Gasless Trans-Umbilical Laparoscopically-Assisted Appendectomy in the Pediatric Population: An Early Experience

Background: The aim of this study is to determine the feasibility and safety of the single-port gasless trans-umbilical laparoscopically-assisted appendectomy in the pediatric age group at a single center in a tertiary university hospital in Jordan. Methods: Between April 2018 and July 2019, the surgical records of all patients aged between 0 and 13 years treated with trans-umbilical laparoscopic-assisted appendectomy TULAA for a suspected appendicitis following a clinical, laboratory and ultrasound findings were reviewed retrospectively. Baseline characteristics, white blood cell count, operative time, intraoperative findings, need for additional trocars or for conversion, length of hospital stay and surgical complications were reported.Results: 36 cases were included in the study, 23 (64%) were completed successfully using the gasless TULAA technique. Gas insufflation was needed in 10 (28%) cases and only 3 (8%) had to be converted to the three-port laparoscopic appendectomy technique. There was no significant difference between the gaseous and gasless groups in terms of baseline characteristics, BMI, surgery duration, postoperative recovery period or length of stay. However, the group of patients who needed gas insufflation to complete the procedure had a higher white blood cell count compared to the gasless group. The surgery was completed successfully by senior general surgery residents in 27 (75%) cases while the consultant’s intervention was needed in the remaining cases. The gasless TULAA group were less likely to require complex analgesia (i.e., IV analgesia) compared to the gasless group (OR=0.683).Conclusions: Gasless TULAA is a feasible procedure that can be performed safely by surgical residents as an initial approach for all grades of acute appendicitis in the pediatric age group

The Prevalence of Nocturnal Enuresis among Patients with Vesicoureteral Reflux

Background: To identify the prevalence and other associated factors of nocturnal enuresis in children with vesicoureteral reflux undergoing surgical interventions.Methods: This is a cross-sectional study were the medical records of 40 children with confirmed vesicoureteral reflux were reviewed. Additionally, parents were asked to fill out a questionnaire inquiring about presence, onset & course of nocturnal enuresis as has been defined according to ICD-10.Results: Among the 40 children, 22 children (55%) had nocturnal enuresis before any surgical intervention. However; gender, family history of bedwetting, renal hydronephrosis on ultrasound, positive urine culture, and pre-op creatinine level were found to have statistically insignificant association with nocturnal enuresis. After surgical management only 13 (32.5%) children experienced nocturnal enuresis.Conclusion: This study can conclude that there is a weak correlation between NE and VUR in patients undergoing surgical intervention. Also, the surgical management of VUR did not significantly affect the prevalence of NE. However, it is an essential problem for both families and children in Jordan for which specific guidelines should be developed

Are We over Dissecting the Cord in Orchidopexy?

Background: Orchidopexy is a procedure of securing the testis inside the scrotum in patients with cryptorchidism. In the literature, various dissection techniques have been described to lengthen the spermatic cord to ensure a tension-free fixation of the testis to the lowest point of the scrotum.Objectives: The aim of this study is to determine if incorrect measurement of the spermatic cord’s length during open inguinal orchidopexy had led surgeons to over dissect the cord in a way that may pose an increased risk of testes, vas deferens and spermatic vessels.Materials and Methods: We prospectively studied the results of 40 orchidopexies performed in 40 patients with peeping or canalicular undescended testis , which was done at the Jordan university hospital in Amman from April 2018 to March 2019 , We compared the position of the testis before and after tunneling inside the inguinal canal. The difference in length is measured and analyzed.Conclusion: Failure to account for the subcutaneous fat layer thickness during orchidopexy increases the likelihood of over dissecting the spermatic cord which increases the risk of vas and vessels injury In this study we found that there is a difference between the cord length outside and inside the canal with excess length after passing the cord inside the canal ranges from 1-3 cm . This means that we do not need to dissect the cord to make the testis reaches the scrotum from outside. This decreases the risk of harming the cord and its contents