The ins and outs of pyloromyotomy: what we have learned in 35 years.

Purpose/background: The aim of the study is to evaluate a large series of infantile hypertrophic pyloric stenosis (IHPS) patients treated by one pediatric surgeon focusing on their diagnostic difficulties and complications.

Methods: From July 1969 to December 2003 (inclusive), the charts of 791 infants with IHPS were retrospectively reviewed.

Results: There were 647 (82%) males and 144 (18%) females; mean age was 38 days, median 51 (range 7 days-10 months).

Testicular atrophy after attempted pediatric orchidopexy for true undescended testis.

Background/purpose: A normal testis in the scrotum is the most important outcome of the attempted pediatric orchidopexy for a true undescended testis. The reports of post-orchidopexy testicular atrophy in the literature have ranged from non-existent to unclear. Our purpose in this study was to estimate the incidence of and associated risk factors for post-orchidopexy testicular atrophy.

Open appendectomy for pediatric ruptured appendicitis: a historical clinical review of the prophylaxis of wound infection and postoperative intra-abdominal abscess.

Background: We conducted a 3-decade clinical review of prophylaxis for wound infection and postoperative intra-abdominal abscess after open appendectomy for pediatric ruptured appendicitis.

Methods: We reviewed the charts of patients with ruptured appendicitis who underwent open appendectomy performed by the same pediatric surgeon at the Hospital for Sick Children, Toronto, Canada, between 1969 and 2003, inclusive. We evaluated 3 types of prophylaxis: subcutaneous (SC) antibiotic powder, peritoneal wound drain and intravenous (IV) antibiotics.

Delayed management of giant omphalocele using silver sulfadiazine cream: an 18-year experience.

Background/purpose: To assess the value of topical silver sulfadiazine (SSD) cream in the treatment of babies with a giant omphalocele.

Methods: From 1991 to 2008 inclusive, 20 infants with giant omphalocele (defined as >10 cm diameter) were treated with SSD, leaving a large ventral hernia to be repaired at a later date.

Results: There were 12 boys and 8 girls.

A pediatric surgeon's 35-year experience with pilonidal disease in a Canadian children's hospital.

Background: There is an ongoing debate regarding the optimal surgical management for pilonidal disease in the pediatric population. The purpose of this study was to evaluate a pediatric surgeon's experience at a Canadian children's hospital over 35 years.

Methods: We performed a retrospective review of the charts of patients seen and treated from July 1969 to December 2003, inclusive.

What is the significance of contrast "blush" in pediatric blunt splenic trauma?

Purpose: Contrast extravasation (CE) associated with blunt splenic injuries (BSIs) in adults is commonly treated with embolization or splenectomy. Whether this is necessary in children is unclear. We sought to determine if CE on initial computed tomography (CT) is associated with negative outcomes in children with BSI.

Outcomes after muscle flap vs prosthetic patch repair for large congenital diaphragmatic hernias.

Background: Repair of large congenital diaphragmatic hernia (CDH) defects still pose a significant challenge, as the defects cannot be repaired primarily. Two techniques have been widely used: autologous anterior abdominal wall muscle flap and prosthetic patch. The latter has been used more often.

Management of blunt splenic injury in children: evolution of the nonoperative approach.

Background: Nonoperative management of blunt splenic injury (BSI) was first proposed at our institution in 1948. Since that time, treatment of patients with BSI has evolved from routine splenectomy to an aggressive spleen-preserving philosophy. This report summarizes our institutional experience for the last 50 years.

Long-term functional results following resection of neonatal sacrococcygeal teratoma.

Purpose: Sacrococcygeal teratoma (SCT) is the most common congenital neoplasm in neonates. We wished to assess the long-term functional outcome of children undergoing SCT resection.

Methods: Records of neonates diagnosed with SCT from two surgeons' practices, and operated on between 1970 and 2006, were retrospectively reviewed.

The very large recurrent postoperative scrotal hydrocele after pediatric inguinal hernia repair: a rare problem.

Purpose: To report the rare problem of a very large recurrent postoperative scrotal hydrocele after pediatric inguinal hernia repair.

Methods: From July 1969 to December 2007 inclusive, the charts of five boys mean age 8 years (range 7 months-16 years) with very large recurrent postoperative scrotal hydroceles were reviewed (Research Ethics Board approval 1000007698).

Results: In each case, there was a very large recurrent postoperative symptomatic scrotal hydrocele (3 right, 1 left, 1 bilateral).

An asymptomatic presentation of gastric outlet obstruction secondary to congenital antral web in an extremely preterm infant.

A case of gastric outlet obstruction secondary to antral web in a preterm infant born at 25 weeks gestation is reported. The diagnosis was suspected on plain abdominal radiograph performed postnatally to confirm position of the umbilical catheters. On the initial radiograph (at age 1 h), a dilated stomach with a gasless abdomen was noted.

Predictors of metachronous inguinal hernias in children.

