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

Non-palpable testes. Orchiopexy in single stage.

From 1986 to 1990, 53 non-palpable testes were treated in the department of Pediatric Surgery and Endocrinology at the Regina Margherita Hospital, Turin, Italy. The reported patients were 45, 8 of them were bilateral with both testes non-palpable, 13 of the remaining patients were right cryptorchid and 24 were left. All patients received medical treatment, by LH-RH nasal spray and HCG, before surgery. None of the non-palpable testes descended by hormone therapy only, so that surgical exploration was always required. In the 53 reported cases, 10 gonads were not found, 13 were atrophic and 30 were abdominal. All abdominal gonads were positioned into the scrotum by orchiopexy in a single stage. Half of the patients underwent operation before the age of 2. Therefore, it is to be pointed out that the younger a patient the shorter his inguinal canal, this facilitates orchiopexy for high, undescended testes. In 10 patients a testicular biopsy was made during surgical procedure. Normal morphology and normal spermatogonia content were observed in the abdominal testes of the patients who had reached the age of 1 year. During the follow-up of the reported patients no upward displacement was observed. Eleven patients underwent postoperative testicular ultrasonography which showed that parenchymal structure of the operated testis was normal and the volume of the testis was slightly smaller than normal. Based on their experience, the authors suggest to correct cryptorchidism before the age of one year, surgical procedure follows immediately after ineffective hormone therapy.

[A gastric trichobezoar: a report of a clinical case with anomalous presentation]. / Tricobezoar gastrico: descrizione di un caso clinico a presentazione anomala.

The Authors describe a case of a voluminous trichobezoar in a girl 9 years old. The patient was referred for evaluation of abdominal pain that presented after a banal blunt abdominal trauma occurred some days earlier. On physical examination an epigastric mass was detected. For a few days the girl suffered of inappetence and postprandial vomit. She was noted to have thin and sparse hair, thin eyebrows and onychodysplasia: these findings were considered as features of cutaneous adnexa dystrophy. The blood test and other laboratory findings were within normal limits. Abdominal US and UGI series failed to detect the nature of the mass. Therefore the patient underwent gastroscopy that showed a voluminous trichobezoar, so big and hard that gastrotomy was required for removal. The weight of the mass was 700 g; it occupied the whole stomach from fundus to pylorus. Postoperative recovery was uneventful. After discharge the patient was referred to the Neuropsychiatric Service for treatment trichophagia and prevention of recurrence. The most common site of trichobezoar is stomach. Clinical findings are often aspecific. US and UGI series may not allow the correct diagnosis. A rational diagnostic suspicion can arise when alopecia circumscripta is present. Endoscopy remains the elective technique: this procedure can be contemporarily diagnostic and therapeutic. Surgical approach is required only in case of trichobezoar with peculiar size, shape and hardness. We feel that a neuropsychiatric support is necessary to avoid recurrence.

[Hematoma and pulmonary contusion as a consequence of closed injury of the thorax in childhood]. / L'ematoma e la contusione polmonare quale conseguenza di trauma chiuso del torace in età pediatrica.

A personally observed case of internal chest injury is described with emphasis on the clinical and radiological features of the contusion and lung haematoma produced and the relative therapeutic problems.