Safety and feasibility of enhanced recovery after surgery-based management model for ambulatory pediatric surgical procedures

BACKGROUND There is still some room for optimizing ambulatory pediatric surgical procedures,and the preoperative and postoperative management quality for pediatric patients needs to be improved.AIM To discuss the safety and feasibility of the enhanced recovery after surgery(ERAS)-based management model for ambulatory pediatric surgical procedures.METHODS We selected 320 pediatric patients undergoing ambulatory surgery from June 2023 to January 2024 at The First People’s Hospital of Liangshan Yi Autonomous Prefecture.Of these,220 received ERAS-based management(research group)and 100 received routine management(control group).General information,postoperative ambulation activities,surgical outcomes(operation time,postoperative gastro-intestinal ventilation time,and hospital stay),postoperative pain visual analogue scale,postoperative complications(incision infection,abdominal distension,fever,nausea,and vomiting),and family satisfaction were compared.RESULTS The general information of the research group(sex,age,disease type,single parent,family history,etc.)was comparable to that of the control group(P>0.05),but the rate of postoperative(2 h,4 h,and 6 h after surgery)ambulation activities was statistically higher(P<0.01),and operation time,postoperative gastrointestinal ventilation time,and hospital stay were markedly shorter(P<0.05).The research group had lower visual analogue scale scores(P<0.01)at 12 h and 24 h after surgery and a lower incidence of total postoperative complications than the control group(P=0.001).The research group had higher family satisfaction than the control group(P=0.007).CONCLUSION The ERAS-based management model was safe and feasible in ambulatory pediatric surgical procedures and worthy of clinical promotion.

Reasons for Elective Surgery Cancellations in a Senegalese Pediatric Surgery Department

Introduction: Cancellation of elective surgery is common in developing countries. This decision is difficult to make as it generates economic and organizational consequences for the healthcare facility and an additional source of stress for patients and their caregivers. This study aimed to analyze the various aspects of this medical problem. Patients and Methods: We conducted a prospective and descriptive study over six months (from January 1st, 2017, to June 30th, 2017) at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Senegal. Results: Ninety-one cases were collected. The cancellation rate was 20.8%. Infants were affected in 36.3% of cases. Among anesthesiologists, 83.5% were residents, and 16.5% were specialists. Cancellation in nephroblastoma children with an indication for extended nephrectomy represented 15.4% of cases. Concerning reasons for cancellation, comorbidities, dominated by respiratory infections, accounted for 28.5% of cases, patient absences for 24.2%, and issues related to the anesthesiologist for 17.6%. Cancellations were avoidable in 33% of cases. Patients were responsible for cancellation in 37.4% of cases, the healthcare system in 33%, and medical reasons in 29.7%. Conclusion: Our findings suggest that one-third of cancellations could have been avoided with improvements in the healthcare system. Actions should be taken to reduce the cancellation rate in our context.

Optimal timing for plastic surgical procedures for common congenital anomalies:A review

Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group countries.The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons.These children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery etc.These conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,etc.and require immediate surgical intervention.Some,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for surgery.Some,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous recovery.Another extremely important category is that of patients where the operative intervention is done based on their age.Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate ages.There are advantages and disadvantages of intervention at different ages.In this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic surgeons.Obstetricians,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.

Management of Acute Idiopthic Intestinal Invaginal in Infants at Conakry University Hospital

Introduction: Acute intestinal intussusception (AII) has been known for a long time but its diagnosis sometimes remains difficult and its etiologies, particularly the idiopathic forms, poorly elucidated. The objective of this study was to describe the clinical and therapeutic aspects of acute intestinal intussusception in order to contribute to the improvement of the management of this condition in the pediatric surgery department of the Donka National Hospital. Materials and Methods: This is a retrospective descriptive study of patients taken in charge of acute idiopathic intestinal intussusception over a period of 7 years (January 2017 to December 31, 2023). Results: We collected 72 patients operated on for IIA, i.e. a hospital frequency of 1.1% and an incidence of 10.3 cases per year. The mean age was 16.58 months with extremes of 3 months and 28 months. The sex ratio was 12.5 in favor of the boy. The triad of ombredanne dominated the clinical picture and paroxysmal abdominal pain with period of calm represented the main reason for consultation (72 cases) i.e. 100%, followed by vomiting (62 cases) and rectal bleeding (50 cases). Ultrasound was performed in 56 patients visualizing the intussusception sausage in 54 patients or 75%. The most common anatomoclinical variety of intussusception was the ileo-caeco-colic form with 35 cases (or 38%) followed by the ileocolic form 24 cases (33%). The surgical procedure performed was a manual reduction in 54 patients or 75% and an anastomosis resection in 18 patients;the appendectomy of principle was done in 62.25%. The postoperative course was simple in 64 patients or 88.88%. The mortality rate was 6.94 %. Conclusion: AII is a common abdominal surgical emergency in infants. Recognition of the Ombredanne triad especially abdominal pain with a period of calm in children and infants in particular is an important element for vital prognosis. Early diagnosis and close interdisciplinary cooperation between pediatric, radiology and pediatric surgery teams could improve the management of IIA and allow this condition to remain benign in children.

