David M Powell

George Washington University, Washington, Washington, D.C., United States

Are you David M Powell?

Claim your profile

Publications (9)16.93 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Two techniques are used for laparoscopic appendectomy (LA): division of the mesoappendix with the harmonic scalpel and ligation of the appendix with an endoloop (EL), or division of the mesoappendix and appendix with an endostapler (ES). Using an ES is a cost-effective technique that provides an outcome benefit in children who require appendectomy. Case series. Academic, tertiary care children's hospital. Seventy-five children who underwent LA from January 1, 2002, to March 31, 2004. Laparoscopic appendectomy. Age, diagnosis, length of stay, surgical time, total operating room time, complications, and instrumentation costs were compared between the EL and ES groups. There was no significant difference in age, length of stay, perforated, gangrenous, or acute appendicitis diagnoses, or complications between the groups. The surgical time and total operating room time for LA in children in the ES group were significantly shorter than in children in the EL group by 15% and 17%, respectively (P<.05). The disposable equipment costs for LA were $201 per case in the ES group vs $400 per case in the EL group. The mean 14.9-minute increase in total operating room time in children in the EL group resulted in $373 of additional operating room and anesthesia costs. The decreased disposable equipment costs and shorter surgical time of LA in the ES group led to cost savings of $572 per case as compared with children who underwent LA with an EL. There is no significant difference in outcome between children who undergo LA with an EL or with an ES. However, this study supports the use of the ES for LA as a more cost-effective technique that is associated with reduced surgical time.
    Archives of Surgery 02/2007; 142(1):58-61; discussion 62. DOI:10.1001/archsurg.142.1.58 · 4.93 Impact Factor
  • Jeffrey R Lukish · David M Powell ·
    [Show abstract] [Hide abstract]
    ABSTRACT: To minimize the risk of exsanguinating hemorrhage, the authors describe a technique of laparoscopic ligation of the median sacral artery before posterior sagittal resection of type I sacrococcygeal teratoma (SCT). Two female infants with antenatally diagnosed SCT underwent postnatal evaluation and preoperative imaging and were taken to the operating room. In both patients, pneumoperitoneum was established via an epigastic 5-mm trocar. Two additional trocars were inserted in the right and left lower quadrants. The peritoneal reflection was opened to the right of the sigmoid colon, and the presacral space was explored. A large median sacral artery was identified easily, isolated, and divided. The children then were placed in a prone position, and the tumors underwent en bloc resection via a Chevron incision with minimal blood loss. The laparoscopic portion of the procedure was performed in an average of 15 minutes. This is the first report of laparoscopic ligation of the median sacral artery before posterior resection of a sacrococcygeal tumor in an infant. This technique can be performed easily with minimal morbidity. Division of this artery is a logical preventative measure and may reduce the risk of hemorrhage during operative resection.
    Journal of Pediatric Surgery 09/2004; 39(8):1288-90. DOI:10.1016/j.jpedsurg.2004.04.042 · 1.39 Impact Factor
  • Todd A. Ponsky · Chris Coppola · Gary E. Hartman · David M. Powell ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Infection with the acid-fast bacilli Mycobacterium avium and Mycobacterium intracellulare, collectively referred to as the Mycobacterium avium complex (MAC) is a substantial diagnostic and clinical problem in children with human immunodeficiency virus (HIV) infection. Because blood cultures in patients with M. avium infection (MAI) are frequently negative, tissue biopsy and culture are often required to confirm the diagnosis or rule out malignancy. The use of laparoscopic mesenteric lymph node biopsy in three children presenting with clinical symptoms and radiographic findings (abdominal lymphadenopathy) consistent with MAC infection is described here. Three ports were utilized and positioned dependent upon CT findings. Adequate specimens for diagnosis were obtained without morbidity in all three children. This experience supports the use of laparoscopy as the preferred method of confirming intra-abdominal MAC infection in HIV infected children.
