Contemporary management of pyloric stenosis
Hypertrophic pyloric stenosis is a common surgical cause of vomiting in infants. Following appropriate fluid resuscitation, the mainstay of treatment is pyloromyotomy. This paper reviews the aetiology and pathophysiology of hypertrophic pyloric stenosis, its clinical presentation, the role of imaging, the pre and postoperative management, current surgical approaches and non-surgical treatment options. Contemporary postoperative feeding regimens, outcomes and complications are also discussed. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - May 9, 2016 Category: Pediatrics Authors: Matthew Jobson, Nigel J Hall Source Type: research
Pediatric tracheostomy
Tracheotomy refers to a surgical incision made into a trachea. Tracheostomy, on the other hand, refers to a surgical procedure whereby the tracheal lumen is positioned in close proximity to the skin surface. Tracheostomy is an uncommon procedure in the pediatric population. When required tracheostomy is typically performed as an open surgical procedure under general anesthesia with the patient intubated. However, it may need to be performed under local anaesthesia or over a rigid bronchoscope in the patient with a precarious airway. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 25, 2016 Category: Pediatrics Authors: Paolo Campisi, Vito Forte Source Type: research
Primary tracheo-bronchial tumours in children
Primary tracheobronchial tumours are rare lesions that can be benign or malignant, with different location along the airway tree.Symptoms may include wheezing, chronic pneumonia, asthma, chest pain, recurrent cough, atelectasis, haemoptysis and weight loss.Due to the heterogeneity of symptoms, diagnosis can be difficult and the airway involvement can lead progressively to a bronchial or tracheal obstruction.Due to the rarity of primary tracheobronchial tumours in children, there are not any oncological guidelines on pre-operative work-up, treatment and follow-up. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 22, 2016 Category: Pediatrics Authors: Patricio Varela, Luca Pio, Michele Torre Source Type: research
Primary tracheobronchial tumors in children
Primary tracheobronchial tumors are rare lesions that can be benign or malignant, with different location along the airway tree. Symptoms may include wheezing, chronic pneumonia, asthma, chest pain, recurrent cough, atelectasis, haemoptysis, and weight loss. Due to the heterogeneity of symptoms, diagnosis can be difficult and the airway involvement can lead progressively to a bronchial or tracheal obstruction. Due to the rarity of primary tracheobronchial tumors in children, there are not any oncological guidelines on pre-operative work-up, treatment, and follow-up. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 21, 2016 Category: Pediatrics Authors: Patricio Varela, Luca Pio, Michele Torre Source Type: research
Pediatric Tracheomalacia
Tracheomalacia (TM) is defined as increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies, but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild to moderate symptoms and will not need surgical intervention, some will need life changing surgical treatment. (Sou...
Source: Seminars in Pediatric Surgery - February 21, 2016 Category: Pediatrics Authors: Jose Carlos Fraga, Russell W. Jennings, Peter C.W. Kim Source Type: research
Vascular rings
The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. Another cause of tracheal compression occurring only in infants is the innominate artery compression syndrome. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 21, 2016 Category: Pediatrics Authors: Carl L. Backer, Michael C. Mongé, Andrada R. Popescu, Osama M. Eltayeb, Jeffrey C. Rastatter, Cynthia K. Rigsby Source Type: research
Tracheobronchial stents in children
Tracheobronchial obstruction is infrequent in children and still remains a challenging matter of concern. Management alternatives vary from conservative treatment to complex surgical techniques or endoscopic interventional procedures. Airway stenting in children is relatively recent and follows the trail of the experience in adult patients. Nevertheless, there are basic differences between both age groups like the benign nature of most obstructions and the small size of the pediatric airway. These specific features raise the issues of the precise role of tracheobronchial stenting in children and the selection of the most a...
