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At least 19 recordsLinked to original sources
PubMed1979

Routine primary repair vs two-stage repair of tetralogy of Fallot.

Fifteen of 194 patients (7.7%) with tetralogy of Fallot operated upon since January 1, 1972 under a protocol of routine primary repair despite young age died in-hospital. Most deaths were from low cardiac output. Young age and smallness of size increased the risk of operation. No deaths occurred among patients older than 4 years. High hematocrit was also a risk factor. Transannular patching has an independent effect in increasing risk. The post-repair ratio of peak pressure in the right ventricle to that in the left did not exert an independent effect. To project current risks of a two-stage approach, we determined that five of 158 patients (3.2%) died in-hospital after secondary intracardiac repair after a previous Blalock-Taussig or Waterston anastomosis between 1967--1978. Using these data and those we have published on the risk of shunting, we project that except in very small babies, the risks of hospital death of a two-stage approach are not less than those of primary repair done without a transannular patch, except when body surface area is less than about 0.35 m2. When a transannular patch is used in the primary repair, the two-stage approach is projected to be safer when the child has a body surface area of about 0.48 m2 or smaller.

Age Factors↗
PubMed1979

One-stage repair of a cervical esophagostome with two myocutaneous flaps from the neck and shoulder.

A large esophagostome in a heavily radiated neck was reconstructed in one stage, using a sternocleidomastoid myocutaneous flap for lining and a trapezius myocutaneous flap for covering. The patient began eating on the seventh day and was discharged on the tenth day following the repair. Barium swallow studies demonstrated a widely patent esophagus, and the patient now has good esophageal speech.

Adult↗
PubMed1979

Classic shunting operations as part of two-stage repair for tetralogy of Fallot.

One hundred forty-nine consecutive patients with tetralogy of Fallot, with or without pulmonary atresia, underwent Blalock-Taussig or Waterston operation for initial palliation. Of these patients, 45 were less than 6 months old, and 63 were less than 1 year old. The type of shunt, and the presence or absence of pulmonary atresia did not have a significant effect (p greater than 0.2) on hospital mortality. Parametric analysis showed a significant effect of age (p = 0.03), the risk of hospital death being 6% at 1 month of age, 4% at 3 months, 3% at 6 months, and 2.5% at 12 months. No late deaths occurred before the age of 3 years. Six patients (4.2% of the hospital survivors) required another operation before they were 3 years old. Severe arm ischemia occurred after a Blalock-Taussig shunt in 1 infant with Down's syndrome.

Adolescent↗
PubMed1978

One-stage repair of compound leg defects with free, revascularized flaps of groin skin and iliac bone.

The successful revascularized free transfer of a composite flap of groin skin with attached iliac bone is presented in two patients. The findings in the preliminary dissections and injection studies in cadavers are discussed, and the superficial circumflex iliac system is recommended as a stem for free flaps of groin skin and iliac bone. If iliac bone alone is required for a revascularized graft, then the deep circumflex iliac system would seem suitable for the stem. Further clinical cases are necessary to determine the indications for this procedure, and patients should be carefully selected. The need for preoperative preparation and planning on a sound anatomical background is emphasized, and preoperative angiography seems advisable. The ability to sew small vessels together reliably is one thing: the when and where is another.

Adolescent↗
PubMed1979

Experience with the van der Meulen one-stage hypospadias repair.

The van der Meulen one-stage hypospadias repair for distal hypospadias with minimal or nor chordee is described. It has been used in 65 cases and the results were good or excellent in 50 patients. There were no instances of postoperative urethral fistula.

Child↗
PubMed1979

The radiographic approach to injuries of the prostatomembranous urethra in children.

