GIT

Quotes from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Surgery is indicated only for selected patients with any one of three conditions: (1) when the absorptive surface area is definitely too small to allow enteral feeding; (2) when severe dysmotility in grossly dilated loops entails stagnation of chyme; and (3) when intestinal transit time is too fast to allow sufficient absorption of nutrients. In the first group of patients, intestinal transplantation is the mainstay of surgical therapy. In the second group, peristalsis can be improved by intestinal tapering or tapering and lengthening. In the third group, antiperistaltic segment…

Quotes from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Resection of the jejunum is well tolerated owing to the enormous adaptive capacity of the ileum, the intact enterohepatic circulation of bile salts, and the preserved absorption of fat-soluble vitamins and vitamin B12. In contrast, if the entire ileum is lacking, absorption of nutrients is significantly more difficult because of the limited intestinal adaptation capacities of the jejunum. Nonabsorbed intestinal contents, including bile acids, spill over into the colon and may cause significant diarrhea. Furthermore, loss of the ileum leads to a reduction of the bile salt pool, m…

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "These are usually found in the retrorectal space and do not communicate with the urinary tract. Cystic rectal duplications must be distinguished from cystic sacrococcygeal teratoma, tailgut cyst, and an anterior meningocele. When associated with an anorectal malformation and sacral anomalies, the cyst may be part of the Currarino syndrome. Rarely, a rectal duplication cyst presents as rectal prolapse in an infant.

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Imaging is a critical aspect of preoperative preparation. The choice of imaging is dictated by the site of the duplication, clinical urgency, and the potential for associated anomalies. Isolated small bowel duplications often require no preoperative investigations other than abdominal sonography, a plain abdominal radiograph and routine blood tests. Occasionally, a technetium-99m pertechnetate radionuclide scan is helpful in detecting heterotopic gastric mucosa. In contrast, thoracoabdominal lesions demand detailed radiologic imaging of mediastinal, abdominal, and spinal componen…

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "The assistant should grasp and laterally retract the posterior wall of the stomach near the greater curvature to ensure no wall of the stomach is folded on itself causing four layers to be included in the staple line. This also prevents the sleeve from twisting as sequential firings take place, resulting in a spiral staple line." Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "Anastomotic leakage and bleeding may present initially only as sustained tachycardia; …

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "The advantages of this technique are preservation of the pylorus, which prevents the dumping syndrome prevalent in bypass, reduced malabsorption (although nutritional deficiencies remain a challenge), relative simplicity and shorter operative time versus bypass, and fewer postoperative complications than bypass, as there is only one staple line and no new spaces are created for internal hernia. Although weight loss is slightly less than that after bypass, a sleeve can later be converted to bypass if the malabsorptive component is later necess…

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "Patient selection is very important and should be a joint decision from a MDT consisting of paediatrician, surgeon, dietician and psychologist. Before decision-making, patients are thoroughly investigated to identify any underlying condition causing obesity, e.g. hypothyroidism or Prader-Willi syndrome (PWS). Investigations also look for any obesity-related co-morbidities. Blood investigations include full blood count, urea and electrolytes, liver function and metabolic profile to look for non-alcoholic hepatic steatosis or type 2 diabe…

quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "running the bowel from the ligament of Treitz to the cecum. This is done more ergonomically by using two working ports and two monitors as shown in Fig. 30.1. The first half of the running should be done looking to the monitor on the left at the top of the patient, and the second half the surgeon has to switch places to the left of the patient and look to the other monitor usually moving to the patient’s lower body. It is important when running the bowel to visualize both sides of the bowel and the mesentery."

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Regarding current treatment of annular pancreas by duodenoduodenostomy

In treatment of hypokalemic Hypochloremic metabolic alkalosis , in cases of infantile pyloric stenosis

A practical approach to the volume of resuscitation is suggested by Dalton et al. Resuscitation is based on serum chloride, where Cl < 85 mmol/kg —3 boluses of 20 ml/kg NS and Cl < 97mmol/kg—2 boluses of 20 ml/kg NS, gets to metabolic readiness for surgery, avoiding multiple blood draws.