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1. Laparoscopic management of the congenital chylous ascites in a newborn: Case report

Author

Petra Zahradnikova, Rebeka Pechanova, Lenka Fedorova, Rene Jager, Barbora Nedomova, and Jozef Babala

Subjects
chylous ascites, congenital ascites, fibrin glue, laparoscopy in newborn, newborn surgery, Surgery, RD1-811, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising.

Published
2023
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4. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Author

Fabio Medas, Chiara Dobrinja, Ebtesam Abdullah Al-Suhaimi, Julia Altmeier, Said Anajar, Akif Enes Arikan, Irina Azaryan, Lovenish Bains, Giancarlo Basili, Hakan Bolukbasi, Marco Bononi, Farzad Borumandi, Mehmet Buğra Bozan, Gabriela Brenta, Laurent Brunaud, Maximilian Brunner, Antoine Buemi, Gian Luigi Canu, Federico Cappellacci, Sara Burchfield Cartwright, Ignasi Castells Fusté, Beatriz Cavalheiro, Giuseppe Cavallaro, Andres Chala, Shun Yan Bryant Chan, John Chaplin, Mustafa Sajjad Cheema, Costanza Chiapponi, Maria Grazia Chiofalo, Emmanuel Chrysos, Annamaria D'Amore, Michael de Cillia, Carmela De Crea, Nicolò de Manzini, Leandro Luongo de Matos, Loredana De Pasquale, Paolo Del Rio, Marco Stefano Demarchi, Muthuswamy Dhiwakar, Gianluca Donatini, Jose Miguel Dora, Valerio D'Orazi, Viyey Kishore Doulatram Gamgaram, Vitalijus Eismontas, El Hassane Kabiri, Hadj Omar El Malki, Islam Elzahaby, Octavian Enciu, Antoine Eskander, Francesco Feroci, David Figueroa-Bohorquez, Dimitrios Filis, Gorostidi François, Pedro Frías-Fernández, Armando Gamboa-Dominguez, Volkan Genc, Davide Giordano, Antonio Gómez-Pedraza, Giuseppa Graceffa, James Griffin, Sofia Cuco Guerreiro, Karan Gupta, Keshav Kumar Gupta, Angela Gurrado, Jiannis Hajiioannou, Tommi Hakala, Wirsma Arif Harahap, Lindsay Hargitai, Dana Hartl, Andrzej Hellmann, Jiri Hlozek, Van Trung Hoang, Maurizio Iacobone, Nadia Innaro, Orestis Ioannidis, J H Isabelle Jang, Jose Candido Xavier-Junior, Milan Jovanovic, Reto Martin Kaderli, Fahmi Kakamad, Krzysztof Kaliszewski, Martin Karamanliev, Hiroshi Katoh, Andro Košec, Bozidar Kovacevic, Luiz Paulo Kowalski, Robert Králik, Sanjay Kumar Yadav, Adriána Kumorová, Savvas Lampridis, Konstantinos Lasithiotakis, Jean-Christophe Leclere, Eugene Kwong Fei Leong, Melvin Khee-Shing Leow, James Y Lim, Leonardo S Lino-Silva, Shirley Yuk Wah Liu, Núria Perucho Llorach, Celestino Pio Lombardi, Javier López-Gómez, Eleonora Lori, Lourdes Quintanilla-Dieck, Roberta Lucchini, Amin Madani, Dimitrios Manatakis, Ivan Markovic, Gabriele Materazzi, Haggi Mazeh, Giuseppe Mercante, Goswin