Search

Background: A small percentage of patients who undergo surgical correction of a chest wall deformity will have results so unsatisfactory that a second procedure, the so-called "re-do", will be required. Conclusions: The literature contains very little information regarding the technique and results of these procedures. Based on experience with 18 "re-do" procedures, the authors believe that recurrent deformities should be surgically corrected. Although this is a somewhat diverse group based on age at the first and second procedure, type of original operative procedure, and interval between the procedures, the operative approach is standard, and the results are predictable.

This report describes a variation of the transverse chest wall incision to elevate all soft tissue layers of the chest wall in one layer during repair of chest wall deformity in children. This is a report of an experience in 285 cases.

Gastroesophageal reflux (GER) occurs frequently in infants with esophageal atresia (EA). The definitive management is primary repair and often includes tube gastrostomy. The recent finding of lower esophageal sphincter (LES) pressure changes with tube gastrostomy suggests that GER might be related to gastrostomy rather than EA per se. To evaluate this thesis, two populations of patients from different children's hospitals were reviewed: EA with and without routine gastrostomy. The two populations were similar with respect to number of infants, associated anomalies, distribution in the Waterston classification, morbidity, and mortality. One hundred sixteen patients were studied. Of the 66 survivors who underwent gastrostomy and repair of EA, 30 were found to have GER (45.5%) and 12 required fundoplication (18.2%). Of 31 surviving patients who underwent repair of EA without gastrostomy, 11 had GER (35.5%) and four required fundoplication (12.9%). These data suggest that tube gastrostomy does not significantly contribute to the GER associated with EA.

Recent advances in technology have fueled interest in the field of urodynamics and have made possible accurate diagnosis of voiding abnormalities in children. A thorough understanding of the underlying physiology and institution of the appropriate pharmacologic agents and/or teaching techniques results in correction of the underlying problems in 90% of the cases. Symptoms, techniques of diagnosis, therapeutic regimens, and results of therapy are presented.

The intelligent management of newborn infants who have symptoms or signs of intestinal obstruction requires a familiarity with the meconium plug syndrome. Although recognized and described a decade ago, 1 this syndrome has not yet been widely discussed in the surgical and pediatric literature. Some questions arose at the time of the original report, particularly related to the etiology and the relationship of this type of obturant obstruction to meconium ileus associated with fibrocystic disease and to dyskinetic colonic function associated with congenital aganglionic megacolon. Although we have acquired little additional information regarding the etiology of the meconium plug syndrome, sufficient time has now elapsed to provide a greater body of experience for analysis and to bring to the reader's attention some of the problems that we have encountered in the management of this entity. For these reasons we propose to reconsider the meconium plug syndrome and to recount our experience with the nine originally reported infants and 21 additional patients treated at the Columbus Children's Hospital.