Background Pediatric surgical practice lags behind medicine in presence and use of evidence,primarily due to time constraints of using existing tools that are not specific to pediatric surgery,lack of sufficient patie...Background Pediatric surgical practice lags behind medicine in presence and use of evidence,primarily due to time constraints of using existing tools that are not specific to pediatric surgery,lack of sufficient patient data and unstructured pediatric surgery training methods.Method We developed,disseminated and tested the effectiveness of an evidence-based resource for pediatric surgeons and researchers that provides brief,informative summaries of quality-assessed systematic reviews and meta-analyses on conflicting pediatric surgery topics.Results Responses of 91 actively practicing surgeons who used the resource were analysed.The majority of participants found the resource useful(75%),improved their patient care(66.6%),and more than half(54.2%)found it useful in identifying research gaps.Almost all participants reported that the resource could be used as a teaching tool(93%).Conclusion Lack of awareness of the resource is the primary barrier to its routine use,leading to potential calls for more active dissemination worldwide.Users of the Canadian Association of Paediatric Surgeons Evidence-Based Resource find that the summaries are useful,identify research gaps,help mitigate multiple barriers to evidence-based medicine,and may improve patient care.展开更多
Background No systematic review and meta-analysis to date has examined multiple child and parent-reported social and physical quality of life(QoL)in pediatric populations affected by Hirschsprung’s disease(HD)and ano...Background No systematic review and meta-analysis to date has examined multiple child and parent-reported social and physical quality of life(QoL)in pediatric populations affected by Hirschsprung’s disease(HD)and anorectal malformations(ARM).The objective of this systematic review is to quantitatively summarize the parent-reported and child-reported psychosocial and physical functioning scores of such children.Methods Records were sourced from the CENTRAL,EMBASE,and MEDLINE databases.Studies that reported child and parent reported QoL in children with HD and ARM,regardless of surgery intervention,versus children without HD and ARM,were included.The primary outcome was the psychosocial functioning scores,and the secondary outcomes were the presence of postoperative constipation,postoperative obstruction symptoms,fecal incontinence,and enterocolitis.A random effects meta-analysis was used.Results Twenty-three studies were included in the systematic review,with 11 studies included in the meta-analysis.Totally,1678 total pediatric patients with HD and ARM underwent surgery vs 392 healthy controls.Pooled parent-reported standardized mean(SM)scores showed better social functioning after surgery(SM 91.79,95%CI(80.3 to 103.3),I2=0).The pooled standardized mean difference(SMD)showed evidence for parent-reported incontinence but not for constipation in children with HD and ARM after surgery that had a lower mean QoL score compared with the normal population(SMD−1.24(-1.79 to–0.69),I2=76%and SMD−0.45,95%CI(−1.12 to 0.21),I2=75%).The pooled prevalence of child-reported constipation was 22%(95%CI(16%to 28%),I2=0%).The pooled prevalence of parent-reported postoperative obstruction symptoms was 61%(95%CI(41%to 81%),I2=41%).Conclusion The results demonstrate better social functioning after surgery,lower QoL scores for incontinence versus controls,and remaining constipation and postoperative obstruction symptoms after surgery in children with HD and ARM.展开更多
Background The efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate.A systematic ...Background The efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate.A systematic review and meta-analysis is presented comparing the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis(IPAA)with ileostomy(diverted)versus the undiverted procedure.Methods Records were sourced from CINAHL,CENTRAL,EMBASE and MEDLINE databases.Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and compared postoperative complications in pediatric patients diagnosed with inflammatory diseases aged less than 18 years who underwent J-pouch with ileostomy versus without ileostomy.The primary outcome was the occurrence of postoperative leaks,and the secondary outcomes were presence of postoperative small bowel obstruction(SBO),pouchitis,stricture and fistula complications.A random-effects meta-analysis was used.Results Twenty-three observational studies in the systematic review were included with 658 patients(83%diverted,17%undiverted).Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without(odds ratio(OR)0.54,95%confidence interval(CI)0.17 to 1.64,I^(2)=16%).There was no difference in the occurrence of SBO,pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without(SBO:OR 2.27,95%CI 0.52 to 9.92,I^(2)=0%,pouchitis:OR 1.76,95%CI 0.95 to 3.24,I^(2)=0%,strictures:OR 2.72,95%CI 0.44 to 16.69,I^(2)=66%).Conclusion The meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.展开更多
Objective The aims were to describe the management of umbilical hernias,to define postoperative complications,and to identify the characteristics of patients that were more likely to have spontaneous resolution of the...Objective The aims were to describe the management of umbilical hernias,to define postoperative complications,and to identify the characteristics of patients that were more likely to have spontaneous resolution of their hernia.Methods All patients referred for umbilical hernia at the Children’s Hospital of Eastern Ontario from January 1990 to April 2017 were examined via retrospective chart review.Spontaneous resolution of umbilical hernia was examined using binary logistic regression.Results We included 2621 patients presenting with an umbilical hernia.A total of 1587(60.5%)patients underwent surgical repair at a median age of 3.6 years(IQR 2.3-5.4).Surgical complications consisted of infection(n=3),bleeding(n=3),hematoma(n=3),and anesthesia-related complications(n=3).For every one-unit increase in defect size,the odds of a spontaneous resolution of the hernia were 5%lower while controlling for prematurity and the presence of comorbidities[adjusted odds ratio(aOR)=0.95;95%confidence intervel(CI)0.93 to 0.97].Premature babies were 80%less likely to experience hernia resolution compared with non-premature babies(aOR=0.20;95%CI 0.03 to 0.74).Conclusion The odds of spontaneous resolution were lower for premature babies and were negatively correlated with defect size.展开更多
文摘Background Pediatric surgical practice lags behind medicine in presence and use of evidence,primarily due to time constraints of using existing tools that are not specific to pediatric surgery,lack of sufficient patient data and unstructured pediatric surgery training methods.Method We developed,disseminated and tested the effectiveness of an evidence-based resource for pediatric surgeons and researchers that provides brief,informative summaries of quality-assessed systematic reviews and meta-analyses on conflicting pediatric surgery topics.Results Responses of 91 actively practicing surgeons who used the resource were analysed.The majority of participants found the resource useful(75%),improved their patient care(66.6%),and more than half(54.2%)found it useful in identifying research gaps.Almost all participants reported that the resource could be used as a teaching tool(93%).Conclusion Lack of awareness of the resource is the primary barrier to its routine use,leading to potential calls for more active dissemination worldwide.Users of the Canadian Association of Paediatric Surgeons Evidence-Based Resource find that the summaries are useful,identify research gaps,help mitigate multiple barriers to evidence-based medicine,and may improve patient care.
