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  • 1
    Online Resource
    Online Resource
    Epigastric hernias in children and the use of ultrasound in its diagnosis
    BMJ ; 2023
    In:  World Journal of Pediatric Surgery Vol. 6, No. 2 ( 2023-04), p. e000544-
    Details
    In: World Journal of Pediatric Surgery, BMJ, Vol. 6, No. 2 ( 2023-04), p. e000544-
    Abstract: There is a paucity of clinical data on pediatric epigastric hernias despite them accounting for up to 6% of all hernia repairs in children. We aimed to provide additional data to supplement those 117 cases of a recent systematic review and to further clarify the role of ultrasound in diagnosing pediatric epigastric hernia. Methods We retrospectively included all 60 patients treated for epigastric hernias in children in two tertiary pediatric surgical departments within 12 years. Associations were tested via point-biserial correlation analyses. Results Epigastric hernias primarily affected preschool children with a median age of 39 months. The vast majority of patients (88%) presented with swelling that was occasionally (30%) accompanied by pain. Fascial defects could be found during clinical examination in 45% of patients with a median size of 5 mm (95% CI 3 to 10). Smaller defects were less likely to be palpable (r=−0.44, 95% CI −0.08 to −0.7, p=0.021). Likewise, ultrasound was used more frequently with smaller fascial defect sizes (r=−0.51, 95% CI −0.16 to −0.74, p=0.007). Laparoscopic repair was used in 11 patients (19%) and more often (4/11) in combination with another simultaneous procedure than open repair (11/48). Conclusions Epigastric hernias are primarily a condition of the preschool child. Ultrasound can be beneficial if the diagnosis cannot be made clinically; otherwise, it is abdicable if it does not change the management of the patient’s epigastric hernia. Laparoscopic repairs might be beneficial for children with multiple defects or simultaneous procedures.
    Type of Medium: Online Resource
    ISSN: 2516-5410
    URL: Article
    DOI: 10.1136/wjps-2022-000544
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2934437-2
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  • 2
    Online Resource
    Online Resource
    Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi-centric Analysis
    Springer Science and Business Media LLC ; 2023
    In:  World Journal of Surgery Vol. 47, No. 9 ( 2023-09), p. 2296-2303
    Details
    In: World Journal of Surgery, Springer Science and Business Media LLC, Vol. 47, No. 9 ( 2023-09), p. 2296-2303
    Abstract: Incidences of pilonidal sinus disease are rising. Guidelines rarely consider children and adolescents and evidence for their treatment is rare. The literature is divided on the choice of the preferable surgical procedure. Therefore, we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort. Methods We retrospectively assessed all patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz between 01/01/2009 and 31/12/2020. Recurrences were defined according to the German national guidelines. The pre-specified analysis via logistic regression included the operative approach, age, sex, use of methylene blue, and obesity as independent predictors. Results We included 213 patients, of which 13.6% experienced complications and 16% a recurrence. Median time to recurrence was 5.8 months (95% confidence interval: 4.2–10.3), which was slightly higher in children than adolescents (10.3 months, 95% confidence interval: 5.3–16.2 vs. 5.5 months, 95% confidence interval: 3.7–9.7). None of the investigated procedures, excision and primary closure, excision and open wound treatment, pit picking, and flap procedures had a decisive advantage in terms of complications or recurrence. Of the independent predictors, only obesity was associated to complications (adjusted odds ratio: 2.86, 95% confidence interval: 1.05–7.79, P  = 0.04). Conclusions We did not find a difference between the investigated procedures, but our analysis is limited by the small sample size in some subgroups. Our data corroborates that recurrences in paediatric pilonidal sinus disease occur early. Factors linked to these differences remain unknown.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-023-07045-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1463296-2
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  • 3
    Online Resource
    Online Resource
    Complications following metal bar removal after Nuss repair are rare in a duocentric retrospective evaluation
    Springer Science and Business Media LLC ; 2022
    In:  Pediatric Surgery International Vol. 38, No. 12 ( 2022-09-22), p. 1919-1924
    Details
    In: Pediatric Surgery International, Springer Science and Business Media LLC, Vol. 38, No. 12 ( 2022-09-22), p. 1919-1924
