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INTRODUCTION: Over the years, congenital lung malformations (CLM) management remains a controversial topic in pediatric thoracic surgery. The Italian Society of Pediatric Surgery performed a national survey to study the current management variability among centers, trying to define national guidelines and a standardized approach of children with congenital lung malformations. METHODS: Following a National Society approval, an electronic survey including 35 items on post-natal management was designed, focusing on surgical, anesthesiology, radiology and pneumology aspects. The survey was conducted contacting all pediatric surgical units performing thoracic surgery. RESULTS: 39 pediatric surgery units (97.5%) participated in the study. 13 centers (33.3%) were classified as high-volume (Group A), while 26 centers (66.7%) were low volume (Group B). Variances in diagnostic imaging protocols were observed, with Group A performing fewer CT scans compared to Group B (p = 0.012). Surgical indications favored operative approaches for asymptomatic CLM and pulmonary sequestrations in both groups, while a wait-and-see approach was common for congenital lobar emphysema. Surgical timing for asymptomatic CLM differed significantly, with most high-volume centers operating on patients younger than 12 months (p = 0.02). Thoracoscopy was the preferred approach for asymptomatic CLM in most of centers, while postoperative long-term follow-up was not performed in most of the centers. CONCLUSION: Thoracoscopic approach seems uniform in asymptomatic CLM patients and variable in symptomatic children. Lack of uniformity in surgical timing and preoperative imaging assessment has been identified as key areas to establish a common national pattern of care for CLM.
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Pneumopatias , Anormalidades do Sistema Respiratório , Humanos , Criança , Pneumopatias/congênito , Anormalidades do Sistema Respiratório/cirurgia , Pneumonectomia/métodos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Pulmão/anormalidades , Itália , Estudos RetrospectivosRESUMO
BACKGROUND: Both thoracic drainage and video-assisted thoracic surgery (VATS) are available treatment for pleural empyema in pediatric patients. MATERIALS AND METHODS: This retrospective multicenter study includes pediatric patients affected by pleural empyema treated from 2004 to 2021 at two Italian centers. Patients were divided in G1 (traditional approach) and G2 (VATS). Demographic and recovery data, laboratory tests, imaging, surgical findings, post-operative management and follow-up were analyzed. RESULTS: 70 patients with a mean age of 4.8 years were included; 12 (17.1%) in G1 and 58 (82.9%) in G2. Median surgical time was 45 min in G1, 90 in G2 (p < 0.05). Mean duration of thoracic drainage was 7.3 days in G1, 6.2 in G2 (p > 0.05). Patients became afebrile after a mean of 6.4 days G1, 3.9 in G2 (p < 0.05). Mean duration of antibiotic therapy was 27.8 days in G1, 25 in G2 (p < 0.05). Mean duration of postoperative hospital stay was 16 days in G1, 12.1 in G2 (p < 0.05). There were 4 cases (33.3%) of postoperative complications in G1, 17 (29.3%) in G2 (p > 0.05). 2 (16.7%) patients of G1 needed a redosurgery with VATS, 1 (1.7%) in G2. CONCLUSIONS: VATS is an effective and safe procedure in treatment of Pleural Empyema in children: it is associated to reduction of chest tube drainage, duration of fever, hospital stay, time of antibiotic therapy and recurrence rate.
