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Acute appendicitis remains the most common surgical emergency in children, with laparoscopic appendectomy (LA) now the standard of care. Same-day discharge (SD) after LA is both feasible and safe in children treated for uncomplicated appendicitis. This study aims to determine if SD following LA for children with uncomplicated appendicitis would improve the quality of care with respect to cost of treatment, patient satisfaction, and complications when compared with a cohort admitted postoperatively.An IRB-approved retrospective review of children, 1-18 years old, treated with LA for uncomplicated appendicitis and eligible for same-day discharge at our hospital from August 2012 to April 2015, was performed with telephone follow-up and satisfaction survey for SD patients. Children discharged the same day postoperatively (SD) were compared with those who were admitted postoperatively and discharged the next day (ND) for baseline characteristics, complications, length of stay (LOS), and hospital charges with Student's t-test. Significance was set at P .05.Of 236 acute, uncomplicated appendicitis patients, 121 (51%) had SD and 115 (49%) had ND. Baseline characteristics and postoperative complications were similar, but SD was associated with shorter LOS, 11.8 ± 2.7 versus 24.8 ± 21.2 (P .001); lower costs, $10,551 ± 2165 versus $12,691 ± 3507 (P .0001); and good family satisfaction, with 25/32 (80%) of those surveyed opting for SD in the future.This study shows good patient/family satisfaction following discharge from the recovery room in addition to expected cost and LOS savings, without increasing complications or shifting costs. SD could become the standard of care, improving quality and value for these patients, and a benchmark for emerging therapies.

Purpose The authors report their experience with doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations (LMs) in children. Methods A retrospective chart review was used to collect data on 11 patients treated with doxycycline sclerotherapy for LMs of the head and neck at our institution since 2003. Radiographic imaging allowed classification of patient LM as macrocystic, microcystic, or mixed according to previously published guidelines. Only patients with macrocystic or mixed lesions were offered doxycycline sclerotherapy. Radiographic imaging and physical examination were used to determine efficacy of treatment. After each treatment, the clinical and radiographic response was characterized as excellent (≥95% decrease in lesion size), satisfactory (≥50% decrease in volume and asymptomatic), or poor ( Results Eleven patients underwent a total of 23 sclerotherapies with an average of 2 treatments per patient (range, 1-4). All 7 patients with macrocystic lesions achieved complete clinical resolution with an average radiographic resolution of 93%. The 4 patients with mixed lesions achieved only partial clinical resolution and an average of 73% radiographic resolution. No patient experienced any adverse effects related to the treatment. At a median follow-up of 8 months, 2 patients (18%) experienced lesion recurrence in the setting of concomitant infection. Conclusion Doxycycline sclerotherapy is safe and effective as a primary treatment modality for macrocystic and mixed LMs of the head and neck in the pediatric population.

Received March 8, 2010, from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (J.R.W., M.G.P., M.C., A.C.), Division of Pediatric Surgery, Department of Surgery (B.M.), and Department of Radiology (S.W.), Maine Medical Center, Portland, Maine USA. Manuscript accepted for publication March 9, 2010. Address correspondence to Joseph R. Wax, MD, Maine Medical Partners Women’s Health, 887 Congress St, Suite 200, Portland, ME 04102 USA. E-mail: waxj@mmc.org primagravid patient underwent an obstetric ultrasound examination at a gestational age of 31 weeks 5 days for a fundal height less than expected. The pregnancy was dated by a 15week sonogram, and the fetus had a known 46,XX karyotype following amniocentesis performed because of an increased risk for trisomy 21 by maternal serum screening. The fetal anatomy was sonographically normal at 18 weeks’ gestation. Sonography revealed a normally grown fetus (1746 g, 43rd percentile) surrounded by a normal amniotic fluid volume. A 2.3 ×1.4-cm lobulated right labial and perineal mass was observed (Figures 1 and 2). A review of the 18-week study confirmed a normal perineum at that time. Color and power Doppler interrogation showed no flow within the lesion. The likely diagnosis was a lipoma, for which the patient was counseled and referred for pediatric surgical consultation. The pregnancy was followed weekly, with the mass showing stable dimensions and appearance. A healthy neonate weighing 3150 g with 1and 5minute Apgar scores of 8 and 9, respectively, was delivered vaginally at 39 weeks’ gestation. The neonate had normal bowel and bladder function with physical examination notable only for the 5 ×4 ×3-cm bilobed mass arising from the right perineum extending to the right labium minora and introitus (Figure 3). Magnetic resonance imaging performed on the second day of life showed a signal intensity consistent with fat, no enhancement with gadolinium contrast, and a 1.7-cm vascular pedicle extending cephalad to the right lateral vagina, lower rectum, and anus (Figure 4). At 1 month of age, the mass was locally excised without complications (Figure 5). Histologic examination of the specimen showed mature adipose tissue interspersed with collagenous bands, leading to the diagnosis of a fibrolipoma.

A novel technique for the laparoscopic repair of femoral hernia is described. An 11-year-old boy who had undergone previous open inguinal herniorrhaphy presented with a persistent bulge in the ipsilateral groin. At laparoscopic exploration, a small femoral hernia was discovered. It was reduced with extrinsic compression and the defect closed laparoscopically using a permanent purse-string suture. The ipsilateral umbilical ligament was dissected off the abdominal wall and secured (plugged) over the internal opening, providing a tension-free repair. The immediate postoperative result was satisfactory and there was minimal postoperative pain. Two-year follow-up confirmed adequate repair, without recurrence. This laparoscopic technique enabled diagnostic precision, contralateral evaluation, and a novel means of patching and buttressing the peritoneal closure with umbilical ligament. The procedure is safe, simple, and provides excellent functional and cosmetic results.

Background There has been increasing interest and concern raised in the surgical literature regarding changes in the culture of surgical training and practice, and the impact these changes may have on surgeon stress and the appeal of a career in surgery. We surveyed pediatric surgeons and their partners to collect information on career satisfaction and work-family balance. Methods The American Pediatric Surgical Association Task Force on Family Issues developed separate survey instruments for both pediatric surgeons and their partners that requested demographic data and information regarding the impact of surgical training and practice on the surgeon's opportunity to be involved with his/her family. Results We found that 96% of pediatric surgeons were satisfied with their career choice. Of concern was the lack of balance, with little time available for family, noted by both pediatric surgeons and their partners. Conclusion The issues of work-family balance and its impact on surgeon stress and burnout should be addressed in both pediatric surgery training and practice. The American Pediatric Surgical Association is positioned to play a leading role in this effort.