Complications after conservative treatment of blunt liver trauma in children.

This series fully validates conservative approach of BLT in hemodynamically stable children. Complications of such approach are uncommon; many can be successfully treated using minimally invasive techniques with very satisfying results

Transfer of surgical competences in the treatment of intersex disorders in Togo

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. Results: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French- speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities

Single-stage correction of posterior hypospadias (178 cases). Comparison of three techniques: free skin graft, free bladder mucosal graft, transverse pedicle preputial graft

Three techniques have been developed for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. This multicenter retrospective study of 178 children who underwent surgery for posterior hypospadias was designed to compare the results achieved with these procedures. Free skin grafts (15 cases) resulted in the most frequent complications, and in particular the most severe strictures; in our opinion this technique should be abandoned. Pedicle preputial grafts (133 cases) gave the greatest number of successes from the outset, and should be preferred whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts (30 cases) were not as good as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position, and for children who have already undergone multiple operations

Multicentric assessment of the safety of neonatal videosurgery

BACKGROUND: Complex procedures for managing congenital abnormalities are reported to be feasible. However, neonatal videosurgery involves very specific physiologic constraints. This study evaluated the safety and complication rate of videosurgery during the first month of life and sought to determine both the risk factors of perioperative complications and the most recent trends in practice. METHODS: From 1993 to 2005, 218 neonates (mean age, 16 days; weight, 3,386 g) from seven European university hospitals were enrolled in a retrospective study. The surgical indications for laparoscopy (n = 204) and thoracoscopy (n = 14) were congenital abnormalities or exploratory procedures. RESULTS: Of the 16 surgical incidents that occurred (7.5%), mainly before 2001, 11 were minor (parietal hematoma, eventration). Three neonates had repeat surgery for incomplete treatment of pyloric stenosis. In two cases, the incidents were more threatening (duodenal wound, diaphragmatic artery injury), but without further consequences. No mortality is reported. The 26 anesthetic incidents (12%) that occurred during insufflation included desaturation (<80% despite 100% oxygen ventilation) (n = 8), transient hypotension requiring vascular expansion (n = 7), hypercapnia (>45 mmHg) (n = 5), hypothermia (<34.9 degrees C) (n = 4), and metabolic acidosis (n = 2). The insufflation had to be stopped in 7% of the cases (transiently in 9 cases, definitively in 6 cases). The significant risk factors for an incident (p < 0.05) were young age of the patient, low body temperature, thoracic insufflation, high pressure and flow of insufflation, and length of surgery. CONCLUSION: Despite advances in miniaturizing of instruments and growth in surgeons' experience, the morbidity of neonatal videosurgery is not negligible. A profile of the patient at risk for an insufflation-related incident emerged from this study and may help in the selection of neonates who will benefit most from these techniques in conditions of maximal safety

Laparoscopic adrenalectomy in children: experience of the GECI in 16 cases

Background: Conventional adrenalectomy usually necessitates a large incision. In some cases, laparoscopic adrenalectomy offers a less aggressive solution to the patient's problem. Patients and Methods: Laparoscopic adrenalectomy for clearly defined lesions was performed in five girls and nine boys with a mean age of 9 years. The indication was incidental discovery in four patients, hypertension in six (two of whom had von Hippel Lindau syndrome), Cushing's disease in two, and gynecomastia or premature puberty in one patient each. The lesion was on the right side in five patients and the left side in six and was bilateral in three. The mean diameter was 35 mm. The urinary concentrations of vanillylmandelic acid and homomandelic acid were normal in five patients with neurogenic tumors and elevated in five patients with pheochromocytoma. An anterior transabdominal approach was used in nine patients and a lateral retroperitoneal approach in seven. Results: The operating time ranged from 35 to 320 minutes. There were three conversions to open surgery (20%). There were no perioperative or postoperative complications. Histologic examination revealed 13 benign lesions (7 pheochromocytomas, 3 ganglioneuromas, 2 cortical adenomas, and 1 hyperplasia), 1 malignant lesion (N-Myc-negative neuroblastoma, which was removed after conversion to open surgery), and two indeterminate lesions. Of the latter lesions, one was an N-Myc-negative gangioneuroblastoma, and the other was an adrenocortical tumor that was treated initially by local excision and 1 month later by total adrenalec via an open approach. There were no tumor remnants in the specimen. All patients are alive without evidence of recurrence with follow-up of 6 months to 4 years. Conclusions: The laparoscopic approach should be reserved for well-defined lesions <0.5 cm that are probably benign, although the nature of the lesion can be difficult to define preoperatively. The indications can be extended to stage I nonsecreting neuroblastoma in some situations and, for some surgeons, to tumors of stage IV or V. There seems to be no age or weight limit. A left-sided lesion usually is resected via a lateral retroperitoneal approach and a right-sided lesion by an anterior transperitoneal approach, but the details of the technique with the anatomy and the surgeon's experience. Oncologic principles must be respected, and the rate of conversion to open surgery is high