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Empiema Pleural , Cirurgia Torácica Vídeoassistida , Criança , Humanos , Pré-Escolar , Cirurgia Torácica Vídeoassistida/efeitos adversos , Desbridamento , Empiema Pleural/cirurgia , Drenagem/métodos , Estudos Retrospectivos , Antibacterianos/uso terapêuticoRESUMO
The need for cholecystectomy during pediatric age has significantly increased in the last two decades. As biliary pathology increases, the probability of complicated cholecystectomies increases too. The aim of this article is to analyze our experience with difficult laparoscopic pediatric cholecystectomy, focusing on the importance of an accurate pre-operative imaging study. We retrospectively analyzed all patients affected by cholelithiasis who underwent laparoscopic cholecystectomy at the Pediatric Surgery Department of San Camillo Forlanini hospital of Rome and Santa Maria alle Scotte University Hospital of Siena from 2017 to 2022. Demographic data, body mass index (BMI), recovery data, laboratory tests, imaging exams, surgical findings, post operative management and outcome were taken into account. Overall, 34 pediatric patients, with a mean age of 14.1 years (6-18 years) were included, with a mean BMI of 29. All patients underwent abdominal ultrasonography and a liver MRI with cholangiography (cMRI). We identified five cases as "difficult cholecystectomies". Two subtotal cholecystectomies were performed. Cholecystectomy in pediatric surgery can be difficult. The surgeon must be able to find alternative strategies to total cholecystectomy to avoid the risk of possible bile duct injury (BDI). Pre-operative imaging study trough ultrasound and especially cMRI is crucial to recognize possible difficulties and to plan the surgery.
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BACKGROUND: Robot-assisted approach to UVJ is getting more and more used in pediatric patients. METHODS: In this retrospective study 26 patients affected by nephro-urological malformations, robotic-surgically treated from 2016 and 2021 at 3 Pediatric Surgery Department were included: 3 (11.5%) primary obstructive megaureter, 2 (7.7%) dysplastic kidneys, 3 (11.5%) duplex collecting system, 18 (69.2%) primary vescico-ureteral reflux (VUR). RESULTS: Mean age at surgery was 6 years old. 22 (84.6%) underwent Lich Gregoire extravesical ureteral reimplantation, 4 (15.4%) total nephroureterectomy. Mean operative time was 230 min. No conversions or intraoperative complications. Median hospital stay was 4 days. There were 4 (15.38%) postoperative complications: 3 (11.54%) persistent VUR and 1 (3.84%) refluxing megaureter. 2 (7.7%) redo-surgery. CONCLUSIONS: Robotic Surgery should be considered a safe and effective technique for treatment of UVJ anomalies in children, because it firstly allows surgeons to approach both upper and lower ureteral ends without modifying trocars' placement.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Ureter , Refluxo Vesicoureteral , Criança , Humanos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Refluxo Vesicoureteral/cirurgia , Resultado do Tratamento , Ureter/cirurgia , Laparoscopia/métodosRESUMO
STUDY OBJECTIVE: Ovarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making. DESIGN: We conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010-2020). PARTICIPANTS: Patients aged 0-18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions. RESULTS: Ninety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary. CONCLUSIONS: Our results showed that a post-menarchal age (p = .001), a pre-operative US ovarian size < 5 cm, (p = .001), the presence of severe abdominal pain (p = .002), a laparoscopic approach (p < .001), and the presence of a functional cyst (p = .002) were significantly associated with conservative surgery.
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Cistos , Doenças Ovarianas , Feminino , Criança , Humanos , Estudos Retrospectivos , Torção Ovariana , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/cirurgia , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/cirurgia , Dor Abdominal/etiologia , Estudos Multicêntricos como AssuntoRESUMO
BACKGROUND: Inguinal hernia repair is one of the most common pediatric surgeries that can be approached with an open or laparoscopic approach. The aim of this study was to describe outcomes and complications of flip flap inguinal hernia repair analyzing our experience in the last 5 years. METHODS: Between 2015 and 2020, 280 children admitted at our department with inguinal hernia requiring surgery were included. Secondary aim was to investigate how confidence of surgeons regarding VLS approach increase during time and how this particular technique represents a primary procedure useful to increase surgeons' skills in performing laparoscopic sutures. RESULTS: One hundred sixty children (57%) underwent open approach, whereas 120 (43%) laparoscopic ligations of hernia. For each group, clinical and surgical data were recorded. We focused on comparing postoperative complications: the most frequent complication was hydrocele (N.=4, 1.4%). Reported postoperative complication were not statistically different between two groups (open N.=3, 1.8% vs. laparoscopy N.=1, 0.8%). No other postoperative complications were documented in our cohort for both groups. In laparoscopic group we registered 3 cases of ipsilateral recurrence (1.6%) and no cases of metachronous hernia. The choice of laparoscopic approach significantly increased from 22% in 2015 to 74% in 2020 (P<0.05) as well as the percentage of male underwent to laparoscopic procedure (38% in 2015 to 74% in 2020, P<0.05). CONCLUSIONS: It is known that the rate of complication or recurrence is similar for open or minimally invasive inguinal hernia repair. Laparoscopy offers advantages such as the possibility of visualizing contralateral internal inguinal ring, reducing the incidence of metachronous inguinal hernia. Moreover, taking confidence with a minimally invasive technique such Flip Flap hernioplasty by performing it repeatedly over time, leads to an improvement of surgeons' skills also in performing laparoscopic sutures, that can be helpful for other complex or tricky procedures.
