Journal of pediatric surgery
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Multicenter Study Comparative Study
Should laparoscopic appendectomy be avoided for complicated appendicitis in children?
Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, recent literature on adults suggests that laparoscopic appendectomy may increase the risk for postoperative infectious complications in complicated (gangrenous or perforated) cases. This study was undertaken to compare the results of open versus laparoscopic appendectomy for complicated appendicitis in children. ⋯ The findings suggest that laparoscopic appendectomy should be avoided in children who have complicated appendicitis because of the increased risk for postoperative intraabdominal abscesses. The authors propose a prospective, randomized trial to verify this finding.
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Intensive care monitoring, blood replacement, and nonoperative treatment of splenic and hepatic injuries in stable patients is the standard practice in pediatric surgery with a success rate of 90% in children's trauma centers. ⋯ The results of this study suggest that intensive care monitoring is not mandatory in hemodynamically stable patients who have isolated liver or spleen injuries. Blood replacement should be indicated in patients who have hematocrit levels lower than 20% and signs of continuing blood loss. Because of structural characteristics of the young liver and spleen, early progressive mobilization can be indicated.
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Bronchogenic cysts and esophageal duplications are usually considered as separate foregut malformations. Yet, both are thought to arise from the same embryological event, division of the embryonic foregut, and they share common histological characteristics, often making their clinical differentiation difficult. ⋯ The histological similarity and anatomic proximity of the "bronchogenic cysts" and the intramural "esophageal duplications" supports their common origin. The possible complications of bleeding, ulceration, infection, and obstruction of the esophagus or airway, should generally lead to prompt resection.
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Comparative Study
Sequential endoscopic/laparoscopic management of cholelithiasis and choledocholithiasis in children who have sickle cell disease.
Cholelithiasis and choledocholithiasis are common complications of sickle cell disease (SCD). With the recent advances in laparoscopic cholecystectomy (LC), which has been used successfully for the management of cholelithiasis in children who have SCD, exclusion of choledocholithiasis before LC is of great importance. ⋯ This sequential approach of endoscopic sphincterotomy and stone extraction followed by LC is a safe and effective approach for the management of cholelithiasis and choledocholithiasis in children who have SCD.
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Case Reports
Surgical emergency embolectomy for the treatment of fulminant pulmonary embolism in a preterm infant.
A massive pulmonary embolism, demonstrated by echocardiography developed in a 3-week-old preterm infant. An etiologic explanation could not be obtained from either history or clinical and laboratory findings. Pulmonary embolectomy was performed as an emergency procedure because of severe hemodynamic impairment despite intensive medical therapy. In children who have massive pulmonary embolism who remain in a compromised hemodynamic state despite intensive medical therapy, pulmonary embolectomy may be considered the alternative emergency treatment.