Role of Radiology and Laparoscopy in Childhood Peptic Ulcer Perforation.

Objective: Peptic ulcer disease (PUD) in children is an uncommon disorder. An estimated 1.3 percent to 20 percent of people die from perforated peptic ulcers (PPU), a PUD consequence. Using a database, we assess the prevalence and prognosis of PPU in patients. We also do radiological and laparoscopic operations for PPU in young patients. In pediatric patients, sufficient accumulation of knowledge about laparoscopic repair is at the level of case reports. This study aims to assess the results in pediatric cases operated for PUP by open or laparoscopic surgery and determine the role of computed tomography (CT) in diagnosing PUP. Methods: Data was collected from the Department of Pediatric Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Turkey, from 2015 to 2020. Patients under 18 years of age who were operated on for PUP between 2015 and 2020 were divided into two groups. Group 1 involved those patients operated by laparoscopic surgery, whereas Group 2 involved those used by open surgery. Both groups were retrospectively evaluated in terms of demographic data, clinical findings, preoperative-intraoperative findings and surgical methods (open or laparoscopic), duration of surgery, duration of nasogastric intubation, time of return to oral feeding, length of hospital stay, and postoperative complications. Results: 18 patients consisting of 15 boys and 3 girls were included in the study. Group 1 involved 10 patients, whereas Group 2 involved 8 patients. In Group 1, the symptom onset period was 1.6 ± 1.9 days, and in Group 2, it was 6.6 ± 6.1 days. In the erect abdominal radiographs (AXR) of 10 (58.8%) patients, the air was under the diaphragm. Six patients whose erect AXRs showed no attitude under the diaphragm but had abdominal pain and acute abdominal manifestation were given abdominal computed tomography (CT) scanning. In all patients with PUP, laparoscopic/open surgery involves primary suturing and repair by omentoplasty (Graham patch). The mean operative time was 87.0 ± 26.3 minutes in Group 1 and 122.5 ± 57.6 minutes in Group 2. The mean length of hospital stay was 3.9 ± 1.3 days in Group 1 and 5.8 ± 2.1 days in Group 2. Neither group developed any major surgical complications. Conclusions: Adolescents with a history of sudden onset and severe abdominal pain may present with peptic ulcer perforation even if there is no known diagnosis of peptic ulcer or predisposing factor. In cases suspected of PUP, it is vital to order and carefully examine erect AXR, which is an easy and inexpensive method. Computed tomography should be the first choice in patients without free air in ADBG but whose anamnesis and findings match peptic ulcer perforation.

Can Percutaneous Internal Ring Suturing Procedure Take the Place of Open Method in the Surgical Treatment of Girls with Inguinal Hernia?

Objectives: Percutaneous internal ring suturing (PIRS) method for inguinal hernia (IH) repair in girls is increasingly used in clinics especially experienced in minimal invasive surgery. We aimed to evaluate and compare our results of laparoscopic PIRS and the open procedure for IH repair in girls in our series. Methods: We retrospectively evaluated female patients in our pediatric surgery clinic who underwent IH surgery between 2012 and 2017 and results were assessed statistically. Results: We identified 293 girls operated in our clinic with IH. In 164 of them, PIRS procedure (group 1) was performed; 73 had right, 26 had left, and 65 (39.6%) had bilateral IH. Among these 65 patients, 16 had only right and 11 had only left IH according to preoperative examination, which turned out to be bilateral during laparoscopy. In the open surgery group (Group II), there were 129 patients. Seventy-eight patients had right, 38 had left, and 13 (10%) had bilateral IH. Sliding fallo-pian tubes were present in seven of Group I versus 21 of group II (p<0.001), while sliding ovaries were present in seven of Group I versus 16 of Group II (p=0.015). Recurrence was observed in only one patient in Group I (p>0.05). Conclusion: The higher rate of bilaterality is still the problem for laparoscopic procedures. Despite over-diagnosis, no more complications were not detected due to PIRS. High ratio of sliding tubes and ovaries can be due to traction for preparing the sac in open surgery. Hematoma can be a serious problem to complete PIRS procedure. Preferred technique from the surgeon's point of view is in favor of PIRS procedure. In addition, PIRS pro-cedure can be more protective for internal genitalia, but more studies with higher numbers and longer follow-up period are needed.