We favor initial non-operative treatment (suprapubic cystostomy drainage only) for prostatomenbranous urethral injuries in children and adolescents. Non-operative treatment usually results in uncomplicated strictures that can be corrected by a 1-stage transperineal or transpublic operation 4 to 6 months later. A hands-off diagnostic approach, which relies on excretory urography and retrograde injection urethrography to demonstrate partial and complete tears, eliminates the need for blind passage of catheters, an invasive procedure that may lead to complicated strictures unsuitable for a 1-stage repair. If a 1-stage repair is planned it is necessary to determine the length of the stricture, whether there are local complications and whether the anterior urethra can be widely mobilized. The radiographic techniques used to plan a corrective operation and to evaluate the results are described.

Adolescent↗
PubMed2026

Surgical management of esophageal atresia with tracheoesophageal fistula in extremely low birth weight neonates: A systematic review.

BACKGROUND: Surgical management of esophageal atresia/tracheoesophageal fistula (EA/TEF) in extremely low birth weight (ELBW) neonates remains challenging and controversial. This study systematically reviews surgical strategies and outcomes in this population. METHODS: Following PRISMA guidelines, Cochrane, Embase, MEDLINE, Scopus, and Web of Science (2004-2024) were searched in February 2025 for studies on surgical management of ELBW neonates with EA/TEF (PROSPERO CRD42025636228). Fatal chromosomal abnormalities were excluded. Demographics, comorbidities, surgical techniques, and complications were analyzed descriptively. Risk of bias was assessed. RESULTS: Eleven publications (five case reports and six case series) comprising 30 patients (Gross type B/C = 1/29) met the eligibility criteria. Mean gestational age was 28.1 (23-34) weeks, and mean birth weight was 760.4 (422-995) g. Twelve primary repairs (PR) and 18 delayed primary repairs (DPR) were performed, including staged repair (n = 11), lower esophageal banding (n = 4), and other techniques (n = 3). Postoperatively, four anastomotic leaks were managed conservatively, six strictures and one recurrent TEF required endoscopic intervention, three fundoplications and two aortopexies were reported (follow-up: 1-198 months, n = 19). Overall mortality was 30% (PR: 8.3%; DPR: 44.4%). Mortality was 60% among neonates with major congenital heart defects (CHD) and 40% among those with VACTERL association. EA/TEF-related complications contributed to 33.3% of deaths. CONCLUSIONS: Mortality in this cohort remains high, particularly with major CHD, and is largely unrelated to EA/TEF-specific complications. In selected cases, PR appears feasible as an alternative to DPR, although conclusions are limited by the small sample size and heterogeneous studies.

Humans↗
PubMed1978

[Suture of flexor tendons and substitution of flexor tendons in the "no-man's land" in children].

From 1969 to 1976, there were 14 primary, 10 secondary one-stage, and 14 secondary two-stage repairs of injured flexor tendons in the so-called 'no-man's-land'. Functional results of these three operational methods are compared in this paper and show that, in children, flexor tendons in uncomplicated wounds can be sutured primarily, even in the 'no-man's-land'. Flexor tendons in complicated wounds also may be primarily sutured, but not as effectively. In the latter case, according to the results under review, secondary two-stage repair, not secondary one-stage repair, must be applied.

Child↗
PubMed1977

One-stage hypospadias repair.

A surgical technique for correction of hypospadias with chordee in one stage is described. This technique which brings the ectopic meatus up to the tip of the glans was successfully applied in 3 cases of penoscrotal and in 8 cases of penile hypospadias.

Humans↗
PubMed1979

Preoperative prediction from cineangiograms of postrepair right ventricular pressure in tetralogy of Fallot.

