Unexpected location of a pilonidal sinus.

Pilonidal sinus disease is typically located in the sacrococcygeal area, although it has been described in other locations. We present a rare case of pilonidal sinus on the scalp and its management.

Alterations in testicular positioning after normal descent: acquired cryptorchidism.

BACKGROUND: Acquired cryptorchidism or acquired undescended testis (UDT) is defined as the displacement of a testicle outside the scrotal sac after normal descent has been verified. There are still no clear guidelines on its management. OBJECTIVES: To analyze patients who underwent surgery for UDT in our setting to determine the prevalence of acquired cryptorchidism and to analyze the demographic and clinical characteristics of the population of children diagnosed with both acquired and congenital cryptorchidism, the age of presentation of both entities and the percentage of bilateral involvement. MATERIALS AND METHODS: This was a retrospective descriptive study using data from the clinical history of patients who underwent surgery for cryptorchidism between 2011 and 2022. The type of cryptorchidism, acquired or congenital, was recorded. Demographic and clinical data were collected. RESULTS: A total of 367 patients and 442 testicular units were included in the study (75 patients had bilateral involvement). In 54.75% (95% CI: 50.09%-59.40%) of the cases analyzed, cryptorchidism was acquired, and the mean age at the time of surgery was 7.39 years (SD 2.95). Twenty percent (95% CI: 16.29%-24.58%) of the patients presented with bilateral cryptorchidism and 64% (95% CI: 52.88%-75.11%) out of them were acquired on both sides. The diagnosis was metachronous in 42.6% (95% CI: 31.21%-54.12%) of bilateral cryptorchidism cases. DISCUSSION AND CONCLUSION: Acquired cryptorchidism accounts for more than half of cryptorchidism cases requiring surgery in our setting, with a clearly different age of presentation than that for congenital cryptorchidism. Therefore, it is necessary to monitor the presence of the testes in the scrotal sac until adolescence. It is also important to monitor patients with a history of cryptorchidism, not only for the management of the operated testicle but also for the early identification of patients who will develop metachronous contralateral cryptorchidism.

Gas Embolism in Pediatric Minimally Invasive Surgery: Should It Be a Concern?

Introduction: Gas embolism can occur during minimally invasive surgical procedures. Its incidence and implications in infants and children are not clear. The objective of this study is to identify gas embolism with transthoracic echocardiography and its consequences in pediatric laparoscopic appendectomy. Materials and Methods: This is a descriptive observational study including children undergoing laparoscopic appendectomy. We performed transthoracic echocardiography during surgery and collected data on intraoperative hemodynamic and respiratory parameters. Results: To date, we have included 10 patients in whom intraoperative transthoracic echocardiography revealed a 50% incidence of gas embolism. All episodes of embolism were grade I or II, and the patients remained asymptomatic. The hemodynamic and respiratory parameters varied slightly during the pneumoperitoneum. Conclusions: Episodes of gas embolism in pediatric laparoscopic appendectomy appeared in up to 50% of patients. Although they were subclinical, we should be aware of the risk of serious events and take measures to maximize safety in pediatric minimally invasive surgery.

Parotid irrigation: A promising option for juvenile recurrent parotitis.

OBJECTIVE: To study whether irrigating the parotid gland with saline solution through the parotid duct reduces the number of inflammatory episodes in patients with juvenile recurrent parotitis (JRP) over a 1-year period. METHODS: This was a retrospective cohort study using the electronic clinical history data of patients with JRP that were treated with parotid irrigation under general anaesthesia at the Paediatric Surgery units of Consorci Sanitari Alt Penedès-Garraf and Hospital Universitari Mútua de Terrassa. The number of inflammation episodes in the year before and the year after treatment was analysed. RESULTS: A total of 15 patients with JRP were evaluated, of whom 10 met the criteria for irrigation. Data from 9 patients were available. The procedure was performed without incident in all of the patients. There was no difficulty with probing the duct and no need for orifice dilation. No post-lavage complications were observed. Four patients had complete resolution of inflammation events (44.4%), and the remaining 5 patients had a decrease in the number of events. The Wilcoxon signed-rank test showed a statistically significant difference between the number of inflammation events before and after the intervention (p = 0.009). CONCLUSIONS: Parotid irrigation with saline solution could be a safe and effective first-line technique for the treatment of JRP. LEVEL-OF-EVIDENCE: IV.

Quality of Life in Pediatric Minimally Invasive Surgery: Cost-Utility Analysis of Laparoscopic Versus Open Appendectomy.

Background: Economic evaluation in health care is becoming increasingly important. Laparoscopic appendectomy (LAp) is one of the most frequent minimally invasive procedures in the pediatric population. The increased costs of this approach in any indication could be justified by proving its cost-utility in terms of health-related quality of life (HRQoL). We aim to perform a cost-utility analysis between open and LAp (open appendectomy [OAp] and LAp). Materials and Methods: We included the data of children operated for acute noncomplicated appendicitis, who agreed to answer a validated quality of life (QoL) questionnaire. Costs were calculated for each patient. We established a threshold for cost-effectiveness (λ) of 20,000 to 30,000€ per quality adjusted life year (QALY) according to previous research. Results: A total of 53 patients were included. Overall mean costs in the OAp were 758.98€ and in the LAp 1525.50€. The incremental cost-effectiveness ratio was 18,000€/QALY, under the threshold of cost-effectiveness, therefore favoring the laparoscopic approach as it improves HRQoL despite the costs. Conclusions: Economic evaluation studies in Pediatric Surgery are scarce and rarely measure outcomes in terms of QoL. This information is important in the decision-making process for institutions and health-care professionals. Our results encourage the use of laparoscopy in pediatric appendectomy to improve HRQoL in our patients.