A recent alternative feeding regimen at the progressive feeding (PF) after a pyloromyotomy for hypertrophic pyloric stenosis (HPS) is the so-called ad libitum feeding (AL).The aim of this study was to determine if thi...A recent alternative feeding regimen at the progressive feeding (PF) after a pyloromyotomy for hypertrophic pyloric stenosis (HPS) is the so-called ad libitum feeding (AL).The aim of this study was to determine if this new feeding regimen has modified the follow-up of postoperative course in HPS.Population and methods.-From January 1998 to December 2003, 97 consecutive neonates have been operated on for HPS in our hospital.This retrospective study was based on the comparison between two groups of patients with different postoperative feeding regimens: group one of 30 neonates with PF regimen and group two of 60 neonates with AL regimen.Seven remaining neonates had had a mucosal perforation and were not included in this comparative study but in a separate group (MP).The clinical, ultrasonographic, operative and postoperative data were compared.Results.-There was no difference between the PF and AL groups for sex ratio M/F = 4/1, preoperative weight loss ratio, ultrasonographic data and intra-operative difficulties rate.A small difference was found -which was not significative -between the PF and the AL groups for median age at diagnosis (44,6 ν36,7 days, respectively).A statistically significative difference between the PF and the AL groups was observed for time to establish feeding (69 vs 35.6 hours, respectively) (P < 0,001), postoperative stay (4.16 vs 2.98 days, respectively) (P < 0,001) and total hospital charges.We didn’t found any difference in the incidence and severity of postoperative emesis whether slow (PF) or rapid (AL) feeding regimens were used.Furthermore, intra-operative mucosal tear didn’t influence postoperative course and the duration of hospital stay.Conclusion.-We recommend AL regimen for routine feeding in simple cases after pyloromyotomy for HPS.It has a positive impact on length of hospital stay, and decreases hospital charges.Most neonates with MP can be managed with a rapid feeding regimen.展开更多
Diagnosis of appendicitis in children represents a continuing diagnostic dilemma for emergency room physicians and paediatric surgeons.If unnecessary surgery should be avoided, delayed diagnosis and treatment of appen...Diagnosis of appendicitis in children represents a continuing diagnostic dilemma for emergency room physicians and paediatric surgeons.If unnecessary surgery should be avoided, delayed diagnosis and treatment of appendicitis is responsible for complications.Use of a diagnostic clinical score may improve the management of the children with abdominal pain.A prospective evaluation of an appendicitis score is presented and discussed.展开更多
Various surgical procedures are used for esophageal substitution in children. With the gastric tube (GT) esophagoplasty procedures,main complications in the long term are related to gastric content reflux and acid pro...Various surgical procedures are used for esophageal substitution in children. With the gastric tube (GT) esophagoplasty procedures,main complications in the long term are related to gastric content reflux and acid production from the GT itself. A case of children operated on with a new procedure of isoperistaltic isolated GT interposition with favorable short-and long-term functional results is presented.展开更多
文摘A recent alternative feeding regimen at the progressive feeding (PF) after a pyloromyotomy for hypertrophic pyloric stenosis (HPS) is the so-called ad libitum feeding (AL).The aim of this study was to determine if this new feeding regimen has modified the follow-up of postoperative course in HPS.Population and methods.-From January 1998 to December 2003, 97 consecutive neonates have been operated on for HPS in our hospital.This retrospective study was based on the comparison between two groups of patients with different postoperative feeding regimens: group one of 30 neonates with PF regimen and group two of 60 neonates with AL regimen.Seven remaining neonates had had a mucosal perforation and were not included in this comparative study but in a separate group (MP).The clinical, ultrasonographic, operative and postoperative data were compared.Results.-There was no difference between the PF and AL groups for sex ratio M/F = 4/1, preoperative weight loss ratio, ultrasonographic data and intra-operative difficulties rate.A small difference was found -which was not significative -between the PF and the AL groups for median age at diagnosis (44,6 ν36,7 days, respectively).A statistically significative difference between the PF and the AL groups was observed for time to establish feeding (69 vs 35.6 hours, respectively) (P < 0,001), postoperative stay (4.16 vs 2.98 days, respectively) (P < 0,001) and total hospital charges.We didn’t found any difference in the incidence and severity of postoperative emesis whether slow (PF) or rapid (AL) feeding regimens were used.Furthermore, intra-operative mucosal tear didn’t influence postoperative course and the duration of hospital stay.Conclusion.-We recommend AL regimen for routine feeding in simple cases after pyloromyotomy for HPS.It has a positive impact on length of hospital stay, and decreases hospital charges.Most neonates with MP can be managed with a rapid feeding regimen.
文摘Diagnosis of appendicitis in children represents a continuing diagnostic dilemma for emergency room physicians and paediatric surgeons.If unnecessary surgery should be avoided, delayed diagnosis and treatment of appendicitis is responsible for complications.Use of a diagnostic clinical score may improve the management of the children with abdominal pain.A prospective evaluation of an appendicitis score is presented and discussed.
文摘Various surgical procedures are used for esophageal substitution in children. With the gastric tube (GT) esophagoplasty procedures,main complications in the long term are related to gastric content reflux and acid production from the GT itself. A case of children operated on with a new procedure of isoperistaltic isolated GT interposition with favorable short-and long-term functional results is presented.