文摘Background No systematic review and meta-analysis to date has examined multiple child and parent-reported social and physical quality of life(QoL)in pediatric populations affected by Hirschsprung’s disease(HD)and anorectal malformations(ARM).The objective of this systematic review is to quantitatively summarize the parent-reported and child-reported psychosocial and physical functioning scores of such children.Methods Records were sourced from the CENTRAL,EMBASE,and MEDLINE databases.Studies that reported child and parent reported QoL in children with HD and ARM,regardless of surgery intervention,versus children without HD and ARM,were included.The primary outcome was the psychosocial functioning scores,and the secondary outcomes were the presence of postoperative constipation,postoperative obstruction symptoms,fecal incontinence,and enterocolitis.A random effects meta-analysis was used.Results Twenty-three studies were included in the systematic review,with 11 studies included in the meta-analysis.Totally,1678 total pediatric patients with HD and ARM underwent surgery vs 392 healthy controls.Pooled parent-reported standardized mean(SM)scores showed better social functioning after surgery(SM 91.79,95%CI(80.3 to 103.3),I2=0).The pooled standardized mean difference(SMD)showed evidence for parent-reported incontinence but not for constipation in children with HD and ARM after surgery that had a lower mean QoL score compared with the normal population(SMD−1.24(-1.79 to–0.69),I2=76%and SMD−0.45,95%CI(−1.12 to 0.21),I2=75%).The pooled prevalence of child-reported constipation was 22%(95%CI(16%to 28%),I2=0%).The pooled prevalence of parent-reported postoperative obstruction symptoms was 61%(95%CI(41%to 81%),I2=41%).Conclusion The results demonstrate better social functioning after surgery,lower QoL scores for incontinence versus controls,and remaining constipation and postoperative obstruction symptoms after surgery in children with HD and ARM.
文摘Background The efficacy of performing a restorative proctocolectomy and J-pouch ileoanal anastomosis without diverting ileostomy in children with inflammatory bowel disease has been a longstanding debate.A systematic review and meta-analysis is presented comparing the occurrence of postoperative complications in children who underwent either the pouch-anal anastomosis(IPAA)with ileostomy(diverted)versus the undiverted procedure.Methods Records were sourced from CINAHL,CENTRAL,EMBASE and MEDLINE databases.Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and compared postoperative complications in pediatric patients diagnosed with inflammatory diseases aged less than 18 years who underwent J-pouch with ileostomy versus without ileostomy.The primary outcome was the occurrence of postoperative leaks,and the secondary outcomes were presence of postoperative small bowel obstruction(SBO),pouchitis,stricture and fistula complications.A random-effects meta-analysis was used.Results Twenty-three observational studies in the systematic review were included with 658 patients(83%diverted,17%undiverted).Pooled estimates showed no difference in occurrence of leaks in children who underwent J-pouch/IPAA with ileostomy versus without(odds ratio(OR)0.54,95%confidence interval(CI)0.17 to 1.64,I^(2)=16%).There was no difference in the occurrence of SBO,pouchitis or strictures in children who underwent J-pouch/IPAA with ileostomy versus without(SBO:OR 2.27,95%CI 0.52 to 9.92,I^(2)=0%,pouchitis:OR 1.76,95%CI 0.95 to 3.24,I^(2)=0%,strictures:OR 2.72,95%CI 0.44 to 16.69,I^(2)=66%).Conclusion The meta-analysis did not find differences in the occurrence of complications in pediatric patients who underwent the IPAA with ileostomy procedure versus without ileostomy.
文摘Objective The aims were to describe the management of umbilical hernias,to define postoperative complications,and to identify the characteristics of patients that were more likely to have spontaneous resolution of their hernia.Methods All patients referred for umbilical hernia at the Children’s Hospital of Eastern Ontario from January 1990 to April 2017 were examined via retrospective chart review.Spontaneous resolution of umbilical hernia was examined using binary logistic regression.Results We included 2621 patients presenting with an umbilical hernia.A total of 1587(60.5%)patients underwent surgical repair at a median age of 3.6 years(IQR 2.3-5.4).Surgical complications consisted of infection(n=3),bleeding(n=3),hematoma(n=3),and anesthesia-related complications(n=3).For every one-unit increase in defect size,the odds of a spontaneous resolution of the hernia were 5%lower while controlling for prematurity and the presence of comorbidities[adjusted odds ratio(aOR)=0.95;95%confidence intervel(CI)0.93 to 0.97].Premature babies were 80%less likely to experience hernia resolution compared with non-premature babies(aOR=0.20;95%CI 0.03 to 0.74).Conclusion The odds of spontaneous resolution were lower for premature babies and were negatively correlated with defect size.
