MedWorm: Correction of Pyloric and Duodenal Stenosis

Endoscopic pyloromyotomy: a new concept of minimally invasive surgery for pyloric stenosis

Endoscopy — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion: Peroral endoscopic submucosal pyloromyotomy appears to be technically feasible and effective. Potential clinical applications, such as for infantile hypertrophic pyloric stenosis or delayed gastric emptying after esophagectomy, could be considered after confirmation of safety in additional survival studies. [...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: Endoscopy)

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Evaluation of Ultrasonographic Parameters in the Diagnosis of Pyloric Stenosis

Journal of Surgical Research — Sat, 14 Jan 2012 22:30:13 +0100

(Source: Journal of Surgical Research)

Pyloromyotomy: randomized control trial of laparoscopic vs open technique

Journal of Pediatric Surgery — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: There was no difference in operating time, hospital stay, or refeeding patterns between open and laparoscopic pyloromyotomy. The complication rates were similar between the 2 methods. However, long-term cosmetic results were significantly superior in the laparoscopic group. (Source: Journal of Pediatric Surgery)

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Journal of Pediatric Surgery — Sun, 01 Jan 2012 05:00:00 +0100

Three boys with ultrasound-confirmed infantile hypertrophic pyloric stenosis presented with minimal electrolyte imbalance and mild clinical dehydration. All 3 had been treated for presumed gastroesophageal reflux with ranitidine for a period of 2 to 5 weeks. There was a limited biochemical response to “resuscitation” with half normal saline and 5% dextrose. Similar findings have been reported with patients on omeprazole, and 1 study has advocated cimetidine therapeutically in infantile hypertrophic pyloric stenosis to reduce the need for surgery. (Source: Journal of Pediatric Surgery)

Single-incision laparoscopic surgery for pyloric stenosis

Pediatric Surgery International — Sat, 17 Dec 2011 16:43:40 +0100

Conclusions The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00383-011-3029-7Authors Yury Kozlov, Pediatric Hospital, Irkutsk, Russian FederationVladimir Novogilov, Pediatric Hospital, Irkutsk, Russian FederationAlexey Podkamenev, Pediatric Hospital, Irkutsk, Russian FederationAndrey Rasputin, Pediatric Hospital, Irkutsk, Russian FederationIrina Weber, Pediatric Hospital, Irkutsk, Russian FederationAlexey Solovjev, Pediatric Hospital, Irkutsk, Russian FederationPavel Yurkov, Pediatric Hospital, Irkutsk, Russian Federation Journal Pediatric Surgery InternationalOnli...

The Role of Ret Genomic Variants in Infantile Hypertrophic Pyloric Stenosis

European Journal of Pediatric Surgery — Wed, 14 Dec 2011 05:00:00 +0100

Eur J Pediatr Surg 2011; 21: 389-394DOI: 10.1055/s-0031-1291357Infantile hypertrophic pyloric stenosis (IHPS) is a common childhood pathology affecting approximately 1–5 children pro 1 000 newborns, with a genetic background as suggested by the familial occurrence. RET is a candidate gene for IHPS due to its role in the development of the intrinsic innervation and ganglia of the smooth musculature and the association of RET variants with another motility disorder (Hirschsprung’s disease). Accordingly, we investigated RET-IHPS associations through sequencing of the complete RET coding region in 32 IHPS patients. Genotype frequencies were compared between patients and 48 controls using the Cochran-Armitage trend test or Fischer’s test for exact p-values. We found 19 RET variants in I...

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Bile duct duplication as a cause of distal bowel gas in neonatal duodenal obstruction

Journal of Pediatric Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Neonatal DA presenting with distal bowel gas via an anomalous bifurcated bile duct conduit is more common than initially thought and occurs more frequently than duodenal stenosis. These patients might be at risk for cholestasis, possibly owing to duodeno-biliary reflux through the ampulla. (Source: Journal of Pediatric Surgery)

Trilogy of gastrointestinal atresias: a case report and review of the literature

Journal of Pediatric Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Abstract: This is a case report of a child with a rare combination of pyloric and colonic atresias, imperforate anus, hypoganglionosis of the rectum and sigmoid colon, unilateral multicystic dysplastic kidney, bilateral sensorineural deafness, spondyloepimetaphyseal dysplasia, subglottic stenosis, growth failure, and limb anomalies. (Source: Journal of Pediatric Surgery)

Laparoscopic pyloromyotomy: is a knife really necessary?

World Journal of Pediatrics : WJP — Mon, 21 Nov 2011 05:00:00 +0100

CONCLUSIONS: Use of hook electrocautery for incising the pylorus provides a bloodless field without affecting the postoperative recovery and outcome. It also obviates any need of specialized instruments like a pyloromyotomy knife or other sharp instruments for pyloric incision. PMID: 22105570 [PubMed - as supplied by publisher] (Source: World Journal of Pediatrics : WJP)

Pancreatic carcinoma masquerading as groove pancreatitis: case report and review of literature.

JOP — Sun, 20 Nov 2011 13:48:02 +0100

CONCLUSION: Several studies have been attempted to clarify the points of differentiation between carcinoma and pancreatitis in the groove area. This discrimination has been proved to be difficult; frequently the definitive diagnosis is only obtained after surgical intervention. This condition should be considered when making the differential diagnosis in pancreatic groove pathology and duodenal stenosis. PMID: 22072250 [PubMed - in process] (Source: JOP)

Double bubble sign

Emergency Medicine Journal — Fri, 18 Nov 2011 05:00:00 +0100

A 4-day-old full-term male neonate presented with postprandial non-bilious vomiting. Delayed meconium passage had been recorded at 36 h of age. Progressive abdominal distention was noted. A supine radiograph of the abdomen showed marked distention of the stomach and proximal duodenum with double bubble sign (figure 1). Air density was not identified distal to the duodenum. Duodenal obstruction was strongly suspected. Exploratory laparotomy revealed duodenal atresia proximal to the ampulla of Vater and severe dilatation in the first part of the duodenum, which were repaired by duodenoduodenostomy. The double bubble sign is a classic radiographic manifestation of duodenal obstruction, the cause of which could be intrinsic (such as duodenal atresia, duodenal stenosis or duodenal web) or ...

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Temporary placement of stent grafts in postsurgical benign biliary strictures: a single center experience.

Korean J Radiol — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSION: Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant. PMID: 22043153 [PubMed - in process] (Source: Korean J Radiol)

Single-site umbilical laparoscopic pyloromyotomy

Seminars in Pediatric Surgery — Mon, 03 Oct 2011 17:22:54 +0100

This article will describe the single-site approach used at the Children's Hospital of Alabama and the early outcomes from its use in a relatively small group of infants. An improvement in the cosmetic appearance of the abdominal wall with the single-site approach appears to be the primary reason for its use. (Source: Seminars in Pediatric Surgery)

Genomic variants in the coding region of neuronal nitric oxide synthase (NOS1) in infantile hypertrophic pyloric stenosis

Journal of Pediatric Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Conclusions: We conclude that NOS1 variants are present in patients with IHPS yet show no significant statistical association with the IHPS phenotype, suggesting at best an adjuvant role for NOS1 in IHPS. (Source: Journal of Pediatric Surgery)

Superobese and super-superobese patients: 2-step laparoscopic duodenal switch

Surgery for Obesity and Related Diseases — Mon, 19 Sep 2011 04:00:00 +0100

Conclusion: In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities. (Source: Surgery for Obesity and Related Diseases)

Superobese and super-superobese patients: 2-step laparoscopic duodenal switch.

Sat, 17 Sep 2011 04:00:00 +0100

CONCLUSION: In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities. PMID: 22014481 [PubMed - as supplied by publisher] (Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery)

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How to manage pyloric tumours that are difficult to resect completely with endoscopic resection: Comparison of the retroflexion vs. forward view technique

Digestive and Liver Disease — Thu, 15 Sep 2011 04:00:00 +0100

Conclusions: Endoscopic submucosal dissection using retroflexion manoeuvre is a more effective method for the curative resection of gastric tumours involving pyloric channel. (Source: Digestive and Liver Disease)

Gastrectomy with isoperistaltic jejunal parallel pouch in a 15-year-old adolescent boy with gastric adenocarcinoma and autosomal recessive agammaglobulinemia

Journal of Pediatric Surgery — Thu, 01 Sep 2011 04:00:00 +0100

Abstract: A 15-year-old adolescent boy with autosomal recessive agammaglobulinemia underwent endoscopy because of unexplained growth failure and malnutrition. Esophagogastroduodenoscopy revealed antropyloric stenosis, and a biopsy showed an invasive gastric adenocarcinoma. Chronic atrophic corpus gastritis type A and Helicobacter pylori were also identified. Abdominal magnetic resonance imaging confirmed the stenosis resulting from a semicircular intramural tumor without obvious local or distant metastatic spread. Gastrectomy with an extended lymphadenectomy was performed. Esophagoduodenal continuity was restored by an interposed jejunal parallel pouch developed from the first jejunal loop. Oral feeding was supplemented by parenteral nutrition via a Broviac catheter, and the patient is wel...

Two Cases of Helicobacter pylori-Negative Gastric Outlet Obstruction in Children

Infectious Diseases in Obstetrics and Gynecology — Wed, 24 Aug 2011 19:34:03 +0100

Gastric outlet obstruction (GOO) in children is most commonly caused by idiopathic hypertrophic pyloric stenosis. Prior to proton pump inhibitors and H2 blockers, peptic ulcer disease (PUD) secondary to H. pylori was a cause of GOO. Both patients presented with a history of weight loss, vomiting, and abdominal pain. Their diagnosis of PUD and GOO was made by EGD and UGI. H. pylori testing was negative for both on multiple occasions but still received H. pylori eradication therapy. Patient 1 after failing pharmaceutical management underwent surgery for definitive treatment. Patient 2 underwent six therapeutic pyloric dilations before undergoing surgery as definitive treatment. These cases suggest that GOO secondary to PUD occurs in the absence of H. pylori infection and surgical management ...

Endoscopic Submucosal Dissection of Gastric Neoplasia Involving the Pyloric Channel by Retroflexion in the Duodenum

Digestive Diseases and Sciences — Sat, 13 Aug 2011 06:12:37 +0100

Conclusions Tumors involving the pyloric channel could be successfully resected by ESD using retroflexion in the duodenum without severe complication. This technique appears to be a feasible and effective method for the treatment of tumors involving the pyloric channel. Content Type Journal ArticlePages 1-7DOI 10.1007/s10620-011-1863-zAuthors Chul-Hyun Lim, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, #505, Banpo-dong, Seocho-gu, Seoul, 137-701 KoreaJae Myung Park, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, #505, Banpo-dong, Seocho-gu, Seoul, 137-701 KoreaChung-Hwa Park, Division of Gastroenterology, Department of Internal...