Our treatment approaches in recurrent chronic intussusceptions.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined etiology in at least 75-90% of patients. Recurrent intussusception occurs in 5-16% of all intussusceptions and the treatment strategy is controversial in this patient group. The treatment of continued recurrent intussusception is a challenging problem when no lead point is revealed despite recurrence. METHODS: We aimed to review our 10 years of experience in recurrent intussusception and describe a new operative technique for recurrent intussusception cases without any lead points. RESULTS: We, retrospectively, reviewed the data of patients with recurrent intussusception in our referral pediatric surgery clinic between 2007 and 2017. Ultrasound-guided hydrostatic reduction (UGHR) was performed on all patients. Surgery was performed on those patients who had findings of acute abdomen and complete intestinal obstruction or two failed attempts of UGHR for diagnostic purposes if a pathologic lead point was suspected based on patient findings and age. Laparoscopy or laparotomy was performed according to surgeon preference and experience. A total of 87 UGHRs were performed. Thirty-three patients were admitted to our clinic due to recurrent intussusception. The mean age was 12.75±14.14 (6-84) months, and 19 were male and 14 were female. Abdominal pain, agitation, and vomiting were common symptoms. UGHR was performed on all 33 patients on at least two different occasions. The time between the first and second UGHR treatments was 42.6±186.19 (0-899) days. The success rate of the second UGHR was 27 out of 33 patients (81.8%). Surgery was performed on six patients. Laparoscopy-assisted ileal folding and fixation to the cecal wall was performed on one patient with recurrent intussusceptions. Appendectomy was performed first, and then, ileal folding with cecal fixation was performed using 4/0 polyglactin sutures. The sutures were placed between the serosal layers of the adjacent terminal ileal loops and the cecal wall. CONCLUSION: Surgeons should try to find permanent solutions for patients with multiple recurrent intussusceptions that are resistant to treatment. Surgical excision of the lead point will help prevent recurrent intussusception. Satisfactory results can also be obtained by UGHR even in patients with recurrences. Laparoscopy is helpful in diagnosis, detection of lead points, and treatment of irreducible intussusception. This new operative technique can be satisfactory for recurrent intussusceptions without any lead points.

Can Positive-Pressure Ventilation be Administered with Laryngeal Mask to Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Operation?

OBJECTIVES: We aimed to investigate the effects of intubation and laryngeal mask airway (LMA) use by evaluating the results of blood gas tests, end-tidal CO2 measurements, and airway changes during laparoscopic inguinal hernia repair in children. METHODS: This study was designed to be a prospective randomized study enrolling 150 ASA-I patients, aged 1-8 years; who were scheduled for laparoscopic inguinal hernia repair. Group 1 (n=75) received general anesthesia with fentanyl, propofol, and rocuronium and they were orotracheally intubated. Group 2 (n=75) received general anesthesia with fentanyl and propofol and were inserted an LMA. Demographical data were recorded. Arterial blood gas test results at baseline, in the 10th min after the insufflation, and in the 10th min after the end of the insufflation were noted. The end-tidal CO2, HR, SPO2, inspiratory pressure, plateau pressure, tidal volume (TV), and respiratory frequencies were recorded. The duration of anesthesia, operation, and insufflations was noted. Emergent complications were recorded. RESULTS: The duration of both anesthesia and recovery was longer in Group 1 compared to Group 2. Hemodynamical parameters, end-tidal CO2 values, TVs, airway pressures, and respiratory frequencies were not statistically significantly different between the groups. There were no statistically meaningful differences in the levels of pH, PCO2, and PO2 between the groups. CONCLUSION: Compared to orotracheal intubation during laparoscopic inguinal surgery; LMA did not cause any statistically significant differences in the blood gas test results or airway pressures and recovery was faster with LMA. Therefore, LMA can be used in pediatric laparoscopic surgery as a safe tool for maintaining the airway.

