Laparoscopy in non-palpable testis: Single surgeon experience

Amaç: Bu çalışmanın amacı, fizik muayenede testisin palpe edilemediği ve ultrasonografi ile de testisin net olarak belirlenemediği ele gelmeyen testis (EGT) olgularında Laparoskopinin etkinliğinin değerlendirilmesidir. Hastalar tek cerrah tarafından değerlendirilip ameliyat edilmiştir. Yöntem: Bu çalışma, 2010-2019 yılları arasında aynı cerrah tarafından opere edilen 28 hastanın 31 EGT olguları geriye dönük olarak değerlendirildi. Bulgular: Laparoskopik ektopik testis araştırılması yapılan toplam 31 testisin 10 tanesi sağ (%32), 21 tanesi ise sol (%68) tarafta saptanmıştır. Ortalama yaş 29 ay (8-132 ay), takip süresi de 6 ay ile 9 yıl arasında değişmektedir. Laparoskopi bulgusuna göre hastalar Vanishing testisi olanlar (n=23), aşağı karın içi yerleşimli (iç halkaya 2 cm’den yakında olanlar) (n=5), yüksek karın içi yerleşimli (iç halkaya 2 cm’den uzakta) olanlar (n=3) olarak 3 gruba ayrılmıştır. Aşağı karın içi yerleşimli 5 testise inguinal orkidopeksi yapılmıştır. Yüksek karın içi yerleşimli 2 hastaya Fowler Stephens 1 ve kros testiküler ektopi olan diğerine de Laparoskopik orkidopeksi ameliyatı yapılmıştır. Vanishing testisi olan hastaların patoloji sonuçlarının incelenmesinde 1 biopside atrofik testis tubul yapısı görülmüş, 3 biopside epididimal dokuya, 3 biopside duktus yapısına ve 2 biopside de hem duktus hem de epididimal dokuya rastlanılmıştır. Bunun dışındaki 14 biopside testis, epididim ya da duktus dokusuna rastlanılmamıştır. Sonuç: Laparoskopik ektopik testis araştırılması, EGT’i olan çocuklarda laparotomi yapılan hasta sayısını azaltmaktadır, özellikle kros testiküler ektopi gibi bir tanının kolaylıkla konulmasını ve tedavisini sağlamaktadır. Laparoskopik ektopik testis araştırılması hem tanısal bir yöntem ve hem de terapötik olarak orkidopeksi yapılabilecek bir yöntemdir.Objective: The aim of this study is to evaluate the effectiveness of laparoscopy in paediatric patients with nonpalpable testes (NPT). Those testicular cases not found in physical examination and in cases where the testicle cannot be clearly detected by ultrasonography. The patients were evaluated and operated by a single surgeon. Method: Between 2010 and 2019, 28 patients with NPT, mean age 29 months, (range 8 to 132 months) were treated. 31 testes were evaluated. Results: According to the laparoscopic findings 3 groups of testes were identified: Vanishing testis (n=23), low abdominal testis (2 cm to the internal ring) (n=3). Inguinal orchidopexy was performed in 5 testicles of the lower intrabadominal. Fowler stephens (FS) 1 surgery was performed in 2 patients with high intraabdominal location. Laparoscopic orchidopexy surgery was performed on the other who had cross testicular ectopia. In the examination of the pathology results of the vanishing testis patients, atrophic testicular tubule structure was seen in 1 biopsy, epididymal tissue in 3 biopsies, ductus structure in 3 biopsies, and both ductus and epididymal tissue in 2 biopsies. Testis, epididymis or ductus tissue were not detected in 14 other biopsies. Conclusion: Laparoscopy reduces the number of laparotomy in children with NPT. Especially, it enables easy diagnosis and treatment of a diagnosis such as cross testicular ectopia. Investigation of laparoscopic ectopic testicle is both a diagnostic method and a therapeutically orchidopexy method

