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Fetal and Pediatric Pathology Aug 2019To evaluate and compare the outcomes of pregnancies with prenatally detected gastroschisis and omphalocele. We retrospectively evaluated prenatally detected...
To evaluate and compare the outcomes of pregnancies with prenatally detected gastroschisis and omphalocele. We retrospectively evaluated prenatally detected gastroschisis and omphalocele cases. Cases were compared in terms of maternal demographic and clinical characteristics as well as pregnancy and neonatal outcomes. This study consisted of 17 gastroschisis and 30 omphalocele cases. Only one case with gastroschisis was terminated due to additional severe limb deformities. Seventeen out of 30 cases of omphalocele were terminated for various reasons (56.7%). All patients with gastroschisis had surgical repair, while 8 out of 13 omphalocele cases had surgery. One patient with an omphalocele died after surgery due to sepsis. Six cases of gastroschisis also died in the neonatal period due to various reasons (6/16, 37.5%). Additional genetic disorders are more frequent in those with omphalocele cases, and they are more frequently terminated during gestation that the gastroschisis fetuses.
Topics: Adolescent; Adult; Congenital Abnormalities; Female; Gastroschisis; Gestational Age; Hernia, Umbilical; Humans; Infant, Newborn; Karyotyping; Maternal Age; Mothers; Pregnancy; Pregnancy Outcome; Prenatal Diagnosis; Retrospective Studies; Young Adult
PubMed: 30892123
DOI: 10.1080/15513815.2019.1585501 -
Hernia : the Journal of Hernias and... Dec 2022Hernia management in patients with cirrhosis is a challenging problem, where indication, timing and type of surgery have been a subject of debate. Given the high risk of... (Review)
Review
PURPOSE
Hernia management in patients with cirrhosis is a challenging problem, where indication, timing and type of surgery have been a subject of debate. Given the high risk of morbidity and mortality following surgery, together with increased risk of recurrence, a wait and see approach was often advocated in the past.
METHODS
The purpose of this review was to provide an overview of crucial elements in the treatment of patients with cirrhosis and umbilical hernia.
RESULTS
Perioperative ascites control is regarded as the major factor in timing of hernia repair and is considered the most important factor governing outcome. This can be accomplished by either medical treatment, ascites drainage prior to surgery or reduction of portal hypertension by means of a transjugular intrahepatic portosystemic shunt (TIPS). The high incidence of perioperative complications and inferior outcomes of emergency surgery strongly favor elective surgery, instead of a "wait and see" approach, allowing for adequate patient selection, scheduled timing of elective surgery and dedicated perioperative care. The Child-Pugh-Turcotte and MELD score remain strong prognostic parameters and furthermore aid in identifying patients who fulfill criteria for liver transplantation. Such patients should be evaluated for early listing as potential candidates for transplantation and simultaneous hernia repair, especially in case of umbilical vein recanalization and uncontrolled refractory preoperative ascites. Considering surgical techniques, low-quality evidence suggests mesh implantation might reduce hernia recurrence without dramatically increasing morbidity, at least in elective circumstances.
CONCLUSION
Preventing emergency surgery and optimizing perioperative care are crucial factors in reducing morbidity and mortality in patients with umbilical hernia and cirrhosis.
Topics: Humans; Hernia, Umbilical; Ascites; Herniorrhaphy; Liver Cirrhosis; Hernia; Treatment Outcome
PubMed: 35507128
DOI: 10.1007/s10029-022-02617-7 -
International Journal of Surgery Case... Jun 2023Infantile umbilical hernia is common in children. It has a regressive course in most cases. Conservative management is the standard in most cases before the age of...
INTRODUCTION AND IMPORTANCE
Infantile umbilical hernia is common in children. It has a regressive course in most cases. Conservative management is the standard in most cases before the age of 3 years unless there are complications such as incarceration, rupture with evisceration which are extremely rare and warrants emergency surgery.