Yason Meyer-Rochow, Olgica Mihaljevic, Julie A Miller, Michele Minuto, Massimo Monacelli, Francesk Mulita, Barbara Mullineris, José Luis Muñoz-de-Nova, Fábio Muradás Girardi, Saki Nader, Tangjaturonrasme Napadon, Constantinos Nastos, Chiara Offi, Ohad Ronen, Luigi Oragano, Aida Orois, Yongqin Pan, Emmanouil Panagiotidis, Ramakanth Bhargav Panchangam, Theodosios Papavramidis, Pradipta Kumar Parida, Anna Paspala, Òscar Vidal Pérez, Sabrina Petrovic, Marco Raffaelli, Constanza Fernanda Ramacciotti, Tomas Ratia Gimenez, Ángel Rivo Vázquez, Jong-Lyel Roh, Leonardo Rossi, Alvaro Sanabria, Alena Santeerapharp, Arseny Semenov, Sanjeewa Seneviratne, Altinay Serdar, Patrick Sheahan, Sean C Sheppard, Rachel L Slotcavage, Constantin Smaxwil, Soo Young Kim, Salvatore Sorrenti, Eleftherios Spartalis, Chutintorn Sriphrapradang, Mario Testini, Yigit Turk, George Tzikos, Kristina Vabalayte, Kelly Vargas-Osorio, Rafael Sebastián Vázquez Rentería, David Velázquez-Fernández, Sanura Malinda Pallegoda Vithana, Levent Yücel, Erwin Danil Yulian, Petra Zahradnikova, Paul Zarogoulidis, Evgeniia Ziablitskaia, Anna Zolotoukho, Pietro Giorgio Calò, A Abdallah, AL Abentroth, V Acheimastos, M Agunaoun, HM Al Bisher, A Al Ghuzlan, H Alakus, M Alkan, MC Almaraz Almaraz, K Amram, S Anesidis, E Anestiadou, D Angelucci, GL Ansaldo, MI Antonopoulou, M Arciniegas, C Armellin, G Arredondo Saldaña, J Astl, E Athanasakis, S Avenia, H Aydın, B Baba, J Babala, MV Banús, LA Barba-Valadez, SV Barcons, F Battafarano, A Bayat, RMC Bella, F Benariba, S Bernardi, EG Bignami, M Bitenc, S Bitsianis, JDD Bolaños de la Torre, E Bonati, T Bonetti, FA Borges, K Bouchagier, M Boudina, A Bourial, I Breuskin, P Brock, C Bruns, MC Burlacu, T Burton, M Buta, D Buzanakov, C Caliseo, D Callanan, V Calu, JM Cameselle-Teijeiro, DJ Camilo-Junior, S Canberk, V Candalise, F Candanedo-Gonzalez, LJ Carrillo Lizarazo, GB Carvalho, D Casallas, C Casolino, L Castellani, C Castillo Morales, G Chambon, V Chatzipavlidou, R Chernikov, A Chorti, TCM Chow, A Chrisoulidou, E Chrysos, S Conrado-Neto, D Cordova García, A Corigliano, A Crocco, A Cuesta, M Čukman, LS Curto, RA Damilano, R D'Anna, M De, A De Virgilio, D Dellaportas, L Demarquet, A Devresse, G Di Meo, R Diaz Pedrero, D Dimitrov, Z Dmitry, P Domínguez Garijo, O Dulgeroglu, AC Dural, A Eksi, M El Hammoumi, H El Kaoui, G Eleni, A Elliyanti, Ş Ersöz, M Escobar-Jiménez, L Fedorova, L Feeley, E Fernández Rodríguez, F Ferreli, A Filoia, A Fingeret, A Francescato, F Gaino, F Galiandro, JF Gallegos-Hernández, G Garas, F García Lorenzo, JP García-Chávez, M Gaudiello, S Gay, S Gerasimos, M Gerek, R Gervasi, A Giordano, B