Merrill Mchoney

• FRCS (Paed Surg) Ph.D.
• Consultant at Oxford University Hospitals NHS Trust

Introduction Oesophageal Foreign body (OFB) ingestion, a common and serious problem in children, can present with a wide variety of symptoms. This paper describes and discusses the rare case of delayed presentation of an oesophageal foreign body, initially presenting as severe nose bleed after trauma. Presentation of Case A 7-year-old girl present...

Background: The coronavirus (COVID-19) pandemic affected the presentation of many conditions. This study analyses and describes the impact of the COVID-19 pandemic on the management of appendicitis in children and the role of laparoscopy. Materials and methods: We performed a prospective (during the pandemic) and retrospective (historic control)...

Although preoperative planning for pediatric oncology surgery often involves a well-developed multidisciplinary process, postoperative discharge planning after surgery is also an important aspect that requires forethought and planning and can involve multiple disciplines in putting an agreed plan into action. It can be informal where time, availabi...

Infantile hypertrophic pyloric stenosis (IHPS) is one of the most commonly encountered paediatric surgical conditions. It is estimated to affect between 1 and 4 infants per 1,000 births, representing the most common cause of surgical intervention in the first 6 months of life. The exact aetiology remains unclear. It is known to be more common in ma...

Objectives : To evaluate the clinical outcomes of herniotomy in preterm infants undergoing early versus delayed repair, the risk factors for complications, and to identify best timing of surgery. Methods : Medline, Embase and Central databases were searched from inception until 25 Jan 2021 to identify publications comparing the timing of neonatal...

Purpose To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance. Methods UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLS...

Gastro-oesophageal reflux (GOR) in newborns does not necessarily represent a clinical disease, but rather a somewhat delayed physiological development that corrects with time. Gastro-oesophageal reflux disease (GORD) is defined as secondary symptoms and complications arising from gastro-oesophageal reflux. GORD requires aggressive medical managemen...

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients.Since surgical patients are already at higher risk of venous thromboembolism than general populations, thisstudy aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk ofvenous thromboembolism. We...

Objective We performed a meta-analysis on Near-infrared Spectroscopy (NIRS) as a biomarker of bowel ischaemia. Summary Background data NIRS allows non-invasive assessment of gastrointestinal regional oxygen saturation (GrSO2). Studies to date have focused on the feasibility of NIRS in clinical practice and its reproducibility. GrSO2 can be used al...

Background This study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair. Method A retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared...

Introduction Hernias in children represent a large portion of workload for paediatric surgeons. Open hernia repair has been the standard surgical approach, however laparoscopic techniques are now employed with similar outcomes. We aimed to characterise our experience of laparoscopic hernia repair and describe rare variants where repair was facilita...

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Su...

Background Management of gastroschisis involves either primary or staged closure. Bowel ischemia and abdominal compartment syndrome (ACS) are possible complications that can be related to a method of treatment. NIRS monitoring has never been applied in this group of patients and may allow for earlier detection of complications. Objective To assess...

Congenital diaphragmatic hernia (CDH) is a group of conditions characterised by developmental defects in the diaphragm. The cause is disordered embryogenesis, resulting in incomplete fusion of elements giving rise to the diaphragm. The diagnosis can be made in the antenatal period and can present in the early postnatal period with respiratory distr...

Omphalitis is a common cause of neonatal morbidity and mortality in low-income settings, mainly due to inappropriate and unhygienic cord-care practices. Early detection and prompt treatment are important to averting morbidity and mortality associated with the condition. Although omphalitis is considered as a simple superficial infection, life-threa...

Phimosis is defined as narrowing of the preputial ring which prevents retraction of the foreskin over the glans penis. Physiological phimosis is almost invariably present at birth. It regresses with age, as the foreskin widens and gradually advances over the glans penis. Pathological phimosis is much more commonly secondary. It may follow recurrent...

Gastro-oesophageal reflux (GOR) is defined as involuntary (passive) reflux of gastric contents into the oesophagus not caused by noxious stimuli. Gastro-oesophageal reflux disease (GORD) is defined as symptoms and complications arising from gastro-oesophageal reflux. GOR can be considered “physiological” up to 3 months of age, and the reflux (witho...