CASE PRESENTATION
Our case was a full term 6-month-old male of normal birth weight with history of umbilical hernia but with no obvious risk factors to develop complications. The loops evisceration was spontaneous with a small umbilical skin damage. The poor parental consultation on early surgical management and delayed presentation of the infant after evisceration could be the possible risks for ischemic changes and shock state at the time of presentation, however, prompt medical resuscitation and surgical management relatively improved postoperative outcomes.
CLINICAL DISCUSSION
Infantile umbilical hernia is considered one of the most encountered abnormalities of infancy. Most umbilical hernias are asymptomatic and discovered after birth. Complications of infantile umbilical hernia as incarceration or spontaneous evisceration are very rare but fatal. Certain factors increase the risk for developing spontaneous rupture of infantile umbilical hernia including the age of the infant or child, the defect size, umbilical sepsis or ulceration and any condition which raises intra-abdominal pressure, i.e., crying, coughing or positive ventilation.
CONCLUSION
Although infantile umbilical hernia is clinically benign condition with a regressive course in majority of cases, the risk of rupture of an umbilical hernia is exceedingly rare in pediatric population; physicians should be warranted with the possible risk factors for spontaneous rupture and in these patients expedite surgical repair.
PubMed: 37247608
DOI: 10.1016/j.ijscr.2023.108352 -
Pediatric Surgery International Nov 2023Outpatient pediatric surgical practice often involves conditions of limited morbidity but significant parental concern. We explore existing evidence-based management...
PURPOSE
Outpatient pediatric surgical practice often involves conditions of limited morbidity but significant parental concern. We explore existing evidence-based management recommendations and the mismatch with practice patterns for four common outpatient pediatric surgical conditions.
METHODS
Using the Cochrane Rapid Review Group recommendations and librarian oversight, we conducted a rapid review of four outpatient surgical conditions: dermoid cysts, epigastric hernias, hydroceles, and umbilical hernias. We extracted patient demographics, intervention details, outcome measures and evaluated justifications presented for chosen management options. A metric of evidence volume (patient/publication ratio) was generated and compared between diagnoses.
RESULTS
Out of 831 articles published since 1990, we identified 49 cohort studies (10-dermoid cyst, 6-epigastric hernia, 25-hydrocele, and 8-umbilical hernia). The 49 publications included 34,172 patients treated across 18 countries. The evidence volume for each outpatient condition demonstrates < 1 cohort/condition/year. The evidence mismatch rate varied between 33 and 75%; many existing recommendations are not evidence-based, sometimes conflicting and frequently misrepresentative of clinical practice.
CONCLUSIONS
Published literature concerning common outpatient pediatric surgical conditions is sparse and demonstrates wide variations in practice. All individual practice choices were justified using either risk of complications or patient preference. Most early intervention practices were based on weak or outdated studies and "common wisdom" rather than genuine evidence.
LEVEL OF EVIDENCE
III.
Topics: Male; Child; Humans; Hernia, Abdominal; Hernia, Umbilical; Herniorrhaphy; Cohort Studies; Testicular Hydrocele
PubMed: 37978994
DOI: 10.1007/s00383-023-05569-w -
Journal of the National Medical... Feb 2021Omphalocele is characterized as a ventral wall defect in which there exists a midline herniation of abdominal viscera into the base of the umbilical cord. Fetuses with a...
Omphalocele is characterized as a ventral wall defect in which there exists a midline herniation of abdominal viscera into the base of the umbilical cord. Fetuses with a diagnosis of this entity are at a significantly increased risk of having an aneuploidy, additional anomalies, or associations with other syndromes such as Beckwith Wiederman. Secondary to these interconnections, there is an elevated risk of fetal loss in affected pregnancies. Detection of concordant abnormalities, appropriate genetic counseling, and involvement of pediatric subspecialties are paramount in affording a prognosis, and providing optimal perinatal management of omphalocele.
Topics: Child; Female; Hernia, Umbilical; Humans; Pregnancy; Prognosis; Ultrasonography, Prenatal
PubMed: 32747314
DOI: 10.1016/j.jnma.2020.07.006 -
Surgical Endoscopy Jan 2023Army medical treatment facilities (MTFs) use a surgery scheduling system that reviews historical OR times to dictate expected procedural time when posting new cases. At...