Our Experience with Laparoscopic Pyloromyotomy in Patients with Infantile Hypertrophic Pyloric Stenosis.

OBJECTIVES: In this study, we aim to discuss our experience with laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis (IHPS) and skills development throughout our learning curve. METHODS: We retrospectively collected data from 15 patients with IHPS who underwent laparoscopic pyloromyotomy between 2016 and 2019 in our clinic. Evolution in operation techniques, peroperative and postoperative surgical complications were analysed. RESULTS: In this research, 15 patients (male-to-female ratio:2.7/1) were studied. The median age at presentation was 36.5 days (25-100 days). Non-bilious projectile vomiting was seen in all of the patients, and in eight cases, marked failure to thrive was seen. Situs inversus totalis was seen in one of the cases as an associated anomaly, no other anomalies were noted. A palpable olive-shaped mass was found in only 33% of infants (five cases). A patient was detected to have no IHPS peroperatively. One of the cases was converted to open technique due to peroperative technical difficulties. A patient underwent 2nd operation due to incomplete pyloromyotomy. The duration of the first and last cases was 110 mins and 35 mins, respectively. CONCLUSION: The laparoscopic approach in patients with infantile hypertrophic pyloric stenosis can result in good postoperative outcomes and satisfying surgery in the hands of surgeons who perform minimally invasive surgery routinely.

Late Intraluminal Stent Application in Strictures due to Corrosive Esophagitis: Our Preliminary Experiences.

OBJECTIVES: Household chemicals result in corrosive esophageal burns in the developing third world countries, and most of them cause esophageal strictures. There is no standard treatment for esophageal strictures. Here, we present our preliminary experience with intraluminal esophageal stents for stricture treatment. METHODS: The files of the patients who had stenosis due to corrosive esophagitis in our clinic were evaluated retrospectively. Stricture lengths were between 30 and 130 mm. Stents were self-expandable, made of nitinol alloy that was covered with silicone, and they were cylindrical in shape with a conical tip. The lengths varied between 60 and 170 mm and the diameters were between 10-20 mm. The stent application was made under general anaesthesia. RESULTS: There were seven patients (four girls and three boys). After stent application, all patients experienced constant or temporary pain, vomiting, and difficulty in swallowing. Bleeding occurred in one patient. Sudden death occurred in one patient, probably as a complication of chest infection. All stents had to be removed in mean 38 days because of embedding of the stent, development of granulation tissue and intolerance. CONCLUSION: More research is needed to determine the type, length and diameter of the stent, the timing and the duration of the application, the length and level of the stricture suitable for stent application and medications during treatment.

Assessment of Patients with Hirschsprung Disease and the Use of Laparoscopy.

