Özlem Balci

Does timing of neonatal inguinal hernia repair affect outcomes

PURPOSE The purpose of this study was to examine practice variability and compare outcomes between early and delayed neonatal inguinal hernia repair (IHR). METHODS Patients admitted to neonatal intensive care units with a diagnosis of IH who underwent IHR by age 1 year in the Pediatric Health Information System from 1999 to 2011 were included. IHR after the index hospitalization was considered delayed. Inter-hospital variability in the proportion of delayed repairs and differences in outcomes for each group were compared. A propensity score matched analysis was performed to account for baseline differences between treatment groups. RESULTS Of the 2030 patients identified, 32.9% underwent delayed IHR with significant variability in the proportion of patients having delayed repair across hospitals (p<0.0001). More patients in the delayed group had a congenital anomaly or received life supportive measures prior to IHR (all p<0.01), and 8.2% of patients undergoing delayed repair had a diagnosis of incarceration at repair. More patients in the early group underwent reoperation for hernia within 1 year (5.9% vs. 3.7%, p=0.02). Results were similar after performing a propensity score matched analysis. CONCLUSIONS Significant variability in practice exists between childrens hospitals in the timing of IHR, with delayed repair associated with incarceration and early repair with a higher rate of reoperation.

Evaluation of 968 children with corrosive substance ingestion

Background and Aims: The aim of the study was to evaluate the etiology, treatment, and prognosis in children who had presented at our clinic with corrosive substance ingestion and comparison of our results with the literature. Materials and Methods: The patients were put on nil by mouth and broad-spectrum antibiotics were administered. Oral fluids were started for patients whose intraoral lesions resolved and who could swallow their saliva. Steroids were not given, a nasogastric catheter was not placed, and early endoscopy was not used. Results: A total of 968 children presented at our clinic for corrosive substance ingestion during the 22-year period. The stricture development rate was 13.5%. Alkali substance ingestion caused a stricture development rate of 23%. A total of 54 patients required 1–52 sessions (mean 15 ±12) of dilatation. Conclusion: We do not perform early endoscopy, administer steroids, or place a nasogastric catheter at our clinic for patients who had ingested a corrosive substance. This approach has provided results similar to other series. We feel that determining the burn with early esophagoscopy when factors that prevent or decrease the development of corrosive strictures will be very important.

Early versus delayed surgical correction of malrotation in children with critical congenital heart disease

PURPOSE The purpose of this study was to compare outcomes between early and delayed surgical correction of malrotation in children with critical congenital heart disease (CHD). METHODS Patients with CHD who underwent cardiac surgery by 1 year of age and had malrotation diagnosed during their initial admission at 34 hospitals contributing to the Pediatric Health Information System in 2004-2009 were included. Ladds procedures performed during the first admission were considered early correction, and those at a subsequent admission were considered delayed. Interhospital variability in the proportion of patients undergoing delayed correction was assessed, and outcomes were compared between the groups. RESULTS Of the 324 patients identified, 85.2% underwent early correction. Significant variability existed in the proportion of patients undergoing delayed correction across hospitals (p<0.0001). Baseline characteristics, including severity of CHD, were similar between the groups. In the delayed group, 27% of patients underwent a Ladds procedure during an urgent or emergent admission, but none had volvulus or underwent intestinal resection. Rates of mortality and readmission within 1 year of malrotation diagnosis were similar in both groups. Chart validation confirmed 100% accuracy of diagnosis and treatment group assignment. CONCLUSIONS In patients with critical CHD, delayed operative intervention for malrotation without volvulus may be a reasonable alternative.

Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi

Amac: Postoperatif yapisikliklar intestinal obstruksuyona yol acmasi, reoperasyon durumlarinda abdominal eksplorasyonu zorlastirmasi, organ yaralanmalarina sebep olmasi nedeniyle hem hasta hem de hekimler icin onemli bir klinik durumdur. Bu calismada brid ileus gelisimine etki eden faktorlerin saptanmasi ve brid ileusdaki tedavi sonuclarinin degerlendirilmesi amaclanmistir. Gerec ve Yontemler: 2005-2010 yillari arasinda cesitli nedenlerle laparotomi yapilan hastalar brid ileus gelisimi acisindan retrospektif olarak degerlendirildi. Bulgular: Bu calismaya l aparotomi yapilan 3271 hasta dahil edildi. Apandisit en sik laparotomi endikasyonuydu (%66). 152 hastada (%4,6) postoperatif brid ileus gelistigi tespit edildi. Bunlarin %88’inin postoperatif ilk 6 ayda, %99’unun da ilk 3 yil icinde gelistigi goruldu. Yas ve cinsiyet ile brid ileus gelisimi arasinda iliski yoktu. Vakalarin %23’u kirli vasifta ameliyatlardi. Temiz, temiz kontamine ameliyatlardan sonra brid ileus gelisme orani %3,4 iken, kontamine ve kirli ameliyatlardan sonra bu oran %10,9 olarak bulundu. Batin icerisine dren yerlestirilmesinin brid ileus gelisimini etkilemedigi saptandi. Ameliyat suresi uzadikca postoperatif brid ileus gelisme oraninin arttigi tespit edildi. Ayrica ameliyatta Meckel divertikulu gibi ek patolojiler arastirilan hastalarda brid ileus gelisme oraninin 3 kat arttirdigi goruldu. Brid ileus gelisen hastalarin %61’i nonoperatif-konservatif yollarla tedavi edilirken %39’unda cerrahi girisim gerektigi tespit edildi. Sonuclar: Calismamizda batin icinde uygulanan ek girisimlerin, operasyon suresinin uzun olmasinin ve intraperitoneal kontaminasyonun brid ileus gelisimini artirdigi gosterilmistir. Bu konulara dikkat edilmesinin brid ileus gelisimini azaltabilecegi dusunulmustur. Cocuk yas grubunda uygun vakalarda konservatif tedavi ile daha yuksek oranlarda basari saglanabilecegi kanisina varilmistir.