BACKGROUND
Army medical treatment facilities (MTFs) use a surgery scheduling system that reviews historical OR times to dictate expected procedural time when posting new cases. At a single military institution there was a noted inflation to umbilical hernia repair (UHR) times that was leading to issues with under-utilized operating rooms.
METHODS
This is a retrospective review determining what variables correlate with longer UHR operative time. Umbilical, ventral, epigastric, and incisional hernia repairs (both open and laparoscopic) were pulled from the local OR scheduling system at Dwight D. Eisenhower Army Medical Center from January 2013 to June 2018.
RESULTS
A total of 442 patients were included in the study with a mean age of 45.74 years and 54.98% male. Patient ASA level (p 0.045), primary vs. mesh repair (p < 0.001), number of hernias repaired (p 0.05), hernia size (p < 0.001), and absence of student nurse anesthetist (SRNA) (p 0.05) all correlated with longer UHR OR times. For the aggregated open hernia repair data, almost all independent variables of interest were statistically significant including age, PGY level, history of DM, case acuity, presence of SRNA, patient ASA level, patient's BMI, hernia defect size, number of hernias, history of prior repair, and history prior abdominal surgery. Multivariate regression analysis was done on the open hernia repair variables with only age and size of hernia being significant.
CONCLUSION
This data were used to create a new case request option (open UHR without mesh and open UHR with mesh) to more effectively utilize available OR time.
Topics: Humans; Male; Middle Aged; Female; Hernia, Umbilical; Operative Time; Surgical Mesh; Hernia, Ventral; Herniorrhaphy; Laparoscopy; Retrospective Studies; RNA, Small Untranslated; Recurrence
PubMed: 36068384
DOI: 10.1007/s00464-022-09478-2 -
BMC Medical Education Dec 2023Congenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world's top 20 causes of morbidity and...
BACKGROUND
Congenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world's top 20 causes of morbidity and mortality. Expensive simulators demonstrate several diseases, but few are related to congenital anomalies. This study aims to develop, validate, and evaluate low-cost simulator models (WALL-GO) of the most common abdominal wall defects, gastroschisis, and omphalocele, to enable diagnosis through an accessible tool with study value and amenable to replication.
METHODS
Market research was conducted to find materials to build low-cost models. The researchers built the model and underwent validation assessment of the selected experts who scored five or more in the adapted Fehring criteria. The experts were assessed through a 5-point Likert scale to 7 statements (S1-7). Statements were assigned values according to relevance in face and transfer validities. Concomitantly, the model was also evaluated by students from 1st to 5th year with the same instruments. Content Validity Indexes (CVIs) were considered validated between groups with concordance greater than 90%. Text feedback was also collected. Each statement was subjected to Fisher's Exact Test.
RESULTS
Gastroschisis and omphalocele model costs were US $15 and US $27, respectively. In total, there were 105 simulator evaluators. 15 experts were selected. Of the 90 students, there were 16 (1st year), 22 (2nd), 16 (3rd), 22 (4th), and 14 (5th). Students and experts obtained CVI = 96.4% and 94.6%, respectively. The CVIs of each statement were not significantly different between groups (p < 0,05).
CONCLUSIONS
The WALL-GO models are suitable for use and replicable at a manufacturable low cost. Mannequins with abdominal wall defects are helpful in learning to diagnose and can be applied in teaching and training health professionals in developing and low-income countries.
Topics: Infant, Newborn; Humans; Gastroschisis; Hernia, Umbilical; Abdominal Wall; Education, Medical, Undergraduate; Learning
PubMed: 38102605
DOI: 10.1186/s12909-023-04929-3 -
The Pan African Medical Journal 2023
Topics: Humans; Floods; Liver Cirrhosis, Alcoholic; Ascites; Hernia, Umbilical; Paracentesis; Liver Cirrhosis
PubMed: 37869230
DOI: 10.11604/pamj.2023.45.159.40944 -
European Journal of Pediatrics Jul 2021Congenital abdominal wall defects, namely, gastroschisis and omphalocele, are rare congenital malformations with significant morbidity. The long-term burden of these...