No association between the SNPs (rs56134796; rs3824934; rs41302375) in the TRPC6 gene promoter and infantile hypertrophic pyloric stenosis in Chinese people

Pediatric Surgery International — Sat, 06 Aug 2011 05:47:05 +0100

Conclusion These three TRPC6 SNPs have no association with the IHPS in Chinese people. However, we cannot deny that TRPC6 would be a susceptible gene with IHPS in Chinese people. May be other SNPs in TRPC6 would have some association with the IHPS in Chinese people. But in this study our results may be due to the fact that these SNPs are not the functional SNPs for the development of IHPS in Chinese people. Content Type Journal ArticlePages 1-4DOI 10.1007/s00383-011-2961-xAuthors Jun-Jie Ju, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, 110004 People’s Republic of ChinaHong Gao, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Sheny...

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Journal of Pediatric Surgery — Sun, 31 Jul 2011 23:00:00 +0100

In this study, the authors reviewed their experience with the circumumbilical incision with a particular emphasis on the relation between postoperative emesis and postoperative time to feeding. (Source: Journal of Pediatric Surgery)

[Advanced gastric cancer : Are there still indications for palliative surgical interventions?]

Der Chirurg — Fri, 29 Jul 2011 23:00:00 +0100

CONCLUSION: Radical tumor resection with palliative intentions (if possible from a technical point of view) resulted in a prolongation of the median survival time of 3 months with an acceptable postoperative morbidity and mortality compared with non-resection procedures. According to the results of individual analysis of each tumor resection intervention, palliative gastrectomy showed a significant prolongation of survival time of 5 months compared with more limited subtotal resection (6 versus 11 months). PMID: 21800190 [PubMed - as supplied by publisher] (Source: Der Chirurg)

Pyloric duplication with communication to the pancreas in a neonate simulating hypertrophic pyloric stenosis

Journal of Pediatric Surgery — Thu, 30 Jun 2011 23:00:00 +0100

Abstract: An 11-day-old neonate presents with worsening nonbilious emesis and radiographic findings suggestive of pyloric stenosis. Using a laparoscopic approach, a slightly asymmetric and hypertrophied pylorus was visualized. The unusual age of presentation and appearance of the pylorus led to the decision to perform an open exploration for suspicion of a pyloric duplication. An incision of the pyloric muscle exposed and confirmed a duplication cyst. Further exposure revealed accessory pancreatic tissue communicating from the cyst to the main body of the pancreas. The duplication cyst and accessory pancreas were resected, and the patient had an uneventful recovery. Pyloric duplication is a rare cause of congenital extrinsic obstruction in the newborn. Even rarer is a communication of the ...

Strangulated perforated hiatus hernia due to pyloric stenosis

Hernia — Sat, 25 Jun 2011 15:51:10 +0100

Abstract The first patient with strangulated hiatus hernia due to pyloric stenosis is reported. A 70-year-old male patient presented as an emergency with severe left-sided chest pain, tachycardia, tachypnea, dysphagia, and nausea but no vomiting. The diagnosis of strangulated hiatus hernia due to pyloric stenosis was suspected, because a CT scan done 24 h following a barium meal showed much retained barium in both infra- and supradiaphragmatic parts of the stomach. Recognition of this condition is important since absence of pneumoperitoneum should not delay the diagnosis. In this complication, the perforation is likely to be at the hiatus, not the fundus as occurs in other causes of strangulation. A gastric drainage procedure should be an essential part of treatment. ...

Ranitidine may modify the biochemical disturbance in hypertrophic pyloric stenosis

ANZ Journal of Surgery — Tue, 31 May 2011 23:00:00 +0100

(Source: ANZ Journal of Surgery)

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Hypertrophic pyloric stenosis in a newborn: a diagnostic dilemma.

Hong Kong Med J — Tue, 31 May 2011 23:00:00 +0100

This report is of a newborn infant with hypertrophic pyloric stenosis. The patient presented with high-volume non-bile-stained output from a nasogastric tube and a dilated gastric bubble on abdominal radiograph. Contrast study ruled out intestinal malrotation. Two ultrasound tests showed that the pyloric muscle thickness and pyloric canal length were within normal limits. Subsequent laparotomy showed a thickened pylorus and pyloromyotomy was performed. The patient showed marked improvement in feeding postoperatively. A high index of suspicion is required for newborn infants presenting with gastric outlet obstruction. Ultrasound and contrast studies provide additional information, but definitive diagnosis may only be available intra-operatively. PMID: 21636874 [PubMed - in process] (Sou...

Letter to the Editor

Journal of Pediatric Surgery — Tue, 31 May 2011 23:00:00 +0100

We read with interest the article of Walker et al concerning the developmental outcomes of infants after surgical repair of pyloric stenosis. It is an important contribution to the controversy regarding the potential neurotoxicity of general anesthesia in young children. Their conclusions however, pose several difficult questions for both the surgeon and anesthesiologist. Specifically, we would like to call attention to the authors' final 2 statements, in which the authors first call for “an assessment of potential alternatives to general anesthesia” and subsequently recommend that “all infants that require general anesthesia for a surgical procedure may need to be enrolled in newborn developmental follow-up clinics.” (Source: Journal of Pediatric Surgery)

Reply to Letter to the Editor

Journal of Pediatric Surgery — Tue, 31 May 2011 23:00:00 +0100

Thank you for the opportunity to respond to the insightful comments from Dr Williams et al. They raise several important points that are worthy of further discussion. First, although our study revealed evidence of neurodevelopmental delay in infants after pyloromyotomy under general anesthesia (GA), this does not necessarily imply causation . Although it remains possible that the delays we observed were solely the result of GA in these infants, it would seem perhaps more likely that they reflect a combination of factors that might include a link between those genes predisposing to infantile hypertrophic pyloric stenosis (IHPS), any residual electrolyte imbalances, mild starvation, and GA . Certainly, as part of our continuing study, we propose to reevaluate these children at 3 years to ass...

Gastric antrum hypertrophy causing outlet obstruction in an infant with congenital diaphragmatic hernia

Journal of Pediatric Surgery — Tue, 31 May 2011 23:00:00 +0100

We report the first case of gastric antrum hypertrophy causing gastric outlet obstruction in an infant with CDH. (Source: Journal of Pediatric Surgery)

Robotic antrum-pyloric resection with intracorporeal anastomosis in a young woman with ectopic pancreas pyloric stenosis

Journal of Robotic Surgery — Mon, 30 May 2011 17:12:18 +0100

Conclusions We show that subtotal gastrectomy for ectopic pancreas can be performed robotically and is a feasible and safe procedure. Content Type Journal ArticlePages 1-4DOI 10.1007/s11701-011-0280-9Authors A. Langone, Complex Structure of General Surgery, S Paolo Hospital, Via Genova 30, 17100 Savona, ItalyG. Gasloli, Complex Structure of General Surgery, S Paolo Hospital, Via Genova 30, 17100 Savona, ItalyI. Caristo, Complex Structure of General Surgery, S Paolo Hospital, Via Genova 30, 17100 Savona, ItalyL. Monteleone, Complex Structure of General Surgery, S Paolo Hospital, Via Genova 30, 17100 Savona, ItalyG. Griseri, Complex Structure of General Surgery, S Paolo Hospital, Via Genova 30, 17100 Savona, ItalyM. Bianchi, Complex Structure of General Surgery, S Paolo H...

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Isolated congenital tracheal stenosis in a preterm newborn

European Journal of Pediatrics — Wed, 18 May 2011 06:09:23 +0100

Conclusion Successful treatment of severe congenital tracheal stenosis and tracheal atresia depends on either prenatal diagnosis or recognition of this condition immediately after birth to perform tracheotomy without delay. Nevertheless, despite any efforts, the therapeutical results of severe tracheal stenosis and tracheal atresia are still unsatisfactory. Content Type Journal ArticlePages 1-5DOI 10.1007/s00431-011-1490-xAuthors Ulrich Krause, Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Robert-Koch-Str. 40, 37099 Göttingen, GermanyRalph M. W. Rödel, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Georg-August-University, Göttingen, GermanyThomas Paul, Department of Pediatric Cardio...

Open transumbilical pyloromyotomy: is it more painful than the laparoscopic approach?

Journal of Pediatric Surgery — Sat, 30 Apr 2011 23:00:00 +0100

Conclusion: Our study suggests that UMBP infants might experience more postoperative pain in the ward, without any impact on various outcomes. A prospective study with a larger sample size should be undertaken to verify these findings. (Source: Journal of Pediatric Surgery)

Early Life Events: Infants with Pyloric Stenosis Have a Higher Risk of Developing Chronic Abdominal Pain in Childhood

The Journal of Pediatrics — Fri, 22 Apr 2011 04:00:00 +0100

Conclusion: We have described a new model to study early life events in infants. Our findings suggest that the presence of pyloric stenosis in infancy and factors involved in its perioperative care represent risk factors in the development of chronic abdominal pain in children at long-term follow-up. This study provides important data to sustain the multifactorial theoretical construct of pain-associated FGID and underscores the importance of early life events in the development of chronic abdominal pain in children. (Source: The Journal of Pediatrics)

Editorial on “Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis: A Meta-Analysis of Randomized Controlled Trials” by Jia et al.

European Journal of Pediatric Surgery — Wed, 13 Apr 2011 23:00:00 +0100

Eur J Pediatr Surg 2011; 21: 75-76DOI: 10.1055/s-0031-1275323© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Full text (Source: European Journal of Pediatric Surgery)

The Cross-technique for single-incision pediatric endosurgical pyloromyotomy

Surgical Endoscopy — Wed, 13 Apr 2011 14:25:08 +0100

Conclusions The Cross-technique appears superior to standard SIPES pyloromyotomy and should be preferentially used for single-incision endosurgical pyloromyotomy for hypertrophic pyloric stenosis. Content Type Journal ArticlePages 1-5DOI 10.1007/s00464-011-1677-2Authors Oliver J. Muensterer, Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL, USAAlbert J. Chong, Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL, USAKeith E. Georgeson, Division of Pediatric Surgery, Department of Surgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL, USACarroll M. Harm...

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Trans-anastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction

Pediatric Surgery International — Fri, 08 Apr 2011 07:07:06 +0100

Conclusions A TAT significantly shortens time to full enteral feeds in infants with CDO significantly reducing the need for central venous access and PN. Content Type Journal ArticlePages 1-5DOI 10.1007/s00383-011-2896-2Authors N. J. Hall, Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD UKM. Drewett, Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD UKR. A. Wheeler, Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD UKD. M. Griffiths, Wessex Regional Centre for Paediatric Surgery, Southampton Unive...

