Giant exomphalos can be successfully managed using conservative or surgical techniques. However,if treatment is complicated by sepsis,early skin cover of the defect becomes necessary. Options include split skin grafti...Giant exomphalos can be successfully managed using conservative or surgical techniques. However,if treatment is complicated by sepsis,early skin cover of the defect becomes necessary. Options include split skin grafting,but in the presence of ongoing infection the risk of graft failure is high and limited skin is available for regrafting. We describe the novel use of a skin substitute (Integra Artificial Skin,Integra Life Sciences Corporation,Plainsboro,NJ) as an alternative to primary grafting in the management of infected giant exomphalos.展开更多
Background/Purpose: Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD)...Background/Purpose: Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD) is an alternative procedure for treatment of gastroesophageal reflux. The aim of this study is to evaluate the results of EGD in our institution and compare them with a neurologically matched group of children who had Nissen fundoplication. Methods: Twenty consecutive patients who had EGD were retrospectively evaluated and the results were compared with a neurologically matched group of 20 consecutive patients who had Nissen fundoplication. Results: Twenty patients had EGD, 17 as a primary procedure. There was no operative mortality but 5 have died of other causes. Resolution of reflux-associated symptoms occurred in all patients. Of the 15 survivors, 5 remain on antireflux medication. Twenty patients had fundoplication. There was no operative mortality, but 8 patients have died of other causes. Failure occurred in 5 patients necessitating further surgery. Of the 10 unreoperated survivors, 6 remain on antireflux medication. Conclusions: Esophagogastric dissociation is an effective antireflux procedure when compared with fundoplication. It has a lower failure rate. We recommend EGD as a primary procedure in selected children with severe neurological impairment.展开更多
文摘Giant exomphalos can be successfully managed using conservative or surgical techniques. However,if treatment is complicated by sepsis,early skin cover of the defect becomes necessary. Options include split skin grafting,but in the presence of ongoing infection the risk of graft failure is high and limited skin is available for regrafting. We describe the novel use of a skin substitute (Integra Artificial Skin,Integra Life Sciences Corporation,Plainsboro,NJ) as an alternative to primary grafting in the management of infected giant exomphalos.
文摘Background/Purpose: Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD) is an alternative procedure for treatment of gastroesophageal reflux. The aim of this study is to evaluate the results of EGD in our institution and compare them with a neurologically matched group of children who had Nissen fundoplication. Methods: Twenty consecutive patients who had EGD were retrospectively evaluated and the results were compared with a neurologically matched group of 20 consecutive patients who had Nissen fundoplication. Results: Twenty patients had EGD, 17 as a primary procedure. There was no operative mortality but 5 have died of other causes. Resolution of reflux-associated symptoms occurred in all patients. Of the 15 survivors, 5 remain on antireflux medication. Twenty patients had fundoplication. There was no operative mortality, but 8 patients have died of other causes. Failure occurred in 5 patients necessitating further surgery. Of the 10 unreoperated survivors, 6 remain on antireflux medication. Conclusions: Esophagogastric dissociation is an effective antireflux procedure when compared with fundoplication. It has a lower failure rate. We recommend EGD as a primary procedure in selected children with severe neurological impairment.
