Journal of pediatric surgery
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Adolescent obesity continues to present one of the most difficult and important challenges for both the pediatric and adult medical communities. Evidence is mounting that bariatric surgery is the only reliable method for substantial and sustainable weight loss; however, the debate continues with regard to the optimal surgical procedure for both adolescents and adults. Although most US adult bariatric surgeons prefer the gastric bypass, our institution has demonstrated equivalent weight loss with significantly less morbidity using laparoscopic adjustable gastric banding (LAGB) in both adults and adolescents. This analysis is an update of our results in our first 73 patients, including resolution of comorbid conditions and compliance data. ⋯ Laparoscopic adjustable gastric banding continues to represent an attractive treatment strategy for morbidly obese pediatric patients with a %EWL of more than 55% at both 1- and 2-year follow-up, with minimal morbidity compared with the gastric bypass. Furthermore, the weight loss associated with LAGB provides excellent resolution or improvement of comorbid conditions. Although there is a necessary commitment by the patient that involves frequent office visits and band adjustments, adolescents are entirely capable of this commitment, and noncompliance should not be a reason to dissuade adolescents from having LAGB. It remains, in our opinion, the optimal surgical option for pediatric patients with morbid obesity.
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Bar displacement is a major complication in repair of pectus excavatum with the Nuss technique. Mechanisms of bar displacement have been elucidated by case-by-case analysis, and specific bar fixation techniques have been developed to deal with each mechanism. The efficacy of our bar fixation techniques is appraised. ⋯ Mechanism-based bar fixation techniques, especially multipoint pericostal wire fixation, seems to be effective in preventing bar displacement following pectus excavatum repair.
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We compared injury severity, hospital course, and outcomes between adolescent blunt trauma patients with and without positive toxicology screens. ⋯ A significant number of adolescents had positive toxicology screens. Our data suggest that toxicology-positive patients were more severely injured, required more hospital care, and had worse outcomes than other adolescent blunt trauma victims.
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Bile-stained vomiting in infancy is abnormal. Malrotation with small bowel volvulus is probably the most worrying of possible causes because if untreated for too long, it can result in massive bowel necrosis. As a consequence, if examination or plain radiography does not suggest another cause, an upper gastrointestinal (GI) series is often performed to exclude malrotation. ⋯ The mesentery was derotated, and the cyst removed with the attached section of jejunum. This case highlights the need to reinvestigate patients with bilious vomiting despite a previous normal upper GI series. The case raises the issue of whether bilious vomiting, with a normal upper GI series, should be investigated further with an abdominal ultrasound scan to identify more unusual causes such as jejunal lymphatic vascular malformations.
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Because of concerns for infectious and hemorrhagic complications, methods of obtaining central venous access after extracorporeal membrane oxygenation (ECMO) vary by institution. For infants requiring ECMO, it has been our practice to exchange the venous cannula for a tunneled central venous catheter (Broviac) at the time of decannulation. The purpose of this study is to compare the incidence of catheter-related complications in these patients to a national registry. ⋯ Critically ill neonates have limited vascular access. The placement of Broviac catheters in the internal jugular vein after ECMO decannulation maximally uses this limited resource. Despite concerns that such catheters are at increased risk for complications, we have found this practice to be safe and effective in this high-risk population.