Neurodevelopmental evaluation of children who were operated due to congenital anomaly with the 'Ages and Stages Questionnaire (ASQ)' and 'ASQ: Social-Emotional'.

BACKGROUND: The purpose of surgeries performed for congenital anomalies in children is to increase the survival rates and provide a developmental comparison to that of their peers. AIM: The objective of this study was to investigate the development of children following surgery for congenital anomalies and the risk factors affecting their development. METHODS: Our study included 33 children who underwent surgery for gastrointestinal anomalies in our clinic between 2011 and 2016, and did not have any syndrome, chromosomal abnormality, or additional abnormality. Developmental levels were evaluated using the Ages and Stages Questionnaire (ASQ) and the ASQ: Social-Emotional (ASQ: SE) scales adapted for the use on Turkish children. Data on patient history were obtained retrospectively from patient files. RESULTS: The study included 33 patients, including 11 with esophageal atresia, 6 with intestinal atresia, 11 with anorectal malformation, and 5 with Hirschsprung's disease. Developmental delay was found in the ASQ of 72.7% of the patients and the ASQ: SE tool was 27% of the patients. The rate of patients with scores below the threshold from each parameter of ASQ was higher than that of the normal population (p < 0.05). Development delay was detected using the ASQ scale in 100% of those with microcephaly at birth, in 91% of premature infants born between 1500 and 2500 g, and in 83.3% of those with low birth weight to gestational age. CONCLUSIONS: In children who underwent surgery due to congenital anomalies, an evaluation through developmental tests, a post-surgical follow-up process, and a referral to the relevant disciplines when necessary may increase the success of surgery as well as increase the life quality of the patient.

Hypospadias and the Use of the Ages and Stages Questionnaire to Evaluate Neurodevelopmental Status of Boys with Hypospadias.

INTRODUCTION: Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention. MATERIALS AND METHODS: Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ-Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social-emotional problems, respectively. RESULTS: Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal-social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal-social skills. CONCLUSION: Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

Minimal esophagus dissection without approximating the hiatus in laparoscopic fundoplication in pediatric population.

OBJECTIVE: An important part of laparoscopic Nissen's fundoplication (LNF) is a proper wrap, which may only be possible with proper dissection of esophagus and hiatus. However, too much dissection of esophagus and hiatus to gain sufficient length of esophagus increases morbidity. The aim of this study is to analyze the effect of minimal esophagus dissection in LNF on recurrence and post-operative hiatal hernia. METHODS: The present study includes the children (0-18 years) who underwent LNF with minimal esophagus dissection and without hiatal closure between 2008 and 2016. The charts of the patients analyzed retrospectively and evaluated in terms of recurrence and post-operative hiatal hernia. RESULTS: There were 143 children. Mean age was 4.5±4.6 year (20 days-17 years). About 54% of the children (n=78) were neurologically impaired. There were two temporary intestinal obstructions which did not require surgery, one esophageal tightness which resolved with one dilatation session and one recurrence with hiatal hernia which required reoperation. CONCLUSION: Minimal esophagus dissection without hiatal closure in LNF avoids dysphagia with no increase in the rate of recurrence and complications.

An indirect effect of COVID-19 pandemic: Increased pediatric perforated appendicitis rate due to delayed admission.

Objectives: Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods: Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results: This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p <0.001), total hospitalization time (p <0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion: Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.

An algorithm for retrieval tools in foreign body ingestion and food impaction in children.

