Management of primary spontaneous pneumothorax in children: Current practices among Turkish pediatric surgeons.

Background: This study aims to evaluate current practices in the management of primary spontaneous pneumothorax among Turkish pediatric surgeons. Methods: Between October 2021 and November 2021, an online survey comprising 19 questions was delivered to all members of the Turkish Association of Pediatric Surgeons (TAPS). A total of 74 respondents (42 males, 32 females; mean age: 42.3±7.9 years; range, 29 to 61 years) were included. Results: The response rate was 17.1% among all society members. The rate of utilization of computed tomography in the initial admission was 27.4%, and the rate of use in cases requiring surgical treatment was 78.4%. A total of 81% of surgeons reported that the size of the pneumothorax influenced management. For the first episode of primary spontaneous pneumothorax, 75.7% of surgeons opted for chest tube drainage, 14.9% for only oxygen administration, 4.1% for needle aspiration, and none of the surgeons preferred video-assisted thoracoscopic surgery. For patients with a persistent air leak after chest tube placement, there was a wide variation in the duration of observation before performing surgery. Video-assisted thoracoscopic surgery was the most preferred surgical intervention (75.3%) and the most preferred surgical method was stapled bullectomy (43.8%). Conclusion: There are practice variations in the management of pediatric primary spontaneous pneumothorax among the society members. However, the majority of members seem to agree on the use of computed tomography, initial treatment, and surgical interventions.

Is testicular microlithiasis associated with testicular pathologies in children?

PURPOSE: To analyze the association of testicular pathologies with TM. METHOD: The retrospective study included pediatric patients who underwent scrotal ultrasonography (US) due to complaints, including testicular pain, discomfort, swelling, scrotal redness in our clinic between June 2020 and January 2022. The patients were divided into two groups. Group 1; patients were diagnosed with testicular pathology or presented with testicular pain. Group 2; patients without testicular pathology or complaints. Patients were also classified as having undescended testis, epididymo-orchitis, varicocele and testicular pain without testicular pathology in group 1. Group 1 and subgroups of group 1 were compared with group 2 for the presence of TM. RESULTS: A total of 516 patients were included in the study. Median age at the time of US examination was 24 months (range 1 month-17 years). There was no significant difference between groups 1 and 2, and boys with undescended testis and group 2 with regard to the presence of TM (p = 0.85, p = 0.55, respectively). TM was significantly higher in patients who had undergone orchiopexy and presented with testicular pain compared to group 2 (p = 0. 013, p = 0.03, respectively). TM was not detected in patients with epididymo-orchitis, varicocele. CONCLUSION: We found no association between TM and testicular pathologies. Testicular pain may be a symptom of microlithiasis.

Potential therapeutic effects of ethyl pyruvate in an experimental rat appendicitis model.

BACKGROUND: Pathophysiology of appendicitis is associated with the underlying inflammatory processes. Ethyl pyruvate (EP) has potent antioxidant and anti inflammatory properties. In this study, we aimed to investigate the effects of EP on the treatment of appendicitis and to examine whether adding EP to the antibiotic treatment could increases the effectiveness of the treatment in a rat appendicitis model. METHOD: Thirty two Wistar rats, which had previously created appendicitis, were randomly divided into 4 groups: Group 1 (0.1 ml saline solution), Group 2 (15 mg/kg ceftriaxone), Group 3 (50 mg/kg EP), Group 4 (EP 50 mg/kg + ceftriaxone 15 mg/kg). In all groups, saline solution, ceftriaxone and EP were administered intraperitoneally and the same procedure was repeated twice a day for the following five days. On day 6, the rats underwent relaparotomy and then intraabdominal findings were recorded. Histopathological examination and interleukin 6 (IL 6) level were performed on appendiceal specimens. RESULTS: Intra abdominal adhesion score was significantly lower in Group 4 than in Group 1. Total inflammation score was significantly lower in Group 2 than in Group 1 and was significantly lower in Group 4 than in Group 3 and 1. IL 6 level was significantly lower in Group 4 than in Group 3 and 1. CONCLUSION: We found that adding EP to the antibiotic therapy increased the efficacy of the treatment in the rat appendicitis model. Further studies are required to apply our findings to the clinical setting.

Comparison of bipolar electrosurgical devices with ligatures and endoclips in the rat appendicitis model.

