Journal of pediatric surgery
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Review Meta Analysis
A systematic review and meta-analysis of caudal blockade versus alternative analgesic strategies for pediatric inguinal hernia repair.
The optimal analgesic strategy for pediatric inguinal hernia repair (IHR) remains undefined. We evaluated the available evidence comparing caudal blockade to alternative analgesic strategies in achieving post-operative analgesia. ⋯ There is no demonstrable difference in post-operative pain scores or rescue analgesia when comparing caudal blockade with alternative pain management strategies after pediatric IHR. This equipoise suggests that caudal blockade may be obviated for lower risk and less time-consuming maneuvers in patients barring supplementary indications for pain control.
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Review Case Reports
Traumatic hepatic artery laceration managed by transarterial embolization in a pediatric patient.
While blunt abdominal trauma with associated liver injury is a common finding in pediatric trauma patients, hepatic artery transection with subsequent treatment by transarterial embolization has rarely been reported. We present a case of a child who suffered from a hepatic artery injury which was successfully managed by supraselective transarterial microcoil embolization, discuss management strategies in these patients, and provide a review of currently available literature.
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Whether children with pancreatic trauma should be managed non-operatively or operatively is controversial. We reviewed outcomes of high-grade pancreatic injuries at two high-volume pediatric surgical centres comparing non-operative and operative management strategies. ⋯ Primary non-operative management of high-grade pancreatic injuries is associated with a significant increase in complications and TPN dependency. Early operative intervention should be pursued whenever feasible.
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Comparative Study
Outcomes of neonatal patent ductus arteriosus ligation in Canadian neonatal units with and without pediatric cardiac surgery programs.
Preterm infants needing patent ductus arteriosus (PDA) ligation are transferred to a pediatric cardiac center (CC) unless the operation can be done locally by a pediatric surgeon at a non-cardiac center (NCC). We compared infant outcomes after PDA ligation at CC and NCC. ⋯ Mortality rates after PDA ligation were similar at CC and NCC, but cranial ultrasound abnormalities and sepsis rates were higher at NCC. Higher morbidity may be associated with different PDA management strategies, including NSAID use or infant transfer. Further studies are needed to investigate the reasons for these differences in morbidity.