Journal of pediatric surgery
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The purpose of the study was to assess the treatment strategies and outcome of right-sided congenital diaphragmatic hernia (R-CDH), particularly extracorporeal membrane oxygenation (ECMO). ⋯ Our data suggest that patients with R-CDH have high ECMO utilization and may experience greater relative benefit from ECMO as evidenced by their higher-than-expected overall survival. Extracorporeal membrane oxygenation may be found to have a distinctive role in managing R-CDH. More high-powered series are needed to elucidate differences between R-CDH and left-sided CDH that may dictate alternate forms of management.
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Patent ductus arteriosus (PDA) ligation is a potentially lifesaving procedure that is frequently performed in very low-birth-weight (VLBW) infants. Video-assisted thoracoscopic surgery (VATS) PDA ligation has many advantages; however, this approach has not been widely used in these extremely small patients. We present a technique using a novel retractor that allows safe VATS PDA ligation in the VLBW neonate. ⋯ The technique is minimally invasive and provides superior visualization of the PDA and surrounding anatomical landmarks. Using this novel retractor, VATS PDA ligation is practical in even the smallest infants. This retractor may facilitate the performance of more advanced thoracoscopic procedures in VLBW infants.
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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. ⋯ The management of BSI in children has changed dramatically for the last 50 years. This study clearly demonstrates the safety of nonoperative management and documents progressively lower rates of splenectomy and transfusion, shorter hospitalization, and an extremely low risk of mortality.
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In the current time-restricted training environment, simulator use in surgical teaching is receiving increasing attention. A large body of literature addresses simulators' effectiveness in surgical education. No prior studies assess how widely simulators are actually being used or attitudes about their effectiveness of those involved in training. ⋯ Trainees and training directors placed significant importance on simulator use in pediatric surgery training. However, most did not feel that simulators had actually improved the trainees' laparoscopic skills. Wider availability of simulation laboratories and protected time for using them would enhance the impact of simulators on pediatric surgery training.
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Multicenter Study
Outcomes of the "clip and drop" technique for multifocal necrotizing enterocolitis.
The "clip and drop" (CD) has been proposed as a useful strategy in the management of severe multifocal necrotizing enterocolitis (NEC). There is little published data on clinical outcomes after this intervention. We report a 2-center experience with this technique. ⋯ With multiple interventions, half the infants in this high-risk group survived and achieved full enteral feeds. The CD is a valuable technique in a selected group of infants with fulminant NEC.