Special Pediatric Surgery Forums
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Constipation is a constant sequela and should be treated aggressively. (This is true also for male patients with perineal fistulas.) We have learned that the lower the defect, the greater the chance of constipation. We have also learned that constipation is a self-perpetuating and self-aggravating condition that eventually produces severe megacolon, chronic faecal impaction, and overflow pseudo-incontinence; it must be vigilantly avoided."
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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Nonsurgical reduction has a longstanding history; it was first described by McDermott in 1994. In principle, an enema pushes back the intussuscepted bowel. The progress of the reduction can be monitored by fluoroscopy or ultrasound. As contrast media, air or water-soluble iodine solutions can be used for fluoroscopy, and physiologic saline, for ultrasound. A success rate of up to 95% has been reported for nonsurgical reduction, so this procedure should be considered as a first-line treatment."
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Between 25% and 40% of children with ulcerative colitis undergo surgical treatment. As most patients today can be stabilised by medical treatment, emergency operations for toxic megacolon, unremitting bleeding, or refractory fulminant colitis are not common. The typical indications for surgery of ulcerative colitis are poor response to optimal medical treatment, dependence on high-dose corticosteroids with significant side effects, delay in growth and maturation, and severe extraintestinal manifestations of the disease. Surgery should not be considered as a primary or early treat…
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "For the surgical management of umbilical polyp, limited exploration of the peritoneal cavity is advisable, because of the possibility of an underlying connection to the ileum by a remnant of the omphalomesenteric duct. The approach is via a circumferential incision around the polyp, trying to preserve as much of the normal umbilicus as possible. The skin defect is repaired using an absorbable purse-string suture. A subumbilical incision is made as described above. The abdominal wall is opened transversely and the peritoneal cavity is entered. If an omphalomesenteric duct remnant …
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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Recurrent intussusception is seen after nonsurgical reduction in up to 13% of all cases, and 30% of all recurrences occur within the first postoperative day. Irritability and discomfort are the first signs of an early recurrence. Nonsurgical reduction may be repeated, especially in infants and younger children with gastrointestinal infections. Hsu et al. analysed the recurrence rate in 686 children and found 15.7% recurrence after the first barium enema reduction, 37.7% after the second, 68.4% after the third, and 100.0% after the fourth reduction. In our institution, we recommen…
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "there is no contraindication for any conservative trial of reduction with respect to duration of intussusception or position of the apex, but nonsurgical treatment must not be undertaken in a patient with clinical signs of shock, peritonitis, or severe obstruction."
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quotes from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The repair of cloacas with longer common channels (>3 cm) represents a real technical challenge and requires a great deal of experience in the management of these cases. For that kind of patient, the pediatric surgeon and/or pediatric urologist should have experience in the management of the urinary structures, including bladder reconstructions, bladder neck reconstructions, ureteral reimplantations, bladder augmentation, and Mitrofanoff procedures, as well as vaginal replacements using rectum, colon, or small bowel." "If the common channel is longer than 5 cm, we recommend …
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "When a baby is born with cloaca, the surgeon must keep in mind that approximately 50% of these patients suffer from a very giant vagina full of fluid (“hydrocolpos”). The hydrocolpos may compress the trigone, interfering with the drainage of the ureters and therefore provoke bilateral megaureters and hydronephrosis. All babies with a cloaca should have a complete urologic evaluation at birth, including an ultrasound of the kidneys and ultrasound of the pelvis. The baby should not be taken to the operating room without this evaluation. If the baby suffers from hydrocolpos, it is m…
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "When a baby is born with this malformation at our institution, we repair this malformation during the newborn period if the baby is otherwise healthy. If the baby is premature or has associated defects, it is always safer to open a protective colostomy or dilate the fistula until definitive repair can be performed. The surgeon must keep in mind that dehiscence and infection in patients with anorectal malformations not only represent a few more days in the hospital and an ugly scar but also represent the possibility of worsening the prognosis for bowel control."
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "We prefer to operate on these babies to give the child an anal opening that is centered in the sphincter and appropriately sized, and to achieve a better cosmetic effect."
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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…
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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…
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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The term “short bowel” was defined by Rickham in 1967 as a small intestinal remnant of 75 cm or less in the newborn, which equals 30% of normal small bowel length in that age group. A more functional description, preferred by most authors, defines a “short bowel syndrome” (SBS) as a state of significant maldigestion and malabsorption due to an extensive loss of functional absorptive intestinal surface area."
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