* Comparison of laparoscopic and open pyloromyotomy: Concerns for omental herniation at port sites after the laparoscopic approach.
- Pyloromyotomy is a common surgical procedure in infants with hypertrophic pyloric stenosis and can be performed with a small laparotomy or laparoscopically. No specific complications have been documented about one of the approaches. We aim to study (severity of) complications of pyloromyotomy and to compare complications of both approaches. Children undergoing pyloromyotomy between 2007 and 2017 were analyzed retrospectively. Complication severity was classified using the Clavien-Dindo classification. We included 474 infants (236 open; 238 laparoscopic). 401 were male (85%) and median (IQR) age was 33 (19) days. There were 83 surgical complications in 71 patients (15.0%). In the open group 45 infants (19.1%) experienced a complication vs. 26 infants in the laparoscopic group (10.5%)(p = 0.013). Severity and quantity of postoperative complications were comparable between both groups. Serosal tears of the stomach (N = 19) and fascial dehiscence (N = 8) occurred only after open pyloromyotomy. Herniation of omentum through a port site occurred only after laparoscopy (N = 6) and required re-intervention in all cases. In conclusion, the surgical complication rate of pyloromyotomy was 15.0%. Serosal tear of the stomach and fascial dehiscence are only present after open pyloromyotomy and omental herniation after laparoscopy respectively. The latter complication is underestimated and requires attention.
* A Comparison of Attachment representations to Mother and Father using the MCAST.
- The aim of the current study was to examine the factorial structure of the Manchester Child Attachment Story Task (MCAST), using a father doll to address the child's attachment representation to father. While the MCAST, a doll story completion task measuring attachment representations in early childhood, has been validated for use with a mother doll, its use for assessing attachment to father is relatively unexplored. Thus, an additional aim was to compare the factorial structure of the child's attachment representation to father and mother, respectively. We analyzed data from 118 first-grade children who underwent counterbalanced administration of the MCAST with a mother and father doll, respectively, within a period of three months. Exploratory factorial analysis revealed similar, three-factor solutions for attachment to father and mother, with a first factor capturing the child's (scripted) knowledge of secure base/safe haven and a second factor reflecting intrusive and conflict behavior. The third factor was different in the father and mother representations, capturing self-care and role-reversal in attachment to father and disorganization in attachment to mother. Findings support the potential usefulness of the MCAST for exploring the father-child relationship and highlight a need for further research on early attachment representations to father.