An Unusual Case of Duodenal Stenosis

Gastroenterology — Sun, 03 Apr 2011 23:00:00 +0100

Question: A 57-year-old woman was admitted to our unit complaining of abrupt onset of upper abdominal pain, nausea, and vomiting. Her symptoms occurred the previous evening and worsened throughout the day until sudden onset of severe upper abdominal fullness and vomiting. She had no history of abdominal trauma, pancreatitis, alcohol abuse, previous surgery, or other specific disease, except for mild hypertension. Upon admission, she had tenderness and muscle defense in the upper to umbilical portion of the abdomen. Laboratory findings revealed a C-reactive protein level of 29 mg/L, an elevation of the serum amylase level (281 U/L), and mild hypertransaminasemia. In addition, serum bilirubin and tumor markers (carcinoembryonic antigen and carbohydrate antigen 19–9) were normal. Endoscopic...

Anaesthesia for specialist surgery in infancy

Anaesthesia and intensive care medicine — Thu, 31 Mar 2011 23:00:00 +0100

Abstract: Common indications for neonatal surgery include inguinal hernias and hypertrophic pyloric stenosis. Less common conditions, that have major implications for anaesthesia, include tracheo-oesophageal fistula, congenital diaphragmatic hernia, exomphalos, gastroschisis and congenital lobar emphysema. The anaesthetic management of these conditions is outlined in this article. (Source: Anaesthesia and intensive care medicine)

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Gastric Cancer — Wed, 23 Feb 2011 23:13:13 +0100

Abstract Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant st...

Seasonal variation of hypertrophic pyloric stenosis: a population-based study

Pediatric Surgery International — Fri, 04 Feb 2011 03:33:44 +0100

Conclusion Hypertrophic pyloric stenosis more commonly presents in the summer. Seasonal variation suggests a possible etiological role for environmental factors. Content Type Journal ArticlePages 1-5DOI 10.1007/s00383-011-2857-9Authors Mohammed F. Zamakhshary, Division of Pediatric Surgery, King Fahad Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi ArabiaSanjeev Dutta, Division of General Surgery, The Hospital for Sick Children, Toronto, ON CanadaTeresa To, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON CanadaDerek Stephens, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON CanadaJacob C. Langer, Institute for clinical evaluative sciences (ICES), Toronto, ON CanadaPaul W. W...

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Hypertrophic pyloric stenosis: predicting the resolution of biochemical abnormalities

Pediatric Surgery International — Mon, 10 Jan 2011 16:09:44 +0100

Conclusion This method of analysis may be of value in comparing the effectiveness of different fluid regimes in use for the correction of biochemical abnormalities in infants with IHPS. Content Type Journal ArticlePages 1-4DOI 10.1007/s00383-010-2813-0Authors David J. Wilkinson, Alder Hey Children’s Hospital, Liverpool, UKRichard A. Chapman, The Freeman Hospital, Newcastle upon Tyne, UKAnthony Owen, Sheffield Children’s Hospital, Sheffield, UKSimon Olpin, Sheffield Children’s Hospital, Sheffield, UKSean S. Marven, Sheffield Children’s Hospital, Sheffield, UK Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358 (Source: Pediatric Surgery International)

A novel association of alveolar capillary dysplasia, atypical duodenal atresia, and subglottic stenosis

Journal of Anesthesia — Thu, 30 Dec 2010 18:03:40 +0100

This report highlights the hazards of the onset and worsening of ACD, and the importance of thorough echocardiography before surgery when atypical duodenal atresia is suspected. Anesthesiologists should also be prepared for the difficulty of intubation. Content Type Journal ArticleDOI 10.1007/s00540-010-1080-5Authors Takeru Shimizu, Department of Anesthesiology and Critical Care Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, JapanTaeko Fukuda, Department of Anesthesiology and Critical Care Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, JapanShinichi Inomata, Department of Anesthesiology and Critical Care Medicine, Graduate Scho...

Epidemiological features of infantile hypertrophic pyloric stenosis in Taiwan: A national study 1996–2004

Journal of Gastroenterology and Hepatology — Thu, 23 Dec 2010 16:52:36 +0100

Conclusions: Taiwan had the second lowest incidence of IHPS reported in the medical literature. IHPS patients can be successfully treated in district and general hospitals with good prognosis. (Source: Journal of Gastroenterology and Hepatology)

Preliminary experience with a new approach for infantile hypertrophic pyloric stenosis: the single-port, laparoscopic-assisted pyloromyotomy

Surgical Endoscopy — Tue, 07 Dec 2010 06:54:38 +0100

Conclusions The feasibility of single-port, laparoscopic-assisted pyloromyotomy obtained in this small sample suggests that this procedure could be an excellent alternative to open or laparoscopic pyloromyotomy as long as it acts as intermediary between the two techniques. Content Type Journal ArticlePages 1-5DOI 10.1007/s00464-010-1505-0Authors Mirko Bertozzi, Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06100 Perugia, ItalyMarco Prestipino, Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06100 Perugia, ItalyNiccolò Nardi, Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. M...

Ectopic opening of the common bile duct and duodenal stenosis: an overlooked association

BioMed Central — Sat, 04 Dec 2010 00:00:00 +0100

Conclusions: The presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment. (Source: BioMed Central)

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Early developmental outcome of infants with infantile hypertrophic pyloric stenosis

Journal of Pediatric Surgery — Wed, 01 Dec 2010 00:00:00 +0100

Conclusions: This unique study found lower than expected developmental scores for infants after surgery for IHPS than for healthy control infants. These findings raise concerns over the potential impact of IHPS and its surgical treatment. Further studies, including continuing developmental review to determine whether these differences persist and their functional importance, should be performed. (Source: Journal of Pediatric Surgery)

Pancreatic resection for metastasis to the pancreas from colon and lung cancer, and osteosarcoma.

JOP — Fri, 12 Nov 2010 21:45:06 +0100

CONCLUSION: Pancreatic resection for metastatic disease may be suggested for selected patients, even those with limited extrapancreatic disease. In this setting, it may offer good palliation and may prolong survival. In cases of acute duodenal bleeding resistant to conservative measures, pancreaticoduodenectomy may represent the only alternative for survival; however, significant morbidity and mortality should be expected. PMID: 21068492 [PubMed - in process] (Source: JOP)

Duodenal switch with omentopexy and feeding jejunostomy—a safe and effective revisional operation for failed previous weight loss surgery

Surgery for Obesity and Related Diseases — Thu, 11 Nov 2010 00:00:00 +0100

Conclusion: Revisional surgery to a duodenal switch is a complex operation and carries a high potential for major complications. Nonetheless, it can be accomplished safely with good long-term results. Omentopexy, drainage, and feeding jejunostomy should be considered at surgery to treat the high potential for delayed ischemic leaks. (Source: Surgery for Obesity and Related Diseases)

Supraumbilical Pyloromyotomy: A Comparative Study Between Intracavitary and Extracavitary Techniques

Journal of Surgical Education — Fri, 29 Oct 2010 00:00:00 +0100

Conclusions: ICP for pyloromyotomy is safe and can be done in large pyloric masses without wound extension. It gives best cosmetic results with minimal complications. (Source: Journal of Surgical Education)

Endosonography-Guided Biliary Drainage with One-Step Placement of a Newly Developed Fully Covered Metal Stent Followed by Duodenal Stenting for Pancreatic Head Cancer

Diagnostic and Therapeutic Endoscopy — Tue, 19 Oct 2010 17:31:07 +0100

An 83-year-old man was admitted to our department, presenting with jaundice, fever, and nausea. CT revealed a pancreatic head tumor with duodenal invasion. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope, a fully-covered metal stent was placed across the puncture tract to bridge the duodenum and the bile duct. After improvement of jaundice, a duodenal metal stent was placed across the stricture of the duodenum. No procedure-related complications occurred. Neither migration nor obstruction of the two stents was observed during the three months followup period. Combination of ESBD using a fully covered metal stent and duodenal stenting is a ...

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Open versus Laparoscopic Pyloromyotomy for Pyloric Stenosis: A Meta-analysis of Randomized Controlled Trials

European Journal of Pediatric Surgery — Sun, 17 Oct 2010 23:00:00 +0100

Eur J Pediatr SurgDOI: 10.1055/s-0030-1261926AbstractObjective: Aim of the study was to compare the outcomes after laparoscopic pyloromyotomy (LP) with those of open pyloromyotomy (OP) for infantile pyloric stenosis.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: European Journal of Pediatric Surgery)

An overview of infantile hypertrophic pyloric stenosis.

Paediatric Nursing — Fri, 01 Oct 2010 00:00:00 +0100

This article reviews the literature on the cause and management of HPS. PMID: 21066945 [PubMed - in process] (Source: Paediatric Nursing)

The current state of evidence-based pediatric surgery

Journal of Pediatric Surgery — Thu, 30 Sep 2010 23:00:00 +0100

Conclusions: The current state of evidence-based surgery in pediatric surgery has remained stable in the first decade of the 21st century. Randomized controlled trials represent less than 0.05% of all publications involving pediatric surgery. Some of the hurdles to evidence based surgery are identified and reviewed. (Source: Journal of Pediatric Surgery)

Sphincterotome stricturoplasty for long ampullary stenoses and benign biliary strictures (with video)

Surgical Endoscopy — Sat, 11 Sep 2010 05:43:24 +0100

Conclusions Compared with balloon stricturoplasty ± biliary stenting, SS is a simple and cost-effective alternative option in managing long ampullary stenosis and/or distal fibrotic biliary stricture during the initial ERCP. Content Type Journal ArticleDOI 10.1007/s00464-010-1340-3Authors Shou-jiang Tang, Division of Gastroenterology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USASundeep Singh, Division of Gastroenterology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USAShailender Singh, Division of Gastroenterology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 093...