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Hérnia Inguinal , Laparoscopia , Hidrocele Testicular , Humanos , Criança , Masculino , Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Hidrocele Testicular/cirurgia , Herniorrafia/métodosRESUMO
AIM OF THE STUDY: To compare a multicentric surgical experience on ovarian teratomas in childhood with the current management trends. DESIGN: A retrospective multicentric pediatric ovarian teratomas surgically treated between January 2000 and August 2020 at four Italian institutions. PubMed database was used to search for Reviews and Systematic Reviews published between January 2010 and August 2020: 15 manuscripts reported 3633 ovarian neoplasms in pediatric age, 1219 (33,5%) of which were ovarian teratomas. RESULTS: A hundred-ten patients with a mean age at diagnosis of 11.8 years were enrolled. Mature cystic teratomas accounted for the 90% of the masses. At surgery, 78 were oophorectomies and 32 were ovary sparing surgeries. Laparoscopy occurred in 16.3% of the surgeries.As regarding the current management trends, the mean age at diagnosis was 11.9 years and 80.5% of the cases were represented by mature teratomas. Of 430 procedures, 331 were oophorectomies while 99 were ovary sparing surgeries and laparoscopy was performed in 23.8% of cases. CONCLUSIONS: Ovary-sparing surgery with laparoscopic approach is increasingly offered as standard treatment for benign masses that fit the criteria for mature teratomas, in the attempt to achieve the best compromise between the preservation of fertility and the prevention of recurrences. Awareness should be raised among pediatric surgeons to reduce unnecessary radical surgery.
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Neoplasias Ovarianas/cirurgia , Teratoma/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Preservação da Fertilidade/métodos , Humanos , Lactente , Laparoscopia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/patologia , Ovariectomia , Estudos Retrospectivos , Teratoma/epidemiologia , Teratoma/patologiaRESUMO
The robotic approach in the treatment of thymus diseases has been described in many papers, but few studies have compared the early outcome of patients after robotic and open transsternal procedure. Our study aims to confirm the non-inferiority of the robotic technique in terms of feasibility, safety and postoperative patient recovery compared to the open standard. This is a retrospective cohort study in which we compare 114 patients who underwent thymectomy for a thymus disease at our thoracic surgery unit. Our robotic surgery programme started in February 2012 with the treatment of mediastinal diseases. Since then, we have performed 57 robotic thymectomies (Group A). This series was compared with 57 patients who underwent open thymectomies (Group B) performed before 2012, and all were properly matched through a propensity score. Hospital and ICU stay, postoperative pain, use of painkillers, operative time and complications rate were analysed. Postoperative pain, evaluated through the Visual Analogue Scale (VAS), was significantly lower in the robotic surgery group (p < 0.001), which was associated with a trend to lower use of painkillers in Group A, although it was not significant (p = 0.06). No statistical differences were observed between the two groups in terms of ICU stay (p = 0.080), although the total hospital stay was significantly longer in Group B (p = 0.003). No statistical differences were observed in operative time (p = 0.492) and complications rate (p = 0.950). The robotic-assisted technique showed the same operative time and complications rate compared with open surgery, thereby confirming its safety and feasibility in myasthenic patients as well as in Masaoka I-II thymomas. The lower postoperative pain and the shorter hospital stay associated with prompt mobilisation and faster chest drainage removal showed the great advantage of the minimally invasive robotic approach in these patients.
