In this series, the percentage of boys circumcised and the prevalence of BXO were both higher than in other published series. BXO may be more common and present at a younger age than previously thought.
Traditionally, in UK-based surgical training, the majority of trainees spend a period of time out of clinical training undertaking research, usually leading to the award of a postgraduate degree or thesis (MD or PhD). The intention of this was to supplement clinical with academic training that developed skills such as critical appraisal, independent working and systematic thinking to enrich future surgical practice. The opportunity for academic activity is a significant factor in choosing a surgical career for many trainees.
A1-A204 in children. We set out to further evaluate the role of lung biopsy in this group of clinically challenging patients by reviewing our experience of this procedure. Methods A retrospective case-note review was carried out of all patients under 18 yrs who underwent a lung biopsy from 1998 to 2011. Data collected included age, mode of biopsy, histological findings, pre and post biopsy diagnosis, pre and post biopsy treatment, and complications of the procedure. Results Thirty three children (12 boys) underwent lung biopsy in the period studied. Their ages ranged from three months to 16 years (median 5 years 5 months). Five biopsies were obtained using a thoracoscopic approach, the remainder via thoracotomy. Following the procedure, 17 patients required ventilation on the intensive care unit for a median of two days. Eight children (24%) experienced a direct complication of the procedure. Seven required an intercostal drain for a pneumothorax, one a tension pneumothorax presenting six days post-operatively. The operative mortality was 12% (4/33). Three children (9%) died within 28 days of surgery, two due to progressive respiratory failure and one following pneumonia. One patient died three months post-operatively due to a persistent air leak from the biopsy site. Twenty-six (79%) biopsies provided a sample adequate for definitive histological diagnosis. In 16 (48%) children the working diagnosis and treatment was changed following lung biopsy. Conclusion Lung biopsy retains a place in the management of children with chronic pulmonary disease when there is diagnostic doubt. However it carries a significant morbidity and mortality which must be borne in mind when considering the need for histological diagnosis.
Introduction Shifts in the landscape of surgical care provision have resulted in a rise in demand for specialist paediatric surgery services. Here we describe a model of a single paediatric surgery service delivering elective surgery across two sites, a specialist children’s hospital and an inner-city district general hospital. This model has allowed for a management of increased demand while maintaining key quality indicators within national standards. Materials and methods In a single specialist paediatric surgical service working at two sites (specialist and non-specialist), service demand was evaluated by number of referrals and waiting list additions and removals over an eight-year period (2011–2018). Daycase rate, 30-day readmission, and 12-month reoperation for three commonly performed general surgery of childhood procedures (umbilical hernia repair, Inguinal herniotomy, orchidopexy) are reported. NHS Getting it Right First Time data are used to allow comparison with national standards. Results Referrals to the service increased 2.5-fold (955 in 2011/12 compared with 2,419 in 2017/18) and waiting list additions increased 1.4-fold (585 compared with 840), net additions to the waiting list indicate that demand was met. Readmission and reoperation rates met or exceeded national standards. Discussion This model allows for a high quality of care to be provided with acceptable daycase rates and low readmission and reoperation rates. We commend this model to other specialist paediatric surgical centres experiencing increasing demand on their services
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