OBJECTIVES: This study aims to evaluate patients who were diagnosed and treated due to Hirschsprung disease (HD) in our clinic. METHODS: We retrospectively evaluated the demographic and clinical findings of the patients with HD, who were operated in our clinic between January 2010 and December 2015. RESULTS: During study period, 28 patients (19 male 9 female) were found to be operated due to HD in our clinic. Mean age was 16.8 months (1-168). "Transanal Endorectal Pull-through (TERPT)" was performed to 20 of them, Duhamell procedure to five and Soave procedure to three of them. TERPT was applied as laparoscopy assisted in four of them and biopsies were taken laparoscopically preoperatively from one of the patients from each group. Soave procedure was performed in three patients; one had anal stenosis and history of recurrent enterocolitis after TERPT procedure and pathologic analysis revealed neuronal intestinal dysplasia and the other one had total colonic HD and performed Soave procedure with colonic patch. Seven (25%) patients had enterocolitis. Frequencies of enterocolitis were three in two patients, two in two patients and one in three patients. Broad spectrum anibiotics and rectal washouts were supplied to these patients. Five of the seven patients with enterocolitis were operated with TERPT; two patients were operated with Duhamell procedure. Only one of them had total colonic HD. Three patients had total colonic HD diagnosis. Two of them were operated with Duhamell-Martin procedure and one was with Soave procedure with colonic patch according to Kimura technique. Anal stenosis developed in two patients after TERPT and treated with dilatations. Soiling rate was 3% (1/28) and this single patient was treated with laxatives and toilet training. Mean duration of hospitalization was 8.75 (2-14) days. Mean length of the removed intestinal segment was 23.6 (5-38) cm. Mean follow-up was for 35.5 (2-56) months. Neither of the patients was followed in the intensive care unit postoperatively nor died. CONCLUSION: TERPT procedure win priority in HD, but other procedures keep importance. Recently, laparoscopy-assisted TERPT is preferred in our clinic in HD therapy due to easy biopsy, full exposure to the transitional zone, the advantage of meso preparation of colon and prevention of strained anastomosis.

Thoracoscopic Resection in the Treatment of Spontaneous Pneumothorax.

OBJECTIVES: We retrospectively evaluated the patients with primer spontaneous pneumothorax (PSP) who were treated with thoracoscopic resection. METHODS: We retrospectively collected the data of the patients with a spontaneous pneumothorax who were operated with video-assisted thoracoscopic surgery (VATS) between 2010 and 2016. RESULTS: During the study period, 10 patients applied to our hospital with spontaneous pneumothorax. Five children (three boys, two girls) with a mean age of 16.6 (16-17) were selected with VATS. Three of the patients had bleb, one of the patients had Congenital Cystic Adenomatoid Malformation (CCAM) type 2, and the last one had chronic emphysematous tissue on pathological analyses. Post-operative follow-up time was 2.2 (1-4) years without any complication. CONCLUSION: Spontaneous pneumothorax is a disease especially seen in puberty. The main reasons are apical segment bullae formation and blebs. VATS is especially advantageous to reach apical segments and for easy resections. Blebs, CCAM and emphysematous lung tissue may cause spontaneous pneumothorax.

Observed or Predicted Albendazole Hepatotoxicity as an Indication for a Resection Procedure in Hepatic Hydatid Disease - A Short Series of Cases.

OBJECTIVE: To highlight the role of albendazole hepatotoxicity in the choice between drainage versus a resection procedure in hepatic hydatidosis. Methods: The charts of four patients were reviewed retrospectively. In three patients, albendazole caused more than 10-fold increases in transaminase levels and was stopped. One patient had concomitant autoimmune hepatitis. Results: In the first case, two large hydatid cysts involving the right and the left hepatic veins were detected. First, left lateral sectionectomy and ligation of the right posterior portal vein branches were performed. Hypertrophy of the remnant liver allowed a safe right posterior sectionectomy two months later. In the second patient, a 9-cm cyst in segments 6 and 7 was treated with pericystectomy. The third patient had a 6-cm centrally located cyst. Pericystectomy, removal of small vesicles from the anterior section bile duct, common bile duct exploration with a T-tube placement were performed. In the patient with auto-immune hepatitis, pericystectomy was chosen for two objectives: 1) to eliminate a cavity prone to recurrence in an immunosuppressed patient 2) to avoid albendazole that may complicate the interpretation of liver function tests. The postoperative period and early follow up of all patients was uneventful. The second and the fourth patients have been followed for 56 and 17 months respectively and no recurrence has been detected. Conclusions: A resection procedure eliminates the cavity and the need for adjuvant albendazole treatment. This is a vital advantage for the small subset of patients with severe albendazole hepatotoxicity.

Endoscopic retrograde cholangiopancreatography in children: Retrospective series with a long-term follow-up and literature review.

