Department Of Pediatric Surgery Research Articles

Safety and Efficacy of Hook Diathermy in the Dissection of the Mesocolorectum During Laparoscopic-Assisted Pull-Through for Hirschsprung Disease in Low-Resource Settings.

Background: Surgical correction is the main line of treatment for the congenital disorder Hirschsprung's disease (HD). Laparoscopic techniques proved their safety and efficacy in previous studies. LigaSure™ is the gold standard for colorectal dissection. However, other sealing methods could be used during the unavailability of LigaSure. Purpose: This study aimed to assess the safety profile of the hook diathermy technique compared to LigaSure in colorectal dissection during laparoscopic-assisted pull-through for HD. Materials and Methods: This case-control study was held in the pediatric surgery department at Assiut University Hospitals between September 2017 and January 2023. The study included 57 HD patients who were surgically operated on during a laparoscopic-assisted pull-through. They were divided into 2 groups according to the sealing methods: the ligasure group included 25 patients, and the hook diathermy group included 32 patients. Results: Both groups had no statistically significant differences regarding age, sex, or weight. The transition zone was present in all patients, and most transition zones were rectosigmoid. No cases reported intraoperative blood transfusion or conversion to an open or transanal approach. Minimum intraoperative blood loss was reported in both groups, with no significant differences. As regards postoperative complications, including bleeding, leakage, perianal excoriation, and enterocolitis, no significant differences between both groups were found. Conclusion: The LigaSure and hook diathermy techniques are safe and effective sealing methods for colorectal dissection during laparoscopic-assisted pull-through for HD.

Comparison of cystectomy and lobectomy of lung hydatid cyst in pediatrics: a retrospective study.

Hydatid cyst is an endemic disease in Iran. The treatment of choice for paediatric lung hydatid cysts is surgical removal of the cyst. However, due to its high prevalence the risk of recurrence after the surgery, cystectomy with capitonnage, which preserves the lung tissue, is a favourable surgical approach compared to lobectomy. Herein, the authors compared the outcome of cystectomy and lobectomy of lung hydatid cysts. This is a retrospective study conducted in the paediatric surgery department. Paediatric patients who had undergone surgery due to pulmonary hydatid cysts were enroled. The patients were divided into two groups including cystectomy and non-anatomic lobectomy. Then, the length of surgery, length of hospitalization, postoperative complications, and the time required to remove the chest tube were calculated in each group. A total of 32 patients were enroled in this retrospective study. Age, sex, location, and size of cysts were not significantly different between the two groups. The duration of surgery in the lobectomy and cystectomy groups was 116.3±33.7 versus 116.1±28.2 min, respectively (P=0.53). Surgery complications including the need for blood transfusion, pneumothorax, need for bronchoscopy and atelectasis were not different between the study groups. The mean time for first chest tube removal was significantly different between the groups with the lobectomy group having a shorter time (P=0.02). The length of hospital and ICU stay were not different between the two surgical procedures. The time to remove the first chest tube was significantly higher in cystectomy compared to lobectomy (P=0.02). The complications and outcome of the cystectomy are comparable to the lobectomy technique. However, the cystectomy method has the advantage of preserving the lung tissue, therefore it's a favourable technique in endemic areas for hydatid cysts where reoperation may be indicated.

Academician Mstislav Vasilievich Volkov (1923–2001) (on the 100th anniversary of his birth)