Congenital Cervico-Mandibular Cystic Lymphangioma in Pediatric Surgical Setting in Guinea

Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.

Timing and approaches in congenital cataract surgery:a four-year,two-layer randomized controlled trial

AIM：To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches.METHODS：In this prospective,randomized controlled trial,we recruited congenital cataract patients aged 3 mo or younger before cataract surgery.Sixty-one eligible patients were randomly assigned to two groups according to surgical timing：a 3-month-old group and a 6-month-old group.Each eye underwent one of three randomly assigned surgical procedures,as follows：surgery A,lens aspiration（I/A）;surgery B,lens aspiration with posterior continuous curvilinear capsulorhexis（I/A＋PCCC）;and surgery C,lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy（I/A＋PCCC＋A-Vit）.The long-term best-corrected visual acuity（BCVA） and the incidence of complications in the different groups were compared and analyzed.RESULTS：A total of 57 participants（114 eyes） with a mean follow-up period of 48.7 mo were included in the final analysis.The overall log MAR BCVA in the 6-month-old group was better than that in the 3-month-old group（0.81±0.28 vs 0.96±0.30;P=0.02）.The overall log MAR BCVA scores in the surgery B group were lower than the scores in the A and C groups（A：0.80±0.29,B：1.02±0.28,and C：0.84±0.28;P=0.007）.A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA.CONCLUSION：It might be safer and more beneficial for bilateral total congenital cataract patients to undergosurgery at 6 mo of age than 3 mo.Moreover,with rigorous follow-up and timely intervention,the postoperative complications in these patients are treatable and do not compromise visual outcomes.

Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.

Pediatric surgery during the COVID-19 pandemic

The coronavirus disease 2019(COVID-19)pandemic has had a major impact on pediatric surgery.The infection is often asymptomatic and atypical in children,while overlapping presentations with other infectious diseases generate additional diagnostic challenges.The high probability of missed pediatric cases and the invasive nature of surgery generate great concern for widespread transmission in this setting.Current guidelines suggest that triage of cases should be made on a case-by-case basis by a multidisciplinary team of experts.Decisionmaking can be assisted by classifying cases as elective,urgent,or an emergency according to the risks of delaying their surgical management.A workflow diagram should ideally guide the management of all cases from admission to discharge.When surgery is necessary,all staff should use appropriate personal protective equipment,and high-risk practices,such as aerosol-generating tools or procedures,should be avoided if possible.Furthermore,carefully designed organizational protocols should be established to minimize transmission while ensuring the uninterrupted operation of pediatric surgery units.For example,surgical teams can be divided into small weekly rotating groups,and healthcare workers should be continuously monitored for COVID-19 symptoms.Additionally,team protocols in the operating room can optimize communication and improve adherence to personal protective equipment use.Isolated operating rooms,pediatric intensive care units,and surgical wards should be specifically designed for suspected or confirmed COVID-19 cases.Finally,transportation of patients should be minimal and follow designated short routes.All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

Effect of Cardioplegia for Myocardial Protection in Pediatric Cardiac Surgery:A Network Meta-Analysis