Purpose: Surgical management of the contralateral groin in unilateral inguinal hernia remains controversial. Our aim was to determine predictors of metachronous inguinal hernias in children using multivariable analysis.

Methods: A retrospective cohort study of 6,302 patients presenting with inguinal hernia to a single surgeon's practice over 35 years was undertaken.

The best 10 clinical articles for the last 50 years from the Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.

Purpose: The aim of the review was to present the best 10 clinical articles for the last 50 years (1956-2006) from the Division of General Surgery, Hospital for Sick Children (HSC), Toronto, Canada. These articles were judged by the major change (impact) in clinical practice of pediatric general surgery after their publication.

Methods: All clinical articles from 1956 to 2006 inclusively written by members of the division (while working at HSC) were evaluated.

Recurrent pyloric stenosis: to dilate or operate? A preliminary report.

Purpose: Idiopathic hypertrophic pyloric stenosis is a common surgical problem in infants, and pyloromyotomy is almost always successful in alleviating the obstruction. There are few reports in the literature that discuss recurrent pyloric stenosis as opposed to incomplete pyloromyotomy. We report 2 such babies with different cures.

Is there a role for routine abdominal imaging in predicting postoperative intraabdominal abscess formation after appendectomy for pediatric ruptured appendix?

To determine if there is a role for routine abdominal imaging in predicting postoperative intraabdominal abscess after appendectomy for the pediatric ruptured appendix. From January 2000 to December 2003 inclusive, 44 consecutive pediatric patients with a ruptured appendix had an open appendectomy and were treated for a minimum of 5 days with triple antibiotics. On postoperative day 5, each patient was evaluated for symptoms (fever, abdominal pain, gastrointestinal dysfunction) and radiological evidence of an intraabdominal fluid collection.

Postoperative pyloric stenosis in the newborn: a forgotten problem.

Purpose: Postoperative vomiting in newborns is a common finding usually attributed to the original surgery. We report 10 newborns whose postoperative course was complicated by pyloric stenosis.

Methods: We reviewed the charts of all newborns who had pyloric stenosis diagnosed after a major abdominothoracic operation over the past 30 years (1973-2003) at a single children's hospital.

Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation.

Objective: We sought to determine the frequency of progression in infants of perianal abscess with and without surgical drainage to fistula in ano to optimize a treatment plan for these children.

Methods: A retrospective cohort study was conducted of all patients who were < or = 1 year of age and presented with perianal abscess to 2 pediatric tertiary care institutions during a 10-year period (January 1995 to February 2005, inclusive). Patients were divided into those who underwent surgical drainage and those who did not, and the rate of subsequent fistula formation was determined.

Tracheoesophageal fistula without esophageal atresia: are pull-back tube esophagograms needed for diagnosis?

Background: A pull-back tube esophagogram (PBTE) is widely accepted in the literature as the radiological investigation of choice for the diagnosis of tracheoesophageal fistula without esophageal atresia. However, PBTE is rarely performed in our institution, as we have been successful in confirming the presence of such fistulae with a contrast material swallow (CS). We hypothesized that PBTE is not the radiological investigation of choice for the diagnosis of the fistula in this condition.

Appendicitis in the child with a ventriculo-peritoneal shunt: a 30-year review.

Purpose: Each year, about 270 children are treated at our hospital for appendicitis, and there are 200 ventriculo-peritoneal (VP) shunt procedures. The incidence of primary peritonitis after a VP shunt is 8% to 12%. The purpose of this article is to try and differentiate these 2 entities.

The role of conservative management in congenital tracheal stenosis: an evidence-based long-term follow-up study.

Background/purpose: Surgery has been the management of choice for severe congenital tracheal stenosis (CTS). The role of conservative management of CTS however is not clear. The aim of this study is to characterize the natural history of CTS, review the radiologic evidence of tracheal growth, and evaluate the clinical outcome and selection criteria of conservative management of CTS.

First successful lower-extremity transplantation: technique and functional result.

Composite tissue transplantation has emerged as a viable alternative to prosthetics and complex reconstructive surgery. Thus far it is reserved for cases which cannot be effectively reconstructed and where it offers some benefits over prostheses. It has been used in the upper extremity with encouraging results and, most recently, in the face.

Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review.

Purpose: This study, by its mere size and uniformity (1 pediatric surgeon), aims to corroborate or refute the teachings and myths of the pediatric inguinal hernia.

Methods: From July 1969 to January 2004, 6361 infants and children with inguinal hernias were seen, operated on, and followed by the senior author. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients.

Wound infection prophylaxis in pediatric acute appendicitis: a 26-year prospective study.

Purpose: The purpose of this study was to determine the best wound infection prophylaxis in pediatric acute appendicitis.

Methods: From 1969 to 1995 inclusive, 453 consecutive pediatric patients at the same children's hospital had an appendix with acute inflammation (acute appendicitis) removed by the same staff surgeon and his resident. The stump was not inverted, and chromic catgut was used throughout.