Background The outcome of antenatally detected fetal intra-abdominal cysts is highly variable and challenging to predict. Antenatal ultrasound scans may be of value in predicting postnatal outcome. Aims To report antenatal and postnatal course of fetal intra-abdominal cysts identified on antenatal ultrasound and establish the value of cyst dimensi...

The Optimal Resources for Children's Surgery (OReCS) Document provides details of what is required for children's surgical care at every level of healthcare in terms of infrastructure, service delivery, training and research. The full executive summary and OReCS documents are available open access/ free of charge via the following link: https://e...

Background Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low- and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children’s Surgery (GICS) was founded in 2016 to identify solutions to problems in children’s surgery by utilizing the expertise of...

Background Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low-and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of p...

Congenital diaphragmatic hernia (CDH) is typified morphologically by failure of diaphragmatic development with accompanying lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Patients who have labile physiology and low preductal saturations despite optimal ventilatory and inotropic support may be considered for extracorpor...

Background The Lancet Commission on Global Surgery reported that 5 billion people lack access to safe, affordable surgical care. The majority of these people live in low-resource settings, where up to 50% of the population is children. The Disease Control Priorities (Debas HTP, Donkor A, Gawande DT, Jamison ME, Kruk, and Mock CN, editors. Essential...

The incidence of postpneumonic empyema has been increasing in recent years in most Western countries. The place of surgery in its management is debatable, with many centers advocating initial pleural drainage and instillation of fibrinolytics, reserving surgery for those who fail to respond to these measures. Some, however, suggest that primary sur...

The laparoscopic approach to fundoplication may offer advantages over the open approach. It offers good access to the oesophagus and stomach, while minimising the surgical wound. There is less postoperative need for use of high dependency units, less respiratory depression due to pain, less postoperative adhesions, better cosmesis and at least equa...

Laparoscopic Duhamel pull-through is a surgical option in typical Hirschsprung disease (HD). Primary laparoscopic Duhamel pull-through is possible in the newborn who responds to washouts. Effective and ongoing washouts are imperative in management preoperatively and in preparation for surgery. Limited bowel prep (twice daily washouts and low-residu...

Minimally invasive surgery (MIS) has become relatively commonplace in paediatric surgery, and is becoming more popular. Paediatric surgeons perform laparoscopic and thoracoscopic surgery with the commonly held belief that MIS is associated with a dampened stress response, more rapid postoperative recovery, and early discharge from hospital. There a...

Thoracoscopic repair of esophageal atresia (OA) and tracheoesophageal fistula (TOF) is one of the most advanced and technically demanding minimally invasive surgery (MIS) operations in pediatric surgery. Since the first report by Rothenberg and Lobe in 1999 [1], there has been much investment in the development of this operation. There remains much...

Potential advantages of the laparoscopic approach to inguinal hernias in children include avoiding handling of the vas and vessels in boys, inspection of the internal genital organs in girls, and diagnosis of asymptomatic contralateral hernia. In experienced hands, the recurrence rate is minimal and approaches that of open surgery. It may be an adv...

The laparoscopic approach for pyloromyotomy is gaining in popularity, mainly as a result of its cosmetic advantage, ease of operation, and good outcome [1, 2]. It requires very basic, inexpensive instrumentation, which probably helps make it cost-effective compared with open surgery [3]. Whatever the reasons for the increasing popularity of laparos...

True spontaneous pneumothorax results almost exclusively from apical subpleural blebs (or less often, from bullae) in tall, thin adolescent males, sometimes with a smoking history. Secondary pneumothorax may occur in patients with underlying lung disease (e.g., cystic fibrosis, Marfan’s disease, asthma). Surgery is indicated in those who do not res...

This atlas of anatomy and operative techniques provides a thorough outline of the procedures commonly used in laparoscopic and thoracoscopic pediatric surgery. Step-by-step operative photographs are accompanied by explanatory text, and line diagrams are used to highlight the important anatomy as seen endoscopically. Alternative techniques, instrume...

