Decreasing surgical site infections in pediatric stoma closures

Ahmad, Hira; Nordin, Andrew B.; Halleran, Devin R.; Kenney, Brian D.; Jaggi, Preeti; Gasior, Alessandra C.; Weaver, Laura; Vilanova-Sánchez, Alejandra; Wood, Richard J.; Levitt, Marc A.

doi:10.1016/j.jpedsurg.2019.09.058

Cited by 12 publications

(3 citation statements)

References 19 publications

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“…If routine pre-operative urine cultures are positive, we give a treatment course of the appropriate sensitive antibiotic based on local microbiome. 17 Post-operative feeding is a controversial issue if…”

Section: Discussionmentioning

confidence: 99%

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A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence

et al. 2023

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Wound dehiscence after posterior sagittal anorectoplasty (PSARP) or anorectal vaginal urethroplasty (PSARVUP) for anorectal malformation (ARM) is a morbid complication. We present a novel anoplasty technique employing para-U-stitches along the anterior and posterior portions of the anoplasty, which helps buttress the midline U-stitch and evert the rectal mucosa. We hypothesized that, in addition to standardized pre- and post-operative protocols, this technique would lower rates of wound dehiscence. A retrospective review of patients who underwent primary PSARP or PSARVUP with the para-U-stitch technique from 2015-2021 was performed. Wound dehiscence was defined as wound disruption requiring operative intervention within 30 days of the index operation. Superficial wound separations were excluded. Descriptive statistics were calculated. The final cohort included 232 patients. Rectoperineal fistula (28.9%) was the most common ARM subtype. PSARP was performed in 75% and PSARVUP in 25%. The majority were reconstructed with a stoma in place (63.4%). Wound dehiscence requiring operative intervention occurred in 4 patients, for an overall dehiscence rate of 1.7%. The dehiscence rate was lower in PSARPs compared to PSARVUPs (0.6% vs 5.2%) and lower for reconstruction without a stoma compared to with a stoma (1.2% vs 2.0%). There were an additional 6 patients (2.6%) with superficial wound infections managed conservatively. We present the para-U-stitch anoplasty technique, which is an adjunct to the standard anoplasty during PSARP and PSARVUP. In conjunction with standardized pre- and post-operative protocols, this technique can help decrease rates of wound dehiscence in this patient population.

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Section: Discussionmentioning

confidence: 99%

“…If routine preoperative urine cultures are positive, we give a treatment course of the appropriate sensitive antibiotic based on local microbiome. 17 Postoperative feeding is a controversial issue if no ostomy is present. There is a vast range in the literature ranging from 0 to 10 days nil per os.…”

Section: Discussionmentioning

confidence: 99%

A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence

et al. 2023

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“…Literature in the pediatric populations focuses almost entirely on factors such as BMI, procedure type, length of surgery, and antimicrobial use. [10][11][12] In contribution to the literature, this study evaluates the incidence of postoperative infection in 738 pediatric patients who were instructed to bathe normally starting 24 hours after their office procedures.…”

Section: Introductionmentioning

confidence: 99%

How Long Should We Keep Children’s Surgical Sites Dry? The Incidence of Infection and Dehiscence After Pediatric Office Procedures

Palacios

Hazkour

Robinson

et al. 2023

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Objective: Studies evaluating the relationship between bathing and adverse surgical site events are sparse. In this study, we examine the incidence of surgical site infection (SSI) and dehiscence in a cohort of pediatric patients who were allowed to bathe 24 hours after their office procedures. Methods: Pediatric patients who underwent office procedures by a single plastic surgeon from 2017 to 2021 were included. All patients were allowed to bathe 24 hours after their office-based skin procedure. Age, sex, procedure type, pre procedure diagnosis, relevant past medical history, instances of dehiscence, and SSI were recorded. Results: 738 pediatric patients were included. Median age was 3.3 years(range 2 months-7 years), 46% were male and 54% were female. The most common pre procedure diagnoses were branchial vestige (24%), melanocytic nevi (21%), polydactyly (15%), congenital non-neoplastic nevus (11%), cyst (9%), hypertrophic scar (8%), and hemangioma(5%). No patients received systemic antibiotics post-procedurally. Six instances of dehiscence were recorded, and no SSIs were seen in any of the 738 patients. Conclusions: The low dehiscence rate and lack of SSIs in our cohort supports the hypothesis that children can bathe normally 24 hours after office procedures without adverse consequences. This recommendation can reduce the burden of post procedure wound care by reducing the length of time patients have to modify their bathing routines.

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Surgical Safety in Children

Yardley

Charlotte

2023

Pediatric Surgery

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Decreasing surgical site infections in pediatric stoma closures

Cited by 12 publications

References 19 publications

A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence

A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence

How Long Should We Keep Children’s Surgical Sites Dry? The Incidence of Infection and Dehiscence After Pediatric Office Procedures

Surgical Safety in Children

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