Çocuklarda nadir boyun ve koltuk altı lipoblastomlarının yönetimi

Objective: Lipoblastomas are benign tumors developing from embryonic fat tissue with few cases reported in the head and neck region. Herein, we aim to present the management of a rare type of lipoblastoma in childhood. Material and Methods: A retrospective chart review was performed on all patients who were admitted due to a mass in the neck and axillary region between January 2015 and December 2019. Data were collected on demographics, comorbidities, preoperative characteristics, operative interventions, and postoperative complications and outcomes. The patients with lipoblastoma were further analyzed. Results: There were 52 patients operated on due to a mass in the neck or axillary region during the study time. The mean age was 5.42±4.16. The majority of the patients (40/52) were diagnosed with enlarged lymph nodes of which 32 (80%) were diagnosed with lymphoma. Among these populations, only two (3.8%) of them were diagnosed with lipoblastoma. Both cases were asymptomatic other than a painless mass. The histopathological examination confirmed the diagnosis of lipoblastoma after surgical excision. Both cases have been uneventful for four years postoperatively. Conclusion: In conclusion, lipoblastomas emerge as a slowly growing mass in early childhood and are mostly seen on the trunk and extremities. Although benign, they have the potential to increase in size and invade adjacent tissues. The gold standard treatment is complete surgical excision. Due to the possibility of recurrence, regular follow-up is strongly recommended after surgery.Amaç: Lipoblastom, embriyonik yağ hücrelerinden köken alan iyi huylu bir tümördür. Baş-boyun bölgesinde bildirilen vaka sayıları sınırlıdır. Bu çalışmada, nadir yerleşimli lipoblastoma yaklaşımı literatür ışığında sunmayı amaçladık. Gereç ve Yöntemler: Kliniğimize Ocak 2015 ve Aralık 2019 yılları arasında boyun ve koltuk altı bölgesinde şişlik ile başvuran hastaların dosyaları geriye dönük olarak incelendi. Olguların demografik özellikleri, eşlik eden hastalıkları, ameliyat bulguları, komplikasyonları ve son durumları belirlendi. Bu olgular arasında lipoblastom tanısı alanlar detaylı olarak analiz edildi. Bulgular: Belirtilen dönemde boyun ve koltuk altı bölgesinde şüpheli lezyon ile yaş ortalaması 5,42±4,16 yıl olan 52 hasta başvurdu. Hastaların büyük çoğunluğunda (40/52) büyümüş lenf nodu mevcuttu ve bu hastaların 32 (%80)’si lenfoma tanısı aldı. Bu hastalardan sadece 2 tanesi (%3,8) lipoblastom tanısı aldı. Her 2 olguda da başvuru anında ana şikâyet ağrısız büyüyen şişlik idi. Cerrahi eksizyon sonrası yapılan histopatolojik inceleme ile lipoblastom tanısı doğrulandı. Erken dönemde komplikasyon gözlenmeyen her 2 olgu da postoperatif 4. yılda sorunsuz takip edilmektedir. Sonuç: Lipoblastom, çocukluk çağında ağrısız büyüyen, çoğunlukla gövde ve ekstremiteleri tutan bir lezyondur. İyi huylu olmasına rağmen büyüme ve çevre dokulara invaze olma eğilimindedir. Cerrahi olarak çıkarılması tedavide altın standarttır. Nüks etme ihtimali nedeni ile uzun süreli takip önerilmektedir

The controversy of surgical intervention for anal canal duplication in children

Objective: Since the first definition of anal canal little has been discovered about the etiology of this rare condition. We present four asymptomatic cases of anal canal duplication with diverse clinical and surgical findings. Methods: A retrospective chart review was performed on four infants presenting with asymptomatic anal canal duplication, born between 2014 and 2016. Clinical characteristics and pathologic findings of patients either by radiological imaging or pathology were evaluated. The primary outcome measure was the complications. Results: All patients were followed-up with physical examination and ultrasound for a mean of 3.5±1.0 years, lastly seen at the beginning of 2018. The female to male ratio was 3:1. Duplicate anal canal length varied between 12-20mm, and two of the four patients had a presacral cystic mass confirmed as a tail gut cyst following surgery. At follow-up, none of the patients had developed symptoms related to anal canal duplication, regardless of whether they had surgical intervention. Conclusion: Though surgical management is the preferred treatment for anal canal duplication, it seems that patients who do not undergo surgery might remain free of symptoms, suggesting that surgical intervention may be unnecessary