Outstanding traumatologist-orthopedist, scientist, teacher and health care organizer, founder of a large school of traumatologists and pediatric orthopedists, academician of the USSR Academy of Medical Sciences and the Russian Academy of Medical Sciences, vice-president of the USSR Academy of Medical Sciences, chief traumatologist and chairman of the Academic Council of the USSR Ministry of Health, Honored Scientist of the RSFSR, laureate of the USSR State Prize, Professor Mstislav Vasilievich Volkov was born on June 1, 1923 in Vladivostok. In 1940, he entered the 2nd Moscow Medical Institute, at the beginning of the Great Patriotic War, he joined the people’s militia, served as a signalman, and after demobilization in 1945, he continued his studies at the Institute, after which he studied in a clinical residency, and then in graduate school at the Department of Pediatric Surgery and Orthopedics under the direction of Professor S. D. Ternovsky. In 1952, he defended his candidate’s thesis «Peculiarities of amputation limb stump in children», and in 1961 – his doctoral thesis «Tumors and dysplasia of bones in children». From 1961 to 1984, M. V. Volkov headed the Central Institute of Traumatology and Orthopedics named after N. N. Priorov and at the same time headed the Clinic of pediatric bone pathology and adolescent orthopedics of this Institute. Mstislav Vasilievich made a huge contribution to the development of traumatology and orthopedics. Under his leadership, 48 doctoral and 50 candidate dissertations were prepared, in which the most pressing problems and numerous specific issues of traumatology, adult and pediatric orthopedics were studied. The results of these studies have become widespread in the practical activities of specialized hospitals in the Soviet Union. M. V. Volkov was the author and co-author of 33 inventions. The Volkov-Oganesyan repositioning-compression and hinge-distraction devices have received the greatest popularity and widespread implementation in practice. For 18 years, Mstislav Vasilievich was the chief traumatologist-orthopedist of the USSR Ministry of Health. He has published over 350 scientific papers, 17 monographs and manuals, many of which have been translated into English, French and German. Academician M. V. Volkov died on December 11, 2001 and was buried at the Vostryakovskoye cemetery in Moscow.

Mental Health, Psychosocial Functioning, and Quality of Life in Adolescents With Hirschsprung Disease

BackgroundStudies of mental health in adolescents with Hirschsprung disease (HD) are scarce. This cross-sectional study investigates mental health, psychosocial functioning and quality of life in HD adolescents. MethodsAdolescents (12–18 years) treated at the Department of pediatric surgery at Oslo University Hospital were invited for participation. Mental health was assessed by interview; Child Assessment Schedule (CAS) and questionnaires; parental Child Behavior Checklist (CBCL) and adolescent Youth Self-Report (YSR). Psychosocial functioning was rated by Child Global Assessment Scale (cGAS). Adolescent Quality of Life was assessed by Pediatric Quality of Life inventory (PedsQL) and chronic family difficulties (CFD) by interview. Medical records were reviewed for somatic history. ResultsThirty-seven adolescents, 28 males, median age 14.3 years, participated. By CAS interview, 8 of 37 (44% of females and 14% of males) fulfilled criteria for psychiatric diagnosis all within emotional and related disorders. Twenty-seven percent had CBCL internalizing scores and 16% had YSR internalizing scores in clinical range indicating emotional problems. By interviewer rated cGAS, 27% were scored in clinical range. By PedsQL 16% reported reduced psychosocial health score. Increased CFD, lower psychosocial functioning and reduced QoL as well as less paternal education were significantly associated with psychiatric diagnosis. Twice as many (4/8) adolescents who either had a stoma or bowel management had a psychiatric diagnosis compared to those who had neither stoma nor bowel management (7/28). ConclusionNearly one in four adolescents with HD fulfilled criteria for psychiatric diagnosis. Mental health problems were associated with reduced psychosocial function and reduced QoL. Level of evidenceIII.

Comparison of robotic-assisted single-incision-plus-one-port laparoscopic pyeloplasty and single-incision laparoscopic pyeloplasty in the treatment of pediatric ureteropelvic junction obstruction

