Search

Routine use of transanastomotic biliary stents (RTBS) for biliary reconstruction in liver transplantation ( LT) is controversial, with conflicting outcomes in adult randomized trials. Pediatric literature contains limited data. This study is a retrospective review of 99 patients who underwent first LT (2005-2014). In 2011, RTBS was discontinued at our center. This study describes biliary complications following LT with and without RTBS. 56 (56%) patients had RTBS. Median age at LT was 1.9 yr ( IQR 0.7, 8.6); 55% were female. Most common indication for LT was biliary atresia (36%). Most common biliary reconstruction was Roux-en-Y choledochojejunostomy (75% with RTBS, 58% without RTBS, p = 0.09). Biliary complications (strictures, bile leaks, surgical revision) occurred in 23% without significant difference between groups (20% with RTBS, 28% without RTBS, p = 0.33). Patients with RTBS had routine cholangiography via the tube at 6-8 wk; thus, significantly more patients with RTBS had cholangiograms (91% vs. 19%, p < 0.0001). There was no difference in the number of patients who required therapeutic intervention via endoscopic or percutaneous transhepatic cholangiography (11% with RTBS, 19% no RTBS, p = 0.26). Routine use of RTBS for biliary reconstruction in pediatric LT may not be necessary, and possibly associated with need for costlier, invasive imaging without improvement in outcomes. [ABSTRACT FROM AUTHOR]

Background/Purpose: Aortopexy is an established treatment method for severe tracheomalacia. It can be performed by thoracotomy or thoracoscopically. The purpose of this study is to review our experience with thoracoscopic aortopexy. Methods: Thoracoscopic aortopexy was performed for treatment of tracheomalacia in five patients. A left-sided approach with three ports was used. The aorta was sutured to the sternum with a series of transversely oriented simple interrupted Prolene sutures. Knots were tied subcutaneously. Pre- and postprocedure bronchoscopy was used to verify improvement in tracheal patency. The study protocol was approved by the Institutional Review Board. A retrospective chart review was performed and indications, perioperative course, and, where available, long-term results were noted. Results: We treated four girls and one boy. Ages were between 6 weeks and 2 years. Weights were between 3.2 and 10 kg. Resolution of symptoms was achieved in all patients. There was no morbidity or mortality associated with the procedure. Length of hospital stay after aortopexy ranged between 4 and 59 days. Follow-up ranged between 34 and 5 months. Conclusions: Thoracoscopic aortopexy is an effective treatment for severe tracheomalacia not controlled by conservative measures. It can be safely performed even in small infants as long as equipment and skill for pediatric thoracoscopy are available. The authors believe that thoracoscopic exposure offers advantages over open technique and is cosmetically more pleasing to patients and their families. It may result in less pulmonary complications, shorter hospital stay, and less narcotic requirement compared to open thoracotomy. [ABSTRACT FROM AUTHOR]