Dog bite injuries of genitalia and rabies immunisation.

n/

Laparoscopic Diagnosis and Excision of a Giant Sigmoid Cystic Duplication

n/

Laparoscopic removal of autoamputated adnexa in infants and neonates

Objective The aim of this study was to describe a new case of autoamputated adnexa in a neonate treated with laparoscopy and to present a review of the  literature as regards laparoscopic management of the autoamputated adnexa in neonates and infants.Summary background data Laparoscopic surgery has become an accepted modality internationally in neonates and infants. We analyzed technical details of laparoscopic procedures adopted in the literature for this rare condition.Materials and methods A literature review was performed to identify additional cases of autoamputated adnexa treated laparoscopically. Cases were limited to the English language and to those affecting girls under 1 year of age.Results In addition to our presented case, 12 cases of autoamputated adnexa in patients less than 1 year of age treated laparoscopically were identified in the literature. Surgical intervention was planned for increasing size of cysts, for no signs of reduction, or for complex cysts, except in one case for suspicion of enteric  duplication. The number of ports for the removal varies from one to three based on different authors. The operative port size ranged from 3 to 5 mm. Camera size was 5mm for all authors when reported but only five authors reported the size of the umbilical port.Conclusion Although laparoscopic removal of autoamputated adnexa can be  successfully accomplished in newborns and infants, 50% of autoamputated adnexa are still treated with laparotomy. Our review revealed the necessity of at least two ports for the identification and removal of the adnexa using the laparoscopic-assisted technique, whereas three trocars in the presence of tenacious adhesions.Keywords: adnexal torsion, autoamputated adnexa, laparoscopy, techniqu

Symptomatic mesodiverticular bands in children

Objective: The aim of this study was to review the English literature about a rare condition such as symptomatic mesodiverticular bands (MDBs) in children.Background: The MDB is an embryologic remnant of the vitelline circulation, which carries the arterial supply to Meckel’s diverticulum. In the event of an error of involution, an arterial band persists and extends from the mesentery to the apex of the antimesenteric diverticulum. This can create a snare-like opening through which bowel loops may herniate and become obstructed. This type of internal hernia is a very rare and often overlooked cause of small bowel obstruction.Materials and methods: A computer-assisted (PubMed) search of the literature to identify all cases of symptomatic MDB reported in English with patients’ age ranging from 0 to 14 years was performed.Results: Eight cases of symptomatic MBD in pediatric age (0–14 years) were found in the literature in the last 50 years. Male : female ratio was 3 : 1. The age of onset ranged from 10 days to 12 years. All cases reported an intestinal occlusion as clinical picture. Internal hernia was the cause of the obstruction in six cases, whereas in two patients the occlusion was due to a direct compression. All patients were approached with emergent laparotomy except one case of laparoscopic approach.Conclusion: MDB causing internal hernia is a very rare event but it should be kept in mind concerning patients with the presentation of small bowel obstruction when early surgery is important to prevent strangulation, gangrene of the bowel, and to avoid dramatic events.Keywords: internal hernia, laparoscopy, Meckel’s diverticulum, mesodiverticular band, small bowel obstructio

Single-port laparoscopic-assisted pyloromyotomy: a 6-year experience

Objective The aim of this paper is to present the results of a 6-year experience with a laparoscopic-assisted approach to infantile hypertrophic pyloric stenosis (IHPS): the singleport, laparoscopic-assisted pyloromyotomy (SPLAP). Summary  background data Ramstedt pyloromyotomy is the procedure of choice for IHPS; however, the best way to approach the pylorus is still debated. The recent literature reports many comparisons between various open and laparoscopic approaches. Here, we report our long-term result with a laparoscopic-assisted technique for IHPS.Materials and methods Thirty-eight infants underwent SPLAP. The approach to the abdominal cavity is performed through a right circumbilical incision and then a 10mm trocar is inserted. After the pneumoperitoneum is established, an operative telescope is introduced. Once the telescope is inserted, the pylorus is easily located and then grasped and exteriorized by the umbilical incision. At this point, conventional Ramstedt pyloromyotomy is performed. Once the pylorus is  reintroduced into the abdomen, a new pneumoperitoneum is created to control mucosal integrity and hemostasis.Results In all 38 cases, adequate pyloromyotomy was performed in a good operative time, without any major intraoperative or postoperative complications, achieving excellent cosmetic results.Conclusion The feasibility of SPLAP found over these 6 years suggests that this procedure is an excellent alternative to open or laparoscopic pyloromyotomy.Keywords: infantile hypertrophic pyloric stenosis, laparoscopic-assisted, pyloromyotom

Associated patent urachus and patent omphalo– mesenteric duct in children: review of the literature

