Observations and experiences of pediatric surgeons working on the field in the first 7 days of the Kahramanmaras earthquake.

Purpose: This study aims to share our experiences and problems, and to suggest solutions as pediatric surgeons who took part in the teams that went voluntarily to the region hit by the Kahramanmaras earthquake during the first 7 days after the disaster. Methods: This study conveys our observations made at Kahramanmaras Sütçüimam University Faculty of Medicine Hospital, where we worked as a volunteer team between February 7 and 14, 2023. Results: During the first few days, there were registration problems due to lack of electricity, water, and internet, as well as issues with sterile surgical environments. In the following days, a lack of auxiliary health personnel was revealed as the main difficulty. Conclusion: Since coordination is important when working as a team in the aftermath of an earthquake, staff from the same center should be deployed together if possible, and a team leader should be selected. Alternative recording systems should be established in case of power outages and computer problems. Secretaries, auxiliary health staff, and technicians should be included in the team in addition to doctors and nurses.

An interesting and rare cause of post-operative intussusception: Roux limb intussusception.

Intussusception is a common disease in children. Most intussusception is idiopathic and approximately 1% develops postoperatively. We present a case of a 6-year-old male patient who underwent surgery for a type 1 common bile duct cyst. In his post-operative 2nd month, the patient presented with a complaint of abdominal pain after eating, but his pain was not accompanied by nausea or vomiting. No pathological findings were evident in the examination or an abdominal X-ray of the patient. Intussusception was detected by ultrasonography and computed tomography. We wanted to introduce this interesting intussusception that originated from the Roux limb that was not seen before.

Our Cases and Literature Review for Presence of Bladder Hernias in the Inguinal Region in Children.

BACKGROUND: The rate of bladder injury during inguinal hernia repair in children is not well known. However, it is known that bladder injury during childhood inguinal hernia repair places a serious morbidity burden on children. We sought to determine an algorithm to avoid accidental bladder injuries. METHODS: Reports that included pediatric patients with inguinal hernias containing the bladder were searched. Keywords and mesh term searches were conducted in the MEDLINE, Scopus, and Web of Science databases. We reviewed our clinical records and found that two patients had inguinal hernias containing the bladder. RESULTS: Nineteen articles reporting on 26 patients diagnosed with the presence of the bladder within the inguinal canal from 1962 to 2021 were included in this article. Our two patients were added to this group. Diagnoses were made incidentally during genitourinary radiological examinations (n = 3), intraoperatively during hernia repair (n = 7), or due to clinical symptoms and findings (n = 18) after standard hernia repair. Bladder augmentation was required for three patients. CONCLUSIONS: During the operation, if there is any suspicion regarding the presence of the bladder in the inguinal region, we suggest performing a preoperative cystogram to confirm the position of the bladder and its injury. We recommend that the sac should be opened and the contents inspected before performing transfixion during high ligation of the hernia sac.

Our experience of operated pediatric ureteropelvic junction obstruction patients.

AIMS: Ureteropelvic junction obstruction (UPJO) may originate from extrinsic or intrinsic causes in children. The aim of this study is to present preoperative and postoperative data of our patients operated for UPJO. METHODS: A total of 64 patients who underwent open pyeloplasty were investigated retrospectively. They were evaluated in terms of demographically, clinics, hydronephrosis, differential renal functions (DRFs), half-time tracer clearance (½TC), and histopathologic results. Patients' numerical results were stated as mean ± standard deviation (SD). RESULTS: Male gender was more prevalent (n = 47, 73.4%) and mean age at surgery was 46.87 months. UPJO was located at the left side in 56.3% (n = 36), and at the right side in 39.1% (n = 25) of patients. It was bilateral in 4.7% (n = 3). Hydronephrosis was found antenatally in 68.8% (n = 44) of patients. The mean preoperative DRF was 49.7% (21-78%) and mean postoperative DRF was 49.2% (20-56%). Mean renal scintigraphic t1/2 was >20 min for all patients. The mean AP diameter was 21.58 mm (10-62 mm). Muscular hypertrophy was the most common pathological finding, mean length of excised segment was 10.26 mm (3-40 mm). Crossing vessel (CV) was detected in 17.18% (n = 11). The CV was statistically associated with increased age of operation, left side, and female gender. Statistically significant hydronephrosis was found in non-CV patients. Re-operation was required in seven patients (7.8%). CONCLUSIONS: Intrinsic pathologies are more seen in the etiology of UPJO patients with antenatal diagnosis and this group needs operation at an earlier age. However, CV is found more commonly in patients who are diagnosed and operated at older ages.

