Guido Ciprandi

The role of transanal endorectal pull-through in the treatment of Hirschsprung's disease - a multicenter experience.

Abstract.The transanal approach (TAA) is a new technique for surgery of Hirschsprungs disease (HD) that was introduced by de la Torre in 1998. The purpose of this multicenter study, including experience from three Austrian and one Italian departments of peadiatric surgery, was to evaluate the role of this approach in HD in 18 children aged 1–72 months. In 14 children the TAA only was performed; in 3 an additional laparoscopy was performed and in 1 conversion to a laparotomy was necessary. One complication (abscess) occurred after laparoscopic-assisted pull-through. The postoperative recovery was rapid, no severe long-term problems were observed. The transanal pull-through technique is generally possible in most classic cases of HD with extension of the disease to the sigmoid colon. If necessary, it can be combined with laparoscopy. Our preliminary results show that the technique is safe, less invasive, and gives excellent cosmetic results, and allows rapid recovery. Long-term results are still pending.

Spinal cord vascular injuries following surgery of advanced thoracic neuroblastoma: an unusual catastrophic complication.

BACKGROUND Spinal cord injury is a possible complication associated with removal of thoracic dumbbell neuroblastomas. Our experience with two children whose postsurgical course was complicated by midthoracic spinal cord ischemia is reported there. Permanent paraplegia resulted in both. PROCEDURE AND RESULTS Preoperative awareness of the origin and distribution of the Adamkiewicz artery (arteria radiculomedullaris magna, ARMM) and of the possible collateral pathways for spinal cord blood supply may be helpful in the planning of operations that involve dissection in the midthoracic posterior mediastinum. Otherwise, a flaccid paraplegia may result. CONCLUSIONS The syndrome is presumed to be triggered by a spasm, an embolism, or a iatrogenic interruption of the ARMM.

Surgery for ulcerative colitis in pediatric patients: functional results of 10-year follow-up with straight endorectal pull-through

Children and adolescents affected by ulcerative colitis (UC) frequently require colectomy because of refractory or chronic symptoms. The aim of this paper is to present our experience and 10-year follow-up results of 28 patients who underwent endorectal pull-through (ERPT) as surgical treatment for UC, with special regard to surgical complications, stooling patterns (frequency of defecation, stool consistency, urgency period), fecal incontinence, and quality of life. A retrospective chart review of these patients was performed to evaluate age at colectomy, indication for surgical treatment, operative procedures, technical details, and early or late complications. Frequency of defecation was less than twice per day in two patients, between three and five times per day in nine patients, and more than six times per day in 10 patients. Stool consistency was normal in 14 patients, loose in five, and liquid in only two cases. Urgency period was normal (minutes) in 14 patients, short (seconds) in four, and absent in three. Ten patients (47%) have perfect or good fecal continence, whereas 11 (52%) patients present moderate to total incontinence. The self-reported emotional health was good in most of the patients. A large number are progressing well at school and are coping with their operations. Studies of quality of life in UC patients who underwent surgical treatment in childhood or adolescence, comparing as well the results according to the surgical technique adopted, must be encouraged.

Surgery in disabled children: general gastroenterological aspects.

UNLABELLED Cerebral palsy (CP) is a non-progressive but not unchanging disorder of movement and/or posture, due to an insult to or anomaly of the developing brain. Gastrointestinal surgery can play a role in the treatment of pathologies frequently associated with a condition of neurological impairment such as gastro-oesophageal reflux disease (antireflux procedure), feeding difficulties (percutaneous endoscopic gastrostomy/jejunostomy) and swallowing difficulties (ligation of salivary gland ducts). Gastro-oesophageal reflux occurs in up to 70-75% of children with cerebral palsy. Children with gastro-oesophageal reflux disease (GERD) may present with feeding difficulties, recurrent vomiting and recurrent chest infection associated with poor growth and nutrition, reactive airway disease particularly nocturnal asthma, choking attacks, anaemia, and wheezing. Nutritional deprivation in children with cerebral palsy is the summation of several factors which result in reduced intake. Percutaneous endoscopic gastrostomy (PEG) has radically changed the handling of children with nutritional problems who, before the introduction of this procedure, were force fed parenterally or enterally, by nasogastric tube, conventional surgical gastrostomy or central venous access. In children with CP, PEG is the preferred technique for long-term enteral feeding. Swallowing dysfunction is the main cause of drooling in cerebral palsy, and medical treatment is often inefficient. Surgical treatment involves neurectomy, translocation of the salivary duct, salivary gland resection or salivary duct (parotid and submandibular) ligation. CONCLUSION This review focuses on the role of surgery in managing gastrointestinal aspects in children with CP and, in particular, surgical experience at our department with fundoplication, PEG placement and ligation of salivary ducts.

