Journal of Pediatric Surgery 50 (2015) 360
Contents lists available at ScienceDirect
Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg
Correspondence Letter to the Editor
Reply to Letter to the Editor
To the Editor,
To the Editor,
Fernandez-Pineda et al. presented a surgical technique for large mesenteric defect closure by the use of a consecutive purse string suture in children [1]. They suggest that a purse string technique permits a more anatomical closure of the mesentery avoiding a kink or twist in the bowel. We first introduced the use of the purse string technique in a 4 year-old girl with a large Treves’ field mesenteric hernia [2]. Although we agree that our technique can also be used in large mesenteric defects after tumor resection, some other surgical pitfalls should be underlined regarding purse string closure of the mesentery. In our previous report, we suggested that large mesenteric defects greater than 10 cm should be closed with a purse string technique opposite to the ileocecal valve. Instead of multiple purse string sutures, the ileocecal mesentery can be closed with interrupted sutures. In this manner, the purse string repair of the mesentery avoids a tight approximation in the widest part of the mesentery and offers better blood supply to bowel. Also, this method allows having a wider small bowel mesentery on the axis of right to left, rather than cranial to caudal. We suggest that a cranial to caudal axis of artery may be more prone to twist and may compromise the bowel supply. This type of closure is easy to perform and results in a more anatomical aspect for either congenital or acquired mesenteric defects in children.
We have read with interest the letter to the editor by Soyer and Çakmak regarding our recent publication “Consecutive purse string suture for mesenteric defect closure after tumor resection in children” in the Journal of Pediatric Surgery [1]. They reported that large mesenteric defects greater than 10 cm should be closed with a purse string technique and interrupted sutures [2]. Large congenital or acquired mesenteric defects in children are not very common and conclusions about the best surgical technique for defect closure are difficult to be drawn. We agree that the purse string technique permits a more anatomical closure of the mesentery avoiding a kink or twist in the bowel. Both consecutive purse string suture and interrupted stitches after the first purse string suture are good surgical options for definitive closure defect. Long-term outcomes about the best surgical approach for large mesenteric defects closure should be obtained from case series, prospective studies and not from case reports.
Israel Fernandez-Pineda⁎ Rosa Cabello-Laureano Virgen del Rocio Children’s Hospital Department of Pediatric Surgery, Sevilla, Spain ⁎Corresponding author. E-mail address: [email protected]
Tutku Soyer Hacettepe University Faculty of Medicine Department of Pediatric Surgery, Ankara, Turkey Corresponding author. E-mail address: soyer/[email protected] Murat Çakmak Ankara University Faculty of Medicine Department of Pediatric Surgery, Ankara, Turkey http://dx.doi.org/10.1016/j.jpedsurg.2014.11.036 References [1] Fernanadez-Pineda L, Cabello-Laureano R. Consecutive purse strings suture for mesenteric defect closure after tumor resection in children. J Pediatr Surg 2014;49:1186–8. [2] Çakmak M, Şenyücel MF, Aslan MK, et al. Surgical repair of Treves field mesenteric hernia: Use of purse-string technique. Eur J Pediatr Surg 2011;21:337–9.
0022-3468/© 2015 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jpedsurg.2014.11.038
References [1] Fernandez-Pineda I, Cabello-Laureano R. Consecutive purse string suture for mesenteric defect closure after tumor resection in children. J Pediatr Surg 2014;49:1186–8. [2] Çakmak M, Şenyücel MF, Aslan MK, et al. Surgical repair of Treves field mesenteric hernia: Use of purse-string technique. Eur J Pediatr Surg 2011; 21:337–9.
Contents lists available at ScienceDirect
Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg
Correspondence Letter to the Editor
Reply to Letter to the Editor
To the Editor,
To the Editor,
Fernandez-Pineda et al. presented a surgical technique for large mesenteric defect closure by the use of a consecutive purse string suture in children [1]. They suggest that a purse string technique permits a more anatomical closure of the mesentery avoiding a kink or twist in the bowel. We first introduced the use of the purse string technique in a 4 year-old girl with a large Treves’ field mesenteric hernia [2]. Although we agree that our technique can also be used in large mesenteric defects after tumor resection, some other surgical pitfalls should be underlined regarding purse string closure of the mesentery. In our previous report, we suggested that large mesenteric defects greater than 10 cm should be closed with a purse string technique opposite to the ileocecal valve. Instead of multiple purse string sutures, the ileocecal mesentery can be closed with interrupted sutures. In this manner, the purse string repair of the mesentery avoids a tight approximation in the widest part of the mesentery and offers better blood supply to bowel. Also, this method allows having a wider small bowel mesentery on the axis of right to left, rather than cranial to caudal. We suggest that a cranial to caudal axis of artery may be more prone to twist and may compromise the bowel supply. This type of closure is easy to perform and results in a more anatomical aspect for either congenital or acquired mesenteric defects in children.
We have read with interest the letter to the editor by Soyer and Çakmak regarding our recent publication “Consecutive purse string suture for mesenteric defect closure after tumor resection in children” in the Journal of Pediatric Surgery [1]. They reported that large mesenteric defects greater than 10 cm should be closed with a purse string technique and interrupted sutures [2]. Large congenital or acquired mesenteric defects in children are not very common and conclusions about the best surgical technique for defect closure are difficult to be drawn. We agree that the purse string technique permits a more anatomical closure of the mesentery avoiding a kink or twist in the bowel. Both consecutive purse string suture and interrupted stitches after the first purse string suture are good surgical options for definitive closure defect. Long-term outcomes about the best surgical approach for large mesenteric defects closure should be obtained from case series, prospective studies and not from case reports.
Israel Fernandez-Pineda⁎ Rosa Cabello-Laureano Virgen del Rocio Children’s Hospital Department of Pediatric Surgery, Sevilla, Spain ⁎Corresponding author. E-mail address: [email protected]
Tutku Soyer Hacettepe University Faculty of Medicine Department of Pediatric Surgery, Ankara, Turkey Corresponding author. E-mail address: soyer/[email protected] Murat Çakmak Ankara University Faculty of Medicine Department of Pediatric Surgery, Ankara, Turkey http://dx.doi.org/10.1016/j.jpedsurg.2014.11.036 References [1] Fernanadez-Pineda L, Cabello-Laureano R. Consecutive purse strings suture for mesenteric defect closure after tumor resection in children. J Pediatr Surg 2014;49:1186–8. [2] Çakmak M, Şenyücel MF, Aslan MK, et al. Surgical repair of Treves field mesenteric hernia: Use of purse-string technique. Eur J Pediatr Surg 2011;21:337–9.
0022-3468/© 2015 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jpedsurg.2014.11.038
References [1] Fernandez-Pineda I, Cabello-Laureano R. Consecutive purse string suture for mesenteric defect closure after tumor resection in children. J Pediatr Surg 2014;49:1186–8. [2] Çakmak M, Şenyücel MF, Aslan MK, et al. Surgical repair of Treves field mesenteric hernia: Use of purse-string technique. Eur J Pediatr Surg 2011; 21:337–9.
