high-resolution-three-dimensional-imaging-footpad-vasculature-murine

High-Resolution Three-Dimensional Imaging of the Footpad Vasculature in a Murine Hindlimb Gangrene Model

Peripheral arterial disease (PAD) is a significant cause of morbidity resulting from chronic exposure to atherosclerotic risk factors. Patients suffering ...

University of Miami

University of Miami Miller School of Medicine

 There are few nationwide studies comparing outcomes of open, laparoscopic (LAP), and percutaneous endoscopic (PEG) gastrostomy tube (GT) placement in the pediatric population.  The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients ≤18 years (excluding newborns) who underwent GT placement. Demographics, hospital characteristics, and outcomes were compared by the GT approach.  There were 3278 patients (41% female, age 3 ± 5 years) identified who underwent GT placement (40% open versus 32% PEG versus 28% LAP). Following an open approach, there were higher rates of GT-related complications (10% versus 4% LAP versus 3% PEG) and postoperative gastrointestinal issues (24% versus 12% LAP versus 9% PEG) on index hospitalization, both  < .001. Readmission within 30 days and 1 year were 18% and 43%, respectively. Overall readmission rates were not affected by the GT approach (44% open versus 44% LAP versus 43% PEG,  = .773). However, readmission for GT-related complications was the lowest following the LAP approach (<0.3% versus 2% open versus 2% PEG,  < .001). When those who also underwent fundoplication were excluded, conversion to gastrojejunostomy or jejunostomy (GJ/J) on readmission was higher following open and PEG approaches (4% open versus 2% PEG versus 0% LAP,  = .039).  Compared with PEG gastrostomy and open gastrostomy, LAP GT placement appears to have lower index complications and reoperation rates, and at least comparable readmission outcomes. Despite these advantages, LAP GT placement remains underutilized.

Pediatric Gastrostomy Tube Placement: Less Complications Associated with Laparoscopic Approach.

 Fundoplications are a common operation in the pediatric population. This study aims to explore outcomes comparing laparoscopic versus open operative techniques.  From 2010 to 2014 the Nationwide Readmissions Database was used to identify patients aged 0-18 years who underwent a fundoplication. Propensity score matched analysis was performed based on 87 covariates. Demographics, hospital factors, readmissions, and complications were compared by surgical technique (laparoscopic versus open).  There were 4411 patients (47% female) who underwent fundoplication via laparoscopic (69%) versus open (31%) technique. Gastrostomy tubes were placed in 75% of patients also undergoing fundoplication. Newborn made up 64% of the cohort, with 47% of newborns having cardiac anomalies and 96% being premature. Open fundoplications were more likely to be performed in newborns (72% versus 61%) and those in the lowest income quartile compared to laparoscopic (41% versus 31%  < .001), both  < .001. The readmission rate was 20% within 30 days and 38% within the year, with 15% admitted to a different hospital. Only 14% of readmissions were elective. Open fundoplication was associated with more unplanned readmissions (94% versus 84%), conversion to gastrojejunostomy tube (11% versus 5%) along with major (5% versus 3%) and minor (8% versus 2%) complications compared to the laparoscopic approach, all  < 0.001.  The majority of fundoplications are being performed in newborns and are being done laparoscopically, which are associated with lower complication and postoperative readmission rates compared to open fundoplications.

Article	Year
Pediatric Gastrostomy Tube Placement: Less Complications Associated with Laparoscopic Approach. Journal of laparoendoscopic & advanced surgical techniques. Part A\| PubMed ID: 34748427	2021
Nationwide Outcomes and Readmission After Pediatric Laparoscopic and Open Fundoplication. Journal of laparoendoscopic & advanced surgical techniques. Part A\| PubMed ID: 34851741	2021

Antoine J. Ribieras

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