Laparoscopic versus open appendectomy in pediatric patients: Operative and postoperative experience

Abstract Objective: Acute appendicitis is very frequently encountered in children. Despite many scientific controversies in supporting classical or laparoscopic appendectomy, there is still no official consensus on this issue. This study aimed to present our experience from the comparison of operative and postoperative effects of laparoscopic and open appendectomy in pediatric patients with acute appendicitis. Materials and methods: The analytical cross-sectional study was conducted at the University Clinic for Pediatric Surgery, Ss. Cyril and Methodius University in Skopje, the Republic of N.Macedonia during the period 2015/2022. The study sample covered 184 hospitalized pediatric patients aged 4-14 years treated with laparoscopic (LA) or open appendectomy (OA). The data of interest included demographic characteristics, and selective operative and postoperative parameters. Results: The average age of the children in LA vs. OA group was 9.63±2.70 with min/max of 4/14 vs. 9.16±2.91 with min/max 2/14 respectively. Postoperative complications were detected in 1 (0.90%) of LA patients and 3 (4.11%) of OA patients with no significant association. Analgesics’ treatment received 57 (51.35%) of the children from LA group and all of the children from OA group.  Conversion from LA to OA happen only in 1 (0.54%) child. The evaluation of parents/guardians related to the satisfaction from the cosmetic appearance of the scar the significantly higher level of satisfaction from the scare after LA compared to OA intervention. Conclusions: Laparoscopic appendectomy was found to be feasible and comparable to open approach in terms of operative time and offers advantages over the latter in terms of postoperative pain, length of hospital stay and earlier return of bowel function to normal. It is a safe approach in all types of appendicitis, with an overall better complication profile than OA

Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration

AIM: The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration.MATERIAL AND METHODS: In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well.RESULTS: The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren’t any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention.CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common

Споредба на лапаро- ÑкопÑка херниоплаÑтика Ñо конвенционална техника кај женÑки деца Ñо индиректна ингвинална хернија