BACKGROUND/AIMS: To investigate the safety and long-term results of endoscopic retrograde cholangiopancreatography (ERCP) in children with a literature review. MATERIALS AND METHODS: All patients within the age range of 6-17 years who underwent ERCP between 1994 and 2014 at our institution were retrospectively evaluated. RESULT: Twenty-four patients with a median age of 15 years underwent ERCP. Cannulation of the papilla was achieved in all patients (100%) without the use of needle-knife papillotomy. Before 1999, ERCP was used as a diagnostic method only in 7 patients (29%). In 17 (71%) patients, the procedure was used for therapeutic purposes. The indications were choledocholithiasis (10 cases, 42%), postoperative complications (5 patients, 21%), and recurrent pancreatitis (2 cases, 8%). In 2 patients (8%), the therapeutic effect was not achieved, thus requiring subsequent operations. There were no major complications. Mild pancreatitis occurred in only 1 patient (4%). Long-term follow-up information was obtained in 16 (67%) patients (median, 18 years; range, 3.5-22.5 years), and no long-term complications were detected. CONCLUSION: Endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis and treatment of pancreatobiliary disorders in the pediatric population. Large-scale studies are required to create evidence-based guidelines specific to children.

Can serum soluble urokinase plasminogen activator receptor be an effective marker in the diagnosis of appendicitis and differentiation of complicated cases?

BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is a new biomarker of inflammation level. The aim of the study was to evaluate whether suPAR levels could be useful to detect acute appendicitis and to differentiate uncomplicated appendicitis (UA) from complicated appendicitis (CA). METHODS: We prospectively studied 105 patients consisting of 40 UA cases, 40 CA cases, and 25 control patients. Blood samples were collected to measure suPAR level, C-reactive protein level, leukocyte counts, neutrophil counts, and neutrophil percentages preoperatively. RESULTS: Median values of suPAR level, C-reactive protein level, leukocyte counts, neutrophil counts, and neutrophil percentages in UA and CA were significantly higher than control patients. suPAR levels of the UA and CA groups showed a statistically significant difference (p=0.016). CONCLUSION: The current study demonstrated that serum suPAR concentrations can be helpful in differentiating CA from UA and in diagnosing acute appendicitis.

Factors Affecting Liver Regeneration in Living Donors After Hepatectomy.

BACKGROUND The safety of living liver donors is the paramount priority of liver transplantation surgeons. The liver has an effective regeneration capacity. The regeneration rate of the liver remnant in living liver donors provides much information useful in liver surgery. The outcome of the remnant liver after hepatectomy can be affected by many different perioperative factors. MATERIAL AND METHODS A total of 46 patients were enrolled in the study. Retrospective clinical data, including preoperative and postoperative early and late computed tomography liver volumetry measurements, estimated resection volumes, resected liver weights, and postoperative laboratory values, were statistically evaluated according to the liver resection type. RESULTS No significant difference was detected in age, sex, calculated and computed tomography estimated total liver volume, intraoperative Hb decrease, postoperative complications, or postoperative portal vein flow rate. Postoperative liver enlargement rates were significant higher in the right hemihepatectomy (RHH) group than in the left lateral sectionectomy (LLS) group. The size of the liver remnant or graft has a major effect on regeneration rate. Postoperative biliary leakage did not have any significant effect on liver regeneration. No post-hepatectomy liver failure was detected among the liver donors. CONCLUSIONS Liver hypertrophy depends on the extent of liver resection. The cause of volume decrease in the LLS group after hepatectomy in our series appears to be the gradual atrophy of liver segment 4. RHH and LLS surgeries differ from each other in terms of resected liver volume, as well as inflammatory activity, and the latter appears to affect liver regeneration.

Percutaneous internal ring suturing as a first choice laparoscopic inguinal hernia repair method in girls: a single-center study in 148 patients.

