Helene Nepomuceno

All Publications

• Outcomes of Pouch Creation in 2-Stage Versus 3-Stage Procedures for Pediatric Ulcerative Colitis: A Propensity Score Matched Comparative Analysis. Inflammatory bowel diseases Thobani, H., Ehsan, A. N., Moturu, A., Nepomuceno, H. M., Taufiq, M., Zahid, N., Tirrell, T. F., Sylvester, K. G., Islam, S., Khan, F. A. 2025

  Abstract

  Staged proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for medically refractory pediatric ulcerative colitis (UC). This study aimed to compare the surgical outcomes of 2-stage and 3-stage IPAA in children of similar disease severity.We queried the NSQIP-Pediatric database (2016-2023) to identify patients under 18 years with UC undergoing IPAA. Patients undergoing IPAA with concurrent colectomy were classified as having a 2-stage procedure, while those undergoing IPAA alone, following a prior colectomy, were classified as having a 3-stage procedure. The primary outcome was a composite of major complications within 30 days, including mortality, organ/space infection, progressive renal insufficiency, systemic sepsis, and intra-abdominal reoperation. The treatment groups were matched using 1:1 propensity score matching to adjust for baseline differences in disease severity.A total of 479 patients met the inclusion criteria (330 underwent 3-stage and 149 underwent 2-stage procedures). The proportion of patients undergoing each approach remained stable over the study period (P = .693). At the time of pouch creation, the 2-stage group had significantly higher rates of steroid use (22.8% vs 14.5%), leukocytosis (21.9% vs 7.1%), and hypoalbuminemia (mean 4.0 vs 4.2 g/dL). After matching, 137 patient pairs were included. There was no significant difference in major complication rates between groups (OR, 1.38; 95% CI, 0.63-3.09).This study demonstrated that surgical outcomes following pouch creation were similar in a matched cohort of children undergoing 2- or 3-stage IPAA, supporting the use of a 2-stage approach in certain patients with limited disease.

  View details for DOI 10.1093/ibd/izaf241

  View details for PubMedID 41128337

• Antibiotic Stewardship in Pediatric Complicated Appendicitis: Assessing the Role of Oral Antibiotics after Discharge. Journal of pediatric surgery Thobani, H., Nepomuceno, H. M., Schwab, M. E., Emengo, P. O., Khan, R., Raymond, S. L., Shah, A. A., Mathew, R., Tirrell, T. F., Islam, S., Sylvester, K. G., Khan, F. A. 2025: 162594

  Abstract

  To determine whether home oral antibiotic (OA) use after appendectomy for pediatric complicated appendicitis reduces post-discharge complications in children who are afebrile prior to discharge.We queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) dataset for children aged 1-18 years who underwent appendectomy for complicated appendicitis between 2019-2023. Patients were included if they were afebrile and had no infective complications (i.e. fever, surgical site infections etc.) at discharge. All patients were stratified into age groups (ages 1-5, 5-10 and 10-18) and were subsequently grouped by whether they were prescribed home OA. The primary outcome measure was post-discharge intra-abdominal abscess (IAA). The relationship between home OA use and post-discharge outcomes was analyzed using multivariable logistic regression.A total of 20,190 patients met criteria, with a median age of 10.0 years (IQR: 6.9-13.1). Approximately 70.9% of patients received home OA and 29.1% did not. Patient characteristics including age, preoperative WBC count, operative time, and length of stay appeared similar at baseline on unadjusted analysis. On multivariable analysis, home OA use did not reduce the odds of IAA in any age group (Age 1-5: aOR=1.27, 95% CI=0.80-2.09; Age 5-10: aOR=1.15, 95% CI=0.90-1.50; Age 10-18: aOR=1.05, 95% CI=0.86-1.30). A subset analysis conducted for patients aged 5-18 years with intraoperative findings of perforated appendicitis also failed to identify any association between home OA use and post-discharge IAA (aOR=1.09, 95% C.I.=0.92-1.29).There appears to be limited benefit to prescribing home OA for children with complicated appendicitis who are afebrile after appendectomy.Retrospective Cohort Study LEVEL OF EVIDENCE: Level III evidence.