Late-onset hypertrophic pyloric stenosis: definition of diagnostic criteria and algorithm for the management

Journal of Pediatric Surgery — Tue, 31 Aug 2010 23:00:00 +0100

Conclusion: Hypertrophic pyloric stenosis is rarely seen after infancy. Analysis of our results and review of the literature prompted us to redescribe this entity as “late-onset HPS” and define the diagnostic criteria. Late-onset HPS is probably an acquired disease of unknown etiology. The management of late-onset HPS has been summarized in an algorithm, which will also be useful in the treatment of GOO in children caused by etiologies other than classical infantile HPS. (Source: Journal of Pediatric Surgery)

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Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity

Surgery for Obesity and Related Diseases — Fri, 20 Aug 2010 00:00:00 +0100

Conclusion: The results of the present study have shown that laparoscopic re-SG is feasible but carries the risk of fistula development, which is difficult to treat. Laparoscopic DS was also shown to be feasible at a cost of not negligible complications, which are easier to manage than with re-SG. The efficacy seemed greater after DS than after re-SG. (Source: Surgery for Obesity and Related Diseases)

Congenital generalized lipodystrophy, type 4 (CGL4) associated with myopathy due to novel PTRF mutations

American Journal of Medical Genetics Part A — Mon, 02 Aug 2010 23:00:00 +0100

In conclusion, mutations in PTRF result in a novel phenotype that includes generalized lipodystrophy with mild metabolic derangements, myopathy, cardiac arrhythmias, atlantoaxial instability, and pyloric stenosis. It is unclear how mutations in PTRF, which plays an essential role in formation of caveolae, affect a wide variety of tissues resulting in a variable phenotype. © 2010 Wiley-Liss, Inc. (Source: American Journal of Medical Genetics Part A)

Laparoscopic management of neonatal paraesophageal hernia with intrathoracic gastric volvulus

Journal of Pediatric Surgery — Sat, 31 Jul 2010 23:00:00 +0100

We report a case of a 3-week-old term infant who presented to the hospital with a history of non-bilious vomiting. Workup for hypertrophic pyloric stenosis eventually revealed the presence of a congenital hiatal hernia and intrathoracic gastric volvulus requiring urgent surgical management. The infant underwent successful laparoscopic repair. We discuss the diagnosis and management of this extremely rare surgical cause of neonatal nonbilious emesis. (Source: Journal of Pediatric Surgery)

A 9-Year Single Center Experience with Circumumbilical Ramstedt's Pyloromyotomy

European Journal of Pediatric Surgery — Wed, 28 Jul 2010 02:20:17 +0100

In this study we retrospectively reviewed our experience with the circumumbilical incision for the treatment of pyloric stenosis with a particular emphasis on the relation between postoperative emesis and postoperative time to feeds.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: European Journal of Pediatric Surgery)

Sonographic Evaluation of Hypertrophic Pyloric Stenosis

Journal of Diagnostic Medical Sonography — Tue, 20 Jul 2010 15:58:05 +0100

Hypertrophic pyloric stenosis (HPS) is a thickening of the pylorus muscle, which connects the stomach to the duodenum. The exact etiology of this condition is not known, but some believe it is an acquired condition occurring after birth. Most cases occur in infants three to six weeks old. Diagnostic medical sonography is a highly important tool used in the diagnosis of HPS. It does not involve any radiation exposure, which makes it safer for infants. Many key characteristics of this condition help to make an accurate diagnosis. Some cases are treated with medications, but most patients have surgery to correct this condition, which has a very good prognosis. This case demonstrates the typical sonographic appearance of a 31/2-week-old infant with HPS. (Source: Journal of Diagnostic Medical S...

Endoscopic ultrasound-guided transduodenal placement of a fully covered metal stent for palliative biliary drainage in patients with malignant biliary obstruction

Surgical Endoscopy — Fri, 16 Jul 2010 16:50:39 +0100

Conclusions EUSBD with a fully covered SEMS in whom ERCP is unsuccessful is effective for palliation of biliary obstruction. The limitations of our study are that we had a small number of patients and a limited follow-up time. Content Type Journal ArticleDOI 10.1007/s00464-010-1216-6Authors Ali A. Siddiqui, Dallas Veterans Affairs Medical Center Department of Internal Medicine 4500 S. Lancaster Road (111B1) Dallas TX 75216 USAJayaprakash Sreenarasimhaiah, Dallas Veterans Affairs Medical Center Department of Internal Medicine 4500 S. Lancaster Road (111B1) Dallas TX 75216 USALuis F. Lara, Baylor Medical Center Departments of Internal Medicine Dallas TX USAWilliam Harford, Dallas Veterans Affairs Medical Center Department of Internal Medicine 4500 S. Lancaster Road (11...

Umbilical crease incision for duodenal atresia achieves excellent cosmetic results

Pediatric Surgery International — Sun, 11 Jul 2010 12:14:23 +0100

Conclusions The outcome of duodenal atresia is satisfactory with excellent cosmesis after a duodenoduodenostomy performed via the umbilical crease incision. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-010-2645-yAuthors Yukiko Takahashi, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 JapanTatsuro Tajiri, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 JapanKouji Masumoto, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 JapanYoshiaki Kinoshita, Kyushu University Department of Pediatric Surgery, G...

Pyloromyotomy Risk Low at Children's Hospitals

Hospitalist News — Wed, 30 Jun 2010 23:00:00 +0100

Major Finding: For infants undergoing corrective surgery for hypertrophic pyloric stenosis, freestanding children's hospitals had the lowest unadjusted complication rate, at 1.2% vs. 1.6% at children's units located within general hospitals and 2.2% at general hospitals. (Source: Hospitalist News)

Microlaparoscopic pyloromyotomy in children: initial experiences with a new technique

Surgical Endoscopy — Fri, 18 Jun 2010 10:45:27 +0100

Conclusion Despite the limited patient population included in this study, we conclude that use of microlaparoscopic pyloromyotomy for hypertrophic pyloric stenosis is safe and feasible, and the technique provides minimal access trauma and superior cosmesis. Content Type Journal ArticleDOI 10.1007/s00464-010-1172-1Authors Salmai Turial, University Medical Centre Department of Pediatric Surgery Langenbeckstr. 1 55101 Mainz GermanyJan Enders, University Medical Centre Department of Pediatric Surgery Langenbeckstr. 1 55101 Mainz GermanyFelix Schier, University Medical Centre Department of Pediatric Surgery Langenbeckstr. 1 55101 Mainz Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

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Familial Aggregation and Heritability of Pyloric Stenosis [Original Contribution]

JAMA — Tue, 15 Jun 2010 19:51:09 +0100

Conclusion Pyloric stenosis in Danish children shows strong familial aggregation and heritability. (Source: JAMA)

Pyloric Stenosis Has Strong Familial Aggregation

Modern Medicine — Mon, 14 Jun 2010 23:00:00 +0100

Pyloric stenosis, which is the most common condition requiring surgery in an infant's first months of life, has strong familial aggregation and high heritability, according to a study in the June 16 issue of the Journal of the American Medical Association. (Source: Modern Medicine)

Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer.

World Journal of Gastroenterology — Fri, 11 Jun 2010 00:30:09 +0100

We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage ...

Current issues regarding endosonography-guided biliary drainage for biliary obstruction

Digestive Endoscopy — Fri, 07 May 2010 23:00:00 +0100

Transpapillary endoscopic biliary drainage is a well-accepted technique for patients with biliary obstruction. However, transpapillary access to the bile duct is not always possible, especially in patients with duodenal stenosis or difficult cannulation of the bile duct during endoscopic retrograde cholangiopancreatography. Percutaneous transhepatic biliary drainage or surgical bypass has been performed in cases of unsuccessful endoscopic retrograde cholangiopancreatography. Recently, endosonography-guided biliary drainage (ESBD) has been developed as a new biliary drainage technique. Current issues regarding ESBD are discussed in this article. Proper indications for ESBD should be established for widespread performance. Technical standardization and dedicated instruments for ESBD are also...

Investigating the use of preoperative nasogastric tubes and postoperative outcomes for infants with pyloric stenosis: a retrospective cohort study

Journal of Pediatric Surgery — Fri, 30 Apr 2010 23:00:00 +0100

Conclusion: The data strongly suggest that preoperative nasogastric tube placement adversely affects postoperative vomiting and consequently increases length of stay. The lack of consensus about the use of preoperative nasogastric tubes coupled with these findings indicates the need to evaluate this practice with a prospective randomized controlled trial. (Source: Journal of Pediatric Surgery)

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Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant.

Canadian Journal of Anaesthesia — Thu, 29 Apr 2010 23:00:00 +0100

CONCLUSION: Persistence of emboli following endoscopic procedures suggests that the entrained gas is insoluble. Room air contamination increases the potential for catastrophic events during laparoscopy and other endoscopic procedures. PMID: 20431981 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Advances in Minimally Invasive Surgery in Pediatrics

Current Gastroenterology Reports — Thu, 22 Apr 2010 09:28:54 +0100

This article reviews the recent advances in minimally invasive pediatric surgery, and the direction we foresee for the field. Content Type Journal ArticleDOI 10.1007/s11894-010-0109-0Authors Jeffrey A. Blatnik, University Hospitals Case Medical Center Department of General Surgery, Division of Pediatric Surgery 11100 Euclid Avenue Cleveland OH 44106-5047 USATodd A. Ponsky, University Hospitals Case Medical Center Department of General Surgery, Division of Pediatric Surgery 11100 Euclid Avenue Cleveland OH 44106-5047 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 (Source: Current Gastroenterology Reports)

Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study

Gastrointestinal Endoscopy — Sun, 11 Apr 2010 23:00:00 +0100

Conclusion: Both the covered and uncovered SEMSs are effective and have comparable 8-week patency in patients with malignant pyloric obstruction, despite different patterns of late stent failure. (Source: Gastrointestinal Endoscopy)

Lack of association between nNOS −84G>A polymorphism and risk of infantile hypertrophic pyloric stenosis in a Chinese population

Journal of Pediatric Surgery — Wed, 31 Mar 2010 23:00:00 +0100

Conclusions: Failure to replicate the initial finding does not detract from its validity, because genetic effects may differ across populations. Differences across populations in linkage disequilibrium and/or allele frequencies may contribute to this lack of replication. The role nNOS in IHPS awaits further investigation. (Source: Journal of Pediatric Surgery)

Hereditary multiple intestinal atresias: 2 new cases and review of the literature

Journal of Pediatric Surgery — Wed, 31 Mar 2010 23:00:00 +0100

Abstract: Intestinal atresias are a common cause of newborn bowel obstruction (Dalla Vecchia LK, Grosfeld JL, West KW, et al, Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 1998; 133[5]:490-496). Hereditary multiple intestinal atresias, first reported by Guttman et al in 1973, is the rarest form of multiple atresias (Guttman FM, Braun P, Garance PH, et al, Multiple atresias and a new syndrome of hereditary multiple atresias involving the gastrointestinal tract from stomach to rectum. J Pediatr Surg 1973;8:633-640; Bass J, Pyloric atresia associated with multiple intestinal atresias and immune deficiency. J Pediatr Surg 2002;37:941-942.). It has been proposed to be autosomal recessive, to involve atresias in a variable combination of sites from stomach to re...

