Purpose
The cosmetic outcomes of surgery for umbilical hernia are not always satisfactory. Reports of the long-term outcome of patient satisfaction are poorly documented because the umbilical shape changes after surgery due to growth. The aim of this study is to clarify the long-term cosmetic satisfactory outcome of both parents and patients who underwent “slit-slide procedure,” which is designed to provide a more natural appearance.
Methods
From 2010 to 2019, 149 patients with umbilical hernia underwent the slit-slide procedure at our hospital. The “slit-slide procedure” allows for the creation of an umbilicus with a more natural and integrated appearance. The questionnaire of the patient satisfaction survey was sent by mail (n = 139), and responses were obtained from 74 (53.2%) respondents. A questionnaire survey on postoperative appearance was also distributed to pediatric surgeons.
Results
The median age at the operation was 2.5 old (2 months to 14 years). The average median age at the time of answering the questionnaire was 6.25 years (2.5 to 14.86). The average median period of observation was 3.2 years (4 months to 8.97 years). Most patients (89.2%) and parents (93.2%) were satisfied with the appearance of the umbilicus. Twenty-seven patients reported improved satisfaction after surgery (36.2%). In most patients, the umbilicus had an oval appearance after the slit-slide procedure. Surgeons tended to score the elongated oval shape highly; however, there was no difference in satisfaction among the shapes.
Conclusion
The slit-slide procedure is not only radical and safe but also achieves a satisfactory aesthetic outcome.
We herein report a 10-month-old female infant with a 4-month history of diarrhea with electrolyte abnormalities and growth impairment. A 4-cm right adrenal tumor was detected by computed tomography. No metastasis or accumulation on I123metaiodobenzylguanidine scintigraphy was recognized in the tumor. A vasoactive intestinal peptide-secreting neuroblastic tumor was suspected, and octreotide was started, but the diarrhea persisted. Tumor extirpation was performed laparoscopically. After tumor removal, the symptoms improved immediately, and her growth caught up by nine months after surgery. A minimally invasive approach for pediatric solid tumor is difficult, especially for neuroblastoma, but may be beneficial for the patient's recovery.
PURPOSE
Cloacal exstrophy (CE) patients may need bladder reconstruction after initially undergoing surgery to obtain continence and improve their quality of life. This study attempts to clarify the clinical features of CE patients who underwent bladder augmentation (BA) and their urinary functional outcomes based on a nationwide survey in Japan.
METHODS
A questionnaire survey was conducted, and 150 CE patients were enrolled. Their clinical characteristics and urinary outcomes were reviewed.
RESULTS
BA was performed in 52 patients (34.7%). Most cases underwent early bladder closure at initial surgery in neonate period. The age at the BA was performed 6.4 [6–9.0] years old. Among them, the most used organ for BA was ileum (n = 30, 57.7%). Regarding the outcomes, the age when the renal function was evaluated was 14.0 [10.0–20.5] years old and the serum creatinine level was 0.44 [0.36–0.60] (mg/dl). Clean intermittent catheterization was required in 37 (71.2%) patients. On the other hand, no dialysis or kidney transplantation was necessary in any of these patients.
CONCLUSION
The renal function and conditions of patients who underwent BA were relatively well preserved. Individualized management with a stepwise surgical approach for CE patients should thus be considered in the future.
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