The aim of this study is to review the experience on managing foreign body ingestion in children with special emphasis on the endoscopic techniques and specific retrieval devices used for foreign body (FB) extraction. The charts of 341 children were reviewed retrospectively. Demographic data, ingested material, removal technique and tool, level of FB, complications, and outcomes were recorded. A total of 364 FBs were removed from 341 children. Among these, 56.5% (n: 206) were entrapped in esophagus, 39% (n: 142) were in stomach, and 4.5% (n: 16) in duodenum and intestine. The most frequently ingested items were coin (42.5%), button batteries (20.6%), and safety pins (12%). Optical forceps (37.9%) were the most commonly used tool and they were used during retrieval of esophageal FB by rigid endoscopy. Retrieval net (20.7%) was the second most common tool and the most common one during flexible endoscopy. Depending on our experience, we strongly advocate rigid endoscopy for esophageal FBs and food impaction in children because it allows both to use optical forceps with a strong grasping ability for blunt FBs and to position sharp and pointed objects inside the rigid endoscope. We recommend retrieval net as the first tool for the extraction of blunt objects and rat tooth retrieval forceps is the best tool for sharp and pointed FBs in stomach.

Laparoscopic assisted anterior transabdominal wall closure using loop suture removing technique in Morgagni hernia: safe and easy method.

PURPOSE: The treatment of MH entails surgical repair either by open abdominal or thoracic approaches or by minimal invasive surgery. The aim of this study is to evaluate the surgical and clinical outcomes of children who underwent laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique. METHODS: This retrospective study includes pediatric patients who underwent surgery for MH between January 2015 and February 2019. The patients' demographic data, symptoms, operative findings and technique and postoperative outcomes were recorded. RESULTS: A total of 17 children with MH were treated. There were 13 boys (76.5%) and four (23.5%) girls. Six patients had trisomy 21 (37%). The mean operation time was 40 min (25-90 min). The hernia sac was removed in all patients and there was no need for prosthetic patch in any of the children. Mean time to start feeding was 10 h (6-24 h). The mean hospitalization time was 2 days (1-5 days). There were no complications intraoperatively or postoperatively. The mean follow-up time was 24 months (6-40). No recurrence occurred during the follow-up time. CONCLUSION: Laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique is a preferable method with excellent outcomes and short hospitalization and feeding time postoperatively. This technique may be performed easily and safely without requiring any additional experience other than basic laparoscopy skills.

Determination of pentraxin 3 levels in diagnosis of appendicitis in children.

BACKGROUND: The aim of this study is to determine whether pentraxin 3 (PTX3) levels can be used in the diagnosis of appendicitis in children. METHODS: Fifteen children under 18 years old, who gave blood samples for reasons other than inflammatory conditions, and 40 children who were proved to have appendicitis (non-perforated or perforated) between August 2017 and January 2018, were enrolled in the study. Patients were classified into subgroups: group 1 (healthy children without any sign of inflammation, n = 15), group 2 (non-perforated appendicitis, n = 25), and group 3 (perforated appendicitis, n = 15). RESULTS: The median PTX3 value was 1.01 ng/mL (minimum value: 0.82, maximum: 1.28) in the control group. The median PTX3 values prior to surgery were 20.68 ng/mL (minimum: 1.02, maximum: 28.471) and 1.46 (minimum: 1.05, maximum: 23.421) ng/mL for non-perforated appendicitis and perforated appendicitis respectively. The PTX3 levels were significantly higher in groups 2 and 3 than in group 1 (P < 0.01). According to receiver operating characteristics analysis the cut-off value of PTX3 levels at admission for appendicitis was 1.30 ng/mL with a sensitivity of 75% and a specificity of 100% (area under the curve, 0.939; P = 0.000). CONCLUSIONS: Pentraxin 3 levels were significantly higher in children with appendicitis than in healthy children. Children with high PTX3 levels complaining of right lower quadrant pain may support a diagnosis of appendicitis. Future studies should be conducted to evaluate changes in PTX3 levels by comparing children with appendicitis versus acute abdominal pain in larger populations to further determine the value of PTX3 in the diagnosis of appendicitis in children.

A Safe and Minimally Invasive Method for Thoracoscopic Lung Biopsy in Interstitial Lung Disease.