Congenital abdominal wall defects, namely, gastroschisis and omphalocele, are rare congenital malformations with significant morbidity. The long-term burden of these anomalies to families and health care providers has not previously been assessed. We aimed to determine the need for hospital admissions and the requirement for surgery after initial admission at birth. For our analyses, we identified all infants with either gastroschisis (n=178) or omphalocele (n=150) born between Jan 1, 1998, and Dec 31, 2014, in the Register of Congenital Malformations. The data on all hospital admissions and operations performed were acquired from the Finnish Hospital Discharge Register between Jan 1, 1998, and Dec 31, 2015, and compared to data on the whole Finnish pediatric population (0.9 million) live born 1993-2008. Patients with gastroschisis and particularly those with omphalocele required hospital admissions 1.8 to 5.7 times more than the general pediatric population (p<0.0001). Surgical interventions were more common among omphalocele than gastroschisis patients (p=0.013). At the mean follow-up of 8.9 (range 1.0-18.0) years, 29% (51/178) of gastroschisis and 30% (45/150) of omphalocele patients required further abdominal surgery after discharge from the neonatal admission.Conclusion: Patients with gastroschisis and especially those with omphalocele, are significantly more likely than the general pediatric population to require hospital care. Nevertheless, almost half of the patients can be treated without further surgery, and redo abdominal surgery is only required in a third of these children. What is Known: • Gastroschisis and omphalocele are congenital malformations with significant morbidity • There are no reports on the long-term need for hospital admissions and surgery in these children What is New: • Patients with abdominal wall defects are significantly more likely than the general pediatric population to require hospital care • Almost half of the patients can be treated without further surgery, and abdominal redo operations are only required in a third of these children.
Topics: Abdominal Wall; Child; Female; Gastroschisis; Hernia, Umbilical; Hospitals; Humans; Infant; Infant, Newborn; Morbidity
PubMed: 33666724
DOI: 10.1007/s00431-021-04005-2 -
Systematic review of mortality associated with neonatal primary staged closure of giant omphalocele.Journal of Pediatric Surgery Apr 2021Surgical management of giant omphalocele has evolved at a slow pace, but evidence on the survival of patients who underwent primary staged closure is scattered and... (Review)
Review
INTRODUCTION
Surgical management of giant omphalocele has evolved at a slow pace, but evidence on the survival of patients who underwent primary staged closure is scattered and atomized.
OBJECTIVE
To analyze the studies about of mortality associated with neonatal primary staged closure of giant omphalocele.
METHODS
Systematic review in three databases using ex-ante search protocol and selection of studies following the phases suggested by PRISMA and MOOSE criteria. Reproducibility and evaluation of methodological quality were guaranteed by using CARE and STROBE.
RESULTS
Seven studies of clinical cases with nine patients, and six cross-sectional studies with 85 individuals were analyzed. These were conducted in the USA mainly, between 1985 and 2018. In the case studies, the death was 11.1% owing to hepatic necrosis and portal system angiomatosis. On the cross-sectional studies, mortality was registered in 18.8% of patients owing to coarctation of the aorta, heart, kidney, intestinal, respiratory or multiple organ failure, an anomaly of venous return, prematurity, ruptured omphalocele, pulmonary hypoplasia, trisomy 13, ARDS, sepsis, and septic shock. The main complication was wound infection with subsequent confection of the silo, found in 5.4% of patients.
CONCLUSION
Only a few studies on staged closure of giant omphalocele were found on a low number of patients. The high survival rate and the low percentage of complications on the 94 analyzed patients suggest the effectiveness and safety of the procedure.
LEVELS OF EVIDENCE
According to the Journal of Pediatric Surgery this research corresponds to type of study level II for retrospective studies, and level IV for case series with no comparison group.
Topics: Cross-Sectional Studies; Hernia, Umbilical; Humans; Infant, Newborn; Infant, Newborn, Diseases; Reproducibility of Results; Retrospective Studies
PubMed: 32981659
DOI: 10.1016/j.jpedsurg.2020.08.019