Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure

Minimally invasive surgery and cancer: controversies part 1

Perhaps there is no more important issue in the care of surgical patients than the appropriate use of minimally invasive surgery (MIS) for patients with cancer. Important advances in surgical technique have an impact on early perioperative morbidity, length of hospital stay, pain management, and quality of life issues, as clearly proved with MIS. However, for oncology patients, historically, the most important clinical questions have been answered in the context of prospective randomized trials. Important considerations for MIS and cancer have been addressed, such as what are the important immunologic consequences of MIS versus open surgery and what is the role of laparoscopy in the staging of gastrointestinal cancers? This review article discusses many of the key controversies in the minimally invasive treatment of cancer using the pro–con debate format

Gastric volvulus in children

PURPOSE: The aim of the study was to review the records of all children who presented with gastric volvulus in the past 10 years. METHODS: The study group consisted of 21 children with an age range from 0.2 months to 4.3 years who were operated for gastric volvulus from 1992 to 2003. RESULTS: Initial symptoms included acute abdominal pain after meals, vomiting, and in 8 cases, acute apnea associated with pallor, cyanosis, and hypotonia. After the first episode, barium studies revealed an organoaxial gastric volvulus in all cases. The surgical procedure was an anterior gastropexy with reinforcement of the esophagogastric angle performed by laparoscopy in 13 cases and by laparotomy in 8 (1 converted laparoscopy). An associated antireflux fundoplication was done in 3 patients. All children received postoperative antireflux medication for at least 1 month. The follow-up ranged from 4 months to 4.8 years. Two children in the laparotomy group required reoperation (Toupet fundoplication) for persistent gastroesophageal reflux disease. All children are currently symptom-free and without treatment. CONCLUSIONS: Gastric volvulus is a clinical and radiological reality, which can be treated by a gastropexy. Initial fundoplication is not mandatory. The laparoscopic gastropexy is a good option and allows a repeat laparoscopic procedure if needed

Léthargie et irritabilité chez l'enfant : Attention à l'invagination !

Chez le petit enfant, l'invagination est une cause classique de douleurs abdominales. Elle représente l'étiologie la plus fréquente d'obstruction intestinale de l'enfant de moins de cinq ans. Cette pathologie, considérée à tort comme facile à diagnostiquer, se manifeste classiquement par la triade douleurs abdomlnales, vomissements et selles muco-sanglantes non diarrhéiques. Toutefois, une part importante des patients présente un tableau clinique incomplet, voire atypique. Le seul signe de présentation peut être une apathie, parfois sévère, isolée ou associée à des phases d'irritabilité, une léthargie, voire un coma. C'est en y pensant qu'un traitement précoce préviendra un état de choc ou une ischémie intestinale prolongée nécessitant une éventuelle résection. L'invagination doit donc être incluse dans le diagnostic différentiel de tout petit enfant se présentant aux urgences avec une léthargie ou un coma, et ceci même en l'absence de plaintes abdominales. Ces éléments sont détaillés à partir d'une présentation clinique

Accidents de trotinette chez l'enfant et l'adolescent : résultats préliminaires

L'apparition du phénomène trottinette au cours de l'année 2000 a entraîné une pathologie propre à ce type d'activité. Notre étude analyse 156 cas d'accidents de trottinette pris en charge par notre service de chirurgie pédiatrique en un an. Ils concernent une majorité de garçons (M : F ratio = 2 : 1) essentiellement dans la tranche d'âge 10 à 13 ans (48% des cas). Nous avons constaté 63% de lésions simples, 31% de fractures dont un tiers ont nécessité une prise en charge chirurgicale. Les atteintes prédominent à la tête, plus particulièrement au visage, ainsi qu'à la cheville et au polgnet. Au moins 45% des accidents sont survenus sur la voie publique, avec un mécanisme de collision dans un tiers des cas, dont plus de la moitié avec un véhicule. Les chutes en descente, suite à un problème de freinage ou une perte d'équilibre représentent 33% du collectif, et 15% sont liés à des problèmes mécaniques ou de manipulation liés à la structure de l'engin. Dès à présent, on peut dire que la gravité des traumatismes peut être atténuée par le port de protections à la tête (visage), aux chevilles et aux poignets. La pratique de la trottinette dans la circulation doit être évitée, puisqu'elle met en danger la vie et entraîne des lésions graves

Evaluation of scooter-related injuries in children

BACKGROUND/PURPOSE: The sudden popularity of the "scooter phenomenon" was followed by an increased rate of injuries associated with its use. This study evaluates the circumstances, types, degrees, and mechanisms of injury related to the use of a scooter in the pediatric population. METHODS: From January 2000 to February 2001, the emergency files of all the children arriving at the authors' institutions with a diagnosis of "scooter related trauma" were reviewed. RESULTS: One hundred fifty-six cases were recorded; 48% of patients were between 10 and 13 years old; 66.6% were boys. There was a incidence peak in September and October. Trauma locations were as follows: face (47.5%), ankle (17.9%), wrist (17.3%), knee (11.5%), and head trauma (12%). Eighty-five percent healed within 1 to 4 weeks; 16.6% needed hospitalization. Fractures occurred in 31% of cases; 38% of these required surgical treatment. Concerning the mechanisms of injury, 45% occurred on the street and sidewalk, 44% of which resulted from collisions with a motor vehicle, 33% were caused by inefficient braking, and 15% were related to a mechanical problem with the scooter's structure. CONCLUSIONS: The authors observed a shift in the children's interest from roller skates toward the scooter. Research on scooter injury prevention needs to be improved, and a program needs to be promoted to reduce the number and the severity of related injuries. For now the authors would recommend head, mainly face, wrist, and ankle protections

Complications of laparoscopic treatment of esophageal achalasia in children

Background/Purpose: The aim of this study was to evaluate the incidence and management of the complications that occurred in some children who underwent laparoscopic Heller’s esophagocardiomyotomy in the authors’ institutions. Methods: Between March 1993 and October 1998, the files of all the children with achalasia who underwent laparoscopic Heller’s esophagocardiomyotomy in a community hospital in Naples, Italy, and a private hospital in Paris, France, were reviewed. A 5-port technique was used associating Heller’s esophagocardiomyotomy to an antireflux surgical mechanism (Dor’s or Toupet’s) in all cases. Intra- and postoperative complications, as well as the postoperative outcome, were evaluated. Results: Ten laparoscopic Heller’s esophagocardiomyotomies were performed in 5 girls and 5 boys with achalasia. Age ranged between 2 and 13 years. Mean operating time was 120 minutes. Hospital stay ranged between 3 and 41 days. Complications were recorded in 3 patients: in 2 an esophageal mucosal perforation and in 1 a prolonged dysphagia. Two of these complications occurred in the last patients operated on. Follow-up varied from 6 months to 6 years. All children were free of symptoms. Conclusions: The results show that laparoscopic Heller’s esophagocardiomyotomy in children is a feasible procedure. Assessment of mucosal integrity immediately after the myotomy must be performed. Complications can happen even if the operation is performed by expert laparoscopic surgeons