Objective To retrospectively analyze the therapeutic effect of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to cavernous transformation of portal vein (CTPV).Methods Retrospectively analyzed 30 cases of children with CTPV admitted by Beijing Children's Hospital in General Surgery Department from Jan.2005 to Dec.2012,and evaluated the clinical efficacy of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to CTPV.Results All of 30 cases admitted operation without serious complication.All children admitted follow-up from 6 to 60 months.Seven cases of 22 patients with gastrointestinal bleeding relapsed bleeding post operation and were cured by conservative treatment.Four cases of 7 relapsing bleeding children had NSAID.All cases of 8 children with simple hypersplenism suggested normal results of blood routine post operation,2 children occurred bloody stools who were cured by conservative treatment.None of patients had serious infection correlating with splenectomy.The size of spleen of patients with gastrointestinal bleeding is larger than patients with simple hypersplenism.Conclusions (1) Ligaturing pericardial blood vessel combined splenectomy is a good choice for children with gastrointestinal bleeding and hypersplenism secondary to CTPV.(2) NSAID may increase the recurrence rate of gastrointestinal bleeding post operation.(3) There may be a negative correlation between the size of spleen and the risk of gastrointestinal bleeding for children with CTPV.

OBJECTIVETo summarize the reason and treatment of redo surgery in Hirschsprung disease for postoperative distension and constipation.

METHODSFrom January to December 2014, 35 patients with constipation and distention after pull-through done elsewhere were referred to our institution. The reasons procedures and outcomes of redo surgery were a retrospectively analyzed.

RESULTSThe indication of reoperation in 21 cases was pathological problems, including residual aganglionosis, retained transition zone bowel, and in 13 cases was anatomical problems, including retained dilated segment, obstructive Soave cuff. One case had both pathological and anatomical problems. Among them, 5 cases belonged to total colonic aganglionosis. All the cases received conservative treatment for about 6 months before reoperation. Five cases had enterostomy before redo pull through surgery. Thirty cases underwent Soave surgery with or without laparoscopy or laparotomy. Twenty-six cases underwent transabdominal Soave surgery, 3 cases transanal Soave surgery, 1 case transanal Soave surgery with laparoscopy. Other surgery included Ikeda surgery, excision of diaphragm or scar, and anoplasty. Postoperative complications were found in 3 patients. One had rectovesical fistula and was cured after operation. Two cases had anastomotic leakage and then underwent diverting ileostomy. Thirty-three cases had a mean follow-up of 59 months. During the follow-up, 32 cases had no distension and constipation. Two cases presented occasional dirty pants, 2 cases frequent soiling, 1 case daily soiling.

CONCLUSIONSReasons of distension and constipation in Hirschsprung's disease after surgery are pathological and anatomical problems. Operation procedure is chosen based on reasons. Transabdominal Soave surgery is safe and effective.

Anastomotic Leak ; Cicatrix ; Constipation ; Digestive System Surgical Procedures ; Hirschsprung Disease ; Humans ; Ileostomy ; Laparoscopy ; Laparotomy ; Postoperative Complications ; Postoperative Period ; Reoperation ; Retrospective Studies

Objective To summarize our therapeutic experiences on patients with pediatric spontaneous biliary duct perforation.Methods We retrospectively analyzed the clinical data of patients diagnosed as spontaneous biliary duct perforation who were admitted into the Department of Pediatric General Surgery,the Beijing Children Hospital from January 2008 to December 2014,and summarized the therapeutic experiences.Results There were 7 boys and 18 girls,with a average age of 2.4 years (range 11 months to 10 years).Twenty-one patients (84.0％) were diagnosed by ultrasonography.Two patients were treated with conservative therapy and were discharged home.The remaining 23 patients were treated with emergent surgery.Of these patients,9 were treated with cholecystostomy and abdominal drainage (the cholecystostomy group),and the remaining 14 were treated with choledochal drainage and abdominal drainage (the choledochal drainage group).The mean hospitalization stay for the cholecystostomy group was 25.2 days,and 3 patients developed comphcations (33.3％).The mean hospitalization stay for thecholedochal drainage group was 16.1 day,and 2 patients developed complications (14.2％).Twenty-four patients were diagnosed to suffer from congenital choledochal cysts or pancreaticobiliary maljunction by imaging studies during or after surgery.Elective choledochal cystectomy with hepaticojejunostomy were performed on 23 stable patients who developed no severe complications.Conclusions Pediatric spontaneous bile duct perforation is closely related with congenital choledochal cysts,and the pathological basis in diagnosis is pancreaticobiliary maljunction.Bile duct elastic fiber hypogenesis and specific blood supply are important to the onset of perforation.Abdominal ultrasonography plays an important role in the diagnosis.Patients with peritoneal irritation and non-localized perforation should be operated in time,and choledochal drainage with abdominal drainage is a good treatment choice.All patients diagnosed as congenital choledochal cysts or pancreaticobiliary maljunction should undergo elective choledochal cystectomy with hepaticojejunostomy.

Objective:To analyze the causes of unplanned reoperation in pediatric patients after elective digestive tract surgery and the prognosis.Methods:Medical records were reviewed from pediatric patients undergoing unplanned reoperation after elective digestive tract surgery at our department from Jan 2012 to Dec 2019. Primary diagnoses, procedures and levels of index surgeries, causes and procedures of unplanned reoperations, and patients' prognosis were analyzed.Results:There were 39 cases, and the primary diagnoses included biliary disease, anal and colorectal disease, and intestinal disease. There were 4 (10%) cases of level Ⅱ surgeries,and 35 (90%) cases of level Ⅲ&Ⅳ surgeries. The index surgical procedures included 19 (49%) biliary-intestinal procedures, 11 (28%) simple intestinal procedures, and 9 (23%) anal and colorectal procedures. The direct causes of unplanned reoperation included 10 (26%) anastomotic leakages, 8 (20%) adhesive intestinal obstructions, 5 (13%) postoperative intussusceptions, 5 (13%) incisional complications (infection, dehiscence and incisional hernia), 3 (8%) postoperative hemorrhages and 8 (20%) miscellaneous (iatrogenic injury and surgical misjudgment). Patients' prognosis included 24 (62%) full recoveries, 9 (23%) further operations, and 5 (13%) deaths, and 1 (3%) short bowel syndrome.Conclusions:Most pediatric unplanned reoperations after elective digestive tract surgery occur in complex surgical procedures. The most common causes of unplanned reoperation are anastomotic leakage, adhesive intestinal obstruction. Unplanned reoperations are often prone to adverse effects on prognosis.

Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.