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  • Author: Piyawan Chiengkriwate x
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Piyawan Chiengkriwate, Surasak Sangkhathat, Sakda Patrapinyokul, Vorapong Chowchuvech, Waricha Janjindamai, Supaporn Dissaneevate and Prasin Chanvitan


Background: The definitive surgical management of gastroschisis is the return of the eviscerated abdominal content into the abdomen as soon as possible. Objectives: Assess the efficacy of using a sutureless elastic ring silo (SERS) for the management of gastroschisis. Methods: Neonates with gastroschisis were enrolled at Songklanagarind Hospital between January 2006 and December 2008. A primary repair (PR) was attempted in all cases. If this was not possible due to concerns about abdominal compartment syndrome, a stage abdominal closure with a silo pouch was fashioned: a traditional silo (TS) or SERS. When the bowel was completely reduced, a second-stage closure was performed in the operating room. Data collected included general demographic data, size of defect, associated anomalies, hospital course, mode of gastroschisis closure, duration of parenteral nutrition (PN) and ventilator, first feeding age, complications, and length of hospital stay (LOS). Results: Twenty-nine children with gastroschisis were treated (PR: 9, TS: 9, and SERS: 11). There were no differences (p >0.05) concerning gender, mode of delivery, APGAR scores, gestational age, birth weight, or defect size. A preformed silo was employed in 20 of 29 cases, TS in nine (31%), and SERS in 11 (38%) cases in an average operative time of 80.6 and 40 minutes, respectively, a significantly shorter operative time in the SERS (p =0.007). Overall, there were no differences (p >0.05) concerning duration of ventilator support (10.2 days), duration of PN (21.3 days), first feeding age (15 days), LOS (26.5 days), and complication. Conclusion: The use of a sutureless elastic ring silo with readily available inexpensive materials is simple, safe and efficacious in our setting.

Open access

Pawan Chansaenroj, Piyawan Chiengkriwate, Sakda Patrapinyokul, Surasak Sangkhathat, Samonmars Kun-Ngern and Alan Geater


Background: Colostomy formation and closure procedures are common operations, frequently be performed in patients with anorectal malformation. Collected information is lacking concerning the outcome of colostomy closure operations and the major factors influencing the outcome.

Objective: The authors examined the outcome and complications of colostomy closure in patients with anorectal malformation, and the major factors influencing the outcome.

Materials and methods: The study period was January 1997 through December 2007. A review of medical records from this period showed 259 cases of anorectal malformations (ARM). The records of one hundred and one patients from Songklanagarind Hospital were examined. The variables considered were first feeding time following the procedure, length of hospital stay and presence of complications. Influencing factors that might be related with these outcomes were identified.

Results: The data showed 107 colostomy closures. The median first feeding time was two days and median post operative hospital stay was five days. There were 13 cases (12.2%) of acute complications, of which the most common was wound infection (four cases, 3.7%) and 16 cases of late complication, most of which were fecal impaction (eight cases, 7.5%). Acute post-operative complications were more likely in patients with co-morbidity prior to surgery (p-value 0.088) and in transverse-end colostomies (p-value 0.004), and with an interval between colostomy formation and closure less than four months or more than eight months (p-value 0.010). Hospital stay was longer in patients with transverse-end colostomy (p-value 0.051), Down syndrome (p-value 0.009) and acute complications (p-value <0.001).

Conclusion: Many variables influenced the outcome of colostomy closure, most commonly co-morbidity prior to surgery, transverse-end colostomy, Down syndrome, and longer or shorter than normal interval between colostomy formation and closure.

Open access

Piyawan Chiengkriwate, Rattaporn Donnapee and Alan Geater


Background: The effectiveness of medical treatment depends on proper drug dosing. The most accurate measurement of a child’s weight is by weighing the child on a scale, and can be done for stable children. However, an emergency, or other conditions may preclude normal weighing. The child’s weight must then be estimated quickly for treatment including drug dosages, equipment sizes, ventilator volume settings, and cardioversiondefibrillation.

Objectives: To assess the accuracy of the Broselow tape in the weight estimation of Thai children.

Methods: Retrospective analysis reviewing the hospital-based data of 4746 Thai children aged less than 15 years. Demographic data, measured weight (MW), and height were collected. The subjects were divided into nine color-coded groups according to the Broselow tape color range and the actual weight plotted according to their groups. Comparison between Broselow tape-predicted weight (TW), height and MW was explored.

Results: A total of 3869 children met the inclusion criteria, of whom 2121 (54.8%) were male. The overall agreement between actual weight and predicted weight was 62.1% (range 36.4-90.5 depending on color-code). The mean difference between TW and MW was -3.56% (95% CI -3.964 to -3.150) with SD 12.91%, P < 0.001. TW was within a 10% error for 58% of children.

Conclusions: The accuracy of the Broselow tape in the weight estimation of Thai children decreases with increasing height. The Broselow tape underestimates Thai children’s weight.