Objective: To compare the efficacy of robotic-assisted single-incision-plus- one-port laparoscopic pyeloplasty (R-SILP+1) with single-incision laparoscopic pyeloplasty (SILP) in pediatric ureteropelvic junction obstruction (UPJO). Methods: The clinical data of 47 children with UPJO who underwent surgery from October 2020 to September 2022 in the Department of Pediatric Surgery of Fujian Provincial Hospital were retrospectively analyzed. According to the surgical method chosen by parents, the children were divided into R-SILP+1 group and SILP group. Baseline data, operative time, intraoperative anastomosis time, volume of blood loss, postoperative hospitalization time, complications, total costs, preoperative and postoperative renal parenchymal thickness (PT), anterior posterior diameter of renal pelvis (APD), and differential renal function (DRF) before and after operation were compared between the two groups, and the clinical efficacy of the two kinds of operation was evaluated. Results: Among the 47 children, 27 were in R-SILP+1 group, including 16 males and 11 females, aged (6.6±3.5) years; 20 were in SILP group, including 12 males and 8 females, aged (6.5±3.5) years. The operations were successful in both groups without conversion to open operation. There were no significant differences between the two groups in baseline data, volume of blood loss, complications, APD and PT at postoperative 6 months, APD, PT and DRF at postoperative 12 months (all P>0.05). Compared with the SILP group, the operative time [(153.0±14.4) vs (189.9±32.6) minutes, P<0.001], intraoperative anastomosis time [(68.8±16.8) vs (97.5±12.0) minutes, P<0.001], postoperative hospitalization time [(6.0±1.3) vs (9.0±1.3) d, P<0.001] were shorter, but the total cost was higher[(57 390±7 664) vs (30 183±4 219) yuan RMB, P<0.001]. Conclusions: Compared with the SILP group, R-SILP+1 can achieve considerable efficacy in treating pediatric UPJO, and has certain advantages in shortening operative time, intraoperative anastomosis time, and postoperative hospitalization time. However, the cost is high.

Efficacy of Bleomycin-Lauromacrogol Foam in Pediatric Macrocystic Lymphatic Malformations With and Without Intracapsular Hemorrhage

BackgroundSclerotherapy is purportedly less effective in patients with hemorrhagic than with non-hemorrhagic lymphatic malformations (LMs). We aimed to compare the efficacy of bleomycin-lauromacrogol foam (BLF) sclerotherapy in the treatment of macrocystic LMs with and without intralesional hemorrhage. MethodsFifty-five children with macrocystic LMs admitted to the Pediatric Surgery Department were retrospectively included. The patients were allocated into a hemorrhage group (23 cases) or a non-hemorrhage group (32 cases) based on the occurrence of an intracapsular hemorrhage. The diagnosis was confirmed by physical examination, color ultrasound, magnetic resonance imaging, and puncture findings. BLF was injected into the capsule after draining the cystic fluid under color ultrasound guidance. Patients whose lesions were unchanged or showed minor change after 1 month were treated again using the same method. Changes in lesion size and the number of treatments were recorded. Effectiveness was classified as excellent (volume reduction ≥90%), good (50%≤volume reduction<90%), or poor (volume reduction <50%). ResultsIn the hemorrhage group, 17, 6, and 0 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 100%. In the non-hemorrhage group, 23, 7, and 2 patients’ outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 93.8%. There was no significant difference in efficacy rate between groups (P = 0.767). ConclusionsBLF is an effective and safe treatment for macrocystic LMs with bleeding. The results were similar in patients with and without bleeding. Level of EvidenceTreatment, Level III.

Evaluation of Tubularized Incised Plate Urethroplasty with Spongioplasty-Dartosoraphy Reinforcement in Pediatric Hypospadias: A Randomized Controlled Study.

The original description of tubularized incised plate urethroplasty (TIPU) was provided by Snodgrass in 1994. The results were significantly improved by several modifications. To decrease the incidence of complications, interposing a vascularized flap after tubularization of the neourethra is recommended. The extent to which the type of interposed tissue has a direct effect on the rate of complications and cosmetic outcomes after TIPU repair is considered the answer to the main hypothesis of this study. This prospective controlled randomized trial was conducted in the Department of Pediatric Surgery, Al-Azhar University, Cairo, Egypt, between May 2019 and May 2023. A total of 220 patients were included in this study. Patients were randomly assigned to either group A or group B. Group A included 110 patients who underwent TIPU with spongioplasty-dartosoraphy reinforcement. The other 110 patients (group B) underwent TIPU with dorsal dartos flap interposition, without spongioplasty. Complications developed in 34 of 220 patients (15.4%). In group A, complications developed in 11 of 110 patients (10.0%). In group B, complications occurred in 23 of 110 patients (20.9%). Although the fistula rate, glanular dehiscence, disruption, and meatal stenosis were not significantly different between the study groups, the skin necrosis rate was significantly lower in group A than in group B. The overall complication rate was significantly lower in group A than in group B. Also, the difference in the mean Hypospadias Objective Scoring Evaluation between the two groups was statistically significant. TIPU with spongioplasty-dartosoraphy reinforcement is an effective modification of conventional TIPU. This modification appears to reduce the rate of complications and yield better cosmetic outcomes.