The objective of this article is to review the literature on a very rare association such as patent urachus and a patent omphalo–mesenteric duct in children. Partial or total failure of the obliteration of urachus gives rise to various anomalies, which can be diagnosed both in childhood and in adulthood. The omphalo–mesenteric duct remnants are the most common anomalies of the gastro-intestinal tract, often asymptomatic. The association of patent urachus and a patent omphalo–mesenteric duct in children is very rare. A computer-assisted (PubMed and Google Scholar) search of the pediatric literature to identify all cases of patent urachus and a patent omphalo–mesenteric duct association was performed. We found only eleven cases of the association of patent urachus and a patent omphalo– mesenteric duct in the pediatric literature. All cases except one were males. When reported, all children affected were full term. The clinical sign reported was umbilical spillage. In all cases was reported a lack of healing of the umbilical stump with different clinical pictures, except two cases. Treatments reported were application of silver nitrate, antibiotic cream, povidone iodine, and application of salves and plasters. Various diagnostic examinations were performed. In none of these patients was the possible association with PU and POMD suspected, but it was evidenced only during the surgical excision. The surgical approach was laparotomy in all cases. The association of patent urachus and a patent omphalo–mesenteric duct in children is very rare approached in all cases by laparotomy. This review underlines the importance of evaluating any persisting umbilical lesions without delay when conventional pharmacological therapy fails.Keywords: omphalo–mesenteric duct, patent omphalo–mesenteric duct, patent urachus, remnants, urachu

The role of laparoscopy in the management of urachal anomalies in children

Objectives Management for urachal anomalies (UAs) is controversial. Although traditional treatment of UAs has been surgical excision, recent literature report also a conservative approach. We reviewed our  experience to define the role of laparoscopy in the management of UAs in children.Patients and methods From July 2005 to July 2015, 23 children  underwent 24 interventions for the treatment of UAs. In four patients, the technique was a laparoscopicassisted removal of the anomaly, in two  patients a laparoscopic-assisted drainage of an urachal abscess, and a pure laparoscopic technique was started in 17 patients.Results Laparoscopic-assisted removal of the UAs was achieved in five cases. In two cases a laparoscopic-assisted drainage of an urachal abscess was performed. The remaining patients were treated by pure laparoscopic technique. Operative or postoperative complications did not occur. Follow-up ranged from 6 months to 10 years and 6 months.Conclusion The pure laparoscopic approach to UAs appears safe and effective in most urachal remnants. Laparoscopic-assisted excision is an alternative approach that is easier to perform in infants. The decision to remove the UAs must be taken after an accurate informed consent of the parents, especially in cases of asymptomatic anomalies

Is the double cross flap technique the panacea for avoiding fistula formation in hypospadias surgery?

Objective The aim of this study was to analyze retrospectively the 9-year experience of a single institution in the use of the double cross flap technique to interpose a double dartos flap to protect the neourethra with the aim of preventing fistula formation.Patients and methods Between October 2005 and September 2014 a total of 127 children with distal and midshaft primary hypospadias underwent tubularized incised plate urethroplasty by means of a double dartos flap obtained with a double cross flap to protect the neourethra. A Foley catheter was left in situ for 7 days. Success was defined as no incidence of complications requiring reintervention, along with good cosmetic result. A questionnaire was administered to estimate parental satisfaction. Parents were asked to evaluate the cosmetic appearance of the penis as good, acceptable, bad, or indifferent.Results The patient age at the time of surgery ranged from 12 months to 10 years (median 39 months). Three patients exhibited fistula at follow-up (2.3%). In two patients a glandular dehiscence of the urethroplasty occurred (1.5%). Mild stenosis of the neomeatus occurred in three patients (2.3%). No penile iatrogenic rotation occurred. A ‘good’ cosmetic result was reported by 68.5% of parents, acceptable by 22.8%, bad by 3.9% and indifferent by 4.7% of parents as per the parental questionnaire.Conclusion The double cross flap technique is not the panacea to prevent fistula formation in hypospadias surgery. Nevertheless, it offers an unquestionable advantage in terms of avoidance of fistula formation. The experience and skills of the surgeon performing urethroplasty remain the mainstay for best results

Feasibility of a tubularised incised-plate urethroplasty with double de-epithelised dartos flaps in a failed hypospadias repair: A preliminary report

Background: Reoperation for failed hypospadias has been considered to be seriously problematic. The dense fibrotic tissue causes difficulties in wound healing and increases the rate of complications. The tubularised incised-plate urethroplasty (TIPU) method has become a preferred method for all varieties of hypospadias in the past decade. However, fistulas are still one of the most common complications of this technique. The aim of this paper was to present the preliminary results of TIPU procedure with double de-epithelised dartos flaps in failed hypospadias repair. Materials and Methods: All patients were treated between January 2009 and August 2010 by the same procedure, utilising TIPU with double de-epithelised dartos flaps. Vascularised ventral dartos flaps harvested from each side of the penis with their vascular supply were transposed to cover the suture line by wrapping them from either side of the penis. Results: There were 21 boys with failed hypospadias: 20 had previously undergone TIPU, and one Koyanagi repair. Patients presented with very large fi stulas in four and dehiscence in 17. Repair of the failed hypospadias using TIPU with double de-epithelised dartos flaps was quite successful, with no fistula recurrence or dehiscence observed. Conclusion: The preliminary results showed that TIPU with double de-epithelised dartos flaps is a useful method of successfully repairing failed hypospadias

Secondary involvement of Meckel’s diverticulum by group A β-hemolytic streptococcus in a child with upper airways infection treated by laparoscopic-assisted resection

We report a case of a 5-year-old boy with acute abdomen following an upper airways infection who developed Meckel’s diverticulum perforation secondary to group A β-hemolytic streptococcus and its successful treatment by a laparoscopic-assisted intervention. To the best of our knowledge, such an event has never been reported previously.Keywords: group A β-hemolytic streptococcus, intestinal perforation, Meckel’s diverticulu