Background: Interstitial lung disease (ILD) represents a spectrum of lung diseases that may contain different levels of fibrosis and inflammation. Sometimes, the clinical picture and imaging studies are insufficient to determine the diagnosis and lung biopsy becomes crucial, which may be performed in a thoracoscopic or open manner. The aim of this study was to present a new minimally invasive biopsy method that seems to be technically easy, safe, and inexpensive. Herein, we present a minimally invasive method for thoracoscopic lung biopsy using a Vicryl loop. Methods: The charts of patients with suspected ILD who underwent thoracoscopic lung biopsy using a Vicryl loop between 2007 and 2017 were analyzed retrospectively. Results: Nine patients were identified, four were boys and five were girls. The median age was 76 months. The mean weight of the patients was 10.9 kg. The mean chest tube removal time was 3.8 days. The mean surgical time was 37 minutes. There was an air leakage for 13 days in one child postoperatively. Conclusions: Thoracoscopic lung biopsy with a knot and scissors is an easily applicable and minimally invasive method that may be performed in children with suspected ILD.

Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance.

Ates U, Tastekin NY, Mammadov F, Ergün E, Göllü G, Can ÖS, Uçar T, Bingöl-Kologlu M, Yagmurlu A, Aktug T. Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance. Turk J Pediatr 2018; 60: 221-224. Adherent tunneled catheters can usually be removed by a surgical cut down, but in some cases the line can become stuck to the wall of the central veins. In such cases, forceful traction can cause vascular injury, or fracture of the catheter. We present four cases of fixated cuffed tunneled catheters. Three children had acute lymphoblastic leukemia and one had an immunodeficiency syndrome. All catheters were made from polyurethane. Indwelling times were 12-24 months. All patients` catheters were removed with great difficulty by trans-femoral access. The angiography-assisted technique is safe and easily-applied for the removal of stuck catheters in pediatric patients. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous catheters (CVCs) in children.

Uso de la ecografía como una herramienta no invasiva decisiva para determinar el tamaño preciso del tubo endotraqueal en niños anestesiados / Use of ultrasonography as a noninvasive decisive tool to determine the accurate endotracheal tube size in anesthetized children

Introducción. Es difícil determinar el tamaño adecuado y la posición traqueal correcta del tubo endotraqueal (TET) en los niños. El objetivo de este estudio fue determinar el diámetro traqueal en los niños mediante el uso de la técnica ecográfica como herramienta objetiva y compararlo con fórmulas de uso frecuente basadas en la edad para calcular el tamaño del TET. Pacientes y métodos. Se inscribió de forma prospectiva a pacientes a los que se les iba a practicar una cirugía programada en un hospital pediátrico de alta complejidad. Se determinó el diámetro traqueal transversal infraglótico mediante ecografía. Un anestesista, que no podía ver el examen ecográfico, determinó el tamaño del tubo y realizó la intubación evaluando el espacio entre las cuerdas vocales con la ayuda de la vista directa de un laringoscopio. Se registraron los diámetros traqueales medidos con las ecografías, los diámetros de los tubos, los controles de presión/pérdida de aire y los resultados de los cálculos del tamaño de los tubos basados en la edad. Resultados. Se inscribieron en total 61 pacientes con una media de edad de 12 ± 4,21 (2-17) y un peso medio de 38 ± 22,94 (10-106). El diámetro de la tráquea en la medición ecográfica fue de 13.0 (11,4-15,1). El diámetro externo del TET determinado por el anestesista fue de 8,42 ± 1,43, el calculado por la fórmula de Cole fue de 9.0 ± 1,42, el calculado por la fórmula de Khine fue de 7,67 ± 1,46 y el calculado por la fórmula de Motoyama fue de 8,33 ± 1,42. En 31 (47,7%) pacientes, se insufló el manguito después de la colocación del TET debido a la pérdida de aire. El tubo tuvo que reemplazarse por uno más grande a causa de la pérdida excesiva de aire en un paciente. Se halló una correlación intraclase deficiente entre los cálculos del diámetro traqueal determinado por ecografía y los cálculos del diámetro del tubo basado en la edad (diámetro traqueal frente a Cole -amp;#91;0,273-amp;#93;, Khine -amp;#91;0,207-amp;#93; y Motoyama -amp;#91;0,230-amp;#93;). Conclusión. La medición ecográfica del diámetro traqueal transversal es un método adecuado para determinar el tamaño correcto del tubo endotraqueal en comparación con las fórmulas basadas en la edad.