Long-term outcomes in pediatric appendiceal carcinoids: Turkey experience

The tendency of non-operative management of appendicitis let us explore the natural history of appendiceal carcinoids, compare them with appendicitis patients, and determine the possibility of deciding the extent of the surgery and post-operative follow-up on behalf of the intraoperative findings. A retrospective review was performed of patients with appendicitis between 2009 and 2017. Of 2781 patients, 10 (0.36%) were diagnosed with appendiceal carcinoids. Sixty percent were female with an average age of 13.101.73. The mean tumor size was 0.97 +/- 0.34cm with 70% located at the tip. Majority had an insular pattern (n=9), six had subserosal fat tissue invasion, one had extension to mesoappendix, one had vascular invasion, and two had lymphatic invasion. The average mitotic index was 3.20 +/- 1.40/50HPF, and Ki 67 activity was 3 +/- 1.7%. The mean follow-up period was 66.40 +/- 25.92months. Patients were further evaluated with ultrasonography (n=10), CT (n=3), and MRI (n=10). Serum markers including chromogranin (n=9), NSE (n=6), and 5-HIAA (n=6) were normal. None required further treatment and had any symptoms of carcinoid syndromes or recurrences post-operatively.p id=Par2 Conclusion: Other than appendectomy, no additional surgery or follow-up is required in appendiceal carcinoids less than 1.5cm in size, regardless of the lymphoid or vascular invasion

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effectiveness of Frenotomy in Ankyloglossia Treatment Between 0-1 Years Old

Objective: The aim of this study is to present the frenotomy technique in cases of ankyloglossia (tongue-tie), which is diagnosed and treated in the first year of life. Patients were operated by a single surgeon. Method: Cases of ankyloglossia operated at Biruni University Faculty of Medicine Hospital Pediatric Surgery Clinic Between 2016-2020 were evaluated retrospectively in terms of clinical complaints, age, type of ankyloglossia, surgical technique, indications and results of surgery. Results: Frenotomy was performed in 56 patients including 47 boys (84%) and 9 girls (16%), between the ages of 0-1. Average age of the patients was 93 days (1-360). Patients were divided into two groups as Group 1 (n: 40: 0-90 days old) and Group 2 (n: 16: 90-360 days old). Patients were admitted with complaints of having difficulty in sucking the mother’s breast, not being able to take their tongue out, feeding with a bottle, pain at the nipple and not being able to grasp the breast. No additional intervention was required for bleeding in Group 1, and in 12 (75%) patients in Group 2 bleeding control was achieved using bipolar cautery. During follow-up, significant improvement was obtained in all patients who had difficulty in sucking and gripping the nipple. Improvement was observed in 15 of 25 patients with nipple pain. Conclusion: Frenotomy is an easily applied surgical procedure with minimal complications. Additional application may be required for bleeding control in infants older than 3 months. It should be considered that the probability of recurrence may depend on the type, intervention used and thickness of the frenulum, and phrenotomy may not be sufficient. The improvement in breast feeding function of Frenotomy may provide a significant improvement in the complaints of nipple pain, and may contribute to the emotional attachment between the mother and her baby. Randomized controlled trials are required to determine the effects of phrenotomy.</jats:p

The Controversy of Surgical Intervention for Anal Canal Duplication in Children

Objective: Since the first definition of anal canal little has been discovered about the etiology of this rare condition. We present four asymptomatic cases of anal canal duplication with diverse clinical and surgical findings.&#x0D; Methods: A retrospective chart review was performed on four infants presenting with asymptomatic anal canal duplication, born between 2014 and 2016. Clinical characteristics and pathologic findings of patients either by radiological imaging or pathology were evaluated. The primary outcome measure was the complications.&#x0D; Results: All patients were followed-up with physical examination and ultrasound for a mean of 3.5±1.0 years, lastly seen at the beginning of 2018. The female to male ratio was 3:1. Duplicate anal canal length varied between 12-20mm, and two of the four patients had a presacral cystic mass confirmed as a tail gut cyst following surgery. At follow-up, none of the patients had developed symptoms related to anal canal duplication, regardless of whether they had surgical intervention.&#x0D; Conclusion: Though surgical management is the preferred treatment for anal canal duplication, it seems that patients who do not undergo surgery might remain free of symptoms, suggesting that surgical intervention may be unnecessary.&#x0D; doi: https://doi.org/10.12669/pjms.36.6.1832&#x0D; How to cite this:Akova F, Altinay S, Aydin E. The Controversy of Surgical Intervention for Anal Canal Duplication in Children. Pak J Med Sci. 2020;36(6):1330-1333. doi: https://doi.org/10.12669/pjms.36.6.1832&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</jats:p