The study aims to compare the conventional open technique for treating inguinal hernia versus laparoscopic assisted technique of percutaneous closure of the internal inguinal ring in female children with clinically diagnosed indirect inguinal hernia. Materials and methods: The study is a prospective analytical (case control) study performed at the University Clinic for Pediatric Surgery in Skopje in the period 2015-16. Twenty  female children aged 1-14 years with clinically diagnosed indirect inguinal hernia were analyzed. Children from the experimental group were treated with laparoscopic hernia repair, and those from the control group with conventional techniques. Results: The average duration of the intervention in the experimental and control group was 27.6 ± 6.1 vs.64.8 ± 7.2 minutes. The length of hospital stay in the two groups was 10.8 ± 3.1 vs. 27.2 ± 4.2 hours. The shortest stay was 8 vs. 24 hours and the longest 18 vs. 36 hours. Fifty percent of the children in the experimental group took up a normal position in bed for less than 4 hours compared to the control group in which it happened in 9 hours. The average time to recovery from bed in the two groups was 4.1 ± 0.9 vs. 9.9 ± 1.8 hours with a minimum of 3 vs. 7 and maximum of 6 vs. 12 hours. The average length of the mark was 1.9 ± 0.9 mm in the experimental and 34.8 ± 17.4 mm in the control group. Analgesia because of pain was given to 2 (20%) children in the experimental group and to 8 (80%) in the control group. Easy impressive scar have 8 (80%) patients in the control group and no patient in the experimental group. The mark does not disturb the esthetics in 9 (90%) of patients in the experimental group and in 2 (20%) in the control group. Conclusion: Laparoscopic assisted technique of percutaneous closure of the internal inguinal ring with one port represents a minimally invasive method and ultimate achievement in this field for treatment of inguinal hernias in children, with special advantage in females.ИÑтражувањето има за цел да ги Ñпореди отворената конвенционална техника за третман на ингви- налните хернии наÑпроти лапароÑкопÑки аÑиÑтирана техника на перкутано затворање на внатреш- ниот ингвинален прÑтен кај женÑки деца Ñо клинички дијагноÑтицирана индиректна ингвинална хернија. Матерјал и методи: ИÑтражувањето претÑтавува проÑпективна аналитичка (case control) Ñтудија, Ñпроведенa на УниверзитетÑката клиника за детÑка хирургија во Скопје во периодот 2015-16. Опфатени Ñе 20 женÑки деца на возраÑÑ‚ од 1-14 години Ñо клинички дијагноÑтицирана индирекна ингвинална хернија. ИÑпитаниците од иÑпитуваната група Ñе третирани Ñо лапароÑкопÑка херни- оплаÑтика, а оние од контролната група Ñо конвенционална техника. Резултати: ПроÑечното време- трање на интервенцијата во иÑпитуваната, одноÑно контролната група изнеÑува 27,6±6,1 vs. 64,8±7,2 минути. Должината  на преÑтојот во болница во двете групи  Ð¸Ð·Ð½ÐµÑува  10,8±3,1 vs. 27,2±4,2 чаÑови. Ðајкраткиот преÑтој изнеÑува 8 vs. 24 чаÑа, а најдолгиот 18 vs. 36 чаÑа. ПедеÑет проценти од децата во иÑпитуваната група заземале нормална положба во кревет за помалку од 4 чаÑа Ñпоредено Ñо оние од контролната група кај кои тоа изнеÑувало 9 чаÑа. ПроÑечното време до вертикализација во кревет во двете групи изнеÑува 4,1±0,9 vs. 9,9±1,8 чаÑови Ñо минимум 3 vs. 7 и макÑимум 6 vs. 12 чаÑови. ПроÑечната должина на белегот изнеÑува 1,9±0,9 мм во иÑпитуваната и 34,8±17,4 мм во контролната група. Ðналгезија поради болка е дадена кај 2 (20%) од децата во иÑпитуваната и 8 (80%) од оние во контролната група. ЛеÑно впечатлив белег имаат 8 (80%) од пациентите во контролната група и ние- ден пациент од иÑпитуваната група. Белегот не ја нарушува еÑтетиката кај 9 (90%) од пациентите во иÑпитуваната група, и кај 2 (20%) од оние во контролната група. Заклучок: ЛапароÑкопÑки аÑиÑтирана техника на перкутано затворање на внатрешниот ингвинален канал Ñо еден порт претÑтавува мини- мално инвазивна метода за третман на ингвинални хернии во детÑка возраÑÑ‚ и врвно доÑтигнување во оваа проблематика, Ñо поÑебни предноÑти кај женÑките деца

EVALUATION OF TWO SURGICAL TREATMENTS OF PRIMARY VESICOURETERAL REFLUX AMONG CHILDREN: A 15 YEARS EXPERIENCE

Aim: aim of the study was to evaluate the efficiency of two different surgical treatments of vesicoureteral reflux (VUR) on succesfull rate and patient outcome. Methods: Retrospective study on children with primary VUR and their surgical treatment from 1999 to 2014 in the University Clinic for Pediatric Surgery in Skopje. A total of 76 children (114 ureters) with VUR ranging from second to fifth grade were treated surgically, 44 patients (67 ureters) with an open surgical technique and 32 patients (47 ureters) with endoscopic treatment ”STING” procedure. The following parameters were analyzed: duration of the intervention, duration of the hospitalization, the need for antibiotics and analgesic therapy and the need for blood and blood derivatives transfusion. The result of the surgical treatment was also validated. A good result was considered when reduction of VUR by 2 degrees with the endoscopic method or by 3 degrees in the open surgical technique was noticed. Results: Using open surgical technique, patients were hospitalized for an average of 9 days (range from 5 to 13 days). All children received double antibiotic therapy. The need for analgesics lasted for 3 to 4 days. 90% of treated children needed blood and/or blood derivatives transfusion. Success rate with this method was 93.8%. Endoscopic procedure was performed as a one-day surgical procedure. The average duration was 15 minutes. Single, prophylactic dose of antibiotic was ordinated. There was no need for blood and/or blood derivatives transfusion. The overall success of the treatment was about 70%. Conclusion: Open surgical procedure is used for more complicated cases, VUR grade IV-V or by previously failed. Endoscopic, “STING” procedure was commonly used for patients with VUR grade greater than 2, after previously failed conservative treatment, febrile urinary infection despite antibiotic prophylaxis and/or emergence of new scarring in the renal parenchyma. Patient assessment and decision for what method will be used must always be done individually for each child