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Purpose: The aim of study was to evaluate if pelvic ultrasound can be useful in managing children with chronic idiopathic constipation.Methods: A total of 270 children with idiopathic chronic constipation were enrolled in the study. At baseline and at monthly checkups children were evaluated by clinical score and pelvic ultrasound (US). Patients have been divided in 2 groups, based on pelvic US results: group A with a rectal diameter >3 cm, group B with a rectal diameter <3 cm or rectum not visualized. Both groups were subsequently randomly divided in two subgroups (A1, A2, B1, B2) on the basis of the prescribed treatment (disimpaction for the first week and daily laxative or only daily laxative).Results: After 1 month of therapy all clinical features improved in group A1 and at pelvic US, rectal size reduced and became not visualized; group A2 showed poor clinical response and transverse diameter of rectum did not modify significantly; B1 and B2 groups showed significant improvement only after 2-3 months.Conclusions: Rectal disimpaction is necessary only in presence of MR. Pelvic US is a useful to diagnose MR and to set up the most appropriate treatment protocol for different chronic constipation cases. [ABSTRACT FROM AUTHOR]

Abstract: Background: Management of ovarian cysts in infants is controversial; it can be conservative or surgical, and the management is determined by the cyst''s size and sonographic features. Methods: A surgical approach using a 10-mm umbilically placed operative laparoscope was taken in 3 female infants with antenatally diagnosed large, simple ovarian cysts. The contents of the cysts were partially aspirated and the cyst walls were stripped off the remaining ovarian parenchyma. No intraoperative or postoperative complications were recorded. Conclusions: The one-trocar video-assisted stripping technique for large ovarian cysts in infants appears to be an ovarian-tissue-preserving procedure, and it sidesteps the disadvantages of large scars and formation of adhesions. [Copyright &y& Elsevier]

Postoperative pain is less intense after laparoscopic than after open surgery. However, minimally invasive surgery is not a a pain-free procedure. Many trials have been done in adults using intraperitoneal and/or incisional local anesthetic, but similar studies have not yet been reported in the literature in children. Aim: The aim of this study was to evaluate the analgesic effect of periportal infiltration and intraperitoneal instillation of ropivacaine in children undergoing laparoscopic surgery. Materials and Methods: Thirty patients who underwent laparoscopic surgery were randomly allocated to one of three groups. Group A ( n = 10) received local infiltration of port sites with 10 mL of ropivacaine. Group B ( n = 10) received both an infiltration of port sites with 10 mL of ropivacaine and an intraperitoneal instillation of 10 mL of ropivacaine. Group C did not receive any analgesic treatment. The local anesthetic was always administered at the end of surgery. The degree of postoperative abdominal parietal pain, abdominal visceral pain, and shoulder pain was assessed by using a Wong-Baker pain scale and a Visual Analog Scale (VAS) at 3, 6 12, and 24 hours postoperatively. The following parameters were also evaluated: rescue analgesic treatment, length of hospital stay, and time of return to normal activities. Results: Three hours after operation, patients had low pain scores. Six and 12 hours postoperatively, the abdominal parietal pain was significantly higher ( P < 0.0005) in group C than in the other two groups, both treated with an infiltration at the trocar sites; mean intensity of abdominal visceral pain was significantly lower ( P < 0.0005) in group B than in groups A and C; the overall incidence of shoulder pain was significantly lower ( P < 0.0005) in group B patients than in patients of groups A and C. At 20 hours postoperatively, pain scores were significantly reduced of intensity in all groups. Rescue analgesic treatment was significantly higher in group C, if compared to groups A and B 12 hours after the operation. No statistically significant difference was found in length of hospital stay, but children who received analgesic treatment had a more rapid return to normal activities than untreated patients ( P < 0.0005). Conclusions: Our study demonstrates that the combination of local infiltration and intraperitoneal instillation of ropivacaine is more effective for pain relief in children after laparoscopic surgery than the administration of ropivacaine only at the trocar sites. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess whether deferential reflux in pediatric and adolescent varicocele can be successfully treated laparoscopically. Materials and Methods: Since 2001 at our institution, 148 boys were evaluated for a left varicocele. Preoperatively, all the patients underwent ultrasound scan assessment of testicular volume and color-Doppler US (CDUS) to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boys with isolated deferential reflux or associated to ISV reflux were laparoscopically managed adding to the former procedure, coagulation or clipping of refluxing deferential veins. Results: Reflux in both the ISV and the deferential vein was observed in 21 (14.1%) out 148 boys with varicocele. Only one case (0.6%) of varicocele was caused by an isolated deferential reflux. No reflux in the cremasteric vein was observed. After a median follow up period of 2 years (range, 6 months–5 years), none of our patients with deferential reflux experienced varicocele recurrence either clinically or according to CDUS scanning. No testicular atrophy was observed. Conclusion: Our diagnostic approach is a rigorous standard for identifying all the venous systems concurring with the varicocele. Our proposed technique with laparoscopic interruption or coagulation of deferential veins when proved by CDUS to be refluxing may allow successful treatment for most varicoceles. This method allows reduction in recurrence of varicocele due to a missed deferential reflux. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the role of double-J stent insertion in perinatally detected primary nonrefluxing megaureters as a method to temporize treatment in patients with impaired renal function or to prevent function loss in patients treated expectantly, but deemed at high risk of deterioration. Methods: Two neonates and 8 infants with a ureter greater than 10 mm and an obstructive excretion pattern, including 3 cases with renal function less than 40%, were selected to undergo double-J stent insertion for a 6-month period. Patients underwent surgery if the ureter redilated and the excretion pattern was obstructive at reassessment 3 months after stent removal. Results: Stents were placed at a median age of 3 months (range 1 to 6). Open insertion was necessary in 5 cases (50%). Seven patients (70%) developed stent-related complications (five breakthrough urinary infections) requiring early stent removal in 2 (20%). Five patients (50%) underwent surgery at a median age of 14 months (range 13 to 27), including the 3 patients with decreased renal function at presentation. None required ureteral tapering. None experienced any renal function loss with respect to the initial evaluation. Conclusions: Double-J stent insertion across the vesicoureteral junction allows for effective internal drainage of primary nonrefluxing megaureters, but at the cost of a 70% morbidity rate and various technical drawbacks. Therefore, stenting should be considered on a case-by-case basis. The procedure seems valuable to temporize surgery in patients with decreased renal function. However, given the associated morbidity, it seems impractical for patients with preserved function selected in accordance with currently available prognostic indicators. [Copyright &y& Elsevier]