Correlation between Histological Changes of Liver and Early Surgical Outcome of Kasai Portoenterostomy in Biliary Atresia

Background: Biliary atresia (BA) is a progressive fibrosing obstructive cholangiopathy involving both resulting in the intrahepatic and extrahepatic bile ducts. Hepatic portoenterostomy was first described by Kasai and Suzuki in 1959 to re-establish bile flow in biliary atresia patients. Currently, the accepted management of infants with biliary atresia is to re-establish bile flow by Kasai portoenterostomy followed by liver transplantation when indicated. Purpose: The purpose of this study is to correlate the surgical outcome following Kasai portoenterostomy with liver histology at the time of extended Kasai Portoenterostomy for biliary atresia who are operated in this institution. Methods: This prospective study was done in the department of Pediatric Surgery, BSMMU, with study period from October 2017 to march 2020.Wedge biopsies of liver was taken at the time of Extended Kasai portoenterostomy. Liver biopsies were graded as mild (grade-1), moderate (grade-2) and severe (grade-3) degree of fibrosis by single pathologist. Serial measurement of serum bilirubin were made preoperative and postoperatively to assess the degree of bile drainage in relation to degree of liver fibrosis. Results: A total of thirty infants underwent Extended KPE during study period. The mean age at the time of surgery was 89.7 (±23.4SD) days ranging from 57days to 140 days. 16 infants were operated before 90 days and rest 14 were operated beyond 90 days of life. Out of 30 infants, 3 cases were grade -1 fibrosis, 15 cases were grade- 2 and 12 cases were grade-3 fibrosis. 12(40%) infants cleared jaundice at three months after surgery, of which only 2 patients belonged to grade-3 fibrosis. 9(30%) infants were jaundice free at 6 months, among them 8 infants belonged to lower degree of fibrosis (grade-1 and grade-2). Only 1infant belonged to higher degree of fibrosis (grade-3). Conclusion: Currently, the concept for management of infants with biliary atresia considers successful establishment ..

Comprehensive management of Pindborg tumor in childhood: a case report

Relevance. The calcifying epithelial odontogenic tumor, also known as Pindborg tumor, is a locally aggressive neoplasm characterized by strands and medullary formations of flat and clear cells, often accompanied by spherical calcifications and amyloid-stained hyaline deposits. The Pindborg tumor is rare, representing less than 1% of odontogenic tumors, and typically manifests in individuals aged 20 to 60 years. However, there is a growing incidence of neoplasms of diverse origins in childhood. This article presents a clinical case detailing the comprehensive multi-stage treatment of a pediatric patient with a Pindborg tumor, facilitating complete rehabilitation before reaching adulthood.Clinical case description. This article presents a clinical case detailing the comprehensive management of a patient with a Pindborg tumor. The individual initially sought treatment at the Department of Pediatric Maxillofacial Surgery of A.I. Evdokimov Moscow State Medical and Dental University in 2020, undergoing complete combined treatment until November 2023. Full rehabilitation was successfully achieved by the time of adulthood through a series of four consecutive surgeries, including dental implantation, followed by prosthetics utilizing a non-removable orthopedic structure in the final stage.Conclusion. Initiating comprehensive rehabilitation at an early stage, including dental implantation before reaching adulthood, facilitates complete social adaptation in society and contributes to the patient's harmonious development.

Thyroid diseases in children and adolescents requiring surgical treatment-indications, techniques, results, and complications based on 10 years of the single center's own experience.