PURPOSE: The aim of this study is to compare bipolar radiofrequency-driven vessel sealer, bipolar electrocautery, polyglactin 910 sutures, and endoclips in appendiceal stump closure with respect to operative time, appendiceal stump strength, and inflammation in a rat appendiceal model. METHODS: Forty-eight Wistar-Albino rats, which had previously created appendicitis, were divided into 2 (groups A and B). Each group was further subdivided into 4 subgroups (AL, ABPC, AC, AS, BL, BBPC, BC, and BS) each containing 6 rats. An appendectomy was performed, and the stump was closed by bipolar radiofrequency-driven vessel sealer in the L, bipolar electrocautery in the BPC, endoclips in the C, and ligatures in the S subgroups. Cecum bursting pressures were determined instantly after the operation in group A and on the seventh postoperative day in group B. All operative times were measured. Appendices and appendiceal stumps underwent histopathologic examination. Statistical analyses were performed with Kruskal-Wallis and Mann-Whitney U tests. P < .05 was considered significant. RESULTS: Bursting pressures of the subgroups were comparable on postoperative immediate period and day 7. Operative times were significantly shorter in the L and BPC subgroups in A and B. Histopathologic examination showed that the inflammation scores were similar in group A. In group B, inflammation parameters were also similar except the necrosis status, which was found to be decreased in BL compared with BC and BS. Necrosis status was significantly lower, and lymphocyte quantity was significantly higher in BL and BBPC compared with AL and ABPC. CONCLUSIONS: Bipolar radiofrequency-driven vessel sealer and bipolar electrocautery achieve safe stump closure with satisfactory bursting pressure values in an experimental rat appendicitis model. Decreased operative time and unimpaired healing are encouraging.

Passive smoke exposure is associated with perioperative adverse effects in children.

STUDY OBJECTIVE: To evaluate the frequency of respiratory adverse events during general anesthesia in children passively exposed to cigarette smoke (PSE). DESIGN: Prospective, double blinded, observational study. SETTING: Operating room and recovery room of a university hospital. MEASUREMENTS: Data were collected from 385 children who underwent elective surgery during general anesthesia from June to November, 2008. PSE was identified by using the child's caregivers' information. Respiratory adverse events were recorded during anesthesia and post-anesthesia. MAIN RESULTS: Technique of anesthesia induction and management, distribution of patients' age, gender, surgical procedures, and perioperative analgesic methods were similar in the PSE and non-PSE groups. Respiratory adverse events were reported in 58 patients (15.1%): 50 patients (21.4%) were in the PSE and 8 patients (5.3%) were in the non-PSE group (P = 0.00). The frequency of laryngospasm during anesthesia (P = 0.03) and hypersecretions in the recovery room (P = 0.00) were significantly increased in the PSE group. CONCLUSIONS: Children who are exposed to environmental tobacco smoke and who undergo general anesthesia seem to have an increased risk of respiratory complications in the recovery period rather than during anesthesia.

The advantages of cyanoacrylate wound closure in circumcision.

PURPOSE: To compare 2-octyl-cyanoacrylate (2-octyl-CA) glue with polyglytone 6211 sutures in circumcision wound closure on the basis of operative time, safeness, postoperative pain and cosmesis. PATIENTS AND METHODS: The boys who would undergo circumcision in 18-month period (n = 137) were grouped into two. In Group 1 (n = 64), 6/0 polyglytone 6211 sutures, and in Group 2 (n = 73), 2-octyl-CA glue were used for wound closure. Durations of anesthesia, surgical procedures and postoperative pain, and pain scores on the 2nd and 48th postoperative hours were determined. A classification system was constructed to evaluate cosmesis, intraoperative and postoperative bleeding. Quantitative differences were assessed by Mann-Whitney U and Student's t tests, and qualitative analyses were performed by χ (2) test. p was considered as significant at less than 0.05. RESULTS: The pain scores of the groups were comparable. Durations of anesthesia, surgical procedures and postoperative pain were significantly shorter (p < 0.05); and cosmesis, intraoperative and postoperative bleeding status were significantly better in Group 2 (p < 0.05). CONCLUSION: 2-Octyl-CA seems to be a good alternative to the conventional suturing technique in circumcision wound closure with shorter operation time, ease of appliance, improved safeness, better cosmesis and shorter duration of postoperative pain.

LigaSure compared with ligatures and endoclips in experimental appendectomy: how safe is it?