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S1622: Development of the New “Anti-Migration T”-Stent in Benign and Malignant Pyloric Stenosis: A Pilot Study

Gastrointestinal Endoscopy — Wed, 31 Mar 2010 23:00:00 +0100

Self Expandable Metal Stent (SEMS) is a safe, cost-effective alternative treatment to surgery for pyloric stenosis. But the early migration of covered stent after placement in pyloric channel is the major problem in stent treatment. In spite of the technical advance and development of new models having the effect of anti-migration, the outcomes of the stent are not satisfactory yet. (Source: Gastrointestinal Endoscopy)

T1437: EUS-Guided Choledochoduodenostomy Followed by Endoscopic Antegrade Biliary Stenting via the Fistula for Treatment of Obstructive Jaundice With Duodenal Stenosis

Gastrointestinal Endoscopy — Wed, 31 Mar 2010 23:00:00 +0100

EUS-guided choledochoduodenostomy (EUS-CDS) with insertion of a stent from the duodenal bulb to the extrahepatic bile duct is a possible drainage route in the treatment of patients with obstructive jaundice, when ERCP is unsuccessful. However, stagnant gastroduodenal juice sometimes causes reflux cholangitis through the inserted stent in case that outlet of the gastroduodenal juice is disturbed by stenosis of the duodenum. In those patients, subsequent biliary drainage toward the anal side of the stenosis is desired to prevent the bile duct from reflux of the stagnant fluid. We evaluated the utility of the endoscopic antegrade biliary stenting (EABS) via the fistula for refractory reflux cholangitis. (Source: Gastrointestinal Endoscopy)

W1578: Successful Treatment of Tumors Involving the PYLORIC Channel by ESD Using Retroflexion in the Duodenum

Gastrointestinal Endoscopy — Wed, 31 Mar 2010 23:00:00 +0100

In conclusion, tumor involving pyloric channel could be successfully resected by ESD wihtout complications. (Source: Gastrointestinal Endoscopy)

Learning curves for pediatric laparoscopy: how many operations are enough? The Amsterdam experience with laparoscopic pyloromyotomy

Surgical Endoscopy — Sat, 20 Feb 2010 06:50:37 +0100

Conclusion The number of complications decreased significantly between the first and second groups of the LP patients, with the second group of LP patients quantifying the learning curve. Not only was the complication rate lower in the second LP group, but severe complications also were decreased. This indicates that the learning curve for LP in the current series involved 35 procedures. Content Type Journal ArticleDOI 10.1007/s00464-010-0880-xAuthors M. W. N. Oomen, Academic Medical Center Department of Pediatric Surgery, Emma Children’s Hospital Meibergdreef 9 1105 AZ Amsterdam The NetherlandsL. T. Hoekstra, Academic Medical Center Department of Pediatric Surgery, Emma Children’s Hospital Meibergdreef 9 1105 AZ Amsterdam The NetherlandsR. Bakx, Academic Medic...

Adenocarcinoma arising in a heterotopic pancreas (Heinrich type III): a case report

BioMed Central — Sat, 06 Feb 2010 00:00:00 +0100

Conclusion: Adenocarcinoma arising within the heterotopic pancreas appears to be rare. It is difficult to obtain a correct diagnosis preoperatively. The management of heterotopic pancreas depends on the presence or absence of symptoms. If the patient is asymptomatic or benign, conservative treatment with regular follow-up is recommended. When the patient is symptomatic or there is a suspicion of malignancy, surgical management with intra-operative frozen section diagnosis is indicated. (Source: BioMed Central)

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Reply to Letter to the Editor

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

We are indebted to Professor Schier for his additional information concerning pyloromyotomy. I, too, was puzzled by the ambivalence of Fredet about his procedure and continued use of gastroenterostomy in cases of large tumors. From 1913 until 1920, he wrote mostly about traumatic surgery and did not address pyloric stenosis until 1921. By 1927, he had adopted the Ramstedt operation. His own French colleagues chided him for neglect of his original operation. He, like many other surgeons, was reluctant to leave the mucosa exposed when they could not suture the pyloric muscle transversely. Ramstedt certainly deserves tremendous recognition for his operation. Perhaps Professor Schier could organize an international meeting to celebrate the 100 years since the operation by Ramstedt on August 23...

Delayed presentation of hypertrophic pyloric stenosis: a rare case

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

We report a case of delayed presentation of HPS in a 4 1/2–year-old child in whom the pylorus was hypertrophied and appeared like an “olive,” and for which pyloromyotomy was curative. (Source: Journal of Pediatric Surgery)

Bilateral congenital Morgagni-Larrey's hernia.

World Journal of Pediatrics : WJP — Mon, 01 Feb 2010 00:00:00 +0100

CONCLUSIONS: The diagnosis of bilateral CMLH may be difficult preoperatively, especially if one of the hernial sacs is empty. CT scan is valuable to diagnose bilateral hernias. To repair these hernias, we advocate a transabdominal approach, which allows easy reduction and inspection of contents, access and repair of bilateral hernias, and correction of associated malrotation if present. PMID: 20143216 [PubMed - in process] (Source: World Journal of Pediatrics : WJP)

Expensive “Olives” - Does Hospital Type Affect Pyloromyotomy Outcomes? Analysis of the Kids' Inpatient Database

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:22 +0100

Introduction: Pyloromyotomy for hypertrophic pyloric stenosis is the most common surgical procedure performed on infants. Referrals to specialized pediatric hospitals have been advocated to improve outcomes. The purpose of this study was to determine if hospital type affects lengths of stay (LOS), charges, and morbidity. Methods: Patients undergoing pyloromyotomy for hypertrophic pyloric stenosis were identified in the Kids' Inpatients Database from 2000, 2003, and 2006. Freestanding children's hospitals (CH) were compared to children's units within general hospitals (CHUG) and general/non-children's hospitals (GH). Results: Of the 10,969 patients, 24.7% received care at 30 CH, 34.6% received care at 94 CUGH, and 40.7% received care at 662 GH. CH averaged 30 pyloromyotomies per hospital pe...

Duodenum - Endoscopic Management of a Windsock Diveticulum

The Digital Atlas of Video Education - Gastroenterology — Tue, 19 Jan 2010 09:01:09 +0100

A 24 year old female was referred for complaints intermittent nausea and vomiting and weight loss. The upper GI barium study demonstrates an enlarged diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen around the diverticulum which has been described as the halo sign. Upper endoscopy is performed which identifies a large diverticulum which intermittently obstructs the duodenal lumen. The endoscopic appearance is consistent with a windsock diverticulum. This intraluminal diverticulum is thought to result from incomplete recanalization of the duodenum during embryological development and with complete obstruction, symptoms present during childhood. In contrast, when there is a small aperture in the duodenum, patients may initially remain asymptomatic. Howeve...

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Endoscopic resection of ampullary adenoma after a new insulated plastic pancreatic stent placement: A pilot study

Journal of Gastroenterology and Hepatology — Thu, 14 Jan 2010 00:00:00 +0100

Conclusions: Pre-resection stenting with a polytetrafluoroethylene-insulated stent in patients with adenomas of the major duodenal papilla is a feasible and useful technique to prevent pancreatitis. (Source: Journal of Gastroenterology and Hepatology)

Single-incision laparoscopic pyloromyotomy: initial experience

Surgical Endoscopy — Thu, 24 Dec 2009 19:56:57 +0100

Conclusions Single-incision laparoscopic pyloromyotomy is a safe and feasible procedure with good postoperative results and excellent cosmesis. The main challenge is the spatial orientation of the instruments and endoscope in a small working space. This can be overcome by a more longitudinally oriented working axis than used in the conventional angulated laparoscopic configuration. Content Type Journal ArticleDOI 10.1007/s00464-009-0816-5Authors Oliver J. Muensterer, University of Alabama at Birmingham Department of Pediatric Surgery, Children’s Hospital of Alabama 1600 7th Avenue South ACC 300 Birmingham AL 35233 USAObinna O. Adibe, University of Alabama at Birmingham Department of Pediatric Surgery, Children’s Hospital of Alabama 1600 7th Avenue South ACC 300 Bi...

Test yourself: MCQ and extended matching

Surgery (Medicine Publishing) — Wed, 23 Dec 2009 15:21:11 +0100

For questions 1–4, select the statements which are true and which are false. The correct answers are given below. When considering an infant with pyloric stenosis (Source: Surgery (Medicine Publishing))

The vomiting infant: pyloric stenosis

Surgery (Medicine Publishing) — Wed, 23 Dec 2009 15:21:09 +0100

Abstract: Infantile hypertrophic pyloric stenosis is the commonest reason to perform an intra-abdominal operation on a young infant. It is thus an important condition for the trainee surgeon to understand. It illustrates many important lessons in diagnosis, pre-operative preparation, operative skill and post-operative management and how to apply them to infants and babies to achieve the excellent outcome that is expected with minimal morbidity.For these reasons, and the application of basic sciences, it is a common topic for post-graduate examination.For the trainee in paediatric surgery it is a key operation to learn to perform well and is a stepping stone to performing neonatal surgery. (Source: Surgery (Medicine Publishing))

Percutaneous transcatheter arterial embolization of inferior pancreatico-duodenal artery aneurysms associated with celiac artery stenosis or occlusion

Catheterization and Cardiovascular Interventions — Thu, 17 Dec 2009 00:00:00 +0100

Conclusion:IPDA aneurysms associated with celiac axis stenosis can be successfully treated with percutaneous embolization with minimal recurrence. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Treatment strategy for early gastric cancer with the risk of pyloric stenosis after endoscopic resection

Endoscopy — Tue, 08 Dec 2009 14:16:12 +0100

Endoscopy 2009; 41: 1101-1102DOI: 10.1055/s-0029-1215347© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: Endoscopy)

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Journal of Pediatric Surgery — Sun, 01 Nov 2009 00:00:00 +0100

In this study, the use of intravenous cimetidine (CM) in a small number of infants with HPS is presented. Over a 28-month period, 32 HPS cases, including a sub-group of 17 infants (aged 7-9 weeks) with arterial pH >7.60, were admitted to a tertiary referral unit. Four infants in this sub-group were treated with standard resuscitation fluids for 4 days prior to intravenous CM, while 12 infants received CM immediately. Intravenous CM (10 mg/kg) was given twice daily until arterial pH was less than 7.50. In one case, intravenous omeprazole at 0.1 mg/kg was given instead of CM. In all 17 cases, CM treatment or omeprazole therapy (for 12-48 h) reduced pH to less than 7.50, thus allowing for Ramstedt pyloromyotomy the same day. These patients were allowed oral feeding on the following day and we...

Changing trends in the management of Infantile Hypertrophic Pyloric Stenosis-an audit over 11 years

Irish Journal of Medical Science — Wed, 28 Oct 2009 06:58:40 +0100

Conclusion We conclude a change in practice in the management of IHPS with radiology, particularly ultrasound, playing an increasing role. Content Type Journal ArticleCategory Original PapersDOI 10.1007/BF03169126Authors D. Doyle, Cork University Hospital Dept. of Radiology CorkM. O’Neill, Cork University Hospital Dept. of Radiology CorkD. Kelly, Cork University Hospital Dept. of Radiology Cork Journal Irish Journal of Medical ScienceOnline ISSN 1863-4362Print ISSN 0021-1265 Journal Volume Volume 174 Journal Issue Volume 174, Number 2 / April, 2005 (Source: Irish Journal of Medical Science)

The evidence base for neonatal surgery

Early Human Development — Fri, 23 Oct 2009 15:19:14 +0100

Abstract: The practise of evidence based medicine means integrating the clinical expertise with the best available external clinical evidence from systematic research. There is a lack of supporting scientific evidence from rigorous trials in neonatal surgery. The indications for surgery and the type of operation performed in neonates are rarely supported by randomised controlled trials. As a consequence, the majority of the operations performed in neonates are supported by retrospective studies and surgeon preference.This review article is focussed on operations in neonates which are performed by general paediatric surgeons. Only a few randomised controlled trials have been performed in neonatal diseases such as congenital diaphragmatic hernia, necrotizing enterocolitis, pyloric stenosis a...

