We conclude that Fowler-Stephens orchidopexy has a relatively good outcome. The rates of reoperation after the two-stage Fowler-Stephens orchidopexy were low in this study. Overall success rate compares very favorably to published literature.
Purpose:
Percutaneous Endoscopically placed Gastrostomy (PEG) tubes are frequently used in children. The traditional endoscopic method to remove/change the PEG device requires general anaesthesia in children. A minimally invasive alternative is the ‘Cut and Push’ method (C&P): avoiding the risks/wait times of general anaesthesia and reducing resource burden. Data regarding safety/effectiveness of C&P in children are lacking with concerns raised about the possibility of gastrointestinal obstruction.
Methods:
We retrospectively reviewed all cases of PEG removal / change to button in children (<18yrs) between December 2020 and January 2022. Cases were identified from a prospectively maintained database and all cases of C&P included. Parents/carers were asked if the child had suffered any complications following C&P and if flange was visualised in stools.
Results:
During the time period, 27 PEGs were either removed or changed to button via C&P. The average waiting time for C&P was 14.29 days, significantly shorter than the minimum 6 month waiting time for elective endoscopy. Our evaluation revealed no complications of C&P at median 70 days (range 25-301). In three cases the flange was visualised in the stool, at 2 days, 3 days and 5 weeksfollowing C&P respectively.
Discussion:
These data support the available literature suggesting C&P is an effective means to facilitate minimally invasive and prompt PEG removal / change to button in children. We recommend minimum weight and age parameters for this procedure and further evaluation of the safety and resource implications of this technique.
Aim: Laparoscopic inguinal hernia (IH) repair is an alternative to open surgery. A potential advantage of laparoscopic repair is prevention of contralateral metachronous hernia although some studies report higher recurrence rate. We aim to determine the cost-effectiveness of open versus laparoscopic IH repair taking into account metachronous and recurrence rates. Method: Retrospective single centre study of children (<5 year) undergoing elective open or laparoscopic repair for a unilateral IH between February 2018 -October 2019. Ten cases in each of 4 groups were included (open daycase, open overnight, laparoscopic daycase, laparoscopic overnight).Cases incurring a higher cost due to comorbidities or additional procedure were excluded. Patient level information and costing system (PLICS) data was obtained from the hospital finance. Mean (SD) procedural cost was compared for open and laparoscopic procedures. A financial model was created factoring metachronous and recurrent rates.
Results:Cost of open daycase repair was £1866.24 (SD: 311.15) compared to £2210.13 (SD: 391.36) for daycase laparoscopic repair. For overnight repair, cost of open was £2442.82 (SD: 497.05) compared to £2585.35 (SD: 384.66) for laparoscopic. On calculating the cost-effectiveness point using the difference in metachronous and recurrence rate between the two procedures, laparoscopic is more cost-effective than open daycase repair at 18.43%. For overnight repair, the difference rate is 5.84%.
Conclusion:Our data suggest that based on metachronous and recurrence rates in the current literature, laparoscopic IH repair is more cost-effective than open repair for cases requiring overnight stay whereas for daycase procedures, open IH repair is more cost-effective.
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