Source: Seminars in Pediatric Surgery - February 21, 2016 Category: Pediatrics Authors: Juan L. Antón-Pacheco Source Type: research
Airway tissue engineering for congenital laryngotracheal disease
Regenerative medicine offers hope of a sustainable solution for severe airway disease by the creation of functional, immunocompatible organ replacements. When considering fetuses and newborns, there is a specific spectrum of airway pathologies that could benefit from cell therapy and tissue engineering applications. While hypoplastic lungs associated with congenital diaphragmatic hernia (CDH) could benefit from cellular based treatments aimed at ameliorating lung function, patients with upper airway obstruction could take advantage from a de novo tissue engineering approach. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 21, 2016 Category: Pediatrics Authors: Elizabeth Maughan, Flore Lesage, Colin R. Butler, Robert E. Hynds, Richard Hewitt, Sam M. Janes, Jan A. Deprest, Paolo De Coppi Source Type: research
Glottic stenosis
is a fixed, focal narrowing at the level of the laryngeal inlet, the true vocal cords. It may be either congenital or acquired and be related to a wide range of etiologies.The stenosis may be either anterior, posterior, or in rare cases, complete. Isolated glottic stenosis is rare; lesions often involve adjacent regions, namely the subglottis. A diagnosis is made from careful history and examination, including evaluation by microlaryngoscopy and bronchoscopy. The management of glottic stenosis is challenging and should be tailored to each individual case. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 20, 2016 Category: Pediatrics Authors: Kate A. Stephenson, Michelle E. Wyatt Source Type: research
Laryngotracheoesophageal clefts
are rare congenital anomalies of the aerodigestive tract. Patients may present with airway and/or swallowing impairments. An approach to evaluation and management is presented. Important pearls for conservative and surgical management are discussed. Open versus endoscopic surgical techniques are reviewed. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 20, 2016 Category: Pediatrics Authors: Julie Strychowsky, Reza Rahbar Source Type: research
Subglottic stenosis
(SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 20, 2016 Category: Pediatrics Authors: Niall D. Jefferson, Aliza P. Cohen, Michael J. Rutter Source Type: research
Tracheoesophageal fistula
(TEF) is a relatively rare congenital anomaly. Surgical intervention is required to establish esophageal continuity and prevent aspiration and overdistension of the stomach. Since the first successful report of thoracoscopic TEF repair in 2000, the minimally invasive approach has become increasingly utilized. The main advantages of the thoracoscopic technique include avoidance of a thoracotomy, improved cosmesis, and superior visualization of the anatomy and fistula afforded by the laparoscope’s magnification. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 20, 2016 Category: Pediatrics Authors: Bethany J. Slater, Steven S. Rothenberg Source Type: research
Laryngomalacia
is the most common cause of stridor in neonates. It typically presents with inspiratory stridor, and is often associated with feeding problems. Severe cases present with stridor, apnea, significant respiratory distress, and failure to thrive. Most patients are managed conservatively, and can expect to see symptom resolution by 12-24 months of age. About 10% of patients require surgical treatment for their symptoms. Supraglottoplasty is the surgical technique of choice. Results of this surgery are excellent, and severe complications, such as supraglottic stenosis and aspiration, are uncommon. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 18, 2016 Category: Pediatrics Authors: Joshua Bedwell, George Zalzal Source Type: research
Congenital tracheobronchial stenosis
is a rare disease characterized by complete tracheal rings that can affect variable lengths of the tracheobronchial tree. It causes high levels of morbidity and mortality both due to the stenosis itself and to the high incidence of other associated congenital malformations. Successful management of this complex condition requires a highly individualised approach delivered by an experienced multidisciplinary team, which is best delivered within centralised units with the necessary diverse expertise. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 18, 2016 Category: Pediatrics Authors: Richard J. Hewitt, Colin R. Butler, Elizabeth F. Maughan, Martin J. Elliott Source Type: research
Glossoptosis
causes varying degrees of airway obstruction and feeding difficulties. It can occur as a consequence of micrognathia in Robin Sequence, but can also occur in children with hypotonia. Despite several attempts to classify severity in Robin Sequence patients, taking into account symptoms, presence of concomitant syndromes or malformations, and even endoscopic findings, there is still no general consensus. Furthermore, several management recommendations have been reported without an agreement about indications, efficacy or risks of each treatment option. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - February 17, 2016 Category: Pediatrics Authors: Cláudia Schweiger, Denise Manica, Gabriel Kuhl Source Type: research