Although thyroid abnormalities are observed less frequently in children than in adults, the increased incidence of thyroid cancer makes it mandatory for all pediatric surgeons to be knowledgeable about the disorders of this gland. Thyroid abnormalities can be associated with hyperthyroidism or hypothyroidism and euthyroidism and/or symmetric or asymmetric enlargement of the gland. The present study was undertaken to retrospectively analyze the indications, surgical techniques used, results obtained, and complications found in the surgical treatment of thyroid diseases in children and adolescents in a surgical center for the macro-region of western Poland. The data of 148 patients undergoing total or partial thyroidectomy between 2013 and 2022 were analyzed from the medical records of the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan, Poland. A total of 95 children underwent subtotal thyroidectomy and 64 underwent total thyroidectomy, of which the procedure was widened to include prophylactic removal of neck lymph nodes in 45 patients. There were 113 girls (76%) in the analyzed group, and the average age of the patients at the time of surgical treatment was 15 years. The average time from the diagnosis of thyroid disease to surgery was 4 months, ranging from 2 weeks to 3 years. Of the 64 patients undergoing total thyroid resection, 35 (54.69%) were diagnosed with thyroid cancer. Collaboration within a multidisciplinary team ensures optimal surgical outcomes in children and adolescents with thyroid disease. With extreme caution, thyroid removal is a safe procedure with few complications, but the experience of the surgeon performing thyroid surgery in children remains crucial. Despite the absence of such a diagnosis in the first fine-needle aspiration biopsy, the high percentage of thyroid carcinomas in the analyzed group may be because the initial biopsy was performed in a less experienced center, also in terms of histopathological laboratory. Hence, we point out the necessity of performing a repeat fine-needle aspiration biopsy (according to the Bethesda classification) in a more experienced center before the final decision of thyroidectomy.

Parental satisfaction with paediatric care with and without the support of an eHealth device: a quasi-experimental study in Sweden

BackgroundThe period after a child is discharged from hospital is generally described as challenging for the parents. Their satisfaction with the health services received is an important indicator of the quality of care. eHealth devices are increasingly used in health care to support communication with parents. Differences in levels of parental satisfaction by modality of provided care or by parental background are largely unknown. This study aimed to describe satisfaction with health care between sociodemographic groups of parents, who either received or did not receive an eHealth device for communication between parents and hospital staff as a supplement to routine care after a child’s discharge from neonatal or paediatric surgery departments.MethodsData from a quasi-experimental study was collected in the south of Sweden, between 2019 and 2021. The Pediatric Quality of Life Inventory™ (PedsQL) Healthcare Satisfaction Generic Module was used to assess the parents’ satisfaction with different dimensions of health care. Seventy parents of children hospitalized in a neonatal or a paediatric surgery department were enrolled in intervention (eHealth device, n = 36) and control (no eHealth device, n = 34) groups.ResultsThe parents reported high overall satisfaction with the health care provided and were also highly satisfied within different dimensions of care. Moreover, they reported high satisfaction with using an eHealth device, although having support from the eHealth device was related to neither higher nor lower levels of satisfaction with care. There was a significant difference between fathers and mothers in the multivariate sub-analysis in certain instances regarding satisfaction with communication and the level of inclusion.ConclusionsParents were very satisfied with the health care provided, whether or not they received eHealth. Further research looking at groups with and without the support of an eHealth device is required to further develop future paediatric and neonatal care interventions. Communication and support through eHealth can be a tool to alleviate the distress parents experience after their child’s hospital admission, accommodate the family’s transfer to home, and increase satisfaction with care, but it needs to be evaluated before being implemented.Trial registrationClinical Trials NCT04150120, first registration 4/11/2019.

Can Hisense computer-assisted surgery system (Hisense CAS) improve anatomy teaching in pediatric liver surgery?

This study aimed to investigate the effectiveness of the Hisense computer-assisted surgery system (CAS) in teaching pediatric liver surgical anatomy. The research subjects were residents who underwent standardized training at the Department of Pediatric Surgery at Yijishan Hospital of Wannan Medical College from May 2022 to May 2023. The study recruited a total of 62 students, with 31 students assigned to the Hisense CAS group (12 males and 19 females) and the remaining 31 students serving as controls (Control group, 15 males and 16 females). There were no significant differences in baseline characteristics observed between the two groups. This study found that the average scores of the Hisense CAS teaching group in the liver surgery evaluations were higher than those of the control group. Specifically, the Hisense CAS group had an average score of 84.25 ± 5.70 points in the liver surgery knowledge test, 77.10 ± 8.12 points in the image reading test, and 70.58 ± 8.79 points in the surgical simulation test, while the traditional teaching group had average scores of 73.45 ± 6.12 points, 69.81 ± 6.05 points, and 66.42 ± 6.61 points, respectively; the differences between the two groups were statistically significant (P < 0.05). Furthermore, this study also found that the Hisense CAS teaching model resulted in significantly better teaching satisfaction on the part of the residents in terms of standardized teaching for physicians in pediatric liver surgical anatomy. In conclusion, this study demonstrated greater satisfaction of the residents with the use of 3D reconstruction added to traditional teaching sessions and better performance during the posttraining evaluation.

