Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children

Background. The aim of our study is to compare the efficacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens. Methods. From June 2006 to September 2012, 50 patients underwent LS. The patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1–18). The patients are divided into two groups according to spleen’s longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay. Results. The mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the difference was not significant between groups (P>0.05). Conclusion. LS is safe and effective in enlarged spleens as well as normal sized spleens

Wilms Tumor and Its Management in a Surgical Aspect

Nephroblastoma [Wilms tumor (WT)] is a rare, but the most common, primary renal tumor in children. WT is usually diagnosed between the ages of 1 and 5, with the most common diagnosis at the age of 3. While imaging (ultrasound, computed tomography, and magnetic resonance) can accurately predict up to 95% of WTs, they cannot predict the histologic subtypes and require tissue examination. Surgery is one of the cornerstones of WT treatment. Other aspects of management include chemotherapy and radiation therapy. The Societe Internationale D'oncologie Pediatrique (SIOP) advocates primary chemotherapy in patients less than 6 months of age, whereas the Children's Oncology Group (COG) recommends primary surgery in all cases except those considered not resectable by the surgeon. In this chapter, the surgical therapy of WT is reviewed

Neonatal perforated appendicitis in incarcerated inguinal hernia in the differential diagnosis of testis torsion

Appendicitis in newborns is uncommon and difficult to diagnose. Reports on neonatal appendicitis subsequent to inguinal hernia incarceration are exceptionally rare. We present the case of a 26-day-old infant with perforated appendicitis due to incarceration of a right inguinal hernia, mimicking right testicular torsion

Effects of tissue plasminogen activator in experimentally induced peritonitis

BACKGROUND: We aimed to evaluate the microbiological and immunological effects of tissue plasminogen activator (tPA) in a rat model of peritonitis

Long-termoutcomes of six patients after partial internal biliary diversion for progressive familial intrahepatic cholestasis

Background: Partial internal biliary diversion (PIBD) is an alternative approach for the treatment of devastating pruritus in patients with progressive familial intrahepatic cholestasis (PFIC). In these patients quality of life can be improved and progression of liver disease can be delayed while waiting for liver transplantation. The aim of our study was to evaluate six patients with PFIC who have undergone PIBD in long-term follow-up

Our approach to esophageal perforation secondary to dilatation of caustic esophageal stricture in children

Background: This study aims to review our 20-year experience in children with esophageal perforation and develop an algorithm

Endoscopic pilonidal sinus treatment (EPSIT) versus sinus laser therapy (SiLaT) for sacrococcygeal pilonidal sinus

Introduction: New surgical treatment methods are being investigated in sacrococcygeal pilonidal sinus disease. Minimal invasive methods such as endoscopic pilonidal sinus treatment (EPSIT) and sinus laser therapy (SiLaT) have promising results and advantages of laparoscopic surgery. Aim: To compare the efficiency and safety of EPSIT with SiLaT. Material and methods: Seventy-three patients with pilonidal sinus who had undergone EPSIT or SiLaT within 2 years were evaluated retrospectively. Data of patients’ demographics, complications and postoperative course were collected and compared between the two groups. Results: We analyzed seventy-three patients who underwent EPSIT or SiLaT, with a mean age of 23.4 ±8.4 (12–46) years and body mass index (BMI) of 25.5 ±4.5 (18–38) kg/m2. Among them, 36 patients (26 males, ten females) underwent EPSIT and 37 patients (27 males, ten females) underwent SiLaT. Mean operative time was similar for both groups (32.3 ±14.8 vs. 31.0 ±14.8; p = 0.757). Early complications (minimal bleeding) were recorded in 2 patients in the SiLaT group. The duration of analgesic use was significantly lower in the EPSIT group compared to the SiLaT group (1.3 ±0.5 (1–3) vs. 1.9 ±1.1 (1–5); p = 0.005). The mean postoperative time of total wound healing was similar for both groups: 23.6 ±14.7 (12–90) vs. 25.2 ±14.5 (14–90) days (p = 0.385). There was no significant difference in the average time of return to total daily activity (3.4 ±0.9 (2–5) vs. 3.6 ±1.2 (2–7) days, p = 0.679). There were no significant differences between the groups regarding late postoperative complications (recurrence: 7). Conclusions: Both methods have similar early and late complications. The duration of need for analgesic usage was shorter in EPSIT patients

Mediastinal Masses In Children: Experience With 120 Cases

Primary mediastinal malignancies are rare tumors and can originate from any mediastinal organ or tissue such as thymic, neurogenic, lymphatic, germinal, ormesenchymal. The authors reviewed all cases of primary pediatric mediastinal masses diagnosed over a 25-year period to determine the pattern of presentation, the histology, and the outcome of the surgical treatment. In this study, 120 primary pediatric mediastinal mass cases diagnosed between 1985 and 2011 are retrospectively evaluated according to their age, sex, symptoms, anatomical location, surgical treatment, and histopathological evaluation. The median age of the patients was 5.8 years. There were 34 benign and 86 malign tumors. Thirty patients were asymptomatic. Common symptoms in the patients were cough, dyspnea, fatigue, fever, abdomen pain, back pain, and neurological symptoms. According to their origins, they were presented as neurogenic tumors (38.3%), lymphomas (18.3%), undifferentiated sarcomas (15%), germ cell tumors (7.5%), and the other tumors (22%) thymic pathologies, lymphangiomas, rhabdomyosarcomas, lipomas, hemangiomas, and Wilms' tumor. Complete resection of the tumor was performed in 86 patients, partial resection of the tumor was the intervention in 11 patients. In 23 patients, biopsy was undertaken. Because of the high incidence of asymptomatic or nonspecific presentation such as the upper airway disease, the presentation of a mediastinal mass in children may be challenging. Neurogenic tumors or lymphomas are indicating surgery, if possible complete resection, for both benign and malignant conditions. Although surgery is the mainstay of therapy for most mediastinal tumors, an experienced multidisciplinary approach is necessary