Background Annular pancreas is rare; only 737 cases have been reported in the English literature. In addition, no large analysis has compared children and adults. Recently, prenatal diagnosis and advances in imaging have led to increased experience with this condition. Study Design Data from 103 patients (48 children, 55 adults) with annular pancreas, managed from 1992 to 2006, were reviewed. Patients with isolated duodenal atresia, stenosis, or webs were excluded. Results Median ages at diagnosis were 1 day in children and 47 years in adults. Annular pancreas was more common in girls and women (children, 58%; adults, 69%). Congenital anomalies were more frequent (p Conclusions Annular pancreas is associated with a spectrum of disease that differs in children and adults. Congenital anomalies are more common in children with annular pancreas; complex pancreatobiliary disorders and malignancy are more frequent in adults.

Annular Pancreas: Dramatic Differences Between Children and Adults

https://link.springer.com/content/pdf/10.1007%2Fs11605-017-3423-0.pdf

Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up.

Introduction The management of a recurrent tracheoesophageal fistula (RTEF) includes either open surgery (OS) or an endoscopic treatment (ET); the ideal option is unclear. We aim to comparatively review all published treatment options, and outcomes, for managing RTEF. Materials and Methods A literature search was performed using the keywords “recurrent tracheoesophageal fistula.” All English language articles describing the management of RTEF in children were reviewed. A synthesis of the relevant data is presented in a descriptive form due to the heterogeneity of the included articles. Results A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS. Of the 57 ET patients, there was an 84% success rate compared with 93.5% of 108 OS patients; the failed ET cases were all successfully treated by OS. The refistulation rate after OS was 21% and an average of 1.1 (range 1–2) procedures were required. After ET, the refistulation rate was 63% and an average of 2.1 (range 1–6) treatments were required for success; these results were reported after a maximum follow-up of 9 years and 23 years for ET and OS, respectively. The major complications after OS were 17 (16%) leaks and 4 (3.7%) deaths, while for ET 3 (5%) suffered respiratory distress postoperatively and there was 1 (1.7%) death. Conclusion OS for RTEF has a low morbidity and mortality, a higher success rate, and requires fewer treatments than an endoscopic repair. The ideal ET is undecided but it remains a viable alternative provided treatment failures are anticipated and prompt redo treatments initiated to prevent ongoing respiratory morbidity.

Management of Recurrent Tracheoesophageal Fistulas: A Systematic Review

Introduction Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature. Materials and Methods Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9. Results Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1–9). Eight of these (62%) did not reach consensus. Conclusion Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.

/pdf/ernica-consensus-conference-on-the-management-of-patients-4wmx2gogl9.pdf

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management.

Diagnosis and treatment of communicating bronchopulmonary foregut malformation: Report of two cases and review of the literature.

Tracheoesophageal fistula after primary repair of type C esophageal atresia in the neonatal period: recurrent or missed second congenital fistula

Analysis of Postoperative Reoperation for Congenital Duodenal Obstruction

Diagnostic scoring system of Hirschsprung's disease in the neonatal period.

Purpose: To demonstrate that laparoscopic pyloromyotomy (LP) is less traumatic than the open procedure (OP) for congenital hypertrophic pyloric stenosis (CHPS). Patients and Methods: Seventy-two consecutive cases of LP performed in 1998 through 2000 were compared with 72 consecutive cases of OP done before 1998. The two procedures were compared with multiple clinical parameters including age, body weight, operating time, postoperative antibiotic administration, hospital days, postoperative vomiting, and surgical complications. Laparoscopic pyloromyotomy was performed with a 3.5-mm laparoscope by a three-port technique to complete the pyloromyotomy in situ. The OP was performed through a small supraumbilical crescent incision to do pyloromyotomy by pulling the pylorus out of the abdomen. Results: The mean operating time of LP was significantly shorter than that of OP (24.2 vs. 31.6 minutes). Postoperative antibiotic administration and mean hospital stay were also shorter in the LP group than in the OP grou...

Comparison of 72 Successful Laparoscopic Pyloromyotomies with Open Procedure for Congenital Hypertrophic Pyloric Stenosis

This study was aiming to explore the risk factors contributing to enterostomy in neonates with Hirschsprung disease (HD) to provide a reference for clinicians to make treatment decisions.Medical records of 284 patients diagnosed with HD during the neonatal period were retrospectively analyzed. The patients were divided into 2 groups based on operative intervention (one stage transanal pull-through, versus enterotomy and staged transanal pull-through). Univariate and multivariable logistic regression analysis was performed to identify risk factors contributing to enterostomy.The incidence of enterostomy was 12.0% (34/284) in neonates with HD. Univariate and multivariate logistic regression analysis showed that serum albumin < 25.4 g/L, radiographic results as subphrenic free air, and level of aganglionosis with long-segment or total colonic aganglionosis (TCA) were independent risk factors of enterostomy in neonates, with OR of 42.045 (6.131, 288.319), 285.558 (26.651, 3059.694) and 15.573 (4.319, 56.157), respectively.The low serum albumin level, bowel perforation, and level of aganglionosis with long-segment or TCA could influence the occurrence of enterostomy in neonates with HD. 

/pdf/risk-factors-of-enterostomy-in-neonates-with-hirschsprung-1hysxca4.pdf

Risk factors of enterostomy in neonates with Hirschsprung disease

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