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ABSTRACT: To present special methodical and clinical findings of transjugular intrahepatic portosystemic shunts (TIPSS) in children and to discuss potential indications.
Between 1993 and 1996, 6 children aged 2-13 years were treated by TIPSS-insertion. In four cases, the underlying disease was extrahepatic biliary atresia (EHBA) and in two cases liver fibrosis secondary to treatment of neoplasms during early childhood. Indications for TIPSS insertion were variceal bleeding resistant to other treatment modalities in three patients, hypersplenism in one patient and both bleeding and hypersplenism in two. Portal vein punctures were performed using 16-gauge needles, because 19-gauge fine-needles showed insufficient stiffness. The mean follow-up was 24.5 months.
Shunt insertion succeeded in all children with a mean procedure time of 5.2 hours. Periportal fibrosis associated with EHBA, atypical course of hepatic veins and small diameters and distances of vessels were conditions making the procedure difficult. Bleeding ceased in all patients, peripheral platelet counts rose by a mean value of 58%. Procedure-related complications were minor extrahepatic bleeding in one child and temporary haemolysis in another child. Restenosis resulted in three patients and were treated successfully by means of transjugular interventions. 5 children remain free of symptoms to this day, one child underwent successful orthotopic liver transplantation 8 months after TIPSS.
TIPSS insertion is technically more difficult in children and has to consider child growth and possible subsequent liver transplantation. Potential indications are recurrent variceal bleeding, also of intestinal origin, resistant to standard treatment and clinically significant hypersplenism.
RöFo - Fortschritte auf dem Gebiet der R 07/1998; 168(6):595-603. · 2.76 Impact Factor
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European Journal of Pediatric Surgery 07/1997; 7(3):147-8. · 0.81 Impact Factor
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ABSTRACT: Three-dimensional endorectal sonography with a specially developed system is able to produce an image of the entire pelvic floor including the sphincter muscles and the rectal wall even in small children. This special system is based on conventional endorectal ultrasound and allows recording of a controlled withdrawal of the axially rotating transducer, creating an image sequence resembling that of a spiral CT-scan; this sequence is digitized off-line and evaluated in a three-dimensional form by a workstation computer. This evaluation has several advantages compared with conventional examination, for example, the complete recording of organs with the possibility of volumetry, construction of arbitrary sections, volume-rendering procedures and the interactive segmentation of organ borders and their three-dimensional visualization. Based on images from this 3D endorectal sonography, the normal anatomy of the pelvic floor that is visible using ultrasound is described, followed by some pathological findings concerning continence surgery. Finally we discuss the advantages and restrictions compared to other examination procedures and the possibilities of technical development.
European Journal of Pediatric Surgery 05/1997; 7(2):97-102. · 0.81 Impact Factor
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ABSTRACT: Since 1990, we have been conducting ambulatory pediatric surgery in an unit established solely for this purpose, supported by a team of kindergarten teachers, pediatric nurses, anesthesiologists and pediatric surgeons. This prospective investigation includes all ambulatory pediatric operations performed in our department from 1990 to 1995. In this time 3665 infants and children between the ages of 6 weeks and 18 years underwent an ambulatory operation. The ratio male to female was 4.1 to 1. The series consists of 1400 inguinal hernias, 722 inguinal testes, 191 hydroceles/funiculoceles, 75 umbilical hernias, 667 phimoses, 70 meatotomies, 59 hemangiomas, 217 endoscopies and 264 other surgical procedures. Postoperative complications defined as secondary hemorrhage, fever, obvious vomiting, urine retention and laryngospasm upon terminating anesthesia accompanied by subsequent vomiting occurred in 59 (1.6%) of all infants and children. Wound infections were seen in 0.48% (17/3517) of all patients. The recurrence rate for inguinal hernias were 0.79% and 1.12% for inguinal testes. Our experience enables us to summarize that a variety of pediatric operations can be performed today as ambulatory procedures. Nevertheless one must be prepared for the occurrence of complications and always have capacities free for inpatient care where adequate observation and treatment are available. Further improvement is necessary in quality management. In the last 20 years only a few data have been published about recurrence rates after pediatric ambulatory operations for inguinal hernias and inguinal testes. Therefore we started a prospective long- term study.
Zentralblatt für Chirurgie 02/1997; 122(10):898-900. · 1.02 Impact Factor
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ABSTRACT: Clinical and procedural experience using transjugylar intrahepatic portosystemic shunt (TIPS) on 7 children with recurrent hemorrhage of esophageal varices is reported. Recurrent hemorrhage from esophageal varices following repeated paravasal sclerosing of the varices as well as severe-grade hypersplenism are proposed as the indication for its use. The technical details of TIPS, observed and possible early and late complications, the demand for a decrease in the portosystemic pressure gradient to less than 15 mmHg and the influence of TIPS on improvement of the varices, hypersplenism and the frequently observed malabsorption are described.
European Journal of Pediatric Surgery 09/1995; 5(4):211-5. · 0.81 Impact Factor
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ABSTRACT: The application of opiates after day case surgery in childhood is discussed controversially because of possible complications. Therefore many anaesthetists try to avoid these substances and prefer peripheral analgesics for postoperative pain control.
By distributing a questionnaire concerning the arguments connected with postoperative pain to 267 parents (a total of 78.3% of the questionnaires was returned) of children that had undergone inguinal herniorrhaphy or orchidopexy we hoped to gain insight into the judgement of peripheral analgesics-in this case acetaminophen-following inguinal herniorrhaphy or orchidopexy. During standardized anaesthesia the children received acetaminophen suppositories (15-20 mg/kg BW). After release from the hospital on the same day this drug was administered by the parents in case of necessity.
Need for analgesics was significantly higher in the group of orchidopexy than in the group of herniorrhaphy (p < .01) and even memory of pain three days after the operation seemed to be higher in this group. The sleep patterns were more influenced by orchidopexy. Surprisingly 75% of the children following herniorrhaphy received no analgesics at all after release from the hospital (6 hours postoperatively).
Following herniorrhaphy the postoperative pain therapy with acetaminophen seems to be sufficient. For the postoperative pain treatment after orchidopexy additional measures like local nerve blocks, regional anesthesia or wound infiltrations with local anaesthetics should be considered.
ains · Anästhesiologie · Intensivmedizin 05/1994; 29(2):90-5. · 0.41 Impact Factor
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ABSTRACT: 294 parents whose children underwent day case surgery received a questionnaire covering the topics postoperative analgesia, memory of pain, sleep patterns and assessment of the time spent in the hospital. A total of 80.6% of the questionnaires were returned. We were not able to recognize any indications of behavioral disturbances, in particular disturbances of sleep. The need for analgesics was surprisingly low following release from the hospital. However, even on the third postoperative day 16.8% of the children still had unpleasant or strong memories of the pain they had experienced. Improvement in this area might be achieved by the application of nerve blocks, possibly in combination with analgesics. Further possibilities for improvement exist with premedication. The long waiting periods between hospital admittance and commencement of surgery were found to be very unpleasant. During surgery psychological counseling of the parents should be made possible.
European Journal of Pediatric Surgery 01/1992; 1(6):323-7. · 0.81 Impact Factor