    Abstract: Minimally invasive pectus excavatum repair has gained widespread acceptance and its results and complications are well-described. However, there is a substantial debate on the risks and frequencies of complications following metal bar removal. We, therefore, aimed to analyse all complications that occurred during and after metal bar removal at our two paediatric surgical centres. Methods Bar removal surgeries were identified via procedural codes and electronic records were reviewed using a pre-specified data extraction chart. Both intra- and postoperative complications were included and the latter scored according to Clavien–Dindo. We analysed the influence of the pre-specified potential predictors age, sex, and the number of implanted metal bars on the occurrence of complications using logistic regression. Results We included 279 patients with a median age of 19 years (interquartile range 17–20 years). 15 patients experienced 17 complications. Of 11 postoperative complications, only an enlarging pleural effusion required a chest drain in local anaesthesia, resulting in a Claven-Dindo grade IIIa, whereas the remainder were classified as grade I. Neither age (adjusted odds ratio (aOR) 0.97, 95% confidence interval (CI) 0.84–1.13, P  = 0.73), nor sex (aOR 0.88, 95% CI 0.19–4.07, P  = 0.87) or the number of bars (aOR 0.64, 95% CI 0.15–2.71, P  = 0.547) did influence the occurrence of complications. Conclusion Complications following metal bar removal were scarce in our duocentric retrospective series and usually of minor relevance. However, to address the perceived paucity of data on the frequency and severity of complications following metal bar removal, further studies, including large database research is necessary.
    Type of Medium: Online Resource
    ISSN: 1437-9813
    URL: Article
    DOI: 10.1007/s00383-022-05250-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1463010-2
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  • 4
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    Online Resource
    Influencing factors on operating times for metal bar removal after Nuss repair
    Springer Science and Business Media LLC ; 2023
    In:  Die Chirurgie Vol. 94, No. 9 ( 2023-09), p. 796-803
    Details
    In: Die Chirurgie, Springer Science and Business Media LLC, Vol. 94, No. 9 ( 2023-09), p. 796-803
    Abstract: Metal bar removal after the Nuss repair procedure is prone to be cancelled in cases of operating time shortages due it being suitable to be postponed without harming patients. Consequently, planning operation times as exactly as possible could be one solution. Objective Statistical modelling of operation times of metal bar removal after Nuss repair using the prespecified independent predictors of age, sex, intraoperative complications, and number of implanted metal bars. Material and methods We included all patients whose operation notes included an operation time, which was modelled via linear regression and subject to internal validation via bootstrap. Exploratory analyses also consisted of the surgeon’s experience, the number of stabilizers, the body mass index, and preceding re-do surgery for bar dislocation. Results We included 265 patients (14% ♀) with a median age of 19 years (interquartile range 17–20 years), of whom 81% had 1 and 17% had 2 metal bars removed. The prespecified regression model was statistically significant (likelihood ratio 56; df = 5; P   〈  0.001) and had a bias corrected R 2 of 0.148. Patient age influenced operation times by 2.1min per year of life (95% confidence interval 1.3–2.9min; P   〈  0.001) and 16min per explanted metal bar (95% confidence interval: 10–22min; P   〈  0.001). Conclusion The patient-specific factors of age and the number of explanted metal bars influenced the operation times and can be included into scheduling operation times.
    Type of Medium: Online Resource
    ISSN: 2731-6971 , 2731-698X
    URL: Article
    DOI: 10.1007/s00104-023-01914-w
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 3120893-9
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  • 5
    Online Resource
    Online Resource
    Prenatal Diagnosis of Teratoma in a Torqued Undescended Testis Masked as Unclear Intra-Abdominal Mass
    Georg Thieme Verlag KG ; 2019
    In:  Ultrasound International Open Vol. 05, No. 03 ( 2019-11), p. E96-E97
    Details
    In: Ultrasound International Open, Georg Thieme Verlag KG, Vol. 05, No. 03 ( 2019-11), p. E96-E97
    Type of Medium: Online Resource
    ISSN: 2509-596X , 2199-7152
    URL: Article
    DOI: 10.1055/a-1088-3569
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
    detail.hit.zdb_id: 2838384-9
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