To aid preoperative decision-making, we have related the ratio of postrepair peak pressure in the right and left ventricles (PRV/LV) to preoperative cineangiographic measurements in a retrospective study of 135 patients undergoing complete repair of tetralogy of Fallot or tetralogy of Fallot with pulmonary atresia. Postrepair PRV/LV was related to the preoperative diameter of right (DRPA) and left (DLPA) pulmonary arteries normalized to the descending thoracic aorta (DescThAo) in patients undergoing repair with transannular patching or a valved external conduit by the dquation: PRV/LV = 0.4840/(DRPA/DescThAO + DLPA/DesThAo) + 0.2007. Stenosis of the right pulmonary artery orifice and pulmonary artery arborization abnormalities incrementally increased postrepair PRV/LV. When a transannular patch was not used in classical tetralogy of Fallot, an increment of postrepair PRV/LV usually resulted, depending upon the size of the "anulus" measured intraoperatively: Incremental PRV/LV = 0.09437 . exp(-0.6344 . Z) where Z is a normalized expression in circumference terms of the diameter of the pulmonary arterial outflow tract (DPAOT) measured intraoperatively after infundibular dissection and valvotomy. DPAOT is itself related to the cineangiographically measured pulmonary valve anulus diameter (DPVA): DPAOT = 3.357 . DPVA0.5789 . BSA0.1551. In toto, these relations allow postrepair PRV/LV without transannular patching to be estimated from preoperative cineangiographic measurements. This allows preoperative predictiom in classical tetralogy of Fallot of the need for transannular patching, and in infants this can determine the choice between primary one-stage repair and two-stage repair. Prediction of postrepair PRV/LV when transannular patching or an external conduit is planned allows identification of patients in whom right and left pulmonary arteries are too small for safe complete repair, and in them an initial palliative operation should be done to enlarge the arteries.

Adolescent↗
PubMed1979

Surgical treatment of ventricular septal defect in infancy. Primary repair versus banding of pulmonary artery and later repair.

Results of primary closure of ventricular septal defects are compared with those of two-stage repair, with banding of the pulmonary artery followed by debanding and closure. Apart from the high incidence of unsatisfactory results after banding and a significant morbidity with the two-stage approach, the mortality for primary repair (2.4%) is considerably lower than that achieved with the staged repair (19.3%). Primary repair of ventricular septal defect is advocated for infants resistant to maximal medical treatment. A more flexible policy is adopted for patients with multiple ventricular septal defects and those with associated anomalies.

Child↗
PubMed1977

The adaptability of the glans flap in hypospadias repair.

In severe cases of hypospadias where a multiple-stage repair has been selected, a more functional repair has been selected, a more functional and cosmetic result is possible, without an associated higher complication rate, if the glans flap is incorporated into the final stage of the repair.

Humans↗
PubMed1976

Debate on congenital heart disease. Con: early total repair is not always preferable to palliative surgery in congenital heart disease.

While early one-stage repair of congenital heart lesions can now be done with low operative mortality, there are reasons to believe that sometimes a palliative procedure, followed later by complete repair, has some advantages. Some of the drawbacks to early repair such as presumably be abolished as better valves are produced, and better understanding of cardiopulmonary bypass may reduce operative myocardial damage. However, problems related to the very small size of some outflow tracts and pulmonary arteries may not be so easily overcome.

Age Factors↗
PubMed1977

Embolic pneumopathy induced by oleic acid. A systematic morphologic study.

This paper presents a systematic study of acute and chronic pulmonary lesions resulting from a single intravenous injection of oleic acid and a new fibrosis lung model is proposed: pulmonary interstitial fibrosis is obtained by means of a number of oleic acid intravenous injections. Nineteen adult dogs received 0.045 g/kg or 0.09 g/kg of oleic acid. A systematic morphologic study was carried out after 1, 2, 3, 4, 6, 12, 24, and 48 hours and 1, 2 and 4 weeks. Eleven other adult dogs received weekly one injection of 0.09 g/kg of pure oleic acid over a period of 1 to 3 months. Examination of the lung was carried out by means of light and electron microscopy and morphometry. An early stage characterized by the formation of thrombosis and cellular necrosis was followed by a repair stage with the proliferation of Type 2 cells and fibrotic foci in the subpleural areas. Lipid staining with Sudan IV allowed the onset and disappearance of lipid-laden macrophages to be ascertained. The late stage showed pulmonary fibrosis. The extent of the lesions is related to the number of oleic acid injections. Since interstitial pulmonary fibrosis invariably appeared, and only 2 dogs out of 11 died, the model is satisfactory for pathologist and physiologist.

Animals↗