PURPOSE: The present study aims to compare strength, healing, and inflammation of appendiceal stumps closed by LigaSure Precise (Valleylab, Boulder, CO, USA) device, ligatures using polyglactin 910 (Vicryl, Ethicon, Edinburgh, UK) and endoclips (Ligaclip ERCA, Ethicon, OH, USA), and operation time (OT) in experimental appendectomy. METHODS: Forty-eight Sprague-Dawley rats were divided into two (Group A and B). Each group was further subdivided into three subgroups (AS, AC, AL, BS, BC, BL) containing eight rats. Appendectomy was performed and stump was closed by ligatures in S, by endoclips in C and by LigaSure in L subgroups. OT was recorded. In Group A, cecum bursting pressures (BP) were determined instantly after the operation. In Group B, BP, histological evaluations, and measurements of collagen contents estimated by the tissue hydroxyproline (HPL) level were made on the seventh postoperative day. Statistical analyses were performed with Kruskal-Wallis test and Mann-Whitney U test. P value was considered significant at less than 0.05. RESULTS: BPs of subgroups were comparable on postoperative immediate period and day 7. HPLs and OTs were significantly better in L subgroups. BL had the least inflammation. CONCLUSION: Better healing, less inflammation, shorter OT, and equal strength achieved with LigaSure device comparing with polyglactin 910 ties and endoclips in experimental appendectomy is encouraging.

Heterotopic gastric mucosa leading to recurrent intussusceptions: report of a case.

Although most cases of intussusception during childhood are caused by viral enlargement of the Peyer's patches, the remainder of the cases may be due to congenital anomalies, such as heterotopic gastric mucosa (HGM). This report presents a case of HGM in a 4-year-old boy. The patient presented with acute abdominal signs with a right lower quadrant mass. His medical history indicated three episodes of recurrent intussusceptions. The abdominal ultrasound examination detected an intussusception. A laparotomy revealed an ileocolic intussusception and reduction was accomplished. During exploration, an intraluminal mass in the ileum, which was the lead point, was discovered by palpation. An enterotomy showed a 2-cm-diameter crater-shaped mucosal thickening. An ileal resection and anastomosis was performed. The histopathological examination revealed HGM. Heterotopic gastric mucosa is supposed to be of vitellointestinal tract origin and may cause intussusception as being a lead point in the ileum. Despite its rarity, HGM should be considered in cases of recurrent intussusceptions and diagnostic studies should be performed. A laparotomy is required for the diagnosis and treatment in complicated cases. Surgical management should include reduction of the intussusception and careful manual examination of the ileum which may expose such pathology. An intestinal resection and anastomosis is sufficient to prevent complications.

Is the use of cyanoacrylate in intestinal anastomosis a good and reliable alternative?

PURPOSE: The present study aims to compare strength, healing, and operation time of experimental intestinal anastomoses performed by polyglactin 910 (Vicryl; Ethicon, Edinburgh, United Kingdom) sutures with ethyl-2-cyanoacrylate glue (Pattex; Henkel, Dusseldorf, Germany). MATERIAL AND METHODS: Ninety-six Sprague-Dawley rats were divided into 2 (groups E and L). Each group was further subdivided into 6 subgroups (EA1, EA2, EA3, EB1, EB2, EB3, LA1, LA2, LA3, LB1, LB2, LB3), each containing 8 rats. Intestinal anastomosis was performed by polyglactin 910 sutures in A subgroups and with ethyl-2-cyanoacrylate in B subgroups. The anastomosis was end to end in A1 and B1, side to side in A2 and B2, and end to side in A3 and B3. Time for anastomosis performance (AT) was recorded. In group E, bursting pressures and hydroxyproline levels were determined on the second postoperative day, whereas in group L, the same measurements were made on the sixth postoperative day. One-way analysis of variance was used for analyses of variance in the groups. Quantitative data were analyzed with Student's t test. P value was considered significant at less than .05. RESULTS: There was no significant difference between bursting pressures of subgroup pairs on both postoperative days 2 and 6. Hydroxyproline levels and AT were significantly better in B subgroups. CONCLUSION: Better healing, shorter AT, and equal strength were achieved with ethyl-2-cyanoacrylate compared with polyglactin 910 sutures in intestinal anastomosis in the experimental setting.

Surgical experience in a baby with congenital broncho-biliary fistula.

Congenital tracheobiliary and bronchobiliary fistulae are rare malformations in which patent communications exist between the respiratory system and biliary tract, respectively. We present a newborn who was admitted with respiratory distress and bilious tracheal discharge. Investigation revealed a bronchobiliary fistula originating from the left main bronchus, as well as biliary atresia. Excision of the bronchobiliary fistula was successful and the connection between biliary tract and gastrointestinal system was established by performance of a Roux-en-Y cholecysto-jejunostomy. Diagnostic tools, differential diagnosis, and surgical correction strategies are discussed.