Diagnosis of Caroli’s Disease: a Rare Case Report

Caroli’s disease is a rare disease caused by Ductal Plate malformation. Patients may present with history of intermittent abdominal pain, pruritus and/ or symptoms of cholangitis. Cholangitis, liver cirrhosis, and cholangiocarcinoma are potential complications. It is rarely diagnosed in childhood. A six (06) years old was presented with intermittent abdominal pain, fever, pruritus, and hepatomegaly at the Department of Paediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. After evaluating history, signs/ symptoms, physical examination, biochemical, ultrasonographic and endoscopic !ndings; this case was provisionally diagnosed as a compensated chronic liver disease with portal hypertension due to cause of cholestasis. Finally magnetic resonance cholangiopancreatography (MRCP) was done for further evaluation and the diagnostic !ndings of MRCP was suggestive of Caroli’s disease. After consultation the MRCP report with Pediatric Surgery Department of BSMMU the patient was advised for liver transplantation due to multifocal involvement of liver. Lastly patient was discharged with supportive management. Bangladesh Med J. 2022 Sept; 51(3): 43-46

The Changing Face of Childhood Intussusception: A Refinement in the Technique of Saline Reduction and Outcome.

Intussusception is a common pediatric surgical emergency and an indicator for primary healthcare. We report our experience with childhood intussusception at a tertiary care hospital in the private sector in Central Kerala and add our refinement to the technique of hydrostatic saline reduction which had more desirable outcome. Children presenting with the diagnosis of intussusception which were managed in our department of pediatric surgery at a private hospital in Kerala, India. Eighty children, up to 15 years of age, (43 boys, 37 girls) confirmed to have intussusception on ultrasound and managed in our institution from October 2016 to July 2020 with hydrostatic saline reduction. Sixty-two (77%) of them were aged 3 months to 3 years (numbers <10 to be written in words); the age of idiopathic intussusception. SPSS V25. Association between variables using Chi square test and independent t test. A total of 80 children met the criteria out of that (n = 79) had successful nonoperative reduction. Hydrostatic saline enema 73, One Barium and five air enema. A child presented in shock was taken up for laparotomy and reduced operatively. Six recurred within 24 h (7% early recurrence) and a second attempt at nonoperative reduction succeeded in all six of them. (numbers <10 in words). Eleven children (14%) had a late recurrence, the attempt at saline hydrostatic reduction was successful in only 3 (27%) and 8 went on to have surgery. Six were successfully reduced operatively and 2 had resection anastomosis. After excluding those who need surgery on clinical grounds, we report a 98.7% success with nonoperative reduction for the first instance of intussusception, a 24 h recurrence of 7%, with successful repeat reductions in all. With the refinement in the technique, we could achieve a desirable outcome. At the first presentation, surgery was indicated in 1 of the 80 children. We report a late recurrence rate of 14%, with a 27% success rate for nonoperative reduction. No pathological lead points were identified even in this group. All the children had an uneventful and a faster recovery. In our series, we had 97.5% follow-up rate.

