Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis

Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted  appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome. Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively. Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min  (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which  subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively. Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent. Keywords: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectom

High-grade vesicoureteral reflux in infants: Our experience with endoscopic subureteric injections

Background: Vesicoureteral reflux (VUR) is the most common urological anomaly in pediatric patients. Management options for VUR vary from continuous antibiotic prophylaxis (CAP) to surgery via either endoscopic subureteric injection of a bulking agent or open anti-reflux surgery. In this study, we assess the efficacy of subureteric injections of Dextranomer/Hyaluronic acid Copolymer (Deflux) in managing primary VUR in infant patients with high-grade VUR. Methods: From 2010 to 2015, children less than 1-year-old with primary high-grade VUR were observed prospectively following the administration of endoscopic subureteric injections of Dextranomer/Hyaluronic Acid Copolymer (Deflux). The diagnosis of VUR was based on MCUG, and all patients underwent a holistic clinical, laboratory, and radiological assessment before and after the intervention. Complete success was defined as the resolution of VUR on follow up 1 year post-operatively. Results: A total of 30 infants (50 renal units) with high-grade VUR (grades IV and V) were included in the study. The mean age at surgery was 6.3 ± 2.5 months. Most of the patients presented with a urinary tract infection (90%). Complete symptomatic relief was achieved in 27 patients (90%) at the first post-operative follow-up. Forty-four renal units received one injection, while six required a second injection as they did not meet our treatment success criteria. No patients required a third injection or referral for open surgery. Conclusion: Endoscopic injection of Dextranomer/Hyaluronic acid Copolymer (Deflux) at the vesicoureteral junction is an effective minimally invasive intervention to treat high grades VUR (IV–V) infants. </jats:sec

The outcome of PDA ligation by mini-thoracotomy in premature neonates: A single hospital experience

Background: Various thoracotomy practices have been employed for occlusion of patent ductus arteriosus (PDA) which are not amenable to medical management. We report our preliminary experience of using a mini-thoracotomy approach in small premature infants and determining survival outcomes in relation to factors such as gender, birth weight, age, and type of ventilation used intraoperatively.  Methods: Between January 2004 and December 2012, 52 consecutive premature infants with an echocardiographic diagnosis of isolated PDA, which are not amenable to medical treatment, were included. Those with chromosomal abnormalities, major cardiac congenital anomalies aside from septal defects, and infants who did not receive mechanical ventilation in the first week of life were excluded. The median gestational age was 28 weeks and the median gestational weight at surgery was 705g. The median PDA size was 3.8mm, ranging from 1.6 to 5mm. Twenty-nine patients were given non-selective ventilation and twenty-three were anesthetized using selective right-lung ventilation using a 2-F balloon catheter for arterial embolectomy. A left lateral mini-thoracotomy was performed in all infants and PDA closure achieved by double ligation using zero silk sutures. Results: The median operative time and mean length of hospital stay were 45 minutes and 90 days, respectively. No major hemorrhage requiring blood transfusion occurred during the surgery. The survival rate until hospital discharge was 88.5%. There were no mortalities associated with the surgery itself. Six (11.5%) neonates died postoperatively because of prematurity (p-value=1.000). Pneumonia and atelectasis were among the few complications encountered post ligation. An interesting association was recognized between ventilation and surgical complications; that is neonates who underwent selective right ventilation did not experience any of the complications mentioned above in comparison to those who were put under non-selective ventilation (p-value &lt;0.001). Conclusion: Closure of PDA by double ligation via a left mini-thoracotomy in small premature infants proved to be safe and effective in providing pediatric surgeons adequate exposure within confined and delicate anatomic spaces. No mortalities or major complications were encountered.</jats:p

Duplication cyst of the esophagus: A rare congenital cause for vomiting and respiratory distress