An old technique for surgery of 'high' undescended testis revisited.

INTRODUCTION: Most undescended testes resolve spontaneously in the first year of life. If the testis remains undescended by the second year, the most probable means of scrotal placement is orchiopexy. After the first successful operation for orchiopexy, many surgical modifications were described. This study presents our limited experience with Prentiss' maneuver in six boys with high undescended testes. PATIENTS AND METHODS: Two left, two right and two bilateral testes, in six patients, were operated. Five patients were admitted with the complaint of unilaterally or bilaterally 'empty scrotum'. The sixth patient previously had a right high undescended testis which had been placed in a high scrotal position. Following the standard steps of inguinal orchiopexy Prentiss' maneuver were performed and yielded adequate distance to place the testes mid scrotum. RESULTS: On follow-up, Doppler ultrasound examination revealed normal sized testes with normal blood flow in all patients with dimensions correlated with age. CONCLUSION: Although perhaps only useful in orchiopexy for high undescended testis, incision of the transversalis fascia preserves testicular blood flow by relieving tension on the testicular vessels.

Segmental dilatation of the ileum accompanying hypoproteinemia.

PURPOSE: Segmental intestinal dilatation (SID) is a rare pathologic finding, which causes intestinal obstruction in newborn period and gastrointestinal bleeding, anemia, abdominal pain, malabsorption, and growth failure in older children. We present a case of SID causing hypoproteinemia. PATIENT: A 10-year-old girl presented with recurrent abdominal distension since she was 8.5 months old. She was diagnosed to have protein-losing intestinal lymphangiectasia. Result of physical examination was normal except moderate growth retardation. Her blood workup showed depletion in total protein, albumin, and globulin levels. Gastrointestinal series revealed a dilated segment of small intestine, and Tc(99m)-pertechnetate scintigraphy detected ectopic activity in abdomen. The patient was taken to operation with the presumptive diagnosis of intestinal duplication. A dilated segment of ileum was encountered, and segmental resection and anastomosis were performed. RESULTS: Patient was discharged on the postoperative fourth day and remains well. Histopathologic examination of the specimen revealed SID. DISCUSSION: Segmental intestinal dilatation is an uncommon congenital anomaly. Most of the cases were operated on in newborn period because of intestinal obstruction, and their diagnoses were made perioperatively; the others were diagnosed in older ages during the investigation of nonspecific symptoms. The index patient is the second case of SID having hypoproteinemia in the literature. Gastrointestinal series suggested the diagnosis, and segmental resection and anastomosis were the adequate treatments.

Bronchogenic cyst of the right hemidiaphragm mimicking a hydatid cyst of the liver: report of the first pediatric case.

Bronchogenic cyst (BC), which develops from abnormal budding of the tracheal diverticulum or ventral foregut, is a congenital bronchopulmonary malformation. Localization of the BC varies depending on the level of the abnormal budding. Thoracic or abdominal-sited diaphragmatic lesions are the rarest presentations of the BC. We present a case of BC that originated from the diaphragm and mimicking hydatid cyst of the liver in a 19-month-old girl. Diagnosis of a diaphragmatic lesion was confirmed during laparotomy and complete resection was successful.

Laparoscopic surgery: does it increase the probability of atrial and ventricular arrhythmias in children?

PURPOSE: Despite the minor physiologic changes those occur during laparoscopic procedures, pneumoperitoneum with CO2 insufflation may induce alterations in electrocardiographic (ECG) variables, which may predict severe atrial and ventricular arrhythmias. This study aims to assess QT dispersion (QTD) and P wave dispersion (PWD) changes in children who have undergone laparoscopic appendectomy. PATIENTS AND METHODS: Sixteen patients (12 males and 4 females) who had preoperative diagnosis of appendicitis were included in the study. As laparoscopic exploration revealed appendicitis in all patients, laparoscopic appendectomy was performed. Preinsufflation (ECG1), postinsufflation (ECG2), predesufflation (ECG3), and postdesufflation (ECG4) ECGs were achieved at a speed of 25 mm/s for QTD and PWD analyses. RESULTS: Although mean corrected QTD and PWD at ECG2 and ECG3 were significantly greater than ECG1 and ECG4, those changes induced by insufflation of CO2 were reversible. CONCLUSIONS: The clinical significance of pneumoperitoneum, which causes an increase in corrected QTD and PWD in children, remains to be determined with further studies.