Background. It is hard to determine the appropriate size and correct tracheal position of endotracheal tube (ETT) in children. The aim of this study is to determine tracheal diameter in children by using ultrasonography technique as objective tool and compare it with commonly used aged based formulas for the ETT size estimation. Patients and methods. Patients undergoing elective surgery in a tertiary children's hospital were prospectively enrolled. The subglottic transverse tracheal diameter was determined by ultrasonography. An anesthesiologist who was blind to ultrasonographic examination, determined the tube size and performed intubation by evaluating the space between vocal cords with the help of a direct laryngoscopic view. Ultrasonographically measured tracheal diameter, tube diameters, leak/pressure controls, and results of age-based tube size calculations were recorded. Results. A total of 61 patients, mean age of 12 ± 4.21 (217) years and mean weight of 38 ± 22.94 (10-106) kg were enrolled. The diameter of trachea measured by ultsonography was 13.0 (11.4-15.1). Outer diameter (mm) of the ETT determined by anesthesiologist was 8.42 ± 1.43; calculated by Cole formula was 9.0 ± 1,42; calculated by Khine formula was 7.67 ± 1.46; calculated by Motoyama formula was 8.33 ± 1.42. ETT cuff was inflated after ETT placement due to leak in 31 (47.7%) patients. Tube was replaced by a larger tube due to excessive leak in one patient. Poor intraclass correlation was found between ultrasonographically determined tracheal diameter and aged based tube diameter calculations (tracheal diameter vs Cole -amp;#91;0.273-amp;#93;, Khine -amp;#91;0.207-amp;#93;, and Motoyama -amp;#91;0.230-amp;#93;). Conclusion. Ultrasonographical determination of transverse tracheal diameter is a suitable method for determining the correct endotracheal tube size when compared with the age based formulas.

Use of ultrasonography as a noninvasive decisive tool to determine the accurate endotracheal tube size in anesthetized children. / Uso de la ecografía como una herramienta no invasiva decisiva para determinar el tamaño preciso del tubo endotraqueal en niños anestesiados.

BACKGROUND: It is hard to determine the appropriate size and correct tracheal position of endotracheal tube (ETT) in children. The aim of this study is to determine tracheal diameter in children by using ultrasonography technique as objective tool and compare it with commonly used aged based formulas for the ETT size estimation. PATIENTS AND METHODS: Patients undergoing elective surgery in a tertiary children's hospital were prospectively enrolled. The subglottic transverse tracheal diameter was determined by ultrasonography. An anesthesiologist who was blind to ultrasonographic examination, determined the tube size and performed intubation by evaluating the space between vocal cords with the help of a direct laryngoscopic view. Ultrasonographically measured tracheal diameter, tube diameters, leak/pressure controls, and results of age-based tube size calculations were recorded. RESULTS: A total of 61 patients, mean age of 12 ± 4.21 (2- 17) years and mean weight of 38 ± 22.94 (10-106) kg were enrolled. The diameter of trachea measured by ultsonography was 13.0 (11.4-15.1). Outer diameter (mm) of the ETT determined by anesthesiologist was 8.42 ± 1.43; calculated by Cole formula was 9.0 ± 1,42; calculated by Khine formula was 7.67 ± 1.46; calculated by Motoyama formula was 8.33 ± 1.42. ETT cuff was inflated after ETT placement due to leak in 31 (47.7%) patients. Tube was replaced by a larger tube due to excessive leak in one patient. Poor intraclass correlation was found between ultrasonographically determined tracheal diameter and aged based tube diameter calculations (tracheal diameter vs Cole [0.273], Khine [0.207], and Motoyama [0.230]). CONCLUSION: Ultrasonographical determination of transverse tracheal diameter is a suitable method for determining the correct endotracheal tube size when compared with the age based formulas.