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Infantile hypertrophic pyloric stenosis in a regional centre

Irish Journal of Medical Science — Wed, 14 Oct 2009 17:05:13 +0100

Conclusion The majority of infants with IHPS may be safely managed in regional centres with transfer to specialist paediatric centres reserved for ‘high risk’ cases. The management of IHPS at a regional level has important implications and presents opportunities for surgical training. Content Type Journal ArticleCategory Original PaperDOI 10.1007/BF03166908Authors P. D. Kiely, Mid-Western Regional Hospital and the University of Limerick Biomedical Institute Department of Surgery Limerick IrelandS. Tierney, Mid-Western Regional Hospital and the University of Limerick Biomedical Institute Department of Surgery Limerick IrelandM. Barry, Mid-Western Regional Hospital and the University of Limerick Biomedical Institute Department of Surgery Limerick IrelandP. V. Delane...

Pyloric stenosis: A retrospective study of an Australian population

Emergency Medicine Australasia — Mon, 12 Oct 2009 23:00:00 +0100

Increased awareness of idiopathic hypertrophic pyloric stenosis (IHPS) and readily available ultrasonographic diagnosis might mean that 'classic' presentations are becoming less common. We sought to describe the epidemiology, clinical features and outcomes of children with IHPS in the modern era. A retrospective case review of all cases of IHPS presenting to a single tertiary paediatric hospital over an 11 year period was conducted. Inclusion criteria were met by 329 children with confirmed IHPS. Eighty-four per cent of patients were male and 19% were born premature. Premature infants tended to present later, reflecting postmenstrual age. The median age at presentation was 5 weeks (range 0[ndash]31) with median symptom duration of 7 days (range 1[ndash]95). At least one classic symptom or ...

Impact of spinal anesthesia for open pyloromyotomy on operating room time

Journal of Pediatric Surgery — Wed, 30 Sep 2009 23:00:00 +0100

Conclusions: The use of spinal anesthesia for open pyloromyotomy in infants with HPS shortens the operating room time by reducing the wake-up time. (Source: Journal of Pediatric Surgery)

Duodenal stenosis caused by cystic dystrophy in heterotopic pancreas: Report of a case

Surgery Today — Wed, 23 Sep 2009 05:51:29 +0100

Abstract We herein describe the first reported case of duodenal stenosis caused by cystic dystrophy in heterotopic pancreas (CDHP) in Asia. A 63-year-old man was admitted to the hospital presenting with nausea and vomiting of 2 days’ duration. Laboratory examinations showed an elevation in both the serum amylase level (275 IU/l) and white blood cell count (13 600/µl). A 3-cm-diameter tumor close against the duodenum was pointed out from the results of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP); the tumor contained a cystic and solid component. Endoscopic examinations and an upper gastrointestinal series showed stenosis of the second portion of the duodenum without any mucosal change. The tumor was considered to be located at the submu...

New insights into the pathogenesis of infantile pyloric stenosis

Pediatric Surgery International — Thu, 17 Sep 2009 12:07:12 +0100

Abstract Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of vomiting in infants. Despite numerous hypotheses, the aetiopathogenesis of IHPS is not fully understood. Genetic, extrinsic and hormonal factors have been implicated in the pathogenesis of the disease. Furthermore, abnormalities of various components of the pyloric muscle such as smooth muscle cells, growth factors, extracellular matrix elements, nerve and ganglion cells, synapses, nerve supporting cells, neurotransmitters and interstitial cells of Cajal have been reported. Recently, genetic studies have identified susceptibility loci for IHPS and molecular studies have concluded that smooth muscle cells are not properly innervated in IHPS. Content Type Journal ArticleCategory Re...

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Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty

Surgery for Obesity and Related Diseases — Tue, 15 Sep 2009 23:00:00 +0100

Conclusion: LSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results. (Source: Surgery for Obesity and Related Diseases)

Pyloric stenosis in an iniencephalic infant with a congenital intra-thoracic stomach

Pediatric Surgery International — Thu, 03 Sep 2009 06:24:49 +0100

We report the first case of hypertrophic pyloric stenosis in an intrathoracic stomach in a neonate with congenital ultra-short oesophagus and iniencephaly clausus. Antenatal ultrasound detected right-sided thoracic cystic lesions and postnatal investigations revealed an intra-thoracic stomach and spleen with an ultra-short oesophagus and intact diaphragm. Subsequently, she developed pyloric stenosis. Such neonates require urgent referral to surgical centres for what is a challenging diagnosis and complicated management. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00383-009-2479-7Authors Lucinda C. Winckworth, Chelsea & Westminster Hospital NHS Foundation Trust Department of Neonatology 369 Fulham Road London SW10 9NH UKClare M. Rees, Chelsea & Westminster Hospital...

Pierre Fredet and pyloromyotomy

Journal of Pediatric Surgery — Mon, 31 Aug 2009 23:00:00 +0100

Pyloromytotomy for hypertrophic pyloric stenosis is one of the most important operations of the 20th century. A hundred years ago, few infants with this disease survived. Now every baby with pyloric stenosis should live. We owe a great debt to the surgical pioneers, such as Pierre Fredet, who brought about this remarkable accomplishment. (Source: Journal of Pediatric Surgery)

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Journal of Pediatric Surgery — Mon, 31 Aug 2009 23:00:00 +0100

Many innovations and approaches have been tried for the surgical management of infantile hypertrophic pyloric stenosis (IHPS) since Ramstedt's first successful surgery almost 100 years ago. A new technique is described by the authors, which may offer better results for this common condition. (Source: Journal of Pediatric Surgery)

A novel association of duodenal atresia, malrotation, segmental dilatation of the colon, and anorectal malformation

Pediatric Surgery International — Fri, 21 Aug 2009 15:27:09 +0100

We describe two female neonates who suffered from four gastrointestinal anomalies, including duodenal stenosis or atresia, malrotation, segmental dilatation of the colon, and anorectal malformation. Each patient was managed by two or three operations, resulting in good bowel movements. Since this is the first report of four gastrointestinal anomalies, these cases may provide clues to elucidate the etiology of gastrointestinal tract developmental abnormalities. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00383-009-2459-yAuthors Nobuyuki Morikawa, National Center for Child Health and Development Division of General Surgery 2-10-1 Okura Setagaya-ku Tokyo 157-8535 JapanTatsuo Kuroda, National Center for Child Health and Development Division of General Surgery 2-10-1 Ok...

Early pyloric stenosis: a case control study

Pediatric Surgery International — Fri, 21 Aug 2009 15:27:08 +0100

Conclusions Babies presenting with EPS are more likely to be breast fed and to have a positive family history. EPS is associated with a longer hospital stay. Use of sonographic diagnostic measurements specific to this age group may prevent delays in diagnosis and treatment, and improve outcomes. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2463-2Authors Marie Demian, California & University of California, Irvine School of Medicine Division of Pediatric Surgery, Miller Children’s Hospital, Long Beach Orange CA USASon Nguyen, Miller Children’s Hospital Department of Pediatric Radiology Long Beach CA USASherif Emil, California & University of California, Irvine School of Medicine Division of Pediatric Surgery, Miller Children’s Hospit...

Duodenal stenosis resulting from a preduodenal portal vein and an operation for scoliosis.

World Journal of Gastroenterology : WJG — Thu, 20 Aug 2009 23:00:00 +0100

Authors: Masumoto K, Teshiba R, Esumi G, Nagata K, Nakatsuji T, Nishimoto Y, Yamaguchi S, Sumitomo K, Taguchi T A preduodenal portal vein (PDPV) is known to be a rare cause of duodenal stenosis. We treated a 22-year-old male patient with malnutrition as a result of PDPV and a previously performed operation for scoliosis, who showed an improvement in quality of life after being treated with a combination of nutritional support and surgery. The patient with PDPV had been admitted to our department with duodenal stenosis, ranging from the first to third portions. He had suffered from vomiting since 1 year of age, and he developed malnutrition during the last 6-mo period after orthopedic surgery for scoliosis. The stenosis was related to both the PDPV and the previously performed operation...

Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis

Journal of Pediatric Surgery — Tue, 28 Jul 2009 11:48:04 +0100

Conclusions: This meta-analysis favors the laparoscopic approach with significantly reduced rate of total complications, which is mostly due to a lower wound complication rate. (Source: Journal of Pediatric Surgery)

Congenital Abdominal Aortic Aneurysm and Hypertrophic Pyloric Stenosis in an Infant

Journal of Diagnostic Medical Sonography — Thu, 16 Jul 2009 23:00:00 +0100

Infantile abdominal aortic aneurysms are rare, usually detected incidentally, and associated with connective tissue disease or due to iatrogenic causes. The diagnosis should be considered when a large cystic mass (especially pulsatile) is found in a neonate and confirmed using color and duplex sonography. Undiagnosed aneurysms have a high mortality rate. Surgical treatment is warranted when the patient is stabilized and may result in a normal outcome, although future graft replacement may be necessary. (Source: Journal of Diagnostic Medical Sonography)

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Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period

Gastrointestinal Endoscopy — Thu, 16 Jul 2009 00:00:00 +0100

Conclusions: Most ampullary adenomas are amenable to endoscopy. Underlying malignancy and lateral extension may be risk factors for bleeding and perforation. Smaller lesion size and the absence of dilated ducts are factors favorably affecting success. (Source: Gastrointestinal Endoscopy)

ESPEN Guidelines on Parenteral Nutrition: Pancreas

Clinical Nutrition — Tue, 14 Jul 2009 23:00:00 +0100

Summary: Assessment of the severity of acute pancreatitis (AP), together with the patient's nutritional status is crucial in the decision making process that determines the need for artificial nutrition. Both should be done on admission and at frequent intervals thereafter. The indication for nutritional support in AP is actual or anticipated inadequate oral intake for 5–7days. This period may be shorter in those with pre-existing malnutrition. Substrate metabolism in severe AP is similar to that in severe sepsis or trauma. Parenteral amino acids, glucose and lipid infusion do not affect pancreatic secretion and function. If lipids are administered, serum triglycerides must be monitored regularly. The use of intravenous lipids as part of parenteral nutrition (PN) is safe and feasible whe...