Cardioplegia has been widely used to reduce myocardial injury during pediatric cardiac surgery;however,which cardioplegia solution has the best protective effect has not been established.Thus,we compared the myocardial protective effects of different cardioplegia solutions used in pediatric cardiac surgery.Seven databases were searched to identify the relevant randomized controlled trials.A network meta-analysis with a Bayesian framework was conducted.The outcomes included the following biochemical and clinical outcomes:serum concentrations of the creatine kinase-myocardial band at 6 h postoperatively;cardiac troponin I(cTnI)at 4,12,and 24 h postoperatively;spontaneous beating after declamping;postoperative arrhythmias;inotropic support percentage and duration;mechanical ventilation hours;intensive care unit stay in days;hospital stay in days;and mortality.The group treated with cold crystalloid cardioplegia(cCCP)was chosen as the control group.The 22 studies involved 1529 patients.Six types of cardioplegia solutions were described in these studies,including cold blood cardioplegia,cCCP,del Nido,histidine-tryptophan-ketoglutarate(HTK),terminal warm blood cardioplegia,and warm blood cardioplegia(wBCP).The serum concentrations of the 24-h cTnI with wBCP(MD=−2.52,95%CI:−4.74 to−0.27)was significantly lower than cCCP.The serum concentrations of the 24-h cTnI with HTK(MD=4.91,95%CI:2.84–7.24)was significantly higher than cCCP.There was no significant difference in other biochemical and clinical outcomes when compared to cCCP.In conclusion,wBCP may have a superior myocardial protective effect with lower 24-h cTnI levels postoperatively and similar clinical outcomes after pediatric cardiac surgery.

Morphological changes in the iridocorneal angle and their relationship with intraocular pressure after infantile cataract surgery

·AIM:To evaluate morphological changes in the iridocorneal angle after pediatric cataract surgery.·METHODS:Children who underwent primary infantile cataract surgery were included and 64 eyes from 41 children,including 18 with unilateral cataracts(18 eyes)and 23 with bilateral cataracts(46 eyes)were examined.All patients underwent two gonioscopic examinations to evaluate the iridocorneal angle,before the primary lens removal and before the secondary intraocular lens implantation.The anatomical changes in the iridocorneal angle and the relationship between intraocular pressure(IOP)and iridocorneal angle changes were also analyzed.·RESULTS:The iridocorneal angle was wide in 64 eyes before and after surgery.The trabecular meshwork pigmentation,number of iris processes in every quadrant of the iridocorneal angle,and the width of the ciliary body band in the superior and inferior quadrants at the second gonioscopic examination were significantly increased compared to those at the first examination(P<0.001,P<0.05,P<0.05.and P<0.05,respectively).IOP gradually increased at 1 mo after operation,and returned to the preoperative level at 3 mo.However,IOP still increased significantly at 6 and 12 mo.·CONCLUSION:The main changes after pediatric cataract surgery include an increase in trabecular meshwork pigmentation and number of iris processes,IOP gradually increase and has positive correlation with trabecular meshwork pigmentation and anterior insertion of iris process.

Management of cataract surgery in Lowe syndrome

AIM: To evaluate the ophthalmic and anesthesiologic management of cataract surgery in children with Lowe syndrome receiving lens removal, the development and management of secondary glaucoma.METHODS: This retrospective case series included 12 eyes of 6 children with genetically verified Lowe syndrome receiving cataract removal. Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intra-and postoperative complications were noted as well as clinical examinations such as visual acuity and funduscopy. RESULTS: All children received simultaneous bilateral cataract surgery at the mean age of 8.98±3.58 wk. Lensectomy combined with posterior capsulotomy and anterior vitrectomy was performed in all children. The mean time for cataract surgery per eye was 35.83±8.86 min, whereas the total time of surgery was 153.33±22.11 min. The mean extubation time and duration at recovery room was 42.33±22.60 min and 130.00±64.37 min, respectively. During surgery, a decrease of oxygen saturation below 93% was found in only one child. During the postoperative followup, nystagmus(6 children) and strabismus(5 children) was commonly found in contrast to no case of visual axis opacification. Secondary glaucoma developed in five eyes of three children, which was treated with topical eye drops in only one child. A trabeculectomy was performed in both eyes of one child, whereas removal of syechia and an iridectomy in one eye of one child. CONCLUSION: Bilateral simultaneous cataract surgery under general anesthesia is a safe surgical procedure in Lowe syndrome children. The glaucoma screening with intraocular pressure measurements is crucial in the postoperative management of Lowe syndrome patients to avoid additional visual impairment.