    Pediatric Endosurgery &amp Innovative Techniques 06/2004; 8(2). DOI:10.1089/1092641041360887
  • [Show abstract] [Hide abstract]
    ABSTRACT: Foramen of Morgagni hernia is a rare form of congenital diaphragmatic hernia. We report the use of laparoscopy to diagnose and manage suspected foramen of Morgagni hernias in children. Cardiophrenic masses were seen on chest radiography in two asymptomatic children aged 1 and 3 years. Further radiologic workup was nondiagnostic. Laparoscopy was performed in both children, and the foramen of Morgagni hernias were immediately identified. Laparoscopic repair was performed on one of the children. Both children had uneventful postoperative courses, were discharged home early, and had no evidence of recurrence at the 6-month follow-up examination. Laparoscopy is a safe and effective technique to diagnose and potentially repair foramen of Morgagni hernias. We recommend the use of this modality as the primary diagnostic evaluation in infants and children with suspected foramen of Morgagni hernias.
    Surgical laparoscopy, endoscopy & percutaneous techniques 11/2002; 12(5):375-7. DOI:10.1097/00129689-200210000-00016 · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous clinical practice has included evaluation for the presence of tethered cord in those children who have imperforate anus with a high lesion. To define the incidence in children with low lesions, the authors reviewed their experience with a protocol employing routine magnetic resonance imaging (MRI), regardless of the level of the lesion, to determine the presence of a tethered cord in all children with imperforate anus. A retrospective review of children with imperforate anus was conducted over the last 13 years at our institution. Lesions were categorized as high versus low based on the supralevator or infralevator position of the fistula. Sixty-three patients completed evaluation for a tethered cord. Twenty-two (34.9%) of these 63 patients had a tethered cord: 11 of 41 (26.8%) patients with high lesions and 11 of 22 (50.0%) of those with low lesions. Of those children with a low lesion, 83% of the boys had a tethered cord, whereas 38% of the girls had a tethered cord. Forty-five percent of the patients with low lesions and a tethered cord did not have any other lumbosacral anomalies. All 22 children with a tethered cord underwent surgical release. The incidence of tethered cord in children with low lesions of imperforate anus is not lower than those with high lesions. The authors advocate early evaluation of all children with imperforate anus for a tethered cord.
    Journal of Pediatric Surgery 08/2002; 37(7):966-9; discussion 966-9. DOI:10.1053/jpsu.2002.33817 · 1.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To optimize burn care for children, the authors introduced a protocol incorporating the use of a bioactive skin substitute, TransCyte (Advanced Tissue Sciences, La Jolla, CA). This study was designed to determine whether this management plan was safe, efficacious, and decreased hospital inpatient length of stay (LOS) compared with conventional burn management in children. All pediatric burns greater than 7% total body surface area (TBSA) that occurred after October 1999 underwent wound closure with TransCyte (n = 20). These cases were compared with the previous 20 consecutive burn cases greater than 7% TBSA that received standard therapy. Standard therapy consisted of application of antimicrobial ointments and hydrodebridement. The following information was obtained: burn mechanism, age, size of burn, requirement of autograft, and LOS. Data were analyzed using the student's t test. Data for age, percent TBSA burn and LOS are reported as means +/- SEM. The children who received standard therapy were 2.99 +/- 0.7 years compared with those receiving TransCyte were 3.1 +/- 0.8 years. There was no difference between the treatment groups with regard to percent TBSA burn: standard therapy, 14.3 +/- 1.4% TBSA versus TransCyte, 12.7 +/- 1.3% TBSA. There was no difference in the type of burns in each group, the majority were liquid scald type, 70% in the standard therapy group versus 90% in the TransCyte group. Only 1 child in the TransCyte group required autografting (5%) compared with 7 children in the standard therapy group (35%). Children treated with TransCyte had a statistically 6 significant decreaed LOS compared with those receiving standard therapy, 5.9 +/- 0.9 days versus 13.8 +/- 2.2 days, respectively (P =.002). This is the first study using TransCyte in children. The authors found that this protocol of burn care was safe, effective, and significantly reduced the LOS. This new approach to pediatric burn care is effective and improves the quality of care for children with burns.
