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Correspondence: ravipatcharu@gmail.com 1 Department of Pediatric Surgery, Army Hospital (Research & Referral), New Delhi 110010, India Full list of author information is available at the end of the article Annals of Pediatric Surgery Chand et al. Annals of Pediatric Surgery (2021) 17:9 https://doi.org/10.1186/s43159-021-00076-w significant delay in immediate surgical management in case of failure or complication. The aim of the present study is to find an ideal environment which is very safe for the patient, comfortable for the operators and flexible enough to promptly deal with any complication. Methods This prospective observational study was conducted from July 2014 to May 2020 at a tertiary care pediatric surgery center. All children suspected to have intussusception on clinical presentation and examination and confirmed by USG performed by a senior faculty of radiology were included in the study. Meticulous records were kept so as not to miss any case presenting with intussusception to reduce bias. There were a total 48 patients during the study duration, and all were included in the present study. Data collected included patient demographics, presentation, symptoms, USG findings, procedural information, failure rate, and recurrence rate. Patients with evidence of perforation or peritonitis and parents refusing to consent for the procedure were planned to be excluded from the study. In our study, all patients diagnosed with intussusception were included, as none of them had any exclusion criteria. The Institutional Ethics Committee approved the study. All patients diagnosed with intussusception were admitted to a single hospital. After adequate fluid resuscitation and stabilization, consent was obtained from parents and patient was shifted to the operating room (OR). The anesthetist administered general anesthesia (GA). The pediatric surgery team consisted of either of two pediatric surgeons alternatively, each of whom were practicing consultants at the tertiary care center, along with a pediatric anesthesiologist, and the OR matron was scrubbed and a laparotomy trolley was arranged and kept ready for immediate operative intervention in case of a complication in the form of perforation or a failure of reduction. The two surgeons performed equal surgeries. Both the surgeons are experienced and practicing surgery for more than a decade. The technique was standardized as follows: the patient was placed in a supine position with hips partially abducted and knees partially flexed. A 16-Fr Foley catheter was inserted per rectum for 7–10 cm, and the balloon was inflated with 20 ml normal saline (NS). The radiologist localized the intussusception using USG and provided intraoperative guidance. The Foley catheter was connected to NS infusion warmed to 37 °C and set hanging 1 m above the level of the OR table. NS was allowed to run at full flow, and the progress of the water column into the colon was monitored by USG. Real-time monitoring of reduction of intussusception was done by USG by the radiologist. The time taken for reduction and the volume of fluid infused were recorded. The objective USG criteria for reduction were chosen for reducing measurement bias which were: 1. Disappearance of the intussusceptum after passing through ileocecal valve. 2. Visualization of reflux of fluid and air bubbles through the caecum and ascending colon into the ileum across the ileocecal valve. 3. Demonstration of fluid distended ileum. 4. addition to its home base of The Johns Hopkins Hospital. Editor-in-Chief Gerald Brandacher Johns Hopkins University School of Medicine Co-Editors David H. Sachs Massachusetts General Hospital and Harvard Medical School W. P. Andrew Lee Johns Hopkins University School of Medicine Photo Credit: Johan van Rensburg, South Africa Volume 1 • Issue 1 • Oct/Nov/Dec 2014 Official Journal of the American Society for Reconstructive Transplantation USE THE VIEW menu to isolate specific layer groups. [see below] Black layers are for “Health” Red layers are for Thompson See also Thompson No Wilmer which is preferred For NCR map HIDE those areas that overlap the white frame Suburban Wellness is plotted but HIDDEN JHCP Washington D.C. Baltimore 97 695 Johns Hopkins Green Spring Station Sibley Ambulatory Surgery Center Johns Hopkins White Marsh The Johns Hopkins Hospital Johns Hopkins Bayview Medical Center Johns Hopkins Odenton Not shown on map All Children’s Hospital St. Petersburg, Florida heck * on Fulton location Suburban Outpatient Medical Center Johns Hopkins Health Care and Surgery Center The ranks of residents in the combined Johns Hopkins/ University of Maryland program have grown from 18 in 2010 to 30 in 2016 and will continue to grow. The shift from divisional to departmental status led to an expansion of services, programs and faculty, which provided more surgeries and clinical learning opportunities for residents. New postgraduate fellowships have been added in hand surgery and microsurgery to the existing craniofacial and burn programs, training a total of six fellows every year. Department faculty members Chad Gordon, Damon Cooney and Amir Dorafshar have been named recipients of the prestigious American Association of Plastic Surgeons Academic Scholarship Awards for three years in a row. The annual awards recognize young investigators deemed most likely to advance knowledge in their field. Award funds help them establish and support their own research laboratories. In 2014, the VCA Journal was launched with Gerald Brandacher, scientific director of the reconstructive transplantation program, serving as editorin-chief. The publication is the official journal of The American Society for Reconstructive Transplantation and chronicles advances in the field of vascularized composite allotransplantation. The past five years have seen the launch of several new department programs. These include Hand/Arm Transplant, Face Transplant, Nonbreast Oncologic Reconstruction, Lymphedema and Penile Transplant. The penile transplant program was established after years of research and development of novel surgical techniques to better perfuse the graft and enhance nerve regeneration. It aims to restore genitourinary function in servicemen and civilians who have suffered devastating injuries to the pelvic region. The reconstructive transplant team performed the nation’s most extensive and complicated bilateral arm transplant in 2012 in a quadruple amputee soldier. That success laid the foundation for another above-elbow transplant, in 2015. The department’s hand transplant surgeons have performed three of the four above-elbow transplants in the U.S. to date. Plastic and Reconstructive Surgery | 3 When patients experience lymphedema, the most common treatment approach is the conservative route, reducing the swelling and discomfort with compression and massage therapy and/or diet modification. But some patients find greater relief with surgical management, which may include tissue removal, liposuction, lymph node transfer or the lesser-known lymphovenous bypass. Five years ago, few were performing lymphovenous bypasses. Although the concept had existed for decades, the technology had not yet caught up to the procedure, which involves super-microscopic techniques and equipment. The procedure is now an outpatient one that reroutes the lymphatic system directly to the venous system, bypassing the damaged nodes and connecting the lymphatic channels directly into tiny, almost microscopic veins. It can significantly reduce the swelling and, in some cases, return the limb to normal function. “We’re excited about this technique because it can have the potential to help a lot of people with not a lot of downside for the patient,” says Damon Cooney, assistant professor of plastic and reconstructive surgery. Another microvascular option for patients with lymphedema is lymph node transfer, where surgeons transplant a group of lymph nodes, along with their blood supply, from a healthy part of the body to the affected area. “For years, patients had no good option other than therapy,” says Justin Sacks, director of oncological reconstruction. “Now we have new techniques that address the physiology of the patient, literally rewiring the lymphatic system.” While the department is currently performing several lymphovenous bypasses per month, faculty members are also conducting research to find out how to maximize its success rate, eventually hoping to expand the pool of candidates who could benefit. Improving Surgical Management of Lymphedema
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