Aims: To compare surgical outcomes for a simple purse string method of laparoscopic hernia (LH) repair with a traditional open inguinal hernia (OH) repair in children in a single center. Materials and methods: Following ethical approval, a retrospective review of all children undergoing LH repair from January 2010 to December 2013 versus a histo...

Congenital diaphragmatic hernia (CDH) in the newborn poses challenges to the multi-disciplinary teams involved in its management. Mortality remains significantly high, despite growing understanding and treatment options. Early intubation of antenatally diagnosed cases is crucial in preventing deterioration and persistent pulmonary hypertension. Ear...

There is a paucity of level 1 and level 2 evidence for best practice in surgical management of CDH. Antenatal imaging and prognostication is developing. Observed to expected lung-to-head ratio on ultrasound allows better predictive value over simple lung-to-head ratio. Based on 2 randomised studies, the verdict is still out in terms the best group...

A neonate with gastroschisis had silo placement and near-infrared spectroscopy (NIRS) monitoring of intestinal haemoglobin oxygen saturation (RSO2). An ischemic loop of bowel demonstrated decreased RSO2, with reversal of clinical ischemia and RSO2 postoperatively. This demonstrates possible advantage of monitoring intestinal RSO2 in neonates at ris...

To evaluate the 4-year results following a randomised controlled trial (RCT) comparing open (ONF) and laparoscopic (LNF) Nissen fundoplication in children. It is assumed that long-term results of ONF and LNF are comparable. No randomised studies have been performed in children. A follow-up study was performed in children randomised to ONF or LNF (c...

An 18-month-old boy was witnessed swallowing a cluster of five magnetic toy balls. He was coincidentally noted on plain x-rays to have also recently swallowed a watch battery and a small screw. Initial outpatient management with serial review and x-rays was unsuccessful, and delayed inpatient surgical care by 9 days. Although the child never manife...

Thoracoscopic repair of congenital diaphragmatic hernia is possible in stable neonates and late-presenting cases. However, surgery is usually contemplated only in those who stabilise and improve with medical management. The potential advantages of the thoracoscopic approach are improved cosmesis, less deformity and less intra-abdominal adhesions. A...

Energy sources in laparoscopic surgery fall broadly into three categories. The first and most commonly used is electrocautery, i.e., when an alternating current is passed between tissues and the heat produced used to create the desired effect of cutting and or coagulation. The second is ultrasonic sources; this causes the heat created by the vibrat...

Purpose: Congenital diaphragmatic hernia (CDH) and oesophageal atresia with tracheo-oesophageal fistula (OA/TOF) can be repaired thoracoscopically, but this may cause hypercapnia, acidosis, and reduced cerebral oxygenation. We aimed to evaluate the effect of thoracoscopy in neonates on intra-operative arterial blood gases, CO2 absorption and cerebr...

To compare the clinical outcome and endocrine response in children who were randomized to open or laparoscopic Nissen fundoplication using minimization. It is assumed that laparoscopic surgery is associated with less pain, quicker recovery and dampened endocrine response. Few randomized studies have been performed in children. Parents gave informed...

Mammary duct ectasia is uncommon in children, and is usually considered to be an acquired disease in adults. However the occurrence in infants and children suggest it may be developmental. To report a case series of mammary duct ectasia, and review the published literature to ascertain the common findings and histological findings in children. Case...

Thoracoscopic repair of congenital diaphra­gmatic hernia (CDH) has been described by a number of authors and is increasingly widely practiced. We present a technical learning point. CDH is associated with the presence of a hernia sac in around 20% of all cases. In this case the presence of a ruptured hernia sac complicated the thoracoscopic repair...

Vascular tumours (haemangiomas and malformations) are common tumours of infancy and childhood. They represent a group of mostly benign conditions, which present early, can grow rapidly and be symptomatic or disfiguring. There are various management options, with different cosmetic and functional outcomes. Haemangiomas and vascular malformations hav...

To compare the effects of surgery on energy and protein metabolism in children randomized to undergo laparoscopic and open surgery. We randomized 41 patients to open or laparoscopic Nissen fundoplication. Anesthesia and postoperative management were standardized. We recorded core temperature, respiratory gas exchange preoperatively, intraoperativel...