Introducción. Es difícil determinar el tamaño adecuado y la posición traqueal correcta del tubo endotraqueal (TET) en los niños. El objetivo de este estudio fue determinar el diámetro traqueal en los niños mediante el uso de la técnica ecográfica como herramienta objetiva y compararlo con fórmulas de uso frecuente basadas en la edad para calcular el tamaño del TET. Pacientes y métodos. Se inscribió de forma prospectiva a pacientes a los que se les iba a practicar una cirugía programada en un hospital pediátrico de alta complejidad. Se determinó el diámetro traqueal transversal infraglótico mediante ecografía. Un anestesista, que no podía ver el examen ecográfico, determinó el tamaño del tubo y realizó la intubación evaluando el espacio entre las cuerdas vocales con la ayuda de la vista directa de un laringoscopio. Se registraron los diámetros traqueales medidos con las ecografías, los diámetros de los tubos, los controles de presión/ pérdida de aire y los resultados de los cálculos del tamaño de los tubos basados en la edad. Resultados. Se inscribieron en total 61 pacientes con una media de edad de 12 ± 4,21 (2-17) y un peso medio de 38 ± 22,94 (10-106). El diámetro de la tráquea en la medición ecográfica fue de 13,0 (11,4-15,1). El diámetro externo del TET determinado por el anestesista fue de 8,42 ± 1,43, el calculado por la fórmula de Cole fue de 9,0 ± 1,42, el calculado por la fórmula de Khine fue de 7,67 ± 1,46 y el calculado por la fórmula de Motoyama fue de 8,33 ± 1,42. En 31 (47,7%) pacientes, se insufló el manguito después de la colocación del TET debido a la pérdida de aire. El tubo tuvo que reemplazarse por uno más grande a causa de la pérdida excesiva de aire en un paciente. Se halló una correlación intraclase deficiente entre los cálculos del diámetro traqueal determinado por ecografía y los cálculos del diámetro del tubo basado en la edad (diámetro traqueal frente a Cole [0,273], Khine [0,207] y Motoyama [0,230]). Conclusión. La medición ecográfica del diámetro traqueal transversal es un método adecuado para determinar el tamaño correcto del tubo endotraqueal en comparación con las fórmulas basadas en la edad.

Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results.

BACKGROUND: Obesity is one of the most rapidly increasing health problems in children. Laparoscopic sleeve gastrectomy (LSG) is one of the best treatment options and is feasible and safe in children. The aim of this study was to present the short-term results of a laparoscopic sleeve gastrectomy series in children. METHODS: Children who underwent LSG in 2014-2017 were included in the study. Charts were investigated retrospectively and short-term weight loss was analyzed. RESULTS: Patients who had surgery in 2014-2017 were included in the study. There were six girls and two boys, and the median age was 15 years (range, 11-18 years). Mean weight was 159.25 ± 19.78 kg, and mean body mass index was 61.05 ± 8.5 kg/m2 . Mean operation time was 70 min (range, 65-90 min), mean hospital stay was 5.1 days (range, 3-7 days), and mean follow up was 19.2 months (range, 1-43 months). Of these patients, five had hypertension and were under medication and two of these five also had hyperinsulinemia. One of the five children had Bardet-Biedl syndrome and one had bronchial asthma. After operation, medication was stopped in four of the eight children. At the time of writing, six patients were doing well without postoperative complications, or the need for reoperation. CONCLUSION: Even though the follow-up period was short and the number of patients was small, LSG was a feasible and promising surgical method for morbidly obese children. A multidisciplinary approach and lifelong behavior therapy are key steps for success.

Laparoscopic Gastrostomy in Children: 10 Years of Experience.

OBJECTIVES: Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy. METHODS: The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse-string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally. RESULTS: There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day-18 years), and the average body weight was 13 kg (2300 gr-65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate. CONCLUSION: The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.

Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure.

