Laparoscopic Splenectomy in Children

BACKGROUND: Laparoscopic splenectomy is being performed more commonly in children, although its advantages are not clear. We sought to determine whether laparoscopic splenectomy was superior to open splenectomy. METHODS: The records of all pediatric patients undergoing splenectomy without significant comorbidities over a 12-year period were examined. The patients were divided into those undergoing laparoscopic splenectomy and those undergoing open splenectomy. Demographics, operative time, estimated blood loss, spleen size, length of stay, and total charges were compared between the groups. RESULTS: Eighty-one (58%) children underwent laparoscopic splenectomy, and 59 (42%) children underwent open splenectomy. The groups were similar in age and sex; hereditary spherocytosis was more common in the LS group. Operating time was longer in the laparoscopic splenectomy group (231 +/- 10 min vs 138 +/- 9 min; P\u3c0.001), but blood loss and complication rates were similar. Twelve (15%) conversions were necessary primarily due to spleen size. Although children undergoing LS had a shorter length of stay (2.4 +/- 0.1 vs 4.1 +/- 0.3 days; P\u3c0.001), they incurred higher charges (dollars 21199 +/- 664 vs dollars 15723 +/- 1737; P\u3c0.002). CONCLUSION: Laparoscopic splenectomy is a safe procedure in children, resulting in shorter hospital stay, which may translate into earlier return to activity and a smaller burden on the child\u27s caretakers

General complications after surgery for anorectal malformations

WOS: 000516302200001PubMed: 32086570The introduction of posterior sagittal anorectoplasty (PSARP) by deVries and Pena in the early 80s has impacted to the treatment of patients with anorectal malformations (ARM). It gained great recognition worldwide in a very short time, and since then, surgeons dealing with the treatment of this complex malformation could achieve tremendous progress in contemporary management of this anomaly. Despite the growing experience and body of information globally, the treatment of ARMs continues to be a challenge to the pediatric surgeons due to the nature and the variability of the anomaly, and short- and long-term problems continue to exist even after nearly 40 years of the PSARP era. Today, knowing more about it, pediatric surgeons are committed to do more for their ARM patients to have them as physically and socially healthy individuals

Single center experience in single-incision laparoscopic surgery in children in Turkey

WOS: 000289466100024PubMed ID: 21496541Purpose: Minimally invasive surgery has evolved into single-incision laparoscopic surgery (SILS) in the recent years. Few reports have addressed the practicality of SILS in children. Our current experience with regard to feasibility and effectiveness of SILS in children is presented. Methods: A retrospective review of the operative database for patients operated on using SILS in our department from March 2009 to July 2010 was performed. Data regarding the type of the procedure, age, sex, operative performance, hospital stay, and complications were collected. Main Results: Among 43 patients, cholecystectomy was performed in 11; appendectomy, in 10; unroofing for ovarian cysts, in 5; unroofing for splenic cysts, in 4; oophorectomy, in 6 (ovarian torsion, 2; teratoma, 4); ovary-preserving teratoma excision, in 1; splenectomy, in 1; gonadectomy, in 3; and varicocelectomy, in 2. There were no conversions to standard laparoscopic or open techniques. The only postoperative complication was a wound infection that occurred after an appendectomy. Conclusion: Although currently more expensive, SILS can be performed in children in almost every pediatric surgical procedure that can be accomplished with conventional laparoscopic techniques. The most significant contribution of SILS procedure is cosmesis. Postoperative pain and length of hospital stay were not improved. (C) 2011 Elsevier Inc. All rights reserved

Acute communicating haematocele: unusual presentation after blunt abdominal trauma without solid organ injury

WOS: 000209517600021PubMed ID: 14676518Haematocele is an unusual scrotal disorder in children, and is generally associated with direct trauma to the inguinoscrotal region. A 6-year-old boy with acute communicating haematocele who had a history of blunt abdominal trauma one week earlier is presented. Interestingly, no solid organ injury was detected on his previous admission for abdominal trauma, nor there was a history of hydrocele. (c) 2003 Lippincott Williams & Wilkins