Laparoscopic fundoplication has not been extensively reviewed to establish the efficacy and outcome in infants. Our aims were to investigate the outcome of laparoscopic fundoplication in infants and assess factors predicting outcome. We performed a retrospective study on infants undergoing laparoscopic fundoplication. Demographic data, operating ti...

Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has been described, but its efficacy and safety have not been validated. The aim was to compare our experience of thoracoscopy with laparotomy repair. After ethics approval, we reviewed the notes of neonates with CDH operated in our institution between 2003 and 2008. Two historical group...

Carbon dioxide (CO(2)) is the gas most commonly used to inflate the body cavities during 'keyhole' surgery (e.g. laparoscopy and thoracoscopy). However, CO(2) can be absorbed, leading to increased arterial CO(2) and increased CO(2) elimination from the lungs. These increases in CO(2) are observed following a wide variety of procedures both in adult...

Considerable advances have been achieved in paediatric surgery during the last two decades, which can be partly ascribed to a better understanding of the physiological response to operations and the use of that knowledge to decrease the metabolic response where appropriate. Alongside this, minimally invasive surgery is now well established for many...

The aim of this paper is to review the factors which may affect breath (13)CO(2)/(12)CO(2) natural abundance in patients undergoing surgery or intensive care. Intravenous glucose administration is a major determinant of the (13)CO(2)/(12)CO(2) of breath as intravenous glucose preparations are almost all derived from cornstarch. In addition, the oxi...

The aim of this study was to review the changes in CO(2) excretion and anesthetic management during thoracoscopy in children. We analyzed end-tidal carbon dioxide concentration (EtCO(2); kPa) during CO(2) pneumothorax. EtCO(2) was measured on a continuous basis by using a positive sampling system and recorded every 10 minutes. Baseline and highest...

The metabolic response to laparoscopy in children is not well established. The work done in this thesis investigates some of the metabolic responses and their relationship to the inflammatory responses in children. The aim was to compare the responses between open and laparoscopic surgery. The hypothesis was that laparoscopic surgery is associated...

Monocyte class II major histocompatibility complex (MHC) expression is necessary for antigen presentation and stimulation of T-cells. The aim of this study was to correlate monocyte class II MHC response to operative stress in children and the possible influence of cytokines in the postoperative period. We studied 21 children undergoing elective ab...

Laparoscopic surgery is thought to be associated with a reduced metabolic response compared to open surgery. Oxygen consumption (VO2) and energy metabolism during laparoscopic surgery have not been characterized in children. We measured respiratory gas exchange intraoperatively in children undergoing 19 open and 20 laparoscopic procedures. Prematur...

We performed a randomized controlled trial to compare the inflammatory and immune responses to Nissen fundoplication in infants and children undergoing either open or laparoscopic surgery. Forty children undergoing Nissen fundoplication were randomized to laparoscopy or open surgery using minimization with respect to age, neurologic status, and ope...

The aim of this study was to review the management of the gastrointestinal tract in cloacal exstrophy and to assess the effect of spinal dysraphism on nutritional outcome. Twenty-two patients with cloacal exstrophy were reviewed retrospectively. Gastrointestinal and spinal anomalies were documented. The need for nutritional supplementation was reco...

To assess the accuracy of ultrasound diagnosis of duplex kidneys in the fetus and to identify prognostic features of antenatal sonography associated with this diagnosis. Retrospective identification of cases with an antenatal diagnosis of duplex kidney was made from computerized databases. Results of postnatal radiological investigations were obtai...

The absorption of carbon dioxide (CO2) used for positive pressure pneumoperitoneum may lead to an increased CO2 load. CO2 elimination during laparoscopy has not been investigated previously in paediatrics. The aim of this study was to characterise the pattern of CO2 elimination during laparoscopic surgery in infants and children. Twenty children un...

The outcome and quality of life in children with cloacal exstrophy are greatly influenced by small intestine residual length. We report 2 cases of almost complete midgut deletion in newborns with duodenal atresia in addition to cloacal exstrophy. To our knowledge this combination of anomalies has not been reported previously