for advanced procedures in children is logical. However, the intracorporeal placement and tying of suture can be challenging, leading to prolonged anesthesia and morbidity. We describe our initial experience with the use of a novel unidirectional barbed knotless suture (V-LOC, Covidien, Mansfield, MA) that permits a safe and efficient advanced MIS reconstruction in infants and children.

Increasing age at time of pectus excavatum repair in children: emerging consensus?

Background: Advances in surgical technique for pectus excavatum repair continue to change practice patterns. The present study examines trends in operative age in a nationwide administrative database.

Methods: A cross-sectional descriptive analysis was performed using the Nationwide Inpatient Sample (NIS) and Kids' Inpatient Database (KID) data from 1998 to 2009.

Nonoperative closure of persistent gastrocutaneous fistulas in children with 2-octylcyanoacrylate.

Unlabelled: A persistent gastrocutaneous fistula (pGCF) is an all-too-common complication following removal of a gastrostomy tube (GT) in a child and is associated with significant morbidity. The most common initial methods to manage pGCF include local would care and occlusion techniques. Failure of this approach is followed by surgical excision of the fistula tract and closure of the gastrostomy under general anesthesia.

Laser epilation is a safe and effective therapy for teenagers with pilonidal disease.

Unlabelled: Pilonidal disease (PD) is a frustrating condition because of a recurrence rate as high as 30%. Hair insertion is the essential cause of the disease. Therefore, hair removal with shaving is a part of many postoperative regimens.

Sonographic appearance of canal of Nuck hydrocele.

We present a case of a relatively uncommon entity in a 17-year-old girl who presented to the emergency department with right inguinal pain and discomfort. On sonography, she was thought to have a hydrocele of a patent processus vaginalis, although differentials could not be excluded. The hydrocele was subsequently confirmed at surgery.

Laparoscopic appendectomy in children: use of the endoloop vs the endostapler.

Hypothesis: Two techniques are used for laparoscopic appendectomy (LA): division of the mesoappendix with the harmonic scalpel and ligation of the appendix with an endoloop (EL), or division of the mesoappendix and appendix with an endostapler (ES). Using an ES is a cost-effective technique that provides an outcome benefit in children who require appendectomy.

Design: Case series.