Gallbladder polyps in association with metachromatic leukodystrophy

Polypoid lesions of the gallbladder (PLG) are rare in the paediatric population. Growth in technology with the availability of high-quality ultrasonography and in the experience of radiologists in detecting such lesions, has led to an increase in incidental detection of PLG. In children, the occur either as a primary disorder or in association with other conditions, including metachromatic leukodystrophy, Peutz- Jeghers syndrome, or pancreatobiliary malunion [1]. Due the rarity of these lesions in the paediatric age group, accurate management algorithms are inherited from the adult population. In these, PLG is a more common pathology, occurring in 4\u20137% of patients undergoing ultrasonography, with clinical significance relating largely to their malignant potential [2,3]

Long-term evaluation of patient satisfaction and quality of life in pectus excavatum repair

Abstract Background: The aim of our study was to evaluate long-term patient satisfaction and quality-of-life improvement in grown-up patients treated for pectus excavatum with the Nuss procedure in the pediatric age, searching for correlation between preoperative characteristics and long-term outcomes. Methods: At first, we performed a retrospective analysis of pediatric patients undergoing the Nuss procedure in a 5-year period. We administered, at least 5 years after bar removal, a single-step questionnaire to focus on the assessment of patient satisfaction with operative results. Results: Most patients stated general health and exercise tolerance were improved after the operation. High levels of overall satisfaction were reported after Nuss repair, with 95.6% of patients being either satisfied or very satisfied. Overall, 87.0% of patients stated they would have the operation again. The high overall satisfaction after surgery was not correlated with the deformity severity and the presence of physical symptoms before correction. Conclusions: Patients expressed high levels of satisfaction in terms of self-image and quality of life. Improvement in cosmetic appearance and health in general translated in most patients in an improvement of social life. The degree of postoperative pain after the Nuss procedure is the overriding factor in the patient’s perception of the quality of the postoperative course

A case of massive subcutaneous emphysema and transient ischemic attack due to argon plasma coagulation following endoscopic pilonidal sinus treatment

Pilonidalsinusisasmallholeaffectingtheskinandsubcutaneoustissue,whichusuallycontainshairandskindebris,resultinginthecreationoftheso-calledpilonidalcyst.Theendoscopicpilonidalsinustreatment(EPSiT)isaminimallyinvasiveprocedureconsistingoftheremovalofhairsandcauterizationofthecavityunderdirectendoscopicvision.Inourinstitution,weusedtoendthisprocedurewithargonplasmacoagulation(APC).Here,wediscussacaseof22-year-oldmanaffectedbypilonidaldisease,whodevelopedamassivesubcutaneousemphysemaandsuspectedtransientischemicattacksecondarytogasreabsorptionafteranEPSiTinwhichAPCwassedforthecoagulation

Paediatric surgery in the robotic era: early experience and comparative analysis

The aim of this study is to present our preliminary experience in robotics and a comparative analysis with conventional Minimally- Invasive Surgery (MIS). Cases operated by da Vinci Xi® System from February 2016 to October 2017 are reviewed retrospectively through demographics, diagnosis-procedure and short-term outcome parameters. A comparison with a matching conventional MIS population was also conducted. 40 robotic procedures were carried out and 112 (out of 3705) non-robotic procedures met inclusion criteria for comparison. Among robotic patients we observed: an average age of 143.5 months, weight of 42.9 Kg, operative and anaesthesia induction time respectively of 116.8 and 34.8 minutes. Furthermore, we observed a 6.1-day length of stay, 2.5% conversion rate and no complications. From the comparison between the groups, no statistical difference emerged in the length of stay, in conversion rates or in complications. A statistical significance was observed in terms of operative time in favour of non-Robotic- System. Our experience has meant to introduce the System in our surgical environment, comparing to the conventional MIS (an already established approach routinely performed at our center). Results have shown comparable safety and feasibility

Fish Skin Graft: Narrative Review and First Application for Abdominal Wall Dehiscence in Children

Summary: Acellular fish skin grafts (FSGs) are tissue-based products created by minimally processing the skin of the Atlantic cod (Gadus morhua). The FSG is rich in omega-3 and facilitates tissue regeneration by supporting revascularization and ingrowth in the proliferation and remodeling phases of wound healing. FSG is structurally more similar to human skin than antiviral-processed skin substitutes such as amniotic membrane, and there are no known prion, bacterial, or viral diseases that can be transmitted from North-Atlantic cod to humans. The FSG is processed using a proprietary method that preserves the structure and lipid composition of the skin. FSG is CE marked, and US Food and Drug Administration cleared for multiple clinical applications in partial and full-thickness wounds. FSG is currently the only acellular dermal matrix product that does not originate from mammalian tissues. For this narrative review, Medline and UpToDate were used to include a total of 21 articles published from 2015 to 2022 about fish skin graft use. We also reported a case of a 7-year-old boy who underwent treatment with FSG for abdominal wall dehiscence at our department of pediatric surgery, IRCCS Sant’Orsola- Malpighi, Alma Mater Studiorum, University of Bologna, University Hospital of Bologna. FSG provides a valuable and sustainable treatment that improves wound healing in both adult and pediatric populations. We described the first application of an FSG for wound dehiscence of the abdominal wall in a pediatric patient, reporting how FSG was completely reabsorbed and improved the skin’s repai