Pterygium Popliteal Syndrome Concerning a Case in the Pediatric Surgery Department of the Donka National Hospital (Conakry CHU)

Introduction: Popliteal pterygium syndrome is a rare birth defect, combining craniofacial, genitourinary and musculoskeletal abnormalities. It is an autosomal dominant disease caused by a mutation in the IRF6 gene. We report in this observation the 1st Guinean case corrected by the surgical method as well as a review of the literature for a diagnostic and therapeutic approach. Patient and observation: We present the case of a 7-day old male newborn weighing 2700 g who was received for bilateral cleft lip and palate, lower lip fossa or sinuses, bilateral popliteal pterygium, and triangular skin fold above the hallux. The patient underwent several surgical procedures aimed at correcting these abnormalities. The correction of the pterygium of the lower limbs was ensured by excision of the fibrous band, the tenoplasty in z of the calcaneal tendon on the right side and the skin plasty in z in series then immobilized by plaster splints. The immediate postoperative follow-up was straightforward. Conclusion: Popliteal pterygium syndrome is a rare congenital malformation, the diagnosis is primarily clinical. Early soft tissue lengthening surgery and serial z-skin plasty provide better correction of the knee pterygium. Correct correction of facial abnormalities gives the child a better appearance. The management of this syndrome is multidisciplinary.

Endotracheal Tube Displacement during Cardiac Surgery in Infants: A Retrospective Cohort Study of Its Incidence and Predictors

Introduction: With the traction on the trachea and intrathoracic manipulation during cardiac surgery, the position of the endotracheal tube (ETT) might be changed as compared to before surgery. Migration of the ETT during pediatric cardiac surgery is particularly problematic in infants. Methods: In this retrospective cohort study, chest X-rays were taken in the operating room just before and after surgery. The position of the ETT among all infants under 1 year of age who underwent cardiac surgery between December 2017 to December 2019 was evaluated. The displacement of the ETT position was examined by measuring the position of the tube tip from the tracheal bifurcation on a chest X-ray, and the relationship between surgery-related factors (age, height, weight, sex, surgery time, cardiopulmonary bypass, tube size, use of tube cuff) was analyzed. Results: Eighty-eight of the 141 patients were enrolled. There was a significant proximal displacement of the ETT tip during cardiac surgery. The distance from the carina to the tube tip after surgery was long, on average 2.5 mm, compared to that before surgery (P = 0.013). Cephalad displacement of the ETT either ≥5 mm or ≥2.5 mm was found in 28 and in 38 out of 88 infants after surgery, respectively. After performing multivariate analysis, the use of un-cuffed ETT was the sole exploratory variable predictive of tube tip displacement (OR 0.34, 95% CI 0.10 - 0.93 if ≥5 mm;and OR 0.24, 95% CI 0.08 - 0.75 if ≥2.5 mm displacement;P = 0.04 and 0.01, respectively). Conclusion: Proximal displacement of the ETT during cardiac surgery occurs more frequently in infants with un-cuffed ETT.

Epidemiological Aspects of Diseases Seen in Pediatric Surgery Consultation at the Kara Teaching Hospital

Background: Pediatric surgery in developing countries faces serious problems of inadequate infrastructures and equipment. Since July 2019, a new department was created in the north of Togo. It is in this context that this study is initiated, with the aim of taking stock of the epidemiological distribution of pediatric surgical diseases. Material and methods: This was a retrospective and descriptive study over a period of eighteen months, from October 30, 2019 to April 30, 2021. It took place in the pediatric surgery department of the Kara teaching hospital. It concerns pathologies seen at the consultation in the department collected in consultation register. Epidemiological parameters were studied. Results: In eighteen (18) months, two hundred and fifty-nine children, were seen in pediatric surgery consultation at the Kara Teaching Hospital. The annual frequency of consultations was 172.66. The monthly frequency was 14.39. The average age of the children was 4.56 years with extremes of 2 days and 15 years. There were 194 boys (74.90%) and 65 girls (25.10%). At the consultation, whatever the reason, the examination was normal in 17 children and 242 children had abnormalities. Two hundred and twelve children (81.85%) had each one abnormality and 30 children (11.58%) had each at least two. A total of 298 diseases were reported in the 242 children. These were 218 congenital diseases (73.15%) dominated by urological abnormalities with 37.16% of cases and 80 acquired diseases (26.85%). Acquired diseases were for 26.85% and dominated by limb trauma and infectious pathologies including chronic osteomyelitis. Conclusion: Pathologies seen in pediatric surgery consultation were dominated by congenital diseases. Urological malformations are the most represented. This study forms a basis for other more extensive ones.

