Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy
Roy Gurprashad,
Alex Oldman,
Jessica Burns,
Joe Curry
Issue:
Volume 3, Issue 2, March 2017
Pages:
4-7
Received:
17 February 2017
Accepted:
2 March 2017
Published:
21 March 2017
Abstract: The use of on table cholangiogram (OTC) during laparoscopic cholecystectomy (LC) continues to be a debated topic within surgical practice. Current National Institute for Health and Care Excellence (NICE) guidelines do not advocate its routine use in adult patients, and there is scarce evidence for its use in paediatric cases. We aimed to analyse the outcomes of OTC during laparoscopic cholecystectomy to see if the NICE guidance holds true for children. A retrospective case note review was performed with IRB approval of all children who underwent laparoscopic cholecystectomy between February 2005 and November 2014. A total of 65 patients were identified, 41 female (63%) and 24 male (37%). The median age was 12 years (IQR 6). None of the patients underwent OTC during their LC. Instead, pre-operative ultrasound scan (USS) was performed in all cases. From the cohort, 5 patients (13%) showed abnormalities; 3 of which had a dilated common bile duct, and 2 of which had bile duct stones. All 5 patients went on to receive additional imaging, 2 patients underwent a repeat USS both of which were normal on review; 1 patient had an Endoscopic Retrograde Cholangio-Pancreatectography (ERCP), stent and follow-up Magnetic Resonance Cholangio-Pancreatograthy (MRCP) which was normal; 1 patient had an MRCP, ERCP with sphincterotomy and a follow-up USS which was normal; and 1 patient had an ERCP with follow-up USS which was also normal. In line with current NICE guidance for adults, our study indicates that patients with common bile duct (CBD) stones or a dilated CBD can be identified and managed prior to laparoscopic cholecystectomy. This would suggest that there is no requirement for OTC in children. Similar NICE guidance in Paediatrics may be necessary to avoid unnecessary intervention.
Abstract: The use of on table cholangiogram (OTC) during laparoscopic cholecystectomy (LC) continues to be a debated topic within surgical practice. Current National Institute for Health and Care Excellence (NICE) guidelines do not advocate its routine use in adult patients, and there is scarce evidence for its use in paediatric cases. We aimed to analyse th...
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Surgical Treatment of the Funnel Chest Deformation at the Children
Digtiar Valeryi Andreevich,
Kamenska Marianna Olegovna
Issue:
Volume 3, Issue 2, March 2017
Pages:
8-12
Received:
24 February 2017
Accepted:
16 March 2017
Published:
25 April 2017
Abstract: Introduction: Funnel chest deformation (FCHD) is the most common malformation of the chest. This anomaly appears as the cosmetic and functional disorders of the cardiovascular and respiratory systems. Its main characteristic feature is tendency to progression, closely linked with the growth and age of children. Purpose: To analyze results of surgical treatment at the children with FCHD, using minimally invasive method of thoracoplasty. Materials and methods: The research group included 21 children with FCHD at the age from 4 to 17 years. Symmetrical shape of deformation was revealed in 14 patients (66.6%), the asymmetric shape was revealed in 5 (23.8%) patients, the FCHD – in 2 children (9.5%). Preoperative examination included: routine clinical laboratory research, spirography, electrocardiography, echocardiography, chest radiography in the frontal and lateral projections and computed tomography. All patients underwent thoracoplasty with using method D. Nuss. Results: The period of supervision covered from 6 months to 4 years after surgery operation. Good results were obtained in 17 (80.96%) cases; satisfactory – in 3 cases (14.28%), unsatisfactory – in 1 case (4.76%). Conclusion: Surgical treatment of FCHD with using innovative in Ukraine method of retrosternal metal fixators – is vital importance direction in thoracoplasty, having numerous advantages, compared with resection techniques, as well as minimally invasive and a good cosmetic effect.
Abstract: Introduction: Funnel chest deformation (FCHD) is the most common malformation of the chest. This anomaly appears as the cosmetic and functional disorders of the cardiovascular and respiratory systems. Its main characteristic feature is tendency to progression, closely linked with the growth and age of children. Purpose: To analyze results of surgic...
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