Large-balloon technique for one-step endoscopic biliary stenting in patients with an inaccessible major papilla owing to difficult duodenal stricture (with video)

Gastrointestinal Endoscopy — Wed, 01 Jul 2009 23:00:00 +0100

Conclusions: Use of large-balloon dilation can contribute to successful ERCP in patients with difficult duodenal strictures. (Source: Gastrointestinal Endoscopy)

Management and Outcomes for Children with Pyloric Stenosis Stratified by Hospital Type1

Journal of Surgical Research — Mon, 29 Jun 2009 00:00:00 +0100

Conclusions: Care at our public hospital leads to delayed diagnosis and treatment, resulting in longer preoperative and total LOS in infants with pyloric stenosis, most likely related to the timing of the preoperative US. Efforts should be made to encourage patients to use the outpatient clinic facilities for their ill infants, or for physicians at public hospitals to expedite the US process once the diagnosis of pyloric stenosis is entertained. (Source: Journal of Surgical Research)

Encoscopic management of stenotic anastomosis using a rendezvous technique after pancreatogastrostomy

Digestive Endoscopy — Sun, 21 Jun 2009 23:00:00 +0100

A 46-year-old female patient was referred to our hospital for endoscopic treatment of stenotic pancreatogastrostomy. She had undergone pylorus-preserving pancreatoduodenectomy due to duodenal carcinoma of the papilla of Vater 5 years before referral. Two years after the operation, she had to be hospitalized several times during a 1-year period because of acute recurrent pancreatitis caused by stenosis of the anastomosis of the pancreatoduodenostomy. An endoscopic ultrasound (EUS)-guided rendezvous technique was selected to puncture the main pancreatic duct via a transgastric approach. We identified the dilated main pancreatic duct with a convex array echoendoscope from the lower gastric body near the anastomosis and successfully punctured the dilated main pancreatic duct. The guidewire pas...

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[Miscellanea] Open or laparoscopic pyloromyotomy for infantile pyloric stenosis

Archives of Disease in Childhood — Thu, 18 Jun 2009 23:00:00 +0100

(Source: Archives of Disease in Childhood)

Return of the surgeon in the diagnosis of pyloric stenosis

Journal of Pediatric Surgery — Sun, 31 May 2009 23:00:00 +0100

Conclusion: Surgeons who have undergone focused training to perform US for PS can diagnose the condition without confirmatory testing by a radiologist. (Source: Journal of Pediatric Surgery)

Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel—EPACT II

Journal of Critical Care — Mon, 18 May 2009 00:00:00 +0100

Conclusion: EPACT II recommendations are freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (Source: Journal of Critical Care)

Feasibility of self-expandable metallic stent plus chemotherapy for metastatic gastric cancer with pyloric stenosis

Journal of Gastroenterology and Hepatology — Sun, 10 May 2009 04:00:00 +0100

Conclusions: The present results suggest that chemotherapy after stenting is as effective and safe as chemotherapy after surgery. Stents may replace surgery in combination therapy with chemotherapy for metastatic gastric cancer with gastric outlet obstruction. (Source: Journal of Gastroenterology and Hepatology)

Laparoscopic duodenoduodenostomy in the neonate

Journal of Pediatric Surgery — Fri, 01 May 2009 04:00:00 +0100

Conclusions: Laparoscopic duodenoduodenostomy in the neonate can be safely and successfully performed with excellent short-term outcome. (Source: Journal of Pediatric Surgery)

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Surgical treatment for right colon cancer directly invading the duodenum.

The American Surgeon — Thu, 30 Apr 2009 23:00:00 +0100

In conclusion, duodenal invasion by a right-sided colon carcinoma does not necessarily represent incurable disease. If carefully applied based on the extent of duodenal invasion, active surgical management is very useful for improving patient prognosis without increasing the risks associated with surgery. PMID: 19445288 [PubMed - indexed for MEDLINE] (Source: The American Surgeon)

Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis

Medscape Gastroenterology Headlines — Tue, 21 Apr 2009 02:15:50 +0100

Commentary on a study on a laparoscopic approach for pyloromyotomy in infants, published January 2009 in Lancet. Medscape General Surgery (Source: Medscape Gastroenterology Headlines)

Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report

Journal of Pediatric Surgery — Wed, 01 Apr 2009 04:00:00 +0100

We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy by injection of carbon dioxide into a patent umbilical vein. The diagnosis of carbon dioxide embolism was made on the basis of the abrupt decrease in end-tidal CO2, sudden decreased Spo2, hypotension, and cyanosis. Portable x-ray with the clinical presentation was sufficient for a diagnosis of carbon dioxide embolism. Treatment included termination of CO2 insufflation, placing the patient in Durant's position, and adequate resuscitation as necessary. Despite the fact that the insufflation pressure was in the recommended range, a carbon dioxide embolism was thought to be caused by injection of carbon dioxide into a patent umbilical vein. Although laparoscopic pyloromyotomy has demonstrate...

Hypertrophic pyloric stenosis and pulmonary hypertension in a neonate. A common mechanism?

Acta Paediatrica — Thu, 19 Mar 2009 04:00:00 +0100

In conclusion, the association of pulmonary hypertension and pyloric stenosis has not been described before and may be explained by a lowered plasma concentration of arginine leading to deficient NO synthesis in the affected organ systems. (Source: Acta Paediatrica)

Gastric tube interposition for corrosive esophagitis associated with pyloric stenosis

Surgery Today — Thu, 12 Mar 2009 10:24:51 +0100

We describe how we successfully treated corrosive esophagitis associated with pyloric stenosis, by performing gastric tube interposition for the esophageal reconstruction. After resecting the injured distal part of the stomach, we pulled the pedunculated gastric tube up to the cervix after anastomosis to the jejunal limb in a Roux-en-Y fashion. This reconstruction procedure prevented excessive organ sacrifice and was minimally invasive. Thus, esophageal reconstruction by interposition using a pedunculated gastric tube can be used effectively to treat corrosive esophagitis associated with pyloric stenosis. Content Type Journal ArticleCategory How to Do ItDOI 10.1007/s00595-008-3834-3Authors Atsushi Matsuki, Niigata University Graduate School of Medical and Dental Sciences Division...

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Management of Complications Associated with Partially Covered Biliary Metal Stents

Digestive Diseases and Sciences — Sat, 07 Mar 2009 12:28:14 +0100

Conclusions Major complications associated with PCMS placement include migration and cholecystitis. Their management includes endoscopic revision, cholecystectomy, and gallbladder drainage. Further improvements in the structure and composition of PCMS may prevent these complications. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-009-0756-xAuthors Henry Ho, University of Virginia Health System Digestive Health Center Charlottesville Box 800708 VA 22908-0708 USAAnshu Mahajan, University of Virginia Health System Digestive Health Center Charlottesville Box 800708 VA 22908-0708 USASonia Gosain, University of Virginia Health System Digestive Health Center Charlottesville Box 800708 VA 22908-0708 USAAnimesh Jain, University of Virginia Health System Digestive Hea...

The progressive development of pyloric stenosis: a role for repeat ultrasound

Journal of Pediatric Surgery — Sun, 01 Mar 2009 05:00:00 +0100

Patients presenting in the first 3 months of life with nonbilious emesis are commonly studied by ultrasound. A negative study effectively rules out pyloric stenosis. However, the development of pyloric stenosis is a progressive and dynamic process. The rate of hypertrophy to the point of meeting diagnostic criteria is unknown, and there are no data published in the literature regarding the role of repeat ultrasound in patients with persistent symptoms. During a prospective, randomized trial, the authors identified three patients with negative ultrasounds who subsequently were diagnosed and treated for pyloric stenosis. This series is presented as an illuminating depiction of the development of muscle hypertrophy in patients with pyloric stenosis. Three patients were identified with a negat...

Gastric Foveolar Cell Hyperplasia and its Role in Postoperative Vomiting in Patients with Infantile Hypertrophic Pyloric Stenosis

European Journal of Pediatric Surgery — Fri, 27 Feb 2009 01:34:02 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1039199Abstract Foveolar cell hyperplasia (FCH) has been reported as a rare cause of persistent gastric outlet obstruction in patients with infantile hypertrophic pyloric stenosis (IHPS), which, if present, requires excision of the gastric foveolar folds to resolve the persistent obstruction. This is a review of patients with IHPS diagnosed on abdominal ultrasound to determine the incidence of FCH in IHPS and to evaluate whether it has a causal role in postoperative vomiting following pyloromyotomy for IHPS. The ultrasound images of all children presenting with suspected IHPS to our institution from January 2001 to May 2006 were independently reviewed by our radiology department for evidence of FCH. Three hundred and twenty-nine ultrasounds were perfor...

Hypertrophic Pyloric Stenosis in an Adolescent

Journal of Laparoendoscopic — Thu, 26 Feb 2009 16:57:44 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0: 1-2. (Source: Journal of Laparoendoscopic)

Double-Y Pyloromyotomy: A New Technique for the Surgical Management of Infantile Hypertrophic Pyloric Stenosis

European Journal of Pediatric Surgery — Tue, 17 Feb 2009 19:05:08 +0100

Eur J Pediatr Surg 2009; 19: 17-20DOI: 10.1055/s-2008-1039025Abstract Many innovations and approaches have been tried for the surgical management of infantile hypertrophic pyloric stenosis (IHPS) since Ramstedt's first successful surgery almost one hundred years ago. We define here a new technique focusing on the pylorus which may offer better results for this common condition. A prospective study of 40 patients with infantile hypertrophic pyloric stenosis was carried out over a period of 3 years, from January 2005 to January 2008. The patients were divided into 2 equal groups of 20 patients each. The study was designed that all patients selected for the study would be optimized preoperatively with regard to hydration, acid-base status and electrolyte imbalance. All surgeries were performe...

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Keyhole surgery offers pyloric stenosis benefits

MedWire News - Gastroenterology — Mon, 02 Feb 2009 13:14:27 +0100

A laparoscopic, keyhole approach to correct pyloric stenosis can have advantages over open surgery in infants, a trial published in The Lancet suggests. (Source: MedWire News - Gastroenterology)

Rapid correction of metabolic alkalosis in hypertrophic pyloric stenosis with intravenous cimetidine: preliminary results

Pediatric Surgery International — Sat, 24 Jan 2009 12:36:14 +0100

Conclusion Intravenous CM administration can rapidly normalize severe metabolic alkalosis in HPS patients. As a result, pyloromyotomy can be performed sooner reducing both hospital stay and costs. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2335-9Authors Behrouz Banieghbal, University of the Witwatersrand Division of Pediatric Surgery PO Box 5042 Cresta Johannesburg 2118 South Africa Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358 (Source: Pediatric Surgery International)

Laparoscopic Seromyotomy for Long Stenosis After Sleeve Gastrectomy with or Without Duodenal Switch

Obesity Surgery — Sat, 24 Jan 2009 10:16:43 +0100

Conclusion Laparoscopic seromyotomy after SG for long stenosis is feasible, and efficient for the treatment of symptomatic dysphagia. It has a beneficiary influence on de novo GERD symptoms improvement. There is, however, the risk of postoperative leak. Content Type Journal ArticleCategory New ConceptsDOI 10.1007/s11695-009-9803-0Authors Giovanni Dapri, Saint-Pierre University Hospital Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery 322 rue Haute 1000 Brussels BelgiumGuy Bernard Cadière, Saint-Pierre University Hospital Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery 322 rue Haute 1000 Brussels BelgiumJacques Himpens, Saint-Pierre University Hospital Department of Gastrointestinal Surgery, European School...