A prospective study to assess the feasibility of single port laparoscopic needle assisted repair of pediatric inguinal hernias

Background: Congenital inguinal hernias are very common paediatric surgical conditions with incidence of 0.8 – 4.4% in children and up to 30% in preterm babies, which occur due to the failure of closure of the processus vaginalis. While the gold standard treatment remains to be open herniotomy, in the last two decades minimally invasive surgeries have revolutionized the hernia surgery and have evolved from 3 port to single port, intracorporeal knotting to extracorporeal knotting and 5 mm camera port to 3 mm camera port with multiple benefits. Methodology: This is a prospective study conducted at a single tertiary care centre over 1 year. All the patients admitted under the Department of Paediatric Surgery, with a clinical and/or radiological diagnosis of inguinal hernia and planned for single port laparoscopic needle assisted repair were included in the study. Data was collected in terms of intra operative finding, duration of procedure, complications, pain and post operative hospital stay. Results: A total of 40 patients were included in the study with a male predominance. Clinically majority were right inguinal hernia which was reducible. Intraoperatively, 7 cases of bilateral hernia were identified which were not detected pre operatively. 2 patients who underwent this procedure had complications and majority of the patients had mild pain. Conclusion: Single port laparoscopic herniotomy is at par with gold standard open herniotomy in the paediatric population. This procedure has better cosmesis, lesser post operative pain, hospital stay and most importantly it could identify occult hernias.

Mesenteric and Omental Lymphatic Cysts in Children: A 23-Year Retrospective Descriptive Study from Central India

Introduction: Lymphatic cystic malformations occur in the mesentery of the small and large bowel, omentum and retroperitoneal area and are rare, benign, intra-abdominal cystic lesions. Aim: To review the demographics, clinical presentation and surgical outcomes of children’s mesenteric and omental lymphatic cystic lesions. Materials and Methods: A single-institution, retrospective descriptive study was conducted in the Department of Paediatric Surgery, Gandhi Medical College and Associated Hospitals, Bhopal, India, from January 1, 2000, to December 31, 2023. It included cases of lymphatic cystic lesions in infants and children below 12 years of age involving the mesentery of the small and large bowel and omentum. The details collected from the case records were the age, sex, clinical presentation, radiological investigations carried out, operative findings and the outcome of the operative intervention executed for mesenteric and omental lymphatic cysts in children. The results obtained from the present study are expressed in numbers and percentages. Results: The present study analysed 18 children aged ≤12 years who underwent surgery for lymphatic cysts of the mesentery of the small bowel (n=14), large bowel/mesocolon (n=1) and omentum (n=3) during the study period. There were 11 boys and 7 girls. More than four-fifths (n=15) of the children were ≤5 years old at the time of diagnosis and operative therapy provided. One-third (n=7) of the cases clinically presented with the clinical features of intestinal obstruction. The cysts involved the mesentery of the small bowel in three-fourths (n=14) of the cases. The complete excision of the lymphatic cysts was possible in three-fourths (n=14) of the cases. In 10 children, resection of the adjacent/involved small bowel segment was also required during the operative procedures. Fifty percentage of the cases revealed volvulus of the small bowel caused by mesenteric cysts involving the small bowel. More than half of the cases required resection of the adjacent/involved segment of the small bowel along with excision of the mesenteric cysts. Conclusion: Mesenteric cysts are rare abdominal pathology with diverse clinical presentations ranging from vague abdominal pain and lump to an acute abdomen. Early referral to higher centres, diagnosis and prompt surgical excision of the mesenteric cysts can prevent volvulus, one of the most common complications and requirements of an emergency surgical procedure.

Investigation Of The Frequency Of Arousal Syndrome Upon Awakening In Children After General Anesthesia In The Department Of Pediatric Surgery

Investigation Of The Frequency Of Arousal Syndrome Upon Awakening In Children After General Anesthesia In The Department Of Pediatric Surgery

Lečenje bolnog ravnog stopala kod dece korišćenjem minimalno invazivne hirurške procedure nakon neuspelog konzervativnog lečenja