Use of modified Makuuchi incision for surgical treatment of abdominal tumor in children. / El uso de la incisión de Makuuchi modificada en el tratamiento de tumores abdominales en niños.

OBJECTIVE: Classical transverse, verticalabdominal or thoracoabdominal incisions inpediatric patients are frequently used to removelarge abdominal tumors such as hepatoblastomaand neuroblastoma. We present our initial experienceson our patients who was operated by modifiedMakuuchi incision.MATERIALS AND METHODS: We used this incisionin 6 cases with large abdominal tumors (1 hepatoblastomaand 5 neuroblastoma and/or ganglioneuroma)between January 2019 and August 2020.RESULTS: These patients had previously receivedchemotherapy according to appropiate protocol. Theexposure of surgical field was perfect with this incisionand dissection of the tumors was easily performed.Complete removal of large abdominal tumors was successfullyachieved in the patients although the masseshave close proximity and adhesions with importantstructures and organs. There was serous collection in2 patients and it resolved spontaneously. No wound infection, hernia or wound dehiscence was observedduring a mean follow-up of 9.6 months (ranged from3 to18 months).CONCLUSION: According to our preliminary experiences,the Modified Makuuchi incision provides a niceexposure for removal of large abdominal tumors to thesurgeons and is well tolerated by children.

OBJETIVO: Las incisiones clásicastransversa, abdominal vertical o toracoabdominal enpacientes pediátricos son utilizadas frecuentementeen la escisión de tumores abdominales de gran tamañocomo el hepatoblastoma y el neuroblastoma.Presentamos nuestra experiencia inicial en pacientesoperados usando la incision de Makuuchi modificada.MATERIALES Y MÉTODOS: Usamos esta incision en6 casos con tumores abdominales de gran tamaño (1hepatoblastoma y 5 neuroblastomas y/o ganglioneuroma)entre Enero 2019 y Agosto 2020. RESULTADOS: Los pacientes recibieron quimioterapianeoadyuvante según protocolo. La exposicióndel campo quirúrgico, así como la disección del tumor,fue perfecta con esta incisión. Se logró remover la totalidadde los tumores con éxito a pesar de su proximidady adherencias a órganos vecinos. Dos pacientespresentaron colecciónes serosas que se resolvieronespontáneamente. No se observaron infecciones de herida, hernias o dehiscencia de heridas durante elperíodo de seguimiento con una media de 9.6 meses(rango de 3-18 meses). CONCLUSIONES: Según nuestra experiencia preliminar,la incisión de Makuuchi modificada ofrece alcirujano una buena exposición del campo quirúrgicopara la extirpación de tumores abdominales de grantamaño, además de ser bien tolerada por los niños.

Protective Effects of Hydrogen-Rich Saline on Experimental Intestinal Volvulus in Rats.

BACKGROUND: Intestinal volvulus can cause morbidity and mortality. Surgical reduction, on the other hand, could result in ischemia-reperfusion (I/R) injury. Hydrogen rich saline solution (HRSS neutralizes free radicals in the body. This study aimed to investigate the effects of HRSS in I/R injury in experimental intestinal volvulus in rats. METHODS: Thirty rats were randomly allocated into 5 groups. All procedures were done under general anesthesia and sterile conditions in each animal. Five ml/kg of saline and HRSS were administered intraperitoneally (ip) in Sham (Group 1) and HRSS (Group 2) groups, respectively. Groups 3, 4, and 5 constituted the study groups in which volvulus was created in a 5-cm- long ileal segment 2 cm proximal to the ileocecal valve. After 2 hours the volvuli were reduced and following 2 hours of reperfusion, these segments were removed. In volvulus-I/R group (Group 3) no additional procedure was done. HRSS was administered shortly before reperfusion (reduction of the volvulus) in Treatment I (Group 4) and 1 h before experimental volvulus in Treatment II (Group 5) groups. Blood and intestinal tissue samples were obtained from all rats at the 4th hour. Both tissue and blood total oxidant (TOS) and antioxidant status (TAS) levels were determined and tissue histomorphologies were studied. Oxidative stress indices (TOS ÷ TAS) (OSI) were calculated. RESULTS: Tissue TOS and OSI levels and histomorphological injury scores were statistically lower in treatment groups than I/R group, whereas blood TOS and OSI levels were similar between the groups. CONCLUSIONS: This study provides biochemical and histomorphological evidence that HRSS prevents intestinal damage in I/R injury caused by volvulus.