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Procedimentos Cirúrgicos Robóticos/métodos , Timectomia/métodos , Timoma/cirurgia , Timo/cirurgia , Neoplasias do Timo/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Segurança , Resultado do TratamentoRESUMO
OBJECTIVES: Somatic mosaicism of PIK3CA gene is currently recognized as the molecular driver of Klippel-Trenaunay syndrome. However, given the limitation of the current technologies, PIK3CA somatic mutations are detected only in a limited proportion of Klippel-Trenaunay syndrome cases and tissue biopsy remains an invasive high risky, sometimes life-threatening, diagnostic procedure. Next generation sequencing liquid biopsy using cell-free DNA has emerged as an innovative non-invasive approach for early detection and monitoring of cancer. This approach, overcoming the space-time profile constraint of tissue biopsies, opens a new scenario also for others diseases caused by somatic mutations. METHODS: In the present study, we performed a comprehensive analysis of seven patients (four females and three males) with Klippel-Trenaunay syndrome. Blood samples from both peripheral and efferent vein from malformation were collected and cell-free DNA was extracted from plasma. Tissue biopsies from vascular lesions were also collected when available. Cell-free DNA libraries were performed using Oncomine™ Pan-Cancer Cell-Free Assay. Ion Proton for sequencing and Ion Reporter Software for analysis were used (Life Technologies, Carlsbad, CA, USA). RESULTS: Cell-free circulating DNA analysis revealed pathogenic mutations in PIK3CA gene in all patients. The mutational load was higher in plasma obtained from the efferent vein at lesional site (0.81%) than in the peripheral vein (0.64%) leading to conclude for a causative role of the identified variants. Tissue analysis, available for one amputated patient, confirmed the presence of the mutation at the malformation site at a high molecular frequency (14-25%), confirming its causative role. CONCLUSIONS: Our data prove for the first time that the cell-free DNA-next generation sequencing-liquid biopsy, which is currently used exclusively in an oncologic setting, is indeed the most effective tool for Klippel-Trenaunay syndrome diagnosis and tailored personalized treatment.
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Ácidos Nucleicos Livres/genética , Classe I de Fosfatidilinositol 3-Quinases/genética , DNA/genética , Sequenciamento de Nucleotídeos em Larga Escala , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Mosaicismo , Mutação , Análise de Sequência de DNA , Adulto , Ácidos Nucleicos Livres/sangue , Tomada de Decisão Clínica , DNA/sangue , Feminino , Marcadores Genéticos , Humanos , Síndrome de Klippel-Trenaunay-Weber/sangue , Síndrome de Klippel-Trenaunay-Weber/genética , Síndrome de Klippel-Trenaunay-Weber/terapia , Biópsia Líquida , Masculino , Pessoa de Meia-Idade , Fenótipo , Projetos Piloto , Valor Preditivo dos Testes , PrognósticoRESUMO
In the last three decades, fetal ovarian cysts were diagnosed more frequently, due to technological improvement and the increasing use of prenatal screening ultrasound. Nonetheless, treatment uncertainties are still present, either prenatally or postnatally. Recently, significant innovations on diagnosis and treatment have been proposed and a more conservative, minimally invasive approach may be offered to the Pediatrician or the Surgeon who face with this condition during prenatal or neonatal age. (...).
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Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Cistos Ovarianos/cirurgia , Cirurgia Vídeoassistida/métodos , Feminino , Humanos , Recém-Nascido , Itália , Cistos Ovarianos/diagnóstico por imagem , Gravidez , Ultrassonografia Pré-Natal/métodosRESUMO
The most appropriate treatment for the infantile Hypertrophic Pyloric Stenosis (HPS) is still debated. The non-surgical conservative treatment with oral or intravenous administration of atropine does not enjoy a widespread appreciation for several factors (...).