Pelvic Health Assessment in Adult Females Following Pediatric Appendicitis: A Monocentric Retrospective Case—Control Study

open10noAbstract: Background: The anatomical location of the appendix in females determines its close contact with the internal genitalia, involving the latter in case of acute appendicitis (AA). The aim of this study was to evaluate the incidence of pelvic health impairment in adult women who underwent appendicectomy during childhood. Materials and Methods: A retrospective observational study was conducted including all female patients who underwent appendicectomy for acute appendicitis at our Center between January 1985 and December 1995. The patients were divided into two groups, i.e., complicated AA (Group A) and not complicated AA (Group B), and were asked to respond to a questionnaire investigating their general health status, fertility impairment, ectopic pregnancies, miscarriages, endometriosis, and chronic pelvic pain. The same questionnaire was administered to female volunteers with past medical history (PMH) negative for AA. The data were compared using chi-square test and Fisher exact test (a p value < 0.05 was considered for statistical significance). Results: In total, 75 patients operated for AA during childhood (22 in Group A and 53 in group B) and 44 female volunteers with PMH negative for AA (group C) were enrolled in the study. Seventeen patients (77.3%) in group A, 40 (75.4%) in group B, and 29 (65.9%) in group C (p > 0.05) had pregnancies. The number of miscarriages among women who became pregnant in their life was 5 in group A, 13 in group B, and 12 in group C (p > 0.05). Chronic pelvic pain was reported by 7 out of 22 (31.8%) patients in group A, 7 out of 53 (13.2%) in group B, and 5 out of 44 (11.4%) in group C (A vs. C: p = 0.04, OR = 3.64; A vs. B: p = 0.06 and B vs. C: p = 0.52). Conclusions: In our series, AA, complicated or not, neither determined repercussions on fertility, risk of miscarriages, and ectopic pregnancies nor increased the risk of developing endometriosis. However, women who experienced complicated AA showed a higher prevalence of chronic pelvic pain onset in adulthood compared to healthy women.openParente, Giovanni; Di Mitri, Marco; D’Antonio, Simone; Cravano, Sara; Thomas, Eduje; Vastano, Marzia; Lunca, Robert; Gargano, Tommaso; Libri, Michele; Lima, MarioParente, Giovanni; Di Mitri, Marco; D’Antonio, Simone; Cravano, Sara; Thomas, Eduje; Vastano, Marzia; Lunca, Robert; Gargano, Tommaso; Libri, Michele; Lima, Mari

Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children

Abstract: Background: Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI’s management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. Materials and methods: The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. Results: An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. Conclusion: We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way

Idronefrosi pielica

N/

Ultrasound findings to predict failure of conservative treatment in the appendix testis torsion

Background Torsion of the appendix testis (TAT) is considered the most common cause of acute scrotum in childhood. When clinical and ultrasound (US) findings agree with the diagnosis, after testicular torsion has been excluded, conservative therapy is attempted whereas scrotal exploration and removal of the hydatid are required when medical therapy has failed. We hypothesized there are US features that can predict the failure of conservative therapy. Methods We conducted a retrospective analysis on pediatric patients treated for TAT. The age of patients, number of days spent with symptoms before the start of treatment, presence of epididymitis and/or hydrocele, and dimension of the twisted hydatid were analyzed. A search for a correlation between these variables and failure of conservative treatment was conducted. Results Patients were divided into 2 groups based on the efficacy of conservative management: responders (group I) and non-responders subjected to surgical treatment (group II). No statistically significant differences were registered in regard to age (p = 0.25), average dimension of hydatid (p = 0.09), and time gap between symptoms and the start of therapy (p = 0.92) between the 2 groups. An associated epididymitis was described in 27.5% of patients in group I and 41.7% in group II (p = 0.03; OR 1.89), and associated hydrocele was described in 33.4% of patients in group I and 45.8% in group II (p = 0.03; OR 1.83). Considering the odds ratios, the probability of surgical intervention when presenting only epididymitis without hydrocele is estimated to be 15%, when presenting only hydrocele without epididymitis: 9%, with both epididymitis and hydrocele: 74%, and without epididymitis nor hydrocele: 2%. Conclusions The presence of both epididymitis and hydrocele at first US evaluation is associated with a high probability of conservative treatment failure, thus predicting the need for surgical intervention

The role of the early video-assisted thoracoscopic surgery in children with pleural empyema

Purpose Pleural empyema (PE) is a collection of purulent material in the pleural space. PE’s management in children is a challenge and an inappropriate diagnostic-therapeutic work up can lead to serious short and long-term complications. The aim of this study is to define the correct timing to approach a pediatric PE by video-assisted thoracoscopic surgery (VATS). Methods A retrospective observational study was conducted including pediatric patients who underwent video-assisted thoracoscopy for pleural empyema between May 2005 and September 2022. Results 62 patients were subjected to VATS for PE (32 in Group Early VATS, 30 in Group Late VATS). It emerged that the elapsed period between the onset of symptoms and surgery correlates in a statistically significant way with the post-operative stay in intensive care (z score 4.3 and p value < 0.0001) and the analysis between early VATS, late VATS and postoperative hospitalization showed a statistically significant reduction of the post-operative hospitalization in the early VATS groups (p value < 0.02). Conclusions VATS resulted to be safe and effective for the treatment of PE in children, and an early minimally invasive thoracoscopic intervention (early VATS) correlates with better outcomes, specifically in terms of intensive care hospitalization and overall hospitalization