INTRODUCTION: We sought to retrospectively assess the operative findings and clinical outcomes of 148 girls who underwent laparoscopic inguinal hernia repair with the percutaneous internal ring suturing (PIRS) technique. METHODS: Between 2010 and 2014, girls with inguinal hernia underwent surgery using the laparoscopic PIRS technique described by Patkowski. Demographic and perioperative findings, complications, and recurrences were evaluated. RESULTS: A total of 205 inguinal hernia repairs were performed in 148 children with a mean age of 5.83 years (1 month-16 years). In 57 girls (38.5 %), the hernias were bilaterally repaired, while in 91 girls (61.5 %) hernias were unilaterally repaired. The mean follow-up time was 3.6 years (range 2.5-6.1 years). No serious complications or recurrence were noted. Granuloma occurred in one patient. CONCLUSION: The PIRS technique is a safe, simple and effective procedure for girls. Excellent cosmetic results and reduced recurrence rates are associated with this method. This procedure is particularly suitable for girls because they lack a spermatic cord and vascular structures that can cause complications with this technique in boys. Based on our experience and others in the literature, we suggest that the PIRS procedure might be considered a gold standard for inguinal hernia operations in girls.

Oesophageal duplication cyst mimicking hydatid cyst in endemic areas.

The cystic appearance of both oesophageal duplications and pulmonary hydatid cysts can cause a misdiagnosis very easily due to rarity of cystic oesophageal duplications beside the higher incidence of hydatid cyst, especially in endemic areas. Here we report a 7-year-old girl with an oesophageal duplication cyst on the left side misdiagnosed as a hydatid cyst. The aim of the study is to report rare oesophageal duplications in the differential diagnosis of intrathoracic cysts.

Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children.

Background. The aim of our study is to compare the efficacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens. Methods. From June 2006 to September 2012, 50 patients underwent LS. The patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1-18). The patients are divided into two groups according to spleen's longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay. Results. The mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the difference was not significant between groups (P > 0.05). Conclusion. LS is safe and effective in enlarged spleens as well as normal sized spleens.

Ultrasound-guided hydrostatic reduction of intussusception with saline: Safe and effective.

PURPOSE: The study was undertaken to assess the efficacy of ultrasound-guided saline enema in reducing intussusception and to determine the role of age and duration of symptoms on this event. METHODS: The case records of patients who were treated for intussusception at our institutions over the past 10 years were retrospectively analyzed. A total of 419 patients were treated for intussusception and 375 of them were included into the study. Patients were excluded if they had symptoms and signs of acute abdominal disease and required surgery as an initial treatment. RESULTS: Hydrostatic reduction was successful in 313 of the 375 patients (83.46%). The procedure-related complication rate was nil. There were 29 episodes of recurrences in 23 patients, and recurrence rates did not differ between patients who responded to hydrostatic reduction and those who required surgery. Younger age [median (range); 11 months (3-108 months) vs. 20 months (1-180 months); p<0.05], rectal bleeding (p<0.01) and long duration of symptoms [mean (range); 1.95 days (1-7 days) vs. 1.44 days (1-10 days); p<0.01] were significantly associated with failed hydrostatic reduction. CONCLUSION: Ultrasound-guided hydrostatic reduction is an easy, safe and effective method for the treatment of intussusception in the absence of acute abdominal findings.

Does percutaneous internal ring suturing contain risk of ilioinguinal nerve entrapment?

