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

Endoscopic treatment of vesicoureteral reflux in pediatric patients

Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR). Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis

Pediatric office procedures.

The practice of pediatric urology has changed much during the last 25 years. Procedures that were once done only on inpatients are now done as ambulatory cases, comprising more than 60 per cent of all surgery. This trend has continued, with even more cases being done as office procedures. These consist of circumcision, meatotomy for stenosis, lysis of labial adhesions, and meatal dilatation after hypospadias repair. If an operation is done with attention to detail, it can be completed with minimal complications, although, as evidenced with circumcision, those that do occur can carry significant morbidity and even cause death. The primary limiting factor for performing procedures in the office is the comfort of the patient. The procedure, by necessity, has to entail minimum pain and great ease in obtaining hemostasis and requires a cooperative patient and family. Therefore, even as the number of operations performed on an out-patient basis increases, there are a finite number of cases suitable for the office