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Background: Pancreatic malignancy and chronic pancreatitis are rare in the pediatric, adolescent, and young adult (AYA) population, making pancreas resections an infrequent procedure in this demographic. Only case reports and small case series exist in the literature describing surgical outcomes and complications in this population. The aim of this study was to review the surgical outcomes of pediatric/AYA patients undergoing pancreaticoduodenectomy (PD) at our institution., Methods: All pediatric/AYA adult patients (≤30 years) undergoing PD over a 15-year period (1998-2013) from a large academic institution were included. We provide adult (>30 years) data from our same institution for observational comparison. Retrospective chart review was performed to identify pertinent preoperative, perioperative, and postoperative data., Results: Twenty-two patients with a median age of 25 years (range, 11-30 years) underwent PD. The most common postoperative histologic diagnoses were chronic pancreatitis (6, 27.3%), solid pseudopapillary neoplasm (5, 22.7%), and adenocarcinoma (4, 18.2%). Complications were 31.8% in the pediatric/AYA cohort and 58.6% in the adult cohort. The most common postoperative complication was intraabdominal abscess, which occurred in three patients (13.6%). Thirty-day mortality was 0% for pediatric/AYA patients. There were no recurrences or disease-related deaths in patients with solid pseudopapillary neoplasm. Pediatric patients with adenocarcinoma had a median survival of 10.2 mo (interquartile range, 9-21), in contrast to adults of 57.8 mo (interquartile range, 11-132)., Conclusions: This is the largest series of PD procedures reported in the pediatric/AYA population. The procedure appears to be safe, with no 30-day mortalities and an acceptable complication rate., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: To evaluate utilization and costs associated with robotic surgery in children., Materials and Methods: We identified patients in the Pediatric Health Information System database who underwent robotic surgery between October 2008 and December 2013. After determining the six most frequently performed surgeries in this group, we identified patients who underwent equivalent nonrobotic surgeries at the same hospitals. Equivalent surgeries were defined as open procedures for urology and laparoscopic procedures for general surgery. We examined trends in the numbers of surgeries performed and compared hospitalization costs between patients undergoing elective robotic and nonrobotic surgery for each procedure., Results: The number of robotic surgeries performed increased by 19.8% per year (P < 0.001). The most common robotic surgeries performed were pyeloplasty (n = 760), ureteral reimplantation (n = 351), nephrectomy (n = 145), partial nephrectomy (n = 56), gastrointestinal antireflux procedure (n = 61), and cholecystectomy (n = 46). Total increase over time was primarily driven by increases in urologic surgeries (17.4% per year, P < 0.001). Postoperative length of stay was shorter after robotic surgeries than equivalent open urologic surgeries but not equivalent laparoscopic general surgery procedures. Total hospitalization costs were higher for robotic surgeries than equivalent urologic or general surgery procedures., Conclusions: Use of robotic surgery in pediatrics is increasing especially in the management of urologic conditions. Costs of robotic surgery-associated hospitalizations were higher than nonrobotic surgery-associated hospitalizations., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: To compare 30-d outcomes between laparoscopic and open intestinal resection performed on pediatric patients with ulcerative colitis and Crohn disease., Materials and Methods: We identified all proctocolectomies performed on patients with ulcerative colitis and all intestinal resections with primary anastomosis performed on patients with Crohn disease in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric. We compared demographic, clinical, and 30-d outcome characteristics between patients who underwent an open or laparoscopic resection., Results: Of the 140 patients with ulcerative colitis who underwent proctocolectomy, 103 (74%) were performed laparoscopically. Patients undergoing laparoscopic colectomy had shorter postoperative length of stay (LOS) and fewer incisional complications. On multivariate analysis, open versus laparoscopic proctocolectomy is not an independent predictor of postoperative LOS for patients with ulcerative colitis. Of the 188 patients with Crohn disease who underwent an intestinal resection, 122 (65%) underwent laparoscopic resection. In comparison with patients undergoing open resection, patients undergoing laparoscopic resection had similar rates of complications but a shorter postoperative LOS., Conclusions: For children with ulcerative colitis, laparoscopic proctocolectomy is not independently associated with a difference in postoperative LOS. In unadjusted analyses, laparoscopic bowel resections for children with Crohn disease may be associated with a shorter postoperative LOS compared with that of open procedures. Additional accrual of cases within the American College of Surgeons National Surgical Quality Improvement Program Pediatric will allow for risk-adjusted analyses of outcomes, including factors independently associated with incisional complications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Rates of cholecystectomy for biliary dyskinesia are rising. Our objective was to identify clinical determinants of symptom improvement in children undergoing cholecystectomy for biliary dyskinesia., Methods: This retrospective cohort study included patients undergoing cholecystectomy for biliary dyskinesia from 2006-2013 who had their gallbladder ejection fraction (EF) measured by either cholecystokinin-stimulated hepatobiliary iminodiacetic acid scan and/or fatty meal ultrasound. Patients presenting from 2010-2013 were interviewed >1 y after cholecystectomy to determine symptom improvement, complete symptom resolution, and any postoperative clinical interventions related to biliary dyskinesia. Sensitivity and positive predictive values for the diagnostic tests for symptom improvement were calculated. Multivariable logistic regression models were used to identify preoperative characteristics associated with symptom improvement., Results: Of the 153 included patients, 76% were female, 89% were Caucasian, and 39% were obese. At postoperative evaluation, symptom improvement was reported by 82% of the patients and complete symptom resolution in 56%. For both the hepatobiliary iminodiacetic acid and fatty meal ultrasound, the sensitivity of the test to predict symptom improvement increased with higher EF, whereas the positive predictive values remained around 80%. Of the 41 patients who participated in phone interview for long-term follow-up, 85% reported symptom improvement and 44% reported complete symptom resolution. Factors associated with symptom improvement included a shorter duration of pain, a history of vomiting, and a history of epigastric pain., Conclusions: Despite not identifying an EF level that predicted symptom improvement, over 80% of patients undergoing cholecystectomy for biliary dyskinesia reported symptom improvement. These results support continuing to offer cholecystectomy to treat biliary dyskinesia in children., (Copyright © 2015 Elsevier Inc. All rights reserved.)