INTRODUCTION: Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. PATIENTS AND METHODS: This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. RESULTS: This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12-20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1-14) days. Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group. CONCLUSION: Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. TREATMENT STUDY: Level III.

Esplenectomía laparoscópica en la población pediátrica: seguimiento a largo plazo / Laparoscopic splenectomy in pediatric age: long-term follow-up

Introducción: En el último siglo, con los avances en los procedimientos diagnósticos, los trastornos hemáticos han aumentado drásticamente en la población pediátrica. Paralelamente a este aumento, también se han popularizado las esplenectomías con diversas técnicas y resultados quirúrgicos. La esplenectomía laparoscópica (EL) en la población pediátrica está en general aceptada como un procedimiento técnicamente complejo que requiere de experiencia. El objetivo de este estudio es presentar los resultados del seguimiento a largo plazo de una serie de casos de niños sometidos a una EL por diversos trastornos hemáticos, evaluar las complicaciones posibles y los resultados. Población y métodos: Se consideró para este estudio a todos los pacientes ingresados al hospital que tenían programada una EL entre 2005 y 2016. Se agruparon los parámetros del estudio en cuatro categorías: datos sociodemográficos, evaluación prequirúrgica, seguimiento clínico y complicaciones. Resultados: Los pacientes eran 24 varones (48, 9%) y 25 mujeres (51, 1%). La mediana de edad y peso corporal del grupo del estudio era 12 años y 35 kg, respectivamente. Las indicaciones más frecuentes de EL fueron talasemia (13; 26, 5%) y esferocitosis hereditaria (12; 24, 4%). Desde la perspectiva técnica, a dos pacientes (4%) se les realizó una EL con puerto único. La media de duración de la EL fue de 80 minutos. La tasa total de complicaciones intraoperatorias fue del 4% (2/57). La media de duración de la hospitalización fue de 5 días. La media de duración del seguimiento fue de 6, 4 años (intervalo: de 6 meses a 16 años). No se observaron complicaciones a largo plazo. La concentración de bilirrubina y la necesidad de transfusiones de sangre disminuyeron significativamente durante el seguimiento a largo plazo (p < 0, 05). Conclusiones: La EL es una herramienta poderosa en las manos de cirujanos experimentados. Es un procedimiento seguro y eficaz en los niños con trastornos hemáticos, con una hospitalización más breve y una tasa menor de complicaciones.

Introduction: In the last century, with the advancement of the diagnostic procedures, hematologic disorders in pediatric age group have been increased dramatically. In parallel with this increase, splenectomy procedures have also been popularized with different techniques and surgical outcomes. Laparoscopic splenectomy (LS) in the pediatric age group is generally accepted as a technically demanding procedure, which needs experience. The purpose of this study is to present the long-term follow-up results of a case series of children who underwent LS for a variety of hematologic disorders, evaluate possible complications and outcomes. Population and methods: All patients who were admitted to the clinic and who were scheduled for LS from 2005 to 2016 were considered for this study. The study parameters were grouped in four categories including socio-demographic data, preoperative evaluation, clinical follow-up and complications. Results: There were 24 male (48.9%) and 25 (51.1%) female patients. The median age and body weight for the study group was 12 years and 35 kg. Most common indications for LS were thalassemia (13; 26.5%) and hereditary spherocytosis (12; 24.4%). As a technical standpoint, 2 patients (4%) underwent singleport LS surgery. The mean time for LS surgeries was found as 80 minutes. The total intraoperative complication rate was 4% (2/57). The mean time for hospital stay was 5 days. Mean follow-up period was 6.4 years (range: 6 months-16 years). There was no long-term complication. Bilirubin levels and need for blood transfusion significantly decreased in the long term follow-up period (p <0.05). Conclusions: LS is a powerful tool in the hands of an experienced surgeon. It's a safe and effective procedure in children with hematologic disorders resulting in shorter length of stay and lower complication rates.