Introduction/Aim: Flexible flatfoot (FFF) is one of the most common skeletal deformities in the pediatric population, especially in preadolescence. This retrospective observational study evaluates results of a calcaneal subtalar extra-articular arthrodesis (subtalar arthroereisis) with one cannulated screw for the treatment of painful flexible flatfoot in children, after previously failed conservative treatment. Material and Methods: Preadolescent and adolescent pediatric patients were observed at the Department of Pediatric Orthopedic Surgery. The study included 28 feet of 15 children (5 girls and 10 boys) during a 6-year period, from 2016 to 2021 (average 36 months). The average age was 11.46 years (range 8-15 years). We performed the same operative technique under fluoroscopy for all patients. Radiographic parameters were taken before, after operative treatment, and after hardware removal. The following radiological parameters were measured: talo-calcanear (TC), talo-navicular (TN), talo-first metatarsal bone (T1MT) and calcanear pitch (CP) angles, in the anteroposterior and/or lateral views. Functional outcomes (extension and eversion of the foot) before surgery and after hardware removal were compared. Results: After operative treatment, the midfoot radiographic parameters were not statistically significantly altered; however, the subtalar joint and forefoot were statistically significantly improved: both radiologically and clinically. The range of extension and eversion of the foot were remarkably reduced without disturbing the morphological and functional aspects of the talocrural and subtalar joints. Conclusion: Extra-articular arthrodesis, using a cannulated screw is a minimally invasive technique, represents an optimal method for the operative treatment of symptomatic flexible flatfoot in children. This technique is simple, efficient and does not disrupt the anatomy of the foot.

An innovative surgical treatment method in persistent rectal prolapse: Ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy.

Herein, the results of the cases, who underwent surgical repair with or without ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy due to recurrent rectal prolapse, were discussed. The demographic characteristics, surgical technique, and results of children who were operated in the department of Pediatric Surgery for rectal prolapse between 2004 and 2022 were retrospectively analyzed. In 18 years, six pediatric cases (2 females [33%] and 4 males [67%]) were operated for persistent rectal prolapse. The mean operative age of the patients was 7.5 years (2.1-17), and all had severe rectal prolapse. Some of these patients were followed up in other centers and their rectal prolapse continued despite diet changes, toilet behavior training, and the treatment of sclerosing agents. Rectal trimming was applied to one of the first two patients who were operated for anal atresia and recurrence did not occur. In the second case who underwent laparoscopic colon pull-through, Ekehorn rectopexy was performed alone and no recurrence was observed also in this case. Considering that rectosigmoid colon adhesions formed on the anterior abdominal wall due to colostomy opening-closing may provide ventral sigmoidopexy, it was decided to offer the option of applying both methods together. Three of the next four cases were diagnosed with cystic fibrosis. All four underwent ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy. Ekehorn's butterfly sutures were removed on 15th day and Foley catheters on 21st day. Three cases with cystic fibrosis were uneventful. However, a 14-year-old girl with a history of sexual abuse relapsed 6 months later. Ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy is a successful and unique method in terms of providing intestinal fixation. It may be the primary option for definitive surgical treatment of persistent rectal prolapse.

Histopatološki nalaz u enteričkim nervnim pleksusima kod dece sa poremećajima intestinalnog motiliteta - iskustvo jednog centra

Introduction/Aim: The aim of the study was to determine the frequency of various histopathological findings in biopsies of children with intestinal hypomotility and the incidence and characteristics of Hirschsprung disease (HD). Methods: Biopsies of colon and rectum taken due to intestinal hypomotility and chronic constipation at the Department of Pediatric Surgery of the University Children's Hospital in Belgrade over the 10-year period (from 2009 to 2018) were reviewed using pathology reports from the archive of the Institute of pathology, Faculty of Medicine, University of Belgrade. Results: A total of 287 patients with intestinal motility disorder were identified, with 554 biopsy samples. Of the total number of patients, 56% (161/287) were without any morphological changes in enteric nervous system (ENS). The most common histopathological findings were HD (69/287; 24%) and immaturity of ganglion cells (29/287; 10%). Isolated hypoganglionosis of ENS was found in 5 (2%) cases. Heterotopia of ganglion cells was the only finding in 8 (3%) cases. Rare causes of intestinal dysmotility were: eosinophilic proctitis/colitis (EPC) (4/287), neuronal intestinal dysplasia B (2/287), unclassified disganglionoses (3/287). Rectosigmoid variant of HD was the most frequent HD variant (80.3%). Acetylcholinesterase method and immunohistochemical staining were used in 19.5% cases. Conclusions: HD and immaturity of ganglion cells were the most common pathological findings in ENS of constipated children. It is important to differentiate EPC from other lesions of enteric plexuses due to different natural history and therapy.