PURPOSE: In this study, we aim to assess the alteration of IIN functions in children with inguinal hernias operated on using open or 'percutaneous internal ring suturing' (PIRS). METHODS: This study was based on a prospective clinical trial of 60 pediatric patients. They were operated on using PIRS or conventional open hernia repair technique. Group 1 included 35 patients who were treated with PIRS technique. Group 2 included 22 patients who underwent a conventional open hernia repair. The ilioinguinal nerve stimuli in both the operational and non-operational areas were evaluated in patients with peripheral EMG for possible ilioinguinal nerve damage on the hernia side before the operation and to reevaluate ilioinguinal nerve function in the third postoperative week. RESULT: In Group 1, 19 cases underwent a preoperative EMG examination and in 35 cases, EMG examination was obtained postoperatively. Pre- and postoperative EMG results were normal in all cases in Group 1 on both the operational and non-operational sides. In Group 2, 15 preoperative and 25 postoperative EMG examinations were obtained. In Group 2, only one case with a right inguinal hernia who had normal preoperative EMG results showed no IIN response in a postoperative EMG evaluation obtained in the third postoperative week, with a normal left-side response. The EMG was repeated at the three-month postoperative third mark and revealed the same result. In a six-year-old female case, there was a negative EMG response on the non-operative side both pre- and postoperatively.

A retrospective review of the adnexal outcome after detorsion in premenarchal girls.

BACKGROUND: The aim of this study was to report our results on premenarchal girls with adnexal torsion who were treated with different approaches. MATERIALS AND METHODS: Twenty-six adnexal torsions in children were analysed retrospectively. Group 1 included cases of oophorectomy for the twisted adnexa. Group 2 contained the patients with adnexal torsion who untwisted either with a laparoscopic or open approach. Postoperative restoration of ovarian function was evaluated by Doppler ultrasound at the 6 th month. All oophorectomy and biopsy specimens were also evaluated. RESULTS: Group 1 consisted of eleven cases that underwent oophorectomy due to gangrenous change and haemorrhagic infarction. Histology was of a mature teratoma in two cases and haemorrhagic necrosis due to torsion in seven. Group 2 consisted of 15 patients. In 10 out of 15 patients, preoperative biopsy is performed in which their histology revealed haemorrhagic necrosis in eight cases, and simple cyst with a benign nature in two cases. In all of the 10 untwisted adnexas, postoperative radiological imaging showed complete recovery with normal follicular development. No malignancy or increased tumour markers were noted in both groups. CONCLUSION: Adnexas can be left in place regardless of the preoperative degree of necrosis. Biopsy can be added to the procedure to rule out malignancy.

Crossed testicular ectopia: Report of six cases.

Crossed testicular ectopia or transverse testicular ectopia is an extremely rare anomaly characterised by migration of one testis towards the opposite inguinal canal, usually associated with unilateral inguinal hernia. This report describes six cases of crossed ectopic testes, one of the largest series, and with unusual clinical histories.

Wilms' tumor: a 24-year retrospective study from a single center.

Medical records of 71 children with Wilms' tumor at Sisli Etfal Education and Research Hospital between 1990 and 2014 were reviewed. Mean age at diagnosis was 3.11 years (2 days-7 years). Male to female ratio was M/F = 6/10. The incidence of associated anomaly was 16.9%. Clinical manifestations included abdominal mass (89%), hematuria (30%), hypertansion (25%), abdominal pain (15%), fever (5%), restlessness (2%), weight loss (2%), varicocele (1%). Ultrasound (USG) was the most often initial study in a child presenting with abdominal mass. Doppler USG was also made to evaluate the inferior vena cava (IVC) for the presence of tumor extension in children with renal mass. The left kidney was affected in 33 patients (46.5%), the right was affected in 31 patients (43.7%). Two patients was extrarenal (2.8%). And 5 patients (7.04%) were bilateral on the presentation. Preoperative chemotheraphy was done in 14 cases. In 63 patients with unilateral Wilm tm, unilateral radical nefrectomy is performed. In one patient with solitary kidney, nephron sparing surgery (NSS) is performed. In 3 patients with bilateral tm NSS is performed and in 2 patients with bilateral Wilms' tm NSS is performed in one side and nefrectomy on the other side. Out of 71 Wilms tumor (WT) patients, 17 of them has been out of our follow. And 4 of them are died. Ten of them has metastases. Forty children are under follow with no metastases. Patients with WT needs a multimodal, multidisiplinary treatment with the cooperation of pediatric oncologist and pediatric surgeon and needs close follow-up.