Gjeloshi, L Gocký, E Golubinskaya, S González Romero, C González-Mínguez, M Goran, A Gosman, M Granados Garcia, E Greco, M Grünbart, R Grützmann, J Guerlain, XG Guirao, D Guzey, A Hajjij, O Hamdy, MS Hameed, LA Hauth, JD Hernández-Acevedo, JF Hernandez-Carrillo, F Hevilla Sánchez, H Hoi, K Hongkwon, R Hu Zhu, E Huang, K Hyeung Kyoo, V Ignjatovic, A Ioannidis, A Iossa, A Işık, D James, L Jung Hoon, H Kara, J Karajovic, D Kartini, D Khambri, I Kholová, M Kisiel, M Knežević, YQ Koh, C Konca, C Kosmidis, G Kotsovolis, LP Kowalski, R Kralik, P Kuczma, BG Kuravi, A Kurnia, V Kyriaki, CM Lai, B Lallemant, AA Lardhi, S Leboulleux, JW Lee, G Lelli, M Leutner, MY Lim, CM Lim, A Llanos, X Lo, T Loderer, MA López-Corrales, M Ludwig, FF Magnabosco, C Maheo, AL Maia, O Makay, P Maksimova, S Mallick, C Mallouk, Z Mamani, S Mandal, M Manyalich Blasi, G Marincola, M Marulanda, M Mavromati, S Mayilvaganan, S Metso, A Micalizzi, A Michalopoulos, K Min-Su, A Miron, AK Mishra, C Misso, C Mittermair, Y Morosán Allo, M Mourad, M Moysidis, F Nabhan, R Nasiri, C Nastos, KY Ngiam, C Nomine-Criqui, AM Ntziovara, JM Nuño Vázquez-Garza, V Nutautiene, K Obtulovičová, L O'Keeffe, NO Okudur, P Ossola, E Ovejero Merino, M Ozdemir, A Pangonis, SS Panigoro, A Panuzi, D Papaconstantinou, N Pardo Matamoros, S Paschou, A Pasculli, K Paterakis, K Peiris, F Pennestrì, M Peppa, P Perdikaris, I Perdikaris, RH Pérez-Soto, S Piana, M Piccoli, D Pietrasanta, G Placentino, I Pliakos, A Polistena, A Pongtippan, G Potard, V Quinn, P Rahul, T Ramos, A Rankin, P Ratnayake, J Reuto-Castillo, A Ridolfo, J Rios-Valencia, P Riss, E Rival, J Rivillas, D Roi, EM Rollo, A Romanchishen, M Romito, J Rotnagl, B Rovcanin, G Russo, M Sabol, S Saki, S Saleh, A Salih, A Saltiki, G Salvador-Camarmo, DK Samal, S Sánchez-Flores, K Sapalidis, D Sarin, H Sarin, N Savkovic, RS Scheffel, AL Scheinpflug, C Scheuba, N Scheyer, M Schmidt, O Senashova, E Serafini, ML Serrano Arévalo, J Shank, ML Shindo, M Shoshkova, M Shvan, M Sičák, TG Silva, O Simó Guerrero, V Skuletic, N Slijepcevic, Z Slovic, P Soares, A Somova, S Soto, S Spiezia, V Stankovic, KJ Stephenson, E Straub, M Summa, S Surani, AA Syed, S Symeonidis, A Taciak, M Tarallo, A Tarle, N Tasis, K Tausanovic, L Tchabashvili, M Thierry, U Tokarczyk, EA Toma, S Topuz, F Torresan, C Uras, C Vaccaro, Á Valdés de Anca, M Valentini, E Varaldo, JG Vartanian, GI Verras, A Vithanage, H Wijayalathge, P Wiriyaamornchai, YLC Wong, P Wongwattana, S Xenaki, S Xie, M Xu, W Yang, S Yilmaz, YF Yılmaz, T Yotsov, MT Zahid, A Zielke, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, and UCL - (SLuc) Service de néphrologie