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Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estenose Pilórica Hipertrófica/terapia , Administração Intravenosa , Administração Oral , Atropina/administração & dosagem , Humanos , Lactente , Recém-Nascido , Itália , Cirurgia VídeoassistidaRESUMO
AIM: To describe architecture and expression of myosin isoforms of the human cremaster muscle (CM) and to individuate changes in clinically differentiated abnormalities of testicular descent: cryptorchidism or undescended testis (UDT) and retractile testis (RT). BACKGROUND: The CM is a nonsomitic striated muscle differentiating from mesenchyme of the gubernaculum testis. Morphofunctional and molecular peculiarities linked to its unique embryological origin are not yet completely defined. Its role in abnormalities of testicular descent is being investigated. SUBJECTS AND METHODS: Biopsy samples were obtained from corrective surgery in cases of cryptorchidism, retractile testis, inguinal hernia, or hydrocele. Muscle specimens were processed for morphology, histochemistry, and immunohistology. RESULTS AND CONCLUSIONS: The CM differs from the skeletal muscles both for morphological and molecular characteristics. The presence of fascicles with different characterization and its myosinic pattern suggested that the CM could be included in the specialized muscle groups, such as the extrinsic ocular muscles (EOMs) and laryngeal and masticatory muscles. The embryological origin from the nonsomitic mesoderm is, also for the CM, the basis of distinct molecular pathways. In UDT, the histological alterations of CM are suggestive of denervation; the genitofemoral nerve and its molecular messengers directed to this muscle are likely defective. Compared with the other samples, RT has a distinct myosinic pattern; therefore, it has been considered a well-defined entity with respect to the other testicular descent abnormalities.
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Músculos Abdominais/metabolismo , Criptorquidismo/metabolismo , Miosinas/biossíntese , Doenças Testiculares/metabolismo , Músculos Abdominais/anatomia & histologia , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Estudos Prospectivos , Isoformas de Proteínas/biossínteseRESUMO
PURPOSE: To evaluate and compare the feasibility and short-term results of laparoscopic and robotic total oesophago-gastric dissociation (TOGD) with a Roux-en-Y oesophago-jejunostomy. Minimal invasive surgery has multiple advantages in neurologically impaired patients. Robotic approach has overcome disadvantages linked to laparoscopy, in particular, referring to the surgeon fatigue. METHODS: A retrospective study comparing five laparoscopic and five robotic TOGD was conducted between February and October 2016 in Giannina Gaslini Children's Hospital and Section of Pediatric Surgery of Siena. Neurologically impaired children scheduled for TOGD were included. Age, sex, weight, symptomatology, presence of epilepsy, and preoperative X-ray contrast were considered. Operative time, hospital stay, postoperative complications, redo surgery, nutrition rehabilitation, and X-ray contrast study after 5 days and after 1 month from the intervention were recorded. RESULTS: In our series, there were no intraoperative complications, no conversions to open surgery, and no vagal lesions. In two of five robotic cases, a pyloroplasty was necessary. The median operative time was statistically longer in the robotic group. One dehiscence in the robotic group was recorded, and no dumping episodes occurred. No statistical differences in terms of complications were detected. CONCLUSION: TOGD is feasible both with laparoscopic and robotic-assisted surgery with similar results. Robotic approach is considered feasible. At the same time, high laparoscopic skills allow to reach the same results as robotic approach with shorter operative time.