Laparoscopic splenectomy in pediatric age: long-term follow-up. / Esplenectomía laparoscópica en la población pediátrica: seguimiento a largo plazo.

INTRODUCTION: In the last century, with the advancement of the diagnostic procedures, hematologic disorders in pediatric age group have been increased dramatically. In parallel with this increase, splenectomy procedures have also been popularized with different techniques and surgical outcomes. Laparoscopic splenectomy (LS) in the pediatric age group is generally accepted as a technically demanding procedure, which needs experience. The purpose of this study is to present the long-term follow-up results of a case series of children who underwent LS for a variety of hematologic disorders, evaluate possible complications and outcomes. POPULATION AND METHODS: All patients who were admitted to the clinic and who were scheduled for LS from 2005 to 2016 were considered for this study. The study parameters were grouped in four categories including socio-demographic data, preoperative evaluation, clinical follow-up and complications. RESULTS: There were 24 male (48.9%) and 25 (51.1%) female patients. The median age and body weight for the study group was 12 years and 35 kg. Most common indications for LS were thalassemia (13; 26.5%) and hereditary spherocytosis (12; 24.4%). As a technical standpoint, 2 patients (4%) underwent singleport LS surgery. The mean time for LS surgeries was found as 80 minutes. The total intraoperative complication rate was 4% (2/57). The mean time for hospital stay was 5 days. Mean follow-up period was 6.4 years (range: 6 months-16 years). There was no long-term complication. Bilirubin levels and need for blood transfusion significantly decreased in the long term follow-up period (p <0.05). CONCLUSIONS: LS is a powerful tool in the hands of an experienced surgeon. It's a safe and effective procedure in children with hematologic disorders resulting in shorter length of stay and lower complication rates.

INTRODUCCIÓN: En el último siglo, con los avances en los procedimientos diagnósticos, los trastornos hemáticos han aumentado drásticamente en la población pediátrica. Paralelamente a este aumento, también se han popularizado las esplenectomías con diversas técnicas y resultados quirúrgicos. La esplenectomía laparoscópica (EL) en la población pediátrica está en general aceptada como un procedimiento técnicamente complejo que requiere de experiencia. El objetivo de este estudio es presentar los resultados del seguimiento a largo plazo de una serie de casos de niños sometidos a una EL por diversos trastornos hemáticos, evaluar las complicaciones posibles y los resultados. POBLACIÓN Y MÉTODOS: Se consideró para este estudio a todos los pacientes ingresados al hospital que tenían programada una EL entre 2005 y 2016. Se agruparon los parámetros del estudio en cuatro categorías: datos sociodemográficos, evaluación prequirúrgica, seguimiento clínico y complicaciones. RESULTADOS: Los pacientes eran 24 varones (48,9%) y 25 mujeres (51,1%). La mediana de edad y peso corporal del grupo del estudio era 12 años y 35 kg, respectivamente. Las indicaciones más frecuentes de EL fueron talasemia (13; 26,5%) y esferocitosis hereditaria (12; 24,4%). Desde la perspectiva técnica, a dos pacientes (4%) se les realizó una EL con puerto único. La media de duración de la EL fue de 80 minutos. La tasa total de complicaciones intraoperatorias fue del 4% (2/57). La media de duración de la hospitalización fue de 5 días. La media de duración del seguimiento fue de 6,4 años (intervalo: de 6 meses a 16 años). No se observaron complicaciones a largo plazo. La concentración de bilirrubina y la necesidad de transfusiones de sangre disminuyeron significativamente durante el seguimiento a largo plazo (p < 0,05). CONCLUSIONES: La EL es una herramienta poderosa en las manos de cirujanos experimentados. Es un procedimiento seguro y eficaz en los niños con trastornos hemáticos, con una hospitalización más breve y una tasa menor de complicaciones.

Laparoscopic proctocolectomy with ileal j-pouch anal anastomosis in children.

