Gregory T. Banever

Appendicitis in children less than 5 years old: influence of age on presentation and outcome

PURPOSE Appendicitis is the most common emergency surgical condition of the abdomen in children. This study sought to delineate the presentation and the outcome of appendicitis in children younger than 5 years old. METHODS A retrospective review was conducted of all children younger than 5 years of age who underwent appendectomy for acute appendicitis over a 12-year period. RESULTS One thousand eight hundred thirty-six patients younger than 19 years of age underwent appendectomy. Two hundred eighty-one children with an age range of 6 months to 4.9 years were included in this study. Perforation rates were higher in the younger patients (86% <1 year, 74% 1-1.9 years, 60% 2-2.9 years, 64% 3-3.9 years, and 49% 4-4.9 years), but the youngest children had fewer postoperative abscesses. CONCLUSIONS In children less than 5 years old with appendicitis, age has a direct correlation to the stage of disease. The youngest children present with more advanced appendicitis but are less likely to develop postoperative abscesses.

The Nuss Procedure: Our Experience from the First Fifty

Purpose: The Nuss procedure for pectus excavatum has rapidly gained acceptance among pediatric surgeons. We present the results and lessons learned from our initial 50 patients undergoing the minimally invasive pectus repair. Patients and methods: After obtaining Internal Review Board approval, we retrospectively reviewed patients undergoing the Nuss procedure from April 1998 to September 2002. Data, including age, operative time, length of hospital stay, and complications, were recorded. Results: Fifty patients whose average age was 13 years underwent the procedure. The mean operative time was 90 minutes, and the average length of stay was 6 days. Eleven immediate postoperative pneumothoraces were detected, none of which required tube thoracostomy or aspiration. One displaced bar was replaced at 6 weeks, and infection necessitated the removal of that bar at 11 months. A second displaced bar lacking a stabilizer was removed at 15 months with a good cosmetic result. Three bar stabilizer complications occur...

Use of Energy Devices in Thoracoscopy: Quantification of Lung-Sealing Capacity

Purpose: The use of stapling devices in pediatric thoracoscopic surgery is limited due to the decreased maneuverability of 12-mm instruments in a childs chest. The goal of this study is to quantify the ability of 5-mm energy devices to seal lung tissue in the nonsurvival swine model. Methods: Nine 10-kg female swine were divided into three nonsurvival groups. Group A (n = 3): Left thoracotomy with use of a 12-mm stapler (US Surgical Corporation, Norwalk, Connecticut). Group B (n = 3): Left thoracoscopy with use of the LigaSure LS1000 (Valleylab, Boulder, Colorado) 5-mm instrument. Group C (n = 3): Left thoracoscopy with use of the Ultracision LCS-K5 (Ethicon Endo-Surgery, Cincinnati, Ohio) 5-mm instrument. Biopsy specimens of the lingula of the lung were taken. At the end of the procedure, seal burst pressures were recorded. Results: Average burst pressure (mm Hg): A, staples 43.5 (43-44); B, LigaSure 44.9 (40.2-53.6); C, harmonic 37.5 (30-46.4). Average seal length (mm): A, staples 30 (30-30); B, LigaSu...

Clinical Outcomes Following Identification of Tip Appendicitis on Ultrasonography and CT Scan

BACKGROUND/PURPOSE With recent improvements in imaging technology, subtler variations in the anatomy of the appendix can be appreciated. We hypothesized that radiographic findings of tip appendicitis may not correlate strongly with a pathologic diagnosis of appendicitis. METHODS Our radiology database was searched for reports of a diagnosis of tip appendicitis between January 2013 and June 2017 for patients between the ages of 2 and 17. Retrospective chart review was performed for demographic and clinical data, including outcomes. For patients managed operatively, the pathology results were reviewed for evidence of acute appendicitis. Patients managed nonoperatively and those with negative pathology were considered to not have appendicitis. RESULTS Fifty-five patients met inclusion criteria (31 boys and 24 girls); 46/55 patients with tip appendicitis on imaging ultimately did not have appendicitis. Twenty-one patients underwent appendectomy, and 9/21 had pathologic evidence of appendicitis. One patient had a ruptured appendix. No other pathology was identified in the negative appendectomies. Two patients managed nonoperatively required readmission, but not secondary to missed diagnosis of appendicitis. CONCLUSIONS Ultrasound and CT findings of tip appendicitis may not accurately associate with a final diagnosis of acute appendicitis. Clinical judgment should ultimately dictate appropriate initial management, follow-up tests, and imaging. TYPE OF STUDY Diagnostic Study. LEVEL OF EVIDENCE Level III.