Guidelines of the Italian Society of Videosurgery in Infancy (SIVI) for the minimally invasive treatment of fetal and neonatal ovarian cysts.

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. (...).

Guidelines of the Italian Society of Videosurgery (SIVI) in Infancy for the minimally invasive treatment of Hypertrophic Pyloric Stenosis in neonates and infants.

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 (...).

The role of laparoscopy in the diagnosis and the treatment of missed diaphragmatic hernia after penetrating trauma.

BACKGROUND: The traumatic diaphragmatic hernia (TDH) may appear acutely after a blunt or penetrating trauma, or it can remain missed also for many years. The discussion about the utility of a laparoscopic repair in acute and chronic TDH is controversial. METHODS: In this paper, we present two cases of chronic TDH that were successfully treated with laparoscopy. The first patient was treated 1 year after a stab wound and the second one 10 years after a firearm injury. RESULTS: In both cases, the diaphragmatic defects were easily laparoscopically detected and treated. The defects were repaired with a direct running suture owing to the acceptable dimensions of the tears. The mean operative time was 135 minutes (range, 75-195). The blood loss during the operations was unremarkable. No intraoperative complications occurred, and the conversion rate was null. The postoperative course was uneventful in the first patient, whereas the second patient, owing to the intraoperative respiratory problems, needed an accurate respiratory monitoring in the Intensive Care Unit. The mean length of stay after the operation was 7 days (range, 6-8). At follow-up, the clinical examination and the chest X-rays documented no recurrence. CONCLUSIONS: We recommend the use of laparoscopy in left chronic TDH repair, performing a direct suture of the diaphragm when possible.

Renal function adaptation in children with unilateral renal tumors treated with nephron sparing surgery or nephrectomy.

PURPOSE: We studied the natural history of renal function following removal of different amounts of renal mass in a cohort of children with unilateral renal tumors. MATERIALS AND METHODS: We compared kidney function and blood pressure before and after surgery in 26 patients with unilateral renal tumors treated with nephrectomy (group 1, 16 patients) or nephron sparing surgery (group 2, 10 patients). Serum creatinine and blood pressure measurements were indexed to age and sex, and expressed as standard deviation scores (SDSs). Values were means +/- SD. RESULTS: Preoperatively, patients in group 1 had no significant differences with respect to serum creatinine SDS and blood pressure SDS compared to patients in group 2. At a mean cross-sectional followup of 72 and 65 months, respectively, patients in group 1 had higher serum creatinine SDS compared to those in group 2 (1.27 +/- 0.69 vs 0.70 +/- 0.49, p = 0.02), as well as higher systolic blood pressure SDS (0.72 +/- 0.74 vs -0.10 +/- 0.92, p = 0.01) and higher diastolic blood pressure SDS (0.87 +/- 0.77 vs 0.19 +/- 0.62, p = 0.01). Serum creatinine SDS and systolic blood pressure SDS had a significant positive correlation (r = 0.44, p = 0.02). A postoperative longitudinal study of all patients showed a progressive increase in serum creatinine SDS with increasing followup time (r 0.49, p = 0.02). The slope of regression line was sustained by a steep increase of serum creatinine SDS in 5 patients in group 1 and 2 patients in group 2. CONCLUSIONS: In children with unilateral renal tumors nephron sparing surgery minimizes the decrease in renal function following renal ablative surgery, and may be of benefit in children with a progressive renal function decrease, probably due to a congenitally reduced nephron complement.

Long-term outcome of nephron sparing surgery and simple nephrectomy for unilateral localized Wilms tumor.

PURPOSE: We retrospectively assessed survival and local recurrence rates in children with unilateral localized Wilms tumor (WT) treated with nephron sparing surgery (NSS) or simple nephrectomy with removal only of the perirenal fat adherent to the tumor surface. MATERIALS AND METHODS: The records of 70 children with renal tumor, operated on by the same surgeon between January 1968 and December 2003, were reviewed. Of 64 children with WT 52 with localized nonanaplastic WT were enrolled. Treatment was administered according to International Society of Pediatric Oncology protocols 1 to 2001 in all patients but 7, who were operated on between 1968 and 1971. Patients were stratified as having stage I (27), stage II (23) or stage III (2) disease. Surgical treatment included 40 simple nephrectomies, 10 NSSs (only stage I cases ascertained by frozen section) and 2 radical nephrectomies. Mean patient age at operation was 39.5 months (range 1 to 126). Followup ranged from 27 to 431 months (mean 188.4). RESULTS: Event-free survival rate in all localized stages was 88.5% (stage I 92.6%, stage II 87%, stage III 50%). Two infants with stage I disease died after surgery for reasons not related to malignancy. Only 1 patient with stage II lymph node negative WT had local relapse. CONCLUSIONS: Our results are similar to those achieved by radical nephrectomy in previous studies. Leaving Gerota's fascia in situ does not seem to confer a higher risk of local recurrence in patients with low stage nonanaplastic WT. After NSS Gerota's fascia may be used to cover the defect and to maintain tissue plains, thus, facilitating reintervention if necessary.