This retrospective cohort study of 74 consecutive CLMs diagnosed antenatally over a 10-year period demonstrates that most of these lesions will remain asymptomatic throughout childhood. Although the natural history of CLMs in later years remains to be elucidated, we hope that this report on medium-term outcomes will be useful to clinicians who undertake antenatal counselling and may inform the discussion on how best to manage these children.

astric transposition in children is a well-established treatment for long-gap esophageal atresia and long caustic strictures when preservation of the native esophagus is impossible, but does involve laparotomy and, often, thoracotomy incisions. The minimally invasive approach to this operation has been attempted in 7 patients to date in the UK, all at Great Ormond Street Hospital (London, UK). Four patients were male, 3 were female, with a mean age of 3 years and 7 months (range, 5 months to 13 years). Indications were long-gap esophageal atresia where primary anastomosis was impossible (5 patients) and caustic ingestion with long esophageal strictures (2 patients). The stomach was mobilized laparoscopically by using 5-mm instruments and a pneumoperitoneum of 10 mm Hg. Following pyloromyotomy or pyloroplasty, a tunnel in the posterior mediastinum was developed. The fundus of the stomach was drawn to the neck and sutured to the cervical esophagus. The patients were ventilated on our intensive care unit and then returned to the surgical ward before discharge. Gastric transposition was completed laparoscopically in 6 of 7 patients. The mean duration of surgery was 327 minutes (range, 240-455). All patients survived. Minor complications were pneumonia (2), pleural effusion (1), and hiatus hernia (2). The mean hospital stay was 16 days (range, 8-36). Our preliminary experience would suggest that laparoscopic gastric transposition is a safe alternative to open surgery with satisfactory results.

The Royal College of Surgeons have proposed using outcomes from necrotising enterocolitis (NEC) surgery for revalidation of neonatal surgeons. The aim of this study was therefore to calculate the number of infants in the UK/Ireland with surgical NEC and describe outcomes that could be used for national benchmarking and counselling of parents. A prospective nationwide cohort study of every infant requiring surgical intervention for NEC in the UK was conducted between 01/03/13 and 28/02/14. Primary outcome was mortality at 28-days. Secondary outcomes included discharge, post-operative complication, and TPN requirement. 236 infants were included, 43(18%) of whom died, and eight(3%) of whom were discharged prior to 28-days post decision to intervene surgically. Sixty infants who underwent laparotomy (27%) experienced a complication, and 67(35%) of those who were alive at 28 days were parenteral nutrition free. Following multi-variable modelling, presence of a non-cardiac congenital anomaly (aOR 5.17, 95% CI 1.9–14.1), abdominal wall erythema or discolouration at presentation (aOR 2.51, 95% CI 1.23–5.1), diagnosis of single intestinal perforation at laparotomy (aOR 3.1 95% CI 1.05–9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9–237) were associated with increased 28-day mortality. These results can be used for national benchmarking and counselling of parents.

PEG and RIG are both safe methods of gastrostomy insertion with a low rate of major complications. Registration number: NCT01920438 ( http://www.clinicaltrials.gov).

Persistent non-visualisation of the fetal stomach in the antenatal period was associated with a wide range of underlying diagnoses. In many cases, prognosis was poor. Only 37% of pregnancies resulted in liveborn infants surviving more than 6 months. The incidence of an abnormal karyotype was 29%. Diagnosis and outcome was normal in only 9.2% of cases. We propose an algorithm for the management of persistent non-visualisation of the fetal stomach on antenatal ultrasound.

Introduction Duodenal atresia classically presents with a “double bubble” sign and polyhydramnios in the third trimester. The significance of an enlarged stomach detected on a second trimester scan is unclear. Methods A retrospective review of cases identified from the Wessex Fetal Medicine and Antenatally Detected Anomaly (WANDA) regional databases from 1995 to 2012. Scan reports were reviewed and correlated with outcome. Results 33 cases of an enlarged stomach in the second trimester were identified. In nine there were additional major anomalies: four with gastroschisis, three with cardiac anomalies (including two trisomies), one severe growth restriction with dilated bowel loops and one with renal cystic dysplasia. In the 24 fetuses without additional major anomalies, five had early signs of a “double bubble” with the first part of the duodenum visible. Three (60%) had confirmed duodenal atresia after delivery, one with VATER syndrome and one with trisomy 21. In the 19 cases without an early “double bubble” sign, stomach enlargement resolved in eight (42%) and persisted in 11 (58%), one with polyhydramnios. In these 19 babies there was one neonatal death following preterm labour at 26 weeks post amniocentesis. In the 18 cases with postnatal follow up, there were no gastro-intestinal anomalies or feeding problems detected. Conclusions The finding of an isolated enlarged stomach in the second trimester appears to have a good outcome with no associated feeding problems. However if an early “double bubble” sign is seen there is a significant risk of an underlying duodenal atresia.

The Acknowledgements section in this Article is incomplete. "This article is submitted as an observational study in the category of original articles. A small subset of information from this article has been presented at the annual congress of the British Association of Paediatric Surgeons". should read: "This article is submitted as an observational study in the category of original articles. A small subset of information from this article has been presented at the annual congress of the British Association of Paediatric Surgeons.

No abstract