1671International Abstract of Pediatric Surgery

The purpose of this study was to review a single pediatric surgeon's

experience in the treatment of pilonidal disease over a 35-year period. From

July 1969 to December 2003, a retrospective study of 121 adolescents with

this disease (64 boys, 57 girls) was undertaken. All patients were evaluated for

age, sex, clinical diagnosis, infection, treatment, healing time, complications,

and results. Ages ranged from 12 to 19 years (mean, 15 years). Fourteen

patients were treated nonoperatively; their disease is uninfected and

asymptomatic. Of the 107 infected cysts, 90 were excised and packed open,

13 were subjected to marsupialization, and 4 were excised and closed

primarily without drainage. Healing times were 75, 34, and 8 days,

respectively. The disease recurred in 24 (22%) patients: 20 (22%) of 90 in

the packed open group, 3 (23%) of 13 in the marsupialized group, and 1

(25%) of 4 in the primary closure group. The mean time to recurrence was 195

(30-390) days. None of the variables of age, sex, or surgical approach (chosen

arbitrarily by the surgeon) were predictive of recurrence. There were no other

complications and no deaths. The authors observed that the packing open

procedure incurred a much longer healing period (morbidity) than the other

two methods but that recurrence rates were the same.—John N. Schullinger

doi:10.1016/j.jpedsurg.2011.04.068

Thorax

Outcome of congenital diaphragmatic hernia repair depending onpatch typeLaituri CA, Garey CL, Valusek PA, et al. Eur J Pediatr Surg 2010;20(6)

Patch repair of a congenital diaphragmatic hernia (CDH) is associated with a

much higher rate of recurrence than after primary repair. The biosynthetic

options for the repair materials continue to expand. The authors therefore

reviewed their experience to benchmark complication rates as they progress

with the use of new materials. A retrospective review was conducted of all

patients who underwent repair of CDH. Of the 155 patients included in the

study, 101 had primary closure and 54 received a diaphragmatic patch. The

rates of recurrence, small bowel obstruction (SBO), and subsequent

abdominal operations were all significantly higher in the group of patients

requiring patch repair. There were 3 types of patch repair: 37 patients

received a small intestinal submucosa (SIS) patch, 12 had a nonabsorbable

patch, and 5 received an AlloDerm patch. The incidence of SBO in patients

with a nonabsorbable mesh was 17% and associated with 50% recurrence

rate and 67% re-recurrence rate. Small intestinal submucosa was associated

with a 19% incidence of SBO, a recurrence rate of 22%, and 50% re-

recurrence rate; AlloDerm had a 40% incidence of SBO, a 40% recurrence

rate, and a 100% re-recurrence rate.

The data do not justify the continued use of nonabsorbable patches. It is

concluded that there are not enough comparative data to define a superior

biosynthetic material, but it is planned to use the data in SIS to benchmark

the authors' experience with future generation materials.—

Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2011.04.069

Postoperative chylothorax in congenital diaphragmatic herniaKamiyama M, Usui N, Tani G, et al. Eur J Pediatr Surg 2010;20(6)

The mechanisms responsible for postoperative chylothorax in congenital

diaphragmatic hernia (CDH) patients remain unclear. The aim of the present

study was to examine the clinical features of CDH that may contribute to an

association with postoperative chylothorax. One hundred ninety-eight

neonates with CDH, in whom surgical repair of CDH was performed, were

retrospectively studied. The patients were subdivided into 2 groups: patients

with postoperative chylothorax (group I, n = 11) and patients without post-

operative chylothorax (group II, n = 187). The clinical findingswere compared

between both groups to investigate potential predictive parameters. Eleven

(5.5%) of the 198 infants developed a chylothorax. Although the incidence of

a prenatal diagnosis was slightly higher in group I, no relationship with other

clinical features was found that would indicate the severity of CDH or the

occurrence of postoperative chylothorax. Treatment of chylothorax was

drainage alone in 2 cases, total parenteral nutritionwith drainage in 8 cases, and

additional intrathoracic OK-432 infusion in 1 patient. No patient required

surgical intervention for chylothorax. No recurrences were observed in this

series. It was concluded that postoperative chylothorax is not rare after CDH

repair. However, no significant predictive parameters could be identified,

except for the presence of prenatal diagnosis.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2011.04.070

Surgical management of congenital chylothorax in childrenLe Nué R, Molinaro F, Gomes-Ferreira C, et al. Eur J Pediatrs Surg 2010;20/

5307-11

The aim of the study was to determine the role of surgery in the management

of congenital chylothorax (CC). Ten patients were treated for CC. The

population was subdivided into 2 groups: group A consisted of patients in

whom CC healed after conservative treatment (thoracocentesis, pleural

drainage, total parenteral nutrition, somatostatin, intrapleural injections of

povidone-iodine), and group B consisted of patients who needed both

medical and surgical treatment (pleural abrasion and/or pleurectomy).

Conservative treatment was successful in 50% of cases. Of the 3 patients

treated preoperatively with intrapleural injections of povidone-iodine, 2

presented with severe complications. Surgical treatment was successful in

all cases, with no surgical complications. Patients in group B had a

significantly lower birth term (P = .0254) and birth weight (P = .0021) as

compared with group A. Patients with a massive CC (N50 mL/kg per day)

needed surgery significantly more often than those with CC less than 50 mL/

kg per day (P = .0119). It is concluded that postnatal medical management

of CC should consist of thoracocentesis, drainage by tube thoracostomy, and

total parenteral nutrition. If this treatment fails after 10 days, the authors

propose alternative therapies such as somatostatin (although its efficacy is

not clear). Chemical pleurodesis by intrapleural injection of povidone-iodine

must be avoided in infants and small babies. Surgical management by

pleural abrasion and/or pleurectomy appears to be safe and effective. Early

surgical management is proposed for babies with low birth term, birth

weight, and massive CC. Long-term follow-up is needed to evaluate the

potential consequences of this therapy.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2011.04.071

Alimentary tract

A 9-year single center experience with circumumbilicalRamstedt's pyloromyotomyEl.Gohaty Y, Yeap BH, Hempel G. Eur J Pediatr Surg 2010;20(6)