  View details for DOI 10.1016/j.jpedsurg.2025.162594

  View details for PubMedID 40845978

• Pleural drain placement following lung resection in children: A prospective observational study of the Western Pediatric Surgery Research Consortium. Journal of pediatric surgery Kahan, A. M., Kelley-Quon, L. I., Acker, S. N., Vincent, S., Chao, S. D., Nepomuceno, H., Lee, J. H., Padilla, B. E., Ignacio, R. C., Fialkowski, E. A., Fowler, K. L., Cairo, S. B., Munar, D., Pandya, S. R., Russell, K. W., Fenton, S. J., Lee, S. L., Rothstein, D. H. 2025: 162541

  Abstract

  PURPOSE: Pleural drains are used routinely after thoracic surgery in children despite evidence that drainage is not always necessary. The purpose of this study was to assess the necessity of intraoperative drain placement after resectional lung surgery in children, provide a contemporary characterization of the use of pleural drains, and evaluate the utility of intraoperative air leak testing.METHODS: A multi-institutional prospective cohort study was performed at 10 free-standing children's hospitals in the United States from 2023-2024. Patients <18 years old who underwent open or thoracoscopic wedge resection or lobectomy were included. Patients undergoing operation for spontaneous pneumothorax or trauma, those on extra-corporeal life support, those undergoing bi-lobectomy or pneumonectomy, and those undergoing reoperation in the affected hemithorax were excluded. Operative parameters, intra-operative air leak, length of post-operative drain placement, and number of post-operative chest x-rays were evaluated using bivariate comparisons.RESULTS: Among 229 patients (58% male, median age 12.3 years [IQR 5-16]), 113 (49%) underwent wedge resection and the remaining 116 (51%) underwent lobectomy. 201 patients (87.8%) had a pleural drain vs 28 (12.2%) without. Air leak testing was performed for 198 children: among those with a negative leak test (168, 73.4%), 144 (85.7%) had a pleural drain placed. Of the 90 children undergoing wedge resection with air leak test results available, 78 (87%) had a negative leak test and 57 (73%) of those patients still received pleural drainage. None of the 28 cases initially without pleural drainage required post-operative insertion of a pleural drain. Children with pleural drainage had significantly more post-operative chest x-rays compared to those without (median 5 vs 2, p<0.001), and a significantly longer post-operative length of stay (median 3 vs 1 days, p<0.001).CONCLUSION: Pleural drain placement after lung resection in pediatric patients is routine but may not be necessary. Patients with pleural drain incur significantly higher postoperative radiation exposure compared to those without. Randomized control trials of pleural drainage after resectional lung surgery are needed to examine further if the routine use of pleural drainage is necessary.LEVEL OF EVIDENCE: III.

  View details for DOI 10.1016/j.jpedsurg.2025.162541

  View details for PubMedID 40789464

• Home Antibiotic Use after Appendectomy for Complicated Appendicitis Does Not Influence Outcomes in Children Without Postoperative Signs of Infection: A NSQIP-P Observational Study Thobani, H., Nepomuceno, H. M. L., Schwab, M., Emengo, P., Shah, A. A., Raymond, S., Islam, S., Khan, F. A. LIPPINCOTT WILLIAMS & WILKINS. 2024: S349-S350

  View details for Web of Science ID 001348680702172

• Pilonidal granuloma formation after an incision and drainage procedure is associated with retained hair within the sinus - A case series. International journal of surgery case reports Nepomuceno, H., Abrajano, C., Chiu, B. 2024; 125: 110500

  Abstract

  Pilonidal disease may present with a draining secondary sinus or granuloma, but the development of these findings is not well-characterized.Two adolescent males presented with pilonidal disease. The first patient had a gluteal cleft abscess, and an incision and drainage procedure was performed. Although the abscess resolved, the incision site formed a granuloma with intermittent draining wound with granulation tissue. He underwent a pit-picking procedure along with excision of the granuloma. A large amount of hair was also removed from within the pilonidal sinus. The second patient underwent an incision and drainage procedure to treat the pilonidal abscess. The incision site evolved into a granuloma with recurring drainage. A pit-picking procedure was performed, and the granuloma was excised. During the excision, a moderate amount of hair was evacuated from the pilonidal sinus.Many pilonidal patients present with a granuloma or secondary sinus at the gluteal cleft, but there has been no documentation of the natural history of this development. The role of hair is central to pilonidal disease pathophysiology and is a known factor in foreign body granuloma formation - a cutaneous inflammatory response to endogenous or exogenous material in the dermis that is not broken down readily by macrophages.Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus.

  View details for DOI 10.1016/j.ijscr.2024.110500

  View details for PubMedID 39461136