Labial Fusion in Prepubertal Girls

Objective: Labial fusion is a common benign genital disorder in prepubertal girls. Herein we aim to identify the characteristics and treatment outcomes of patients with labial fusion who were diagnosed and treated at our hospital. Material and Methods: Girls with labial fusion who presented to our outpatient department were retrospectively reviewed for their age, complaints, use of topical estrogen treatment, recurrence rate, time of recurrence and complications. Results: A total of 334 patients with labial fusion were identified. The ages of the patients varied between forty days and 8.5 years. Both the vagina and urethra were covered by the labial fusion and only a small gap could be seen near the clitoris in 90% of patients. Additional urinary disorders and vaginal discharge caused by labial fusion were identified in 35% of the patients. Patients were treated with manual detachment of the fusion and topical estrogen creams. Recurrence rate was 25%. Recurrence rates were higher in patients with older age and additional problems. conclusion: Labial fusion is a common benign condition in prepubertal girls. But it can cause urinary disorders in patients and serious anxiety in parents. The treatment can be easier and the recurrence rates lower if it is prevented effectively or diagnosed earlier.

The Value of Plain Abdominal X-Ray and Ultrasound Imaging in Childhood Appendicitis

Objective: Abdominal pain is one of the most common causes of hospitalization in childhood. Here we aimed to evaluate the contribution of positive fi ndings in the upright abdominal x-ray and ultrasound imaging for the diagnosis of acute appendicitis in children admitted with abdominal pain. Material and Methods: The upright abdominal x-ray and ultrasound images of children who presented to our outpatient clinic with suspected acute appendicitis in 2010 were analyzed retrospectively. The patients were divided into 2 groups. The children with a fi nal diagnosis of acute appendicitis constituted group 1, while the patients who were operated on for suspected appendicitis and where the pathology examination was negative for appendicitis and children who required only observation in the hospital or as outpatient for suspected appendicitis made up group 2. Findings accepted to suggest a diagnosis of acute appendicitis on plain x-ray were air-fl uid level at the right lower quadrant, diffuse air-fl uid 1Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Cerrahisi Kliniği, Ankara, Türkiye 2Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Radyoloji Kliniği, Ankara, Türkiye Ahmet ERTÜRK1, Ayşe KARAMAN1, Özlem BALCI1, İbrahim KARAMAN1, Yusuf Hakan ÇAVUŞOĞLU1, İsmet Faruk ÖZGÜNER1, Beytullah YAĞIZ1, Yasemin TAŞÇI YILDIZ2, Derya ERDOĞAN1 Çocuklarda Direkt Batın Grafi si ile Ultrason Bulgularının Apandisit Tanısındaki Değeri The Value of Plain Abdominal X-Ray and Ultrasound Imaging in Childhood Appendicitis

Wandering Spleen with Niemann-Pick Disease

Wandering spleen is a rare entity that develops as a result of splenic hypermobility caused by congenital absence or acquired laxity of splenic suspensory ligaments that hold the spleen in its normal position. It is usually described in women of childbearing age and rare in children. Symptoms include acute or chronic intermittent abdominal pain due to the torsion of the pedicle. It may also be asymptomatic and discovered incidentally on clinical or radiological examination done for other reasons. Niemann-Pick disease is a lipid storage disorder. It is characterized by sphingomyelin and cholesterol accumulation in many organs and predominantly the liver and spleen. Hepatosplenomegaly may develop due to the disease. A 16-year-old girl with Niemann-Pick disease has admitted to our hospital with complaint of amenorrhea. A 10 cm pelvic mass possibly related to the left ovary was detected in her examinations. Laparotomy was performed and a 12 cm wandering spleen was discovered at the left lower quadrant of abdomen. And 5 cm faint, solid mass was found to be fused with the spleen at hilus. Splenectomy was performed. Histopathological examination revealed ceroid histiocytosis throughout spleen. The hilar mass was found to be a necrotic and sclerotic tissue. Although Niemann-Pick disease is reported as an etiological factor for splenomegaly as a cause of wandering spleen in the literature, their association is not reported yet. Asymptomatic wandering spleen can be regarded as abdominal or ovarian mass as in our case. We discussed this case to point out the differential diagnosis of wandering spleen and its rare association with Niemann-Pick Disease.