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Esofagostomia/métodos , Refluxo Gastroesofágico/cirurgia , Jejunostomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Tempo de Internação , Duração da Cirurgia , Estudos RetrospectivosRESUMO
In the last decade, the applicability of robotic surgery has been demonstrated in many interventions, expanding the indications of minimally invasive surgery also to pediatrics. The aim of the study is to evaluate postoperative pain to demonstrate better control following robotic procedures compared to thoraco-laparoscopic surgery. An observational, retrospective, multicentre study was performed involving 204 children undergoing robot-assisted surgery and thoraco/laparoscopic surgery at the Istituto Giannina Gaslini in Genoa and the Siena University Hospital (2013-2017): 83 children underwent robotic-assisted surgery and 121 thoracic-laparoscopic surgery. Personal data and type of intervention were assessed, dividing the patients into four categories: thoracic, gastrointestinal, hepatobiliary and urological surgeries. We analyzed the anesthetic risk according to ASA classification by type of intervention, the type of anesthesia used, the anesthetic drugs used during surgery and in the postoperative period. Both the problems that occurred during the procedures and the number of interventions converted into open during robotic surgery and laparoscopic thoracic surgery were analyzed. Pain was measured on the 1st, 2nd and 3rd day (FLACC or NRS scales). By comparing the two groups (robotics-non-robotics), the analysis shows that postoperative pain does not change with the chosen approach, but always maintains very low values, typical of minimally invasive surgery. The pain score is significantly higher in patients undergoing thoracic surgery, either robotic or thoracoscopic, compared to those undergoing gastrointestinal surgery (P corrected according to Bonferroni: 0.0006) and those undergoing urological intervention (P corrected according to Bonferroni: 0.04). In conclusion, no significant change in the intensity of postoperative pain between the two groups was found, while it is seen that the pain in patients undergoing thoracic interventions (robotic/thoracoscopic) is more intense than that reported for other types of interventions.
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Anestesia , Laparoscopia/métodos , Manejo da Dor , Dor Pós-Operatória/prevenção & controle , Procedimentos Cirúrgicos Robóticos/métodos , Toracoscopia/métodos , Adolescente , Criança , Pré-Escolar , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Dor Pós-Operatória/epidemiologia , Pediatria , Estudos Retrospectivos , Risco , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Toracoscopia/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
BACKGROUND: Urethral duplication associated with epispadias is a rare malformation. Few cases are described in Literature. We report the experience of two centers to add to the literature. METHODS: A retrospective study was conducted in two Italian Centers. All patients with urethral duplication associated with epispadias, treated from 1997 to 2017 were included. The preoperative work-up included renal-urinary ultrasonography and voiding cystourethrogram. All patients underwent surgery according to the Mitchell-Caione technique. Cosmetic result, urinary continence and satisfaction degree of patients at the last follow-up were evaluated as outcomes. Six male patients with urethral duplication in epispadias were included. Two patients presented penile epispadias and four penopubic epispadias. Only one patient had urinary incontinence as presenting symptomatology. The diagnosis of urethral duplication was accidental during preoperative evaluation in the remaining five patients. RESULTS: At last follow-up (mean 8.3 years) all patients but one presented good cosmetic result, one patient presented mild stress urinary incontinence, one presented nocturnal enuresis. The physical genital appearance was improved in all patients. Urethral duplication in association with epispadias is a rare urogenital abnormality. No classification is universally accepted. CONCLUSIONS: Based on our experience, we believe that the presence of any duplication should be carefully searched during surgery for male epispadias.
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Epispadia/complicações , Epispadia/cirurgia , Uretra/anormalidades , Uretra/cirurgia , Doenças Uretrais/complicações , Doenças Uretrais/cirurgia , Adolescente , Criança , Pré-Escolar , Epispadia/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Satisfação do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Incontinência Urinária , Procedimentos Cirúrgicos Urológicos MasculinosRESUMO
PURPOSE: The purpose of this study was to quantify the experience of five Italian centers on the diagnosis and management of isolated fallopian tube torsion (IFTT) in children. METHODS: We retrospectively reviewed the data of 20 patients aged 1-16â¯years of age with surgically diagnosed IFTT between 1991 and 2017 from five Italian centers of pediatric surgery. We analyzed common presenting signs, symptoms, and radiographic findings, as well as surgical interventions to describe management offering further insight into the diagnosis and treatment of this rare entity. RESULTS: Twenty cases of IFTT were collected. Median age was 13.1â¯years. Menarche was present in 14 cases. A clinical history of abdominal pain was present in 13 patients, whereas in 7 patients the clinical picture was an acute abdomen. Ultrasonography was the first diagnostic examination in 16 cases. Surgical approach was by laparoscopy in 16 cases and laparotomy in 4 cases. In 11 patients IFTT was associated with another pathologic condition. In 7 of the remaining 9 IFTT without pathologic association, the girls played sports. Salpingectomy was performed in 13 patients and de-torsion in 7. CONCLUSIONS: IFTT is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. IFTT should be considered in girls with abdominal pain who practice sports with sudden body movements. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular/cystic structure with adjacent normal ovary. Conservative management is controversial but could be preferred in order to provide the best option for future fertility of these girls. TYPE OF STUDY: Treatment Study (Retrospective Study) - Level IV.