A duplication cyst of the esophagus is the 2ndmost common congenital anomaly of the gastrointestinal tract. Although these benign cystic masses can be picked up routinely on a chest X-ray, patients may experience symptoms such as stridor or dysphagia corresponding to lesions within the neck or mediastinum. We present a rare case of a duplication cyst of esophagus in a 2-week-old female baby, which was surgically excised. Our aim in this case report is to raise awareness of this congenital disorder; especially when differential diagnoses such as acute respiratory distress syndrome (ARDS), failure to thrive, asthma, pneumonia, neuromuscular disorders and suspected foreign body inhalation have been ruled out in the pediatric patient.</jats:p

Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis

Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted  appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome.&#x0D; Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively.&#x0D; Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min  (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which  subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively.&#x0D; Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent.&#x0D; Keywords: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectomy </jats:p

Button Gastrostomy Tubes for Pediatric Patients: A Tertiary Care Center Experience

Background and Objective. Gastrostomy tube insertion is one of the most common procedures performed as a radical choice to overcome feeding difficulty in children. This study is aimed at describing the replacement of a button tube instead of the long tube for feeding infants and children requiring gastrostomies in a tertiary care hospital. Design and Setting. This retrospective cross-sectional descriptive study was conducted between January 2009 and August 2019 at Salmaniya Medical Complex which is a tertiary health care institute in the Kingdom of Bahrain. Subjects and Methods. Both charts and electronic health records of pediatric patients between the ages of 0 and 14 years were reviewed. Data were collected including age, sex, nationality, diagnosis, surgical information (procedure center and procedure performed), complications, and follow-up. Results. Out of 34 patients who underwent gastrostomy tube insertion, 30 patients had their long tube replaced by a button gastrostomy. Majority were males (N=18, 60%). Prolonged nasogastric tube feeding was the main indication of referral (N=17, 56%) followed by feed intolerance (N=6, 17%) and gastroesophageal reflux disease (N=5, 16%). The main underlying diseases at referral were neurological impairment (N=19, 63%) and metabolic disorders (N=4, 13%). There was no significant difference between patients with neurological disorders and other diseases in terms of gender, nationality, or age. Laparotomy with gastrostomy is the main approach used (N=18, 60%). No reported complications of button tubes in 50% of the patients (N=15). Conclusions. Prolonged nasogastric tube feeding is the main indication of referral for gastrostomy tube insertion. Neurological disorders are the main diagnosis for the cases operated upon. Laparotomy with gastrostomy is the procedure of choice at our center. Majority of patients had no reported complications of button tube replacement. These children are likely to benefit from the button tube with fewer complications

Button Gastrostomy Tubes for Pediatric Patients: A Tertiary Care Center Experience

Background and Objective. Gastrostomy tube insertion is one of the most common procedures performed as a radical choice to overcome feeding difficulty in children. This study is aimed at describing the replacement of a button tube instead of the long tube for feeding infants and children requiring gastrostomies in a tertiary care hospital. Design and Setting. This retrospective cross-sectional descriptive study was conducted between January 2009 and August 2019 at Salmaniya Medical Complex which is a tertiary health care institute in the Kingdom of Bahrain. Subjects and Methods. Both charts and electronic health records of pediatric patients between the ages of 0 and 14 years were reviewed. Data were collected including age, sex, nationality, diagnosis, surgical information (procedure center and procedure performed), complications, and follow-up. Results. Out of 34 patients who underwent gastrostomy tube insertion, 30 patients had their long tube replaced by a button gastrostomy. Majority were males (N=18, 60%). Prolonged nasogastric tube feeding was the main indication of referral (N=17, 56%) followed by feed intolerance (N=6, 17%) and gastroesophageal reflux disease (N=5, 16%). The main underlying diseases at referral were neurological impairment (N=19, 63%) and metabolic disorders (N=4, 13%). There was no significant difference between patients with neurological disorders and other diseases in terms of gender, nationality, or age. Laparotomy with gastrostomy is the main approach used (N=18, 60%). No reported complications of button tubes in 50% of the patients (N=15). Conclusions. Prolonged nasogastric tube feeding is the main indication of referral for gastrostomy tube insertion. Neurological disorders are the main diagnosis for the cases operated upon. Laparotomy with gastrostomy is the procedure of choice at our center. Majority of patients had no reported complications of button tube replacement. These children are likely to benefit from the button tube with fewer complications.</jats:p