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Browsing by Author "Halleran, Devin R."
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Item Can Fecal Continence be Predicted in Patients Born with Anorectal Malformations?(Elsevier, 2019) Minneci, Peter C.; Kabre, Rashmi S.; Mak, Grace Z.; Halleran, Devin R.; Cooper, Jennifer N.; Afrazi, Amin; Calkins, Casey M.; Corkum, Kristine; Downard, Cynthia D.; Ehrlich, Peter; Fraser, Jason D.; Gadepalli, Samir K.; Helmrath, Michael A.; Kohler, Jonathan E.; Landisch, Rachel; Landman, Matthew P.; Lee, Constance; Leys, Charles M.; Lodwick, Daniel L.; McLeod, Jennifer; Mon, Rodrigo; McClure, Beth; Rymeski, Beth; Saito, Jacqueline M.; Sato, Thomas T.; St. Peter, Shawn D.; Wood, Richard; Levitt, Marc A.; Deans, Katherine J.; Surgery, School of MedicinePurpose The purpose of this study was to identify factors associated with attaining fecal continence in children with anorectal malformations (ARM). Methods We performed a multi-institutional cohort study of children born with ARM in 2007–2011 who had spinal and sacral imaging. Questions from the Baylor Social Continence Scale were used to assess fecal continence at the age of ≥ 4 years. Factors present at birth that predicted continence were identified using multivariable logistic regression. Results Among 144 ARM patients with a median age of 7 years (IQR 6–8), 58 (40%) were continent. The rate of fecal continence varied by ARM subtype (p = 0.002) with the highest rate of continence in patients with perineal fistula (60%). Spinal anomalies and the lateral sacral ratio were not associated with continence. On multivariable analysis, patients with less severe ARM subtypes (perineal fistula, recto-bulbar fistula, recto-vestibular fistula, no fistula, rectal stenosis) were more likely to be continent (OR = 7.4, p = 0.001). Conclusion Type of ARM was the only factor that predicted fecal continence in children with ARM. The high degree of incontinence, even in the least severe subtypes, highlights that predicting fecal continence is difficult at birth and supports the need for long-term follow-up and bowel management programs for children with ARM.Item Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation(Elsevier, 2019) Leys, Charles M.; Hirschl, Ronald B.; Kohler, Jonathan E.; Cherney-Stafford, Linda; Marka, Nicholas; Fallat, Mary E.; Gadepalli, Samir K.; Fraser, Jason D.; Grabowski, Julia; Burns, R. Cartland; Downard, Cynthia D.; Foley, David S.; Halleran, Devin R.; Helmrath, Michael A.; Kabre, Rashmi; Knezevich, Michellle S.; Lal, Dave R.; Landman, Matthew P.; Lawrence, Amy E.; Mak, Grace Z.; Minneci, Peter C.; Musili, Ninette; Rymeski, Beth; Saito, Jacqueline M.; Sato, Thomas T.; St. Peter, Shawn D.; Warner, Brad W.; Ostlie, Daniel J.; Surgery, School of MedicinePurpose Chest tube (CT) management for pediatric primary spontaneous pneumothorax (PSP) is associated with long hospital stays and high recurrence rates. To streamline management, we explored simple aspiration as a test to predict need for surgery. Methods A multi-institution, prospective pilot study of patients with first presentation for PSP at 9 children’s hospitals was performed. Aspiration was performed through a pigtail catheter, followed by 6 h observation with CT clamped. If pneumothorax recurred during observation, the aspiration test failed and subsequent management was per surgeon discretion. Results Thirty-three patients were managed with simple aspiration. Aspiration was successful in 16 of 33 (48%), while 17 (52%) failed the aspiration test and required hospitalization. Twelve who failed aspiration underwent CT management, of which 10 (83%) failed CT management owing to either persistent air leak requiring VATS or subsequent PSP recurrence. Recurrence rate was significantly greater in the group that failed aspiration compared to the group that passed aspiration [10/12 (83%) vs 7/16 (44%), respectively, P = 0.028]. Conclusion Simple aspiration test upon presentation with PSP predicts chest tube failure with 83% positive predictive value. We recommend changing the PSP management algorithm to include an initial simple aspiration test, and if that fails, proceed directly to VATS.