    Journal of Pediatric Surgery 09/2001; 36(8):1118-21. DOI:10.1053/jpsu.2001.25678 · 1.39 Impact Factor
  • Kurt D Newman · David M Powell · George W Holcomb ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Although laparoscopic cholecystectomy has become the procedure of choice for gallbladder removal in children, the treatment of children who have choledocholithiasis remains unclear. For adults who have suspected choledocholithiasis, preoperative endoscopic retrograde cholangiopancreatography (ERCP) is a well-described and effective approach, however, its use for common bile duct stones in children has not been defined. The authors reviewed the records of 131 consecutive children undergoing laparoscopic cholecystectomy on two surgical services to define the efficacy of ERCP followed by laparoscopic cholecystectomy in managing choledocholithiasis in children. Fourteen children were suspected of having common duct stones noted on preoperative ultrasound scan and laboratory data. At ERCP, six children had no stones visualized; eight had stones and underwent stone extraction and sphincter dilation or sphincterotomy. All 14 underwent laparoscopic cholecystectomy a mean of 3.8 days after ERCP. None of the 14 had evidence of retained stones. Only one of 117 children undergoing primary laparoscopic cholecystectomy had unsuspected common bile duct stones and was treated with laparoscopic common bile duct exploration and stone removal. A management plan incorporating ERCP followed by early laparoscopic cholecystectomy is a safe and effective strategy for children who have choledocholithiasis.
    Journal of Pediatric Surgery 08/1997; 32(7):1116-9. DOI:10.1016/S0022-3468(97)90411-5 · 1.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Video-assisted thoracic surgery (VATS) may complement open thoracotomy in children with osteosarcoma requiring pulmonary metastasectomy. The records of children with metastatic pulmonary osteosarcoma considered for initial VATS intervention (n = 9) were reviewed. Two children did not have VATS exploration: one child with multiple bilateral nodules and another child with a deep parenchymal nodule. VATS provided diagnostic biopsy material in all cases when used (n = 7). Two children had benign inflammatory lesions; four children had VATS-directed wedge resections of solitary malignant lesions; and one child had VATS biopsy of diffuse parenchymal and pleural pulmonary disease not amenable to resection. The mean operative time and hospital length of stay were 1.78 +/- 0.54 h and 3.5 +/- 1.8 days, respectively. There were two complications of VATS: bleeding in a child, requiring a transfusion, and a latent pneumothorax in a patient after removal of the chest tube. VATS is safe, serves as an excellent diagnostic modality, complements the open thoracotomy, and may enable the surgeon to avoid more extensive procedures in selected cases.
    Annals of Surgical Oncology 12/1996; 3(6):539-42. DOI:10.1007/BF02306086 · 3.93 Impact Factor
  • David M Powell · Kurt D Newman · Judson Randolph ·
    [Show abstract] [Hide abstract]
    ABSTRACT: A classification of vaginal anomalies has been derived, which permits logical operative decisions. This tool allows the assignment of increasingly involved reconstructive operations to progressively more complex vaginal anatomies. The outcome of this approach in 49 vaginal reconstructions performed in 36 patients over a 25-year period has been analyzed. The cause was found to be congenital adrenal hyperplasia in 21 patients, gonadal dysgenesis in four, and cloaca in two; nine children had other causes. Based on the following anatomic classification and the authors' clinical experience, the following approaches to reconstruction can be recommended. Eight infants with labial fusion (type I) underwent simple introitoplasty. Fourteen patients with distal urogenital sinus (type II) underwent flap vaginoplasty using labioscrotal tissue and/or a posteriorly based flap. Pull-through vaginoplasty was used in 10 children with distal vaginal atresia and proximal urethrovaginal fistula (type III). Four patients with absence of the vagina (type IV) required segmental colon vaginoplasty. Thirteen revisions have been required in nine patients thus far. The follow-up period is 1 to 17 years, and despite the need for reoperation, all but two patients have excellent or satisfactory results based on anatomic and functional considerations. The choice for and timing of vaginal reconstruction rests on precise anatomic evaluation. The complexity of vaginal reconstruction in the growing child and the essentiality of psychosocial adjustment to appropriate sexual identity and function mandate long-term comprehensive follow-up. Optimal care for each patient requires experience and continuity to take the child through diagnosis, surgical reconstruction, stressful adolescence, and into adulthood with full attention to anatomic, physiological, and psychological support.
    Journal of Pediatric Surgery 03/1995; 30(2):271-5; discussion 275-6. DOI:10.1016/0022-3468(95)90573-1 · 1.39 Impact Factor