Ivan M Gutierrez

Publications (2)3.26 Total impact

• Article: Negative pressure wound therapy for children with an open abdomen.

  Ivan M Gutierrez, Gerald Gollin
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  ABSTRACT: PURPOSE: The utility of negative pressure wound therapy (NPWT) in the management of adults with an open abdomen has been well documented. We reviewed our experience with NPWT in the management of infants and children with this condition. METHODS: The records of all children who were treated with NPWT for an open abdomen between March 2005 and September 2009 at a single children's hospital were reviewed. RESULTS: Twenty-five subjects were identified. They included children who developed abdominal compartment syndrome after a laparotomy (n = 12) or in whom the abdomen could not be safely closed at the time of laparotomy (n = 13). NWPT was accomplished with the vacuum-assisted closure (VAC®) system in all patients. The median duration for NPWT was 4.5 days. In 16 subjects, the abdomen was closed successfully after NPWT. In 14 children, the abdominal wall fascia was successfully approximated, and two children underwent a patch abdominal closure. But nine subjects died before an abdominal closure could be attempted. Only two (12.5%) children developed enterocutaneous fistulae. CONCLUSIONS: NPWT is a reliable tool for infants and children with an open abdomen. Wound management was facilitated and abdominal wall closure was ultimately achieved in all survivors. Enterocutaneous fistulae developed in two children, however, these were likely due to underlying bowel injury and would have occurred despite variations in management of the open abdomen.
  Langenbeck s Archives of Surgery 03/2012; · 1.81 Impact Factor
• Article: Failure of enema reduction for ileocolic intussusception at a referring hospital does not preclude repeat attempts at a children's hospital.

  Jennifer L Curtis, Ivan M Gutierrez, Shannon R Kirk, Gerald Gollin
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  ABSTRACT: Some children with intussusception undergo attempted enema reduction at a hospital without pediatric radiology expertise and are transferred to a children's hospital (CH) if this is unsuccessful. We sought to determine whether a failed reduction (FR) at a referring hospital predicted failure of repeated attempts by a pediatric radiologist at a CH. A retrospective review of all children with ileocolic intussusception admitted to a large CH over 9 years was performed. Differences in outcome between those who initially presented to the CH and those who had a FR elsewhere before transfer (FR --> CH) were assessed. A total of 152 subjects were identified. There was no difference in the frequency of successful enema reduction at the CH for those who initially presented at the CH (60.5%) and those who were transferred after a FR elsewhere (60.7%). The only predictor of successful reduction was anatomy, whereby 64% of intussusceptions proximal to the splenic flexure were reduced, but only 35% of those distal to that point (P < .01). Children who are transferred to a CH after failed enema reduction elsewhere should undergo a repeat hydrostatic or pneumatic enema reduction in the absence of other contraindications.
  Journal of Pediatric Surgery 06/2010; 45(6):1178-81. · 1.45 Impact Factor