Subjects
Endocrinology, Endocrinology, Diabetes and Metabolism, Internal Medicine
Abstract

Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p

Published
2023

5. Minimally Invasive Partial Spleen Resection Preserving the Lower Pole in Children: A Technical Report on Feasibility and Safety

Author

Igor Beder, Alessio Pini Prato, Petra Zahradnikova, and Jozef Babala

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Splenectomy, Infarction, Retrospective cohort study, Spleen, Gastroepiploic Artery, Institutional review board, medicine.disease, Thrombosis, Surgery, medicine.anatomical_structure, medicine, business, Complication
Abstract

Background: Laparoscopic partial splenectomy is a surgical option for removing part of the spleen with a pathological mass in a way that ensures preservation of the spleen's physiological functions. We aimed to evaluate the efficacy and feasibility of this procedure, performed while preserving the blood supply from the left gastroepiploic artery, in children. Materials and Methods: Following institutional review board approval, this retrospective study was conducted on patients who, between January 2015 and December 2019, underwent laparoscopic partial splenectomy with preservation of blood supply from the left gastroepiploic vessels. In the article, we described patient indications for surgery, surgical technique, surgery time, complications, and follow-up outcomes. Results: Eleven patients (mean age: 12.3 ± 3.4 years) underwent laparoscopic partial splenectomy. Indications for surgery included nonparasitic cysts (n = 8), pseudocysts (n = 2), and hamartomas (n = 1). The mean benign mass diameter was 60 ± 22 mm. The mean operative time was 193.2 ± 55.1 minutes. The mean size of the retained lower pole was 31.1% ± 3.8%. There was no conversion to open splenectomy or any significant complication. The mean postoperative stay was 9 ± 0.7 days. No thrombosis of the splenic and portal veins was noted in the follow-up period, and no splenic remnant infarction occurred. Conclusions: Laparoscopic partial splenectomy with preservation of blood supply arising from the left gastroepiploic vessels seems to be safe in children. However, a larger study is needed to confirm our results.

Published
2021
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6. Mesenteric cyst causing intestinal volvulus in a newborn

Author

Marian Vidiscak, Lenka Fedorová, Stefan Pavlik, Jozef Babala, Jan Trnka, Martin Lindak, Petra Zahradnikova, and Lubomir Sykora

Subjects
medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, Mesenteric cyst, lcsh:RJ1-570, lcsh:Surgery, lcsh:Pediatrics, lcsh:RD1-811, medicine.disease, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Intestinal Volvulus, 030225 pediatrics, Internal medicine, Pediatrics, Perinatology and Child Health, medicine, Surgery, business
Published
2018

7. Inanimate 3D printed model for thoracoscopic repair of esophageal atresia with tracheoesophageal fistula

Author

Petra Zahradniková, Jozef Babala, Rebeka Pechanová, Martin Smrek, Pavol Vitovič, Miroslava Laurovičová, Tomáš Bernát, and Barbora Nedomová

Subjects
oesophagus, minimally invasive surgery (MIS), thoracoscopic surgery, oesophageal atresia (EA), laparoscopic training, synthetic tissue, Pediatrics, RJ1-570
Abstract

BackgroundThoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) poses significant technical challenges. This study aimed to develop an inexpensive, reusable, high-fidelity synthetic tissue model for simulating EA/TEF repairs and to assess the validity of the simulator.MethodsBy using 3D printing and silicone casting, we designed an inexpensive and reusable inanimate model for training in thoracoscopic EA/TEF repair. The objective was to validate the model using a 5-point Likert scale and the Objective Structured Assessment of Technical Skills (OSATS) to evaluate participants' surgical proficiency.ResultsA total of 18 participants (7 medical students, 4 pediatric surgery trainees, and 7 experienced surgeons), after being instructed and trained, were asked to perform TEF ligation, dissection, as well as esophageal anastomosis using six sliding knots on the EA/TEF simulator. All participants in the expert group completed the task within the 120-minute time limit, however only 4 (57%) participants from the novice/intermediate completed the task within the time limit. There was a statistically significant difference in OSATS scores for the “flow of task” (p = 0.018) and scores for the “overall MIS skills” (p = 0.010) task distinguishing between novice and intermediates and experts. The simulator demonstrated strong suitability as a training tool, indicated by a mean score of 4.66. The mean scores for the model's realism and the working environment were 4.25 and 4.5, respectively. Overall, the face validity was scored significantly lower in the expert group compared to the novice/intermediate groups (p = 0.0002).ConclusionsOur study established good face and content validity of the simulator. Due to its reusability, and suitability for individual participants, our model holds promise as a training tool for thoracoscopic procedures among surgeons. However, novices and trainees struggled with advanced minimally invasive surgical procedures. Therefore, a structured and focused training curriculum in pediatric MIS is needed for optimal utilization of the available training hours.