Splenogonadal fusion-limb deformity syndrome: a rare but important cause of undescended testis

WOS: 000372302000020PubMed ID: 26582293Splenogonadal fusion is a rare congenital anomaly which is characterized by fusion formation between the spleen and gonad. We report a case of a 14-month boy with spleongonadal fusion-limb deformity syndrome focusing on the importance of awareness of this syndrome. The patient was admitted to our clinic because of a left undescended testis, and preoperative diagnosis was not made. During the operation, "spleen-like" tissue attached to the gonad induced splenogonadal fusion, which was confirmed by laparoscopy. The patient also had a short right femur, hip dysplasia and a syndromic face. Splenogonadal fusion anomaly should be considered in the evaluation of undescended testis, especially in patients with facial and limb deformities

Bilirubin Levels at 1st and 3rd Postoperative Months are Significant in Determining the Success of the Kasai Portoenterostomy

Aim: The aim of this retrospective study was to determine the indicators of survival with native liver (NLS) of patients operated for biliary atresia (BA). Materials and Methods: This review included 53 BA patients in a 13-year period. There were two groups: (1) NLS and (2) necessitating transplantation. Age at operation, and bilirubin levels on the 7th day, 1st and 3rd months postoperatively were recorded. Mann-Whitney U and logistic regression analysis were used for statistical analysis for NLS and liver transplantation (LTx). Results: Kasai portoenterostomy (KPE) was performed on 38 patients, and 15 were directed to LTx due to cirrhotic liver at presentation. Twenty-three of 38 patients with KPE survived with native liver, and 15/38 patients required LTx during follow-up. Mean age at portoenterostomy for NLS and necessitating LTx was 54.43 +/- 24.64 and 68.33 +/- 24.35 days respectively (p>0.05). The 1st and 3rd month bilirubin levels were lower in the NLS group (p<0.01). The 1St month and 3rd month bilirubin levels after KP were significant predictors for survival with NLS. A cut-off value of 5.7 mg/dL bilirubin level at the 1st month predicted the necessity of transplantation after KPE with a sensitivity of 83.3% and specificity of 78.9%. Conclusion: Bilirubin levels of the 1st and 3rd months are reliable predictors for the success of portoenterostomy

Can increased intra-abdominal pressure (IAP) be treated more effectively with intravesical pressure measurement in high-risk patients?

WOS: 000328883200011PubMed ID: 24347217BACKGROUND: Increased intra-abdominal pressure (IAP) can result in multiorgan failure. Trauma, mechanical bowel obstruction (MBO), abdominal wall defects (AWD) and fluid resuscitation in septic shock are conditions associated with a high risk of increased IAP in children. It may be possible to treat these conditions more effectively using intravesical pressure measurement. MEHTOHDS: This prospective study was performed between December 2009 and October 2010. Intravesical pressure (IVP) measurement was used to determine IAP. The presence of Intra-abdominal hypertension (IAP > 12 mmHg) and abdominal compartment syndrome (IAP > 15 mmHg + new organ dysfunction) was evaluated in all clinical decisions. RESULTS: IVP monitoring was applied in all patients with abdominal trauma (14), AWD (8), fluid resuscitation for septic shock (7), and MBO (6). A diagnosis of ACS was determined in 14% of trauma patients and required surgery. IAH/ACS occurred in 38% of AWD cases, which required closure. IAH occurred in 43% of patients undergoing fluid resuscitation for septic shock, requiring decompressive intervention. IAH/ACS occurred in 50 % of MBO patients, all of whom required surgery. DISCUSSION: IVP measurement is a useful method to identify candidates for surgical treatment in cases of trauma and MBO. Similarly, IVP monitoring can facilitate the closure of abdominal wall defects and the application of fluid resuscitation in septic shock