BACKGROUND/AIMS: We aimed to evaluate postoperative fecal incontinence scales of children who underwent laparoscopic proctocolectomy and ileal J-pouch anastomosis for familial adenomateous polyposis (FAP) and inflammatory bowel disease (IBD). MATERIALS AND METHODS: Fecal incontinence scores were collected at 3 months post-surgery. A retrospective chart review was also performed to obtain the demographic data and operative technical details. RESULTS: The postoperative Wexner Fecal Incontinence Score was 0 in 9 of 11 patients and satisfactory in the remaining two. None of the children had a major complication. CONCLUSION: Even though the presented study does not have any comparable data, it seems that laparoscopic total proctocolectomy with ileal J-pouch anal anastomosis (TP IPAA) might be the best choice of surgery because it provides good continence with low complication rates.

Evaluation of esophageal injuries secondary to ingestion of unlabeled corrosive substances: pediatric case series. / Evaluación de lesiones esofágicas secundarias a la ingesta de sustancias cáusticas no rotuladas: Serie de casos pediátricos.

Esophageal or gastric injuries secondary to caustic substance ingestion is still an important issue in developing countries. Its clinical spectrum can vary from absence of mucosal injury to complications such as severe burns, strictures and perforation. Physical examination and first endoscopic evaluation are very important in the diagnosis. The objective of this study is to present 154 children who were undergone upper gastrointestinal endoscopy because of caustic substance ingestion including descaler, degreaser, unlabeled bleach, drain opener, surface cleaner, dishwasher rinse aid, hydrochloric acid. Sixty-nine children had positive oropharyngeal findings. Sixtythree children were found to have burns in the first endoscopic examination and forty of these burns were severe burn. In the follow-up, twenty children developed strictures that were undergone dilatation program. Fourteen children in the dilatation program had successful dilatation and intralesional steroid injection. However three children had undergone colonic interposition and three undergone laparoscopic gastroduodenostomy and gastrojejunostomy.

Las lesiones esofágicas o gástricas secundarias a la ingesta de sustancias cáusticas siguen siendo un problema importante en los países en vías de desarrollo. El espectro clínico puede variar desde la ausencia de una lesión en la mucosa hasta complicaciones tales como quemaduras graves, estenosis y perforación. El examen físico y la evaluación endoscópica inicial son sumamente importantes para el diagnóstico. El objetivo de este estudio es presentar los casos de 154 niños sometidos a una endoscopía digestiva alta debido a la ingesta de sustancias cáusticas, entre otras, desincrustante químico, desengrasante, lavandina no rotulada, limpiador de tuberías de desagüe, limpiador de superficies, abrillantador de vajilla y ácido clorhídrico. Se observaron signos orofaríngeos positivos en 69 niños. Con la endoscopía inicial, se hallaron quemaduras en 63 niños; en 40, las quemaduras eran graves. Durante el seguimiento, se produjo estenosis en 20 niños, que fueron incluidos en el programa de dilatación. Entre ellos, fue posible dilatar e inyectar corticoides intralesionales satisfactoriamente a 14 niños. Sin embargo, tres niños fueron sometidos a una interposición de colon, y otros tres, a una gastroduodenostomía y gastroyeyunostomía.

[Conservative management of tracheal rupture in a child after blunt trauma]. / Abordaje conservador de una rotura traqueal en un niño tras una contusión.

La rotura traqueal tras una contusión es rara, aunque potencialmente mortal. En general, se recomienda el tratamiento quirúrgico para la rotura traqueal, aunque también se ha informado recientemente el abordaje conservador en los pacientes con signos vitales y parámetros respiratorios estables. El objetivo de este estudio es informar sobre un caso de rotura traqueal tras una contusión en el cuello producto de un accidente de bicicleta que se trató de manera conservadora.

Tracheal rupture following blunt trauma is rare but is potentially life threatening. Usually surgical treatment is suggested for tracheal rupture however recently conservative management has also been reported for patients with stable vital signs and stable ventilatory state. The aim of this study is to report a case with tracheal rupture following a blunt trauma to the neck after a bicycle accident that was managed conservatively.