Treatment of acute appendicitis with one-port transumbilical laparoscopic-assisted appendectomy: a six-year, single-centre experience.

BACKGROUND: Laparoscopic appendectomy is a feasible and safe alternative to open appendectomy for uncomplicated appendicitis. In the past decade several laparoscopic procedures have been described using one or more ports. We report our experience in treating acute appendicitis with one-port transumbilical laparoscopic-assisted appendectomy (TULAA). PATIENTS AND METHODS: We performed 231 TULAA on patients in the period from November 2001 to September 2007. We introduced an 11 mm Hasson's port using open technique; an operative channel with 10 mm telescope and an atraumatic grasper were used. After intra-abdominal laparoscopic dissection, the appendix was exteriorised through the umbilical access. The appendectomy was performed outside the abdomen as in the open procedure; the operation was completed using only one port in 227 patients (98%), two and three ports in two patients (1%) while conversion to open surgery was needed in two patients (1%). RESULTS: The average operating time was 38 minutes and the median time to discharge was three days. Four (1, 7%) early postoperative complications (two suppuration of the umbilical wound) with no major complications were observed. CONCLUSIONS: Our results demonstrate that TULAA, which combines the advantages of both open and laparoscopic procedures, is a valid alternative form of treating uncomplicated appendicitis. If appendectomy cannot be completed with only one port, insertion of one or more ports may be necessary to safely conclude the procedure.

The value of lung scintigraphy in the management of airways foreign bodies in children.

AIM: A retrospective analysis was made to evaluate our experience in the management of tracheobronchial foreign bodies (TFB) in children (age

[Conservative treatment of children constipation with Macrogol 4,000]. / Il trattamento conservativo della stipsi del bambino con macrogol 4000.

AIM: Macrogol 4,000 is one of the new generation's osmotic laxatives. It is constituted by a heavy molecular weight polymer without additional salts. In most of patients Macrogol 4,000 shows its efficacy in 48 hours from the beginning of treatment. Daily evacuations has been reported after first week therapy with an improvement in quality of life. The aim of this observational study was to demonstrate the efficacy of Macrogol 4,000 in the treatment of constipation in children. METHODS: The effect of Macrogol 4,000 was assessed in 120 children affected by constipation treated with therapeutic doses of Macrogol 4,000. The study period ranged from September 2006 to March 2007. The data analysis was collected with the evaluations concerning clinical examination and the consultation of daily diaries assembled by parents, tracking stooling pattern; in case of loosing contacts with the patient, a telephonic survey has been carried out. The child with symptoms improvement, i.e. reduction of the pain during defecation, daily spontaneous evacuations and better stool consistence, were considered ''normal''. RESULTS: Of the 120 patients, 89 returned to the clinical follow-up, while the remaining 31, who missed the follow-up, has been contacted by telephone. To the final analysis, 103 patients (85.8%) have had a normalization of the clinical symptoms, 9 patients (7.5%) have refused Macrogol 4,000 for the unpleasant flavour, 8 patients (6.7%) did not have any improvement from the treatment. CONCLUSION: The results of this observational study suggest that Macrogol 4,000 could be very useful to treat pediatric patients with constipation, also those affected by neuronal intestinal displasia (NID) type B.