Published
2023
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8. Risk factors of post-surgery complications in children with thyroid cancer

Author

Petra Zahradnikova, Ľudmila Košťálová, Jozef Babala, Z. Pribilincova, Juraj Stanik, Robert Kralik, Lenka Fedorová, Martin Lindak, and Igor Beder

Subjects
Male, medicine.medical_specialty, Adolescent, Hypoparathyroidism, medicine.medical_treatment, Multiple endocrine neoplasia type 2, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, 030225 pediatrics, Adenocarcinoma, Follicular, medicine, Humans, Thyroid Neoplasms, Child, 030223 otorhinolaryngology, Lymph node, Thyroid cancer, Retrospective Studies, business.industry, Multiple Endocrine Neoplasia, Thyroid, Thyroidectomy, General Medicine, Stepwise regression, medicine.disease, Carcinoma, Papillary, Carcinoma, Neuroendocrine, Surgery, medicine.anatomical_structure, Otorhinolaryngology, Medullary carcinoma, Lymphatic Metastasis, Pediatrics, Perinatology and Child Health, Etiology, Neck Dissection, Female, business, Vocal Cord Paralysis, Neck
Abstract

Introduction Thyroid cancer in children is a hot topic because of the large clinical heterogeneity and the risk of severe complications. We aimed to study 1. The frequency, 2. Etiology, and 3. Risk factors of post-surgery complications of thyroid cancer. Material and methods A retrospective analysis including risk factors for post-surgery complications of patients treated for thyroid malignancies in years 2006–2018 was performed. Results Over a period of 12 years 22 patients with thyroid malignancy (68% female; 12.6 ± 4.0 years of age, median follow-up 6 years) were identified. Histologically, 12 (55%) patients had papillary carcinoma. Six patients (27.3%) had multiple endocrine neoplasia type 2 (MEN2) syndrome, 3 (13.7%) patients had medullary carcinoma and 1 patient had follicular carcinoma. Neck lymph node metastases were diagnosed in 8 (36.4%), distant metastases in 6 (27.3%), and both locations were involved in 4 (18.2%) patients. Six (27.3%) children had surgical complications: 1 child had unilateral vocal cord paralysis and transient hypoparathyroidism and 5 had transient hypoparathyroidism. The higher risk of surgery complications in forward stepwise logistic regression was associated in with distant metastases (R2 = 0.584, OR 52.63, p = 0.010). Conclusions Postoperative complications were significantly associated with presence of distant metastases. Favorable results were observed in with children with MEN2 syndrome.

Published
2019
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9. Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19

Author

Petra Zahradníková, René Jáger, Rebeka Pechanová, Lenka Fedorová, Igor Béder, Dominika Barloková, Barbora Nedomová, Peter Švajdler, and Jozef Babala

Subjects
SARS-CoV-2, Necrotising pancreatitis, COVID-19, Pediatrics, RJ1-570, Surgery, RD1-811
Abstract

Purpose: Various manifestations of coronavirus (SARS-CoV-2) have been reported since the pandemic began. Some articles have reported acute pancreatitis in adult patients due to COVID-19 infection. To our knowledge this is the first report of acute hemorrhagic necrotizing pancreatitis in children associated with SARS-CoV-2 infection. Case presentation: A 7-year-old girl with congenital immunodeficiency was referred to the intensive care (ICU) unit with acute respiratory distress syndrome. She required mechanical ventilation (MV) due to pulmonary involvement of COVID-19 (chest CT with lower lung ground-glass opacities). SARS-CoV-2 infection was laboratory confirmed. Following a 49-day stay in the ICU, due to the clinical and radiological signs of acute abdomen and to the rapid deterioration in the clinical status, an indication to proceed an urgent surgerical intervention was made. Intra-operatively an adhesiolysis with blunt dissection of the of gastrocolic ligament was performed, then followed by debridement of the necrotic pancreas (more than 1⁄2 of the pancreas was damaged). Continuous lavage and drainage were placed. During the post-operative period, patient required aggressive MV and insulin therapy for persistent hyperglycemia. The CT scans reported a necrosis of the pancreas and we observed amylase and lipase elevation in the peritoneal lavage sample. Despite active intensive therapy, the patient's condition did not improve and she died 38 days after laparotomy as a result of multi-organ failure. Conclusion: The mechanism for the development of acute haemorrhagic necrotizing pancreatitis in the COVID-19 positive patients is unclear; perhaps it is due to a direct cytopathic effect from the COVID-19 virus, or due to the ACE2 expression in pancreas.

Published
2022
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