For Children With Pyloric Stenosis, Laparoscopic Technique Has Advantages Over Open Surgery

Health News from Medical News Today — Sun, 18 Jan 2009 08:00:00 +0100

The use of small, laparoscopic equipment to correct pyloric stenosis in newborn children has advantages over open surgery - but the laparoscopic technique should only be performed in centres with the required level of expertise. (Source: Health News from Medical News Today)

Laparoscopic Repair of Pediatric Pyloric Stenosis May Speed Recovery

MedPage Today Surgery — Fri, 16 Jan 2009 22:30:00 +0100

LONDON (MedPage Today) -- Laparoscopic surgery for children with pyloric stenosis may be just as safe as open pyloromyotomy, with some additional outcome advantages, researchers found. (Source: MedPage Today Surgery)

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The innovation of success: the pediatric surgery and APSA response to “disruptive technologies”

Journal of Pediatric Surgery — Thu, 01 Jan 2009 05:00:00 +0100

In 1907, just more than 100 years ago, a landmark paper described the work of French surgeon Pierre Fredet as he defined the operation for hypertrophic pyloric stenosis , a technique that has firmly withstood the test of time in providing an optimal outcome for these patients. It was a remarkable innovation at that time, “a new intervention, not yet accepted as meeting the standards of safety, reliability and familiarity with its effects, side effects and complications” . In fact, it could more explicitly have been labeled as a “disruptive technology” or “revolutionary technology,” that introduced into our operative care paradigm a new strategy or technique that revolutionized the care of children with pyloric stenosis that subsequently has been sustained as the treatment choic...

Surgeon-performed ultrasound for diagnosis of pyloric stenosis is accurate, reproducible, and clinically valuable

Journal of Pediatric Surgery — Thu, 01 Jan 2009 05:00:00 +0100

Conclusion: Surgeon-performed ultrasound examination for the diagnosis of HPS is accurate and reproducible through surgeon-to-surgeon instruction on appropriate technique. This skill is a valuable asset in the initial surgical evaluation of any patient with suspected HPS, expediting appropriate management. (Source: Journal of Pediatric Surgery)

Access to the Hypertrophic Pylorus: Does It Make a Difference to the Patient?

European Journal of Pediatric Surgery — Tue, 09 Dec 2008 12:24:05 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1039006Abstract The aim of the study was to evaluate the effects of different access methods for the treatment of pyloric stenosis (PS). Since 2001, we have operated on children with PS using three different access methods: classic right upper quadrant transverse incision (TI), incision on the superior umbilical fold (UI) and laparoscopic (L). We reviewed the records of these children with special emphasis on the number and characteristics of complications, operative time, and length of stay (LOS). We identified 256 patients (212 M, 44 F) with a mean age of 36 days. 138 procedures were performed using TI, 18 with UI and 100 laparoscopically. The mean operative time for patients with TI was 35.9 ± 8.6 min, and for those wi...

Intermittent Wound Perfusion for Postoperative Pain Relief Following Upper Abdominal Surgery: A Surgeon's Perspective

Pain Practice — Tue, 04 Nov 2008 05:00:00 +0100

Conclusion: Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function. (Source: Pain Practice)

Prevalence of infantile hypertrophic pyloric stenosis in Texas, 1999-2002

Birth Defects Research Part A: Clinical and Molecular Teratology — Tue, 04 Nov 2008 05:00:00 +0100

CONCLUSIONS: This study confirmed previous findings that female infants and Black infants have a lower rate of IHPS. Large decreases in rates of IHPS were observed among foreign-born Hispanics and foreign-born Asians, but not among their US-born counterparts. These findings may be explained by differences in the frequency of behavioral risk factors for IHPS or differences in the frequency of ascertainment of mild cases of IHPS by ethnicity or nativity. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

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Predictors of emesis and time to goal intake after pyloromyotomy: analysis from a prospective trial

Journal of Pediatric Surgery — Thu, 30 Oct 2008 18:41:53 +0100

Conclusions: The degree of hypochloremic, hypokalemic, metabolic alkalosis on presentation strongly correlates to the number of episodes of postoperative emesis and time to goal feeds in patients undergoing pyloromyotomy for pyloric stenosis. Furthermore, the corresponding duration of dehydration and failure to thrive appears to correlate with outcomes as there was a significant inverse correlation with weight on admission to the number of episodes of postoperative emesis and time to goal feeds. (Source: Journal of Pediatric Surgery)

Annular pancreas causing localized recurrent pancreatitis in a child: Report of a case

Surgery Today — Wed, 29 Oct 2008 07:02:24 +0100

We report a case of relapsing acute pancreatitis localized in the annulus of an annular pancreas in a young child. A 6-year-old boy complained of abdominal pain and we made a diagnosis of acute pancreatitis based on blood biochemistry results. Over the subsequent 12 months, he experienced two more pancreatitis-like attacks. Endoscopy revealed a duodenal stenosis in the second portion of the duodenum. Ultrasound, computed tomography, and magnetic resonance imaging depicted a ring of pancreatic tissue encircling the duodenum with a duct in the tissue, manifesting dilatation with a characteristic circular pattern around the duodenum. No dilatation of the dorsal pancreatic duct or pancreatic divisum was found. Based on these findings, we diagnosed acute pancreatitis localized in an annul...

Circumumbilical pyloromyotomy in the era of minimally invasive surgery

Journal of Pediatric Surgery — Wed, 01 Oct 2008 04:00:00 +0100

Conclusions: Overall satisfaction with the cosmetic outcome of circumumbilical pyloromyotomy is very high. (Source: Journal of Pediatric Surgery)

Gastric outlet obstruction in children: an overview with report of “Jodhpur disease” and Sharma's classification

Journal of Pediatric Surgery — Wed, 01 Oct 2008 04:00:00 +0100

Conclusions: These patients represent a new disease entity designated as primary acquired gastric outlet obstruction during infancy and childhood. Author's classification is complete and scientific, encompassing all rare causes of GOO. We nickname this idiopathic variety of GOO the Jodhpur disease, the place of the first cases. (Source: Journal of Pediatric Surgery)

Comparison of laparoscopic truncal vagotomy with gastrojejunostomy and open surgery in peptic pyloric stenosis

Surgical Endoscopy — Wed, 24 Sep 2008 08:11:09 +0100

Conclusions This study suggests that LTVGJ is a feasible technique, and intermediate follow-up reveals good symptomatic results when used for PPS. Content Type Journal ArticleDOI 10.1007/s00464-008-0160-1Authors Seok-Mo Kim, Yonsei University College of Medicine Department of Surgery 134 Shinchon-dong Seodaemun-ku Seoul 120-752 South KoreaJyewon Song, Yonsei University College of Medicine Department of Surgery 134 Shinchon-dong Seodaemun-ku Seoul 120-752 South KoreaSung Jin Oh, Yonsei University College of Medicine Department of Surgery 134 Shinchon-dong Seodaemun-ku Seoul 120-752 South KoreaWoo Jin Hyung, Yonsei University College of Medicine Department of Surgery 134 Shinchon-dong Seodaemun-ku Seoul 120-752 South KoreaSeung Ho Choi, Yonsei University College of Medic...

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Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications

Surgical Endoscopy — Wed, 24 Sep 2008 08:11:03 +0100

Conclusions Complications after SG greatly decrease after the learning curve period and can be successfully managed without need of reoperation. Suture-line reinforcement, at least selectively in the middle-upper portion of the staple line and in super-super-obese patients, is recommended to decrease the incidence of specific complications. Content Type Journal ArticleDOI 10.1007/s00464-008-0113-8Authors G. Silecchia, University of Rome “La Sapienza” Department of Surgery “Paride Stefanini”, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyM. Rizzello, University of Rome “La Sapienza” Department of Surgery “Paride Stefanini”, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Casella, University of Rome “La Sapienza...

Negative exploration for pyloric stenosis- Is it preventable?

BMC Pediatrics - Latest articles — Wed, 24 Sep 2008 04:00:00 +0100

Background: The diagnosis of infantile hypertrophic pyloric stenosis (IHPS), although traditionally clinical, is now increasingly dependent on radiological corroboration. The rate of negative exploration in IHPS has been reported as 4%. The purpose of our study was to look at elements of supportive clinical evidence leading to positive diagnosis, and to review these with respect to misdiagnosed cases undergoing negative exploration. Methods: All infants undergoing surgical exploration for IHPS between January 2000 and December 2004 were retrospectively analysed with regard to clinical symptoms, examination findings, investigations and operative findings. Results: During the study period, 343 explorations were performed with a presumptive diagnosis of IHPS. Of these, 219 infants (64%) had...

An Effective Duodenum Bulb Mobilization for Extracorporeal Billroth I Anastomosis of Laparoscopic Gastrectomy

Journal of Gastrointestinal Surgery — Tue, 16 Sep 2008 09:25:37 +0100

Conclusions Feasible duodenal bulb mobilization by complete dissection of the greater omentum allows easy performance of extracorporeal B-I anastomosis and minimizes complications related to anastomosis in LADG. Content Type Journal ArticleDOI 10.1007/s11605-008-0686-5Authors Naoki Hiki, Japanese Foundation for Cancer Research Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital 3-10-6 Ariake, Koto-ku Tokyo 135-8550 JapanTestsu Fukunaga, Japanese Foundation for Cancer Research Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital 3-10-6 Ariake, Koto-ku Tokyo 135-8550 JapanMasanori Tokunaga, Japanese Foundation for Cancer Research Gastroenterological Center, Department of Gastroentero...

A rare presentation in a case of gastric duplication cyst communicating to the pancreatic duct: coincidental detection during pyloromyotomy for hypertrophic pyloric stenosis

Journal of Pediatric Surgery — Mon, 01 Sep 2008 04:00:00 +0100

Abstract: A rare case of gastric duplication of childhood is reported. A 1-month-old boy underwent pyloromyotomy for infantile hypertrophic pyloric stenosis. At laparotomy, a protruding lesion was identified in the anterior wall of the pylorus. The pylorus was hypertrophic as indicated preoperatively, and a normal pyloromyotomy was performed. Wedge biopsy of the protruding lesion revealed an intestinal structure, and gastric duplication was diagnosed. The child remained asymptomatic thereafter, but considering the risk of the duplication becoming symptomatic, a second laparotomy was performed at 1 year of age. The duplication cyst shared part of the wall with the pylorus, and the cyst was removed by cystectomy, leaving the pyloric muscle intact. The cyst was found to be communicating with ...