Laparoscopic Approach in the Treatment of Inguinal Hernia and Associated Pathologies in Children

The data from our follow-up confirm that the results of the laparoscopic IRIS technique, presents an acceptable low percentage of recurrences that is comparable to those of the open technique, with the advantage of reduced post operative pain, rapid return to everyday activities, and optimal cosmetic results. Although the results of our experience seems promising we think that the follow-up is too short and the number of the patients too small for drawing definitive conclusion

Controversies in the Laparoscopic Treatment of Varicocele in the Pediatric Population

At present, treatment of varicocele is still controversial in adolescents for at least three reasons. Firstly, the long-term outcome of treatment is not known in the absence of spermiogram support and in terms of long-term follow-up. Secondly, it is still uncertain which is the best type of operation for children/adolescents. Thirdly, the principle that if a technique is designed for adults, it can also be safely performed in adolescents cannot be applied. A recent systematic literature review and meta-analysis demonstrated that open and laparoscopic techniques appear to yield better results with a microsurgical approach compared with laparoscopy. However, laparoscopic techniques that preserve the lymphatic vessels appear to have a clear advantage by preventing postoperative hydrocele. At present, the evaluation and choice of treatment for adolescent varicocele patients are based not on objective fertility criteria (paternity) but on indirect evidence that testicular function or spermatogenesis and thus ultimately also fertility may be compromised. In the absence of sufficient data regarding the treatment of varicocele at a pediatric age, the choice of the technique appears to depend largely on the experience and preferences of the surgeon rather than on a shared option

Testis-Sparing Surgery in Children. Ten-Year Experience

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The history of the pediatric inguinal hernia repair

The history of inguinal hernia repair is a rich one. For centuries, hernia healers, doctors, anatomists, surgeons and quacks have been devoted to this pathology that has afflicted mankind throughout its evolution. The development of surgical correction mainly focused on adult pathology, with treatments that often involved the loss of the testis. Hernia management in children, however, also dates from antiquity. Described as a swelling on the surface of the belly in ancient papyri, it was treated with tight bandages by the early physicians of Alexandria. For centuries, conservative treatment had been used for the child using primordial trussess, many prayers, and often pagan rituals as the arboreal passage of children described by Marcello of Bordeaux, doctor of the Emperor Theodosius I (347-395 AD), reserving medical intervention only for cases of strangulation in which only reduction was attempted. The middle ages were characterized by an increase in cultural and scientific exchange, during which the first comprehensive surgical textbooks and atlases were written. Different approaches to the inguinal hernia were not taught and passed down through generations of surgeons. The modern era brought a better understanding of the inguinal anatomy, which led to surgical techniques associated with less post-operative complications. Today, the pediatric inguinal hernia repair is one of the most common pediatric operations performed. It is considered a safe procedure with very low complication rate

Mesenteric cyst in 11-year old girl: A technical note. Case report

AbstractWe report on a case of a mesenteric cyst occurred in an 11-year-old girl referred to our institution after a period of 2 months of recurrent abdominal pain. The girl underwent laparoscopic surgery after abdominal Ultrasound Scan (US) and Magnetic Resonance Imaging (MRI) demonstrated a voluminous cyst of about 18 cm × 10.7 cm × 5.8 cm, occupying principally left abdomen. The cyst's root extended into retroperitoneum (Losanoff type 3) so the majority was excised and the remaining was marsupialized with good results. Laparoscopic excision of the mesenteric cyst has been facilitated by rolling the isolated cyst progressively around a grasper obtaining a constant control of the structure: the “spaghetti maneuver”. As confirmed by our experience, a mesenteric cyst can be easily and safely managed by laparoscopy, and the “spaghetti maneuver” is a feasible and effective surgical tool to facilitate the excision

Laparoscopic approach to Meckel's diverticulum

Aim.To retrospective review the laparoscopic management of Meckel Diverticulum (MD) in two Italian Pediatric Surgery Centers. METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted (TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years (range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was established based on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients' demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed. RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min (range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d (range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years (range 10 mo-10 years). CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel's diverticulectomy is safe and effective in the treatment of MD, with excellent results. KEYWORDS: Gastrointestinal bleeding; Ileal duplication; Jejunal hemangioma; Laparoscopy; Meckel’s diverticulum; Minimal invasive surgery; One trocar surger

Transanal irrigation (TAI) in the paediatric population: Literature review and consensus of an Italian multicentre working group

Constipation and fecal incontinence in pediatric patients are conditions due to either functional or organic bowel dysfunction and may represent a challenging situation both for parents, pediatricians, and pediatric surgeons. Different treatments have been proposed throughout the past decades with partial and alternant results and, among all proposed techniques, in the adult population the Transanal Irrigation (TAI) has become popular. However, little is known about its efficacy in children. Therefore, a group of Italian pediatric surgeons from different centers, all experts in bowel management, performed a literature review and discussed the best-practice for the use of TAI in the pediatric population. This article suggests some tips, such as the careful patients’ selection, a structured training with expert in pediatric colorectal diseases, and a continuous follow-up, that are considered crucial for the full success of treatment

A new frog of the Eleutherodactylus abbotti species group (Anura: Eleutherodactylidae) from Hispaniola, with bioacoustic and taxonomic comments on other species

A new species of frog, Eleutherodactylus geitonos sp. nov., is described from the southeastern slope of the Cordillera Central, Dominican Republic. The new frog is closely related to E. haitianus and both species share a small size. They differ in some morphological proportions and other external features, coloration, advertisement calls and DNA sequences of the 16S rRNA gene. Morphological and bioacoustic comparisons with other species in the  E. abbotti species group are also provided. Our preliminary genetic data suggest that the taxonomic status of E. neodreptus (a synonym of E. audanti) and E. melatrigonum need to be re-evaluated