Nursing cooperation related to thoracoscopic surgery in children

Objective:To explore the nursing cooperation of pediatric cardiac surgery by thoracoscopy.Methods:30 patients undergoing thoracoscopy in a third-grade hospital in Yantai were observed and their nursing process was recorded and analyzed.Results:The good cooperation of operating room nurses and equipment nurses can relax the children and increase the success rate of surgery and reduce the occurrence of complications.Conclusion:Full preoperative preparation,close intraoperative cooperation,strict instrument maintenance,and cleaning and disinfection are the guaranteeof pediatric thoracic surgery.

Management of Specific Complications after Congenital Heart Surgery(I)

In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care specialist to fully understand the preoperative anatomy and the intraoperative details of these patients. This allows a timely and appropriate treatment of general and lesion-specific complications. In this article we provide a list of commonly-performed surgical procedures and possible associated problems to be anticipated in the early postoperative period. Then it follows a discussion about the diagnosis and management of these complications, based on their pathophysiological features.

Practice of Pediatric Spinal Anesthesia in a Country with Limited Means: Example of Togo

Introduction: The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in pediatric surgery in Togo. Framework and method of study: This was a prospective study from November 2017 to May 2018 in pediatric surgery at CHU SO de Lomé, in the operating room and hospital ward of CHU Kara. The surgical, anesthesiological and evolutionary aspects of the patients were analyzed. Results: Sixty children were selected for the study who had an indication for sub-umbilical surgery. The male sex was predominant (73.3%). 47 (78.30%) patients were operated on for scheduled surgery. Hernia repair was the most performed surgical intervention (43.30%). The mean duration of the surgery was 78 ± 35.9 minutes. Most of the patients were ASA 1 (98.30%). The local anesthetic used was 0.5% isobaric Bupivacaine. Fentanyl was the predominant adjuvant (55%). The most widely used lumbar puncture needle was 25 Gauge with 75 millimeters in length (63.30%). Diazepam was the most widely used sedative (50%). The predominant spinal anesthesia protocol was spinal anesthesia alone (60%). Only one patient had hypotension (1.70%). Conclusion: The fairly satisfactory pediatric spinal anesthesia in Togo remains poorly performed. Its promotion involves the training of anesthesia practitioners and the strengthening of the technical platform.

Hemi-hepatectomy in pediatric patients using two-surgeon technique and a liver hanging maneuver

AIM： To evaluate the efficacy of the two-surgeon technique with the liver hanging maneuver （LHM） for hepatectomies in pediatric patients with hepatoblastoma. METHODS： Three pediatric patients with hepatoblastoma were enrolled in this study. Two underwent right hemi-hepatectomies and one underwent a left hemihepatectomy using the two-surgeon technique by means of saline-linked electric cautery （SLC） and the Cavitron Ultrasonic Surgical Aspirator （CUSA; Valleylab, Boulder, CO） and the LHM. RESULTS： The mean operative time during the parenchymal transections was 50 rain and the mean blood loss was 235 g. There was no bile leakage from the cut surface after surgery. No macroscopic or microscopic-positive margins were observed in the hepatic transections. CONCLUSION： The two-surgeon technique using SLC and CUSA with the LHM is applicable to even pediatric patients with hepatoblastoma.

Surgical treatment of multiple magnet ingestion in children:A singlecenter study

BACKGROUND Since 2017,the number of magnet ingestion cases has increased year over year in our hospital.Almost all of the ingested magnetic foreign bodies were magnetic beads,and most of the patients experienced intestinal perforations,causing substantial damage.AIM To summarize our experience with surgical treatment of multiple magnet ingestion in children.METHODS The data for general surgeries were collected from January 2010 to April 2020,and the clinical characteristics,treatment methods,and outcomes were summarized and analyzed.Several typical cases were selected and discussed.RESULTS Fifty-six cases of ingested magnetic foreign bodies were collected,of which 47 were magnetic beads.The average patient age was 4.7±3.0 years old.The number of ingested magnetic foreign bodies ranged from 2 to 73.There were 26 cases with symptoms at the time of admission,including two cases of shock.Thirteen patients were discharged successfully following conservative treatment and 43 were treated by surgery.Laparotomy was the main method of operation.Laparoscopy was used in four cases,of which three were converted to open surgery,and one was treated successfully using surgery through the navel.Postoperative complications occurred in seven cases,incision infections were observed in six,and adhesive ileus was observed in one.CONCLUSION Clinicians need to summarize their experiences with treating magnetic foreign body ingestions in detail and carry out clinical research to reduce the damage to children.