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IMPORTANCE: Gangrenous, suppurative, and exudative (GSE) findings have been associated with increased surgical site infection (SSI) risk and resource use in children with nonperforated appendicitis. Establishing the role for postoperative antibiotics may have important implications for infection prevention and antimicrobial stewardship. OBJECTIVE: To compare SSI rates in children with nonperforated appendicitis with GSE findings who did and did not receive postoperative antibiotics. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study using American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP)–Pediatric Appendectomy Targeted data from 16 hospitals participating in a regional research consortium. NSQIP data were augmented with operative report and antibiotic use data obtained through supplemental medical record review. Children with nonperforated appendicitis with GSE findings who underwent appendectomy between July 1, 2015, and June 30, 2020, were identified using previously validated intraoperative criteria. Data were analyzed from October 2022 to July 2023. EXPOSURE: Continuation of antibiotics after appendectomy. MAIN OUTCOMES AND MEASURES: Rate of 30-day postoperative SSI including both incisional and organ space infections. Complementary hospital and patient-level analyses were conducted to explore the association between postoperative antibiotic use and severity-adjusted outcomes. The hospital-level analysis explored the correlation between postoperative antibiotic use and observed to expected (O/E) SSI rate ratios after adjusting for differences in disease severity (presence of gangrene and postoperative length of stay) among hospital populations. In the patient-level analysis, propensity score matching was used to balance groups on disease severity, and outcomes were compared using mixed-effects logistic regression to adjust for hospital-level clustering. RESULTS: A total of 958 children (mean [SD] age, 10.7 [3.7] years; 567 male [59.2%]) were included in the hospital-level analysis, of which 573 (59.8%) received postoperative antibiotics. No correlation was found between hospital-level SSI O/E ratios and postoperative antibiotic use when analyzed by either overall rate of use (hospital median, 53.6%; range, 31.6%-100%; Spearman ρ = −0.10; P = .71) or by postoperative antibiotic duration (hospital median, 1 day; range, 0-7 days; Spearman ρ = −0.07; P = .79). In the propensity-matched patient-level analysis including 404 patients, children who received postoperative antibiotics had similar rates of SSI compared with children who did not receive postoperative antibiotics (3 of 202 [1.5%] vs 4 of 202 [2.0%]; odds ratio, 0.75; 95% CI, 0.16-3.39; P = .70). CONCLUSIONS AND RELEVANCE: Use of postoperative antibiotics did not improve outcomes in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings.

It is with great pleasure that I present Rabbi Sholom D. Lipskar, a phenomenal religious leader who has impacted the lives of many Jewish inmates incarcerated in the Miami-Dade jails [...]

Surgery for children and adolescents with IBD is often thought of as a combination of a failure of medical management and the only option for the severe complications of the disease such as uncontrolled GI bleeding, perforation, fistulae, sepsis, and bowel obstruction. However, in CD, surgery can sometimes be an appropriate option to control disease progression, improve symptoms, allow children to get back on the growth curve, and avoid the toxicities of prolonged use of steroids. In UC, the decision to operate is theoretically curative but the long-term options mandate either intestinal continuity with an ileal pouch or a lifelong ileostomy, both of which can have significant impacts in patients’ quality of life.

Inflammatory myofibroblastic tumors (IMTs) are rare tumors of intermediate biologic potential most often reported in children. Histologic characteristics of IMT include spindle cell proliferation with chronic inflammatory cell infiltrate. IMTs can occur anywhere in the body but are most commonly reported in lung, bowel mesentery, and liver. Nonmesenteric alimentary IMTs are exceedingly rare. We present the second case of colonic IMT presenting as colo-colonic intussusception in a child. The patient is a 12-year-old female who presented with vague abdominal pain for three months. Her workup revealed an intraluminal mass in the descending colon on both CT and colonoscopy. Intraoperatively, the mass was seen causing colo-colonic intussusception. Laparoscopic segmental colon resection was performed, and the patient did well postoperatively. Histology and immunohistochemistry of the mass confirmed IMT.

Congenital diaphragmatic hernias (CDH) are rare congenital anomalies occurring in 1:5000 live births with a wide range of clinical presentations. The Morgagni hernia is the rarest of these defects with the hernia presenting anteriorly, most commonly on the right. Factors found to predict mortality in infants presenting with CDH include prenatal diagnosis, early gestational age, low birth weight, large diaphragmatic defect, associated congenital anomalies, and low APGAR scores. We present the case of a 27-week gestational age premature girl weighing 460 g who required urgent repair of a Morgagni diaphragmatic hernia and a review of the current literature on the topic. To the best of our knowledge, this is the smallest infant to undergo repair of this CDH reported to date.

An interview with various individuals involved in the publishing industry in the early-21st century is presented including the literary agent Simon Lipskar, the writer and editor Amy O'Leary and the periodical editor Evan Ratliff. Particular focus is given to where they think that the publishing business might be headed in the 21st-century. Additional topics discussed include how technology is impacting the publishing industry, observations on e-readers (electronic readers) and digital self-publishing.

Abstract: Background: Restoration of intestinal continuity after Hartmann’s procedure has traditionally required laparotomy. This study compares our experience with laparoscopic and open reversal of Hartmann’s procedure. Study design: All laparoscopic and open Hartmann’s reversal procedures performed between January 1998 and June 2006 were reviewed. Patients with laparoscopic reversal were retrospectively matched by age, body mass index (BMI), and indication to controls with open reversal. Demographic data, perioperative course, and postoperative complications were documented. Results: We identified 41 patients who underwent laparoscopic reversal of Hartmann’s procedure and these were matched to 41 patients with open reversal. The groups had similar average age and BMI. The predominant indication for surgery in both groups was diverticular disease. Conversion to laparotomy occurred in eight patients (19.5%), and was due to dense adhesions or difficulty in identification of the rectal stump. Adhesions were significantly greater in the conversion group (p <0.05), and the rectal stump was not marked in any of these cases. The most common short-term complications were ileus and surgical site infection. There were no anastomotic leaks and no mortalities. The mean operative times in the laparoscopic and open groups were 193 versus 209 min, respectively (p = 0.33). The laparoscopic group had a significantly lower estimated blood loss of 166 versus 326 mL (p < 0.0005), shorter time to bowel function return (4.1 versus 5.2 days, p < 0.05), and a shorter hospital stay (6.4 versus 8.0 days, p < 0.05). The major complication rate was also significantly lower in the laparoscopic group than in the open group (4.8% versus 12.1%, p < 0.05). Conclusions: Laparoscopic reversal of Hartmann’s procedure is a safe and practical alternative to open reversal. It can be performed with similar operative time, fewer complications, and a faster recovery time. Conversion during the reversal procedure was significantly impacted by severity of adhesions and marking of the rectal stump.