Surgicel mimicking recurrent pelvic neuroblastoma in a 3-year-old boy.

INTRODUCTION: Surgicel is a hemostatic agent that consists of oxidized regenerated cellulose and used in surgical procedures as an aid to bleeding control. It is left in the operation site for hemostasis, could cause an operation by mimicking the recurrence of tumor, as in our patient. PATIENTS AND METHODS: A 3-year-old boy was operated by us at the age of 40 days and 2.5 years, respectively, due to pelvic neuroblastoma. He was re-operated for mimicking recurrence or residue tumor secondary to the prior placement of Surgicel within the peritoneal cavity. RESULTS: Re-laparotomy was performed and the mass approximately 2.8 × 2×1 cm in size in front of the right ureter and iliac vessels and behind the bladder was removed by blunt and sharp dissection without damaging these organs. While gelatinous content was evacuated from this mass, there was no apparent tumor appearance. Pathology report was reported as fibrotic tissue characterized by foreign body and foreign body giant cells. The postoperative period was uneventful and he was discharged on the 2nd postoperative day. CONCLUSIONS: In the light of our case, the use of hemostatic agents should be kept to a minimum and should not be left in the body unless it is difficult. Thus, unnecessary examination or recurrent surgery can be avoided.

Protective effects of hydrogen rich saline solution on ventral penile mathieu type flap with penile tourniquet application in rats.

INTRODUCTION: Penile tourniquet (Pt) application aims to work in a bloodless field in penile surgery. When the tourniquet is released, reperfusion injury occurs with the resumption of blood flow. Molecular hydrogen can easily attach to biomembranes and enter cytosol, mitochondria and other organelles of the cell and convert the formed OH- to H2O to prevent cell and tissue damage. AIM: We investigated the effects of hydrogen rich saline solution (HRSS) on penile Mathieu type flap tissue with Pt application in rats. STUDY DESIGN: Thirty-six Wistar-albino male rats were randomly divided into six groups. No operations were performed in the Sham group. Ventral penile Mathieu type flap was prepared and Pt was applied to the root of the penis with a plastic band in other groups. Pt was applied 10 and 30 min in the PT1° and PT³° groups. HRSS was injected intraperitoneally (ip) 5 ml/kg just before Pt was released in the HRSS1° and HRSS³° groups. In the HRSSB group, HRSS was injected 1 h before 10 min of Pt application. At the 4th hour of experiments the rats were sacrificed and tissue samples were taken for biochemical and histopathological studies. Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), myeloperoxidase (MPO), malondialdehyde (MDA) and glutathione (GSH) levels were determined in the penile tissue. The results were analyzed with one-way ANOVA and Pearson's Chi-Squared test. RESULTS: Tissue MDA, MPO, IL-6 and TNF-α values were significantly lower in all HRSS groups compared to PT1° and PT³° groups. Tissue GSH levels of HRSS groups were higher compared to PT groups. Histopathologically, inflammation was found to be higher in PT groups compared to HRSS groups. Interestingly, in the HRSSB group with HRSS administration prior to Pt, the damage was less in grade, but not statistically different than the other HRSS groups (p > 0.05). DISCUSSION: In previous studies, damage in histopathological examinations after Pt could only be demonstrated long after tourniquet applications such as 24 h and with longer duration of Pt such as 30 min. Structural changes in different Pt application times could be demonstrated at 60 min by electron microscopy and 48 h by light microscopy. In this study, the histopathological effect of Pt application could be demonstrated at the 4th hour after release and HRSS was observed to reduce the damage histopathologically as well as biochemically with its anti-inflammatory and antioxidant effects. It was observed that administration of HRSS either before or following Pt did not cause an alteration statistically. CONCLUSION: HRSS reduces tissue oxidative stress and inflammation on the flap tissue and has a protective effect in Pt applied to the hypospadias model created with a penile flap.