Dermoid cyst in undescended testis in a 9-year-old boy.

Testicular dermoid cysts are rare in the pediatric age group: their discovery in an undescended testis is exceptional. The origin of this lesion is still unclear, but it should be considered as a monolayer expression of a mature teratoma. Though surgeons when confronted with these intratesticular cysts have traditionally opted for castration, in presence of small, compact masses, simple enucleation may be recommended, provided that the integrity of the neighboring parenchyma is not affected.

Pressure Ulcers in Pediatric Patients

Pressure ulcers (PUs) are a common and highly relevant professional care issues in hospitals. They are associated with psychological and physical suffering, increased morbidity and mortality rate and higher costs for health care worldwide (Baharestani, Black, Carville, et al., 2009a; Gorecki, Brown, Nelson, et al., 2009; Allman, Laperde, Noel, et al., 1999; Anthony, Reynolds, and Russell, 2004). PU development can be attributed to multiple factors that are fairly well-studied in adults and elderly people (Whittington and Briones, 2004; Horn, Bender, Ferguson, et al., 2004; de Laat, Schoonhoven, Pickkers, et al., 2006; Baharestani et al., 2009a). Through large-scale, nationwide epidemiological studies, the prevalence of PUs in medical care institutions for adults is now known and well documented.

A retrospective systematic data review on the use of a polihexanide-containing product on burns in children

BACKGROUND It is current practice for physicians to use the Prontosan® range of products in children based on their personal clinical experience, despite the lack of safety data in this population. This retrospective data review was designed to obtain information on the safety profile of the Prontosan® range of products in children in routine clinical practice. METHODS Data from newborns, infants and children with burns treated with the Prontosan® range were collected retrospectively from patient medical records. RESULTS The majority of children treated for burns (80.1%) were under the age of four. More boys than girls were subject to burn injury (58.1% vs. 41.9%). The majority of burns (74.7%) were partial thickness burn (IIa and IIb). Safety was analysed based on the adverse events/reactions, infections and interactions/symptoms related to Prontosan® reported in the CRFs. AEs were reported in five children after the use of Prontosan® products: itching (3 cases), rash (1 case) and hypergranulating tissue (1 case). No event was severe and all events resolved favourably with good healing results. In addition, 11 patients developed clinical signs of infection during treatment (mainly Staphylococcus aureus). CONCLUSIONS The Prontosan® range of products is demonstrated as safe and tolerable for use in children as part of burn treatment. Inclusion of this range of products in the protocol of paediatric burn care allows a good healing process starting with appropriate wound cleansing and maintaining moist wound environment.

Surgery in disabled children: General gastroenterological aspects: Gastroenterological surgery and disabled children

Cerebral palsy (CP) is a non‐progressive but not unchanging disorder of movement and/or posture, due to an insult to or anomaly of the developing brain. Gastrointestinal surgery can play a role in the treatment of pathologies frequently associated with a condition of neurological impairment such as gastro‐oesophageal reflux disease (antireflux procedure), feeding difficulties (percutaneous endoscopic gastrostomy/jejunostomy) and swallowing difficulties (ligation of salivary gland ducts). Gastro‐oesophageal reflux occurs in up to 70–75% of children with cerebral palsy. Children with gastro‐oesophageal reflux disease (GERD) may present with feeding difficulties, recurrent vomiting and recurrent chest infection associated with poor growth and nutrition, reactive airway disease particularly nocturnal asthma, choking attacks, anaemia, and wheezing. Nutritional deprivation in children with cerebral palsy is the summation of several factors which result in reduced intake. Percutaneous endoscopic gastrostomy (PEG) has radically changed the handling of children with nutritional problems who, before the introduction of this procedure, were force fed parenterally or enterally, by nasogastric tube, conventional surgical gastrostomy or central venous access. In children with CP, PEG is the preferred technique for long‐term enteral feeding. Swallowing dysfunction is the main cause of drooling in cerebral palsy, and medical treatment is often inefficient. Surgical treatment involves neurectomy, translocation of the salivary duct, salivary gland resection or salivary duct (parotid and submandibular) ligation.