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Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/cirurgia , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/cirurgia , Abdome Agudo/etiologia , Adolescente , Criança , Doenças das Tubas Uterinas/complicações , Tubas Uterinas/diagnóstico por imagem , Feminino , Humanos , Itália , Laparoscopia , Estudos Retrospectivos , Salpingectomia , Esportes , Anormalidade Torcional/complicações , UltrassonografiaRESUMO
Torsion of an epididymal cyst is an extremely rare cause of acute scrotum in children and in young boys. Its reported incidence is 5-20%. The treatment is usually conservative. Many cases (up to 60%) regress spontaneously, especially if below 3 cm. Few cases have been reported in Literature (7 cases/2018). We add our patient as eighth case. He was a 13-year-old boy who was admitted for acute scrotum. Ultrasound excluded torsion of the testis and he was managed for 5 day conservatively. Based on clinical history and physical exam, we decided to perform a prompt surgery that revealed a torsion of epididymal cyst that was confirmed by histological exam.
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Escroto/diagnóstico por imagem , Torção do Cordão Espermático/diagnóstico , Espermatocele/diagnóstico , Doença Aguda , Adolescente , Humanos , Masculino , Torção do Cordão Espermático/cirurgia , Espermatocele/cirurgia , UltrassonografiaRESUMO
Purpose: Robotic surgery should be considered a technical opportunity for many procedures in pediatric age. The purpose of this study is to verify the correlation between robotic procedures and low weight. Materials and Methods: It is a retrospective study (2013-2017). We included all patients who underwent robotic assisted surgery for major procedures in two Italian centers for pediatric surgery. All patients were divided into two groups (group A ≤15 kg and group B > 15 kg). Parameters considered were as follows: time to console, average time procedures, time of hospitalization, and minor/major complications. Statistical test used was Wilcoxon-Mann-Whitney test. Results: We enrolled 83 patients. Group A: 28 patients, medium weight 11.2 kg (range: 7-15 kg). Group B: 55 patients, average weight 40.8 kg (range: 15.2-120 kg). In relation to the outcomes considered, we found statistical significance in relation to surgical time and time at the console. Conclusions: The retrospective analysis of our case found that body weight cannot be considered an absolute contraindication for the execution of surgical procedures in robotics. The improvement of instruments permits to perform complex surgical procedures in low-weight children without additional difficulties. However, it is important to point out that the youngest child of our case had a weight of 7 kg.
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Peso Corporal , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pediatria/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/instrumentaçãoRESUMO
BACKGROUND: Phimosis is a condition in which the foreskin cannot be portrayed on the glans. It is a physiological and common condition in the pediatric age. The pathological form derives from an inflammatory or traumatic lesion. Circumcision is the most common surgical treatment of phimosis but it is a controversial practice, especially in occidental world. METHODS: We enrolled 61 patients with pathological phimosis (22/balanoposthitis, 18/painful erection, 21/urinary discomfort) between 2015-2017. RESULTS: All patients underwent preputialplasty. CONCLUSIONS: Various alternatives to circumcision have been described, as manual retraction therapy, topical steroid therapy, and many types of preputialplasty. We report our technique.