In a study from Italy, colour-Doppler ultrasonography was a reliable diagnostic tool in the preoperative assessment of patients with varicocele. The authors also found that it helped to distinguish those who could be treated laparoscopically from those who should be treated by microsurgical subinguinal ligature. OBJECTIVE To investigate whether colour Doppler ultrasonography (CDUS) is a reliable diagnostic tool for selecting patients with varicocele to undergo either laparoscopy or open microsurgical subinguinal ligation. PATIENTS AND METHODS In a 3-year period, 42 boys affected by left varicocele were evaluated before surgery by inguinal and scrotal CDUS. Using this method it was possible to distinguish Coolsaet type-1 varicocele (due to isolated renal-internal spermatic vein reflux) and Coolsaet type-3 varicocele (due to associated renal-internal spermatic reflux and iliac-deferential reflux). Boys with Coolsaet type-1 varicocele were treated by a laparoscopic transperitoneal Palomo procedure, whereas those with Coolsaet type-3 varicoceles were treated by lymphatic-sparing microsurgical subinguinal ligation. RESULTS The varicocele was Coolsaet type-3 in six patients (14%), who had microsurgical open surgery, and the remaining 36 (86%) had Coolsaet type-1 and had laparoscopic surgery. At the follow-up there was no venous scrotal reflux. In two patients in the laparoscopic group a hydrocele developed after surgery, which resolved spontaneously. CONCLUSIONS This study showed that CDUS was a reliable diagnostic tool for assessing boys with varicocele. It clearly distinguished Coolsaet-type 1 varicoceles that can be treated laparoscopically, from Coolsaet type-3 varicoceles that should be treated with microsurgical subinguinal ligature. [ABSTRACT FROM AUTHOR]

Offers information on urethrocutaneous fistulae, the most common complication of hypospadias surgery. Steps for the management of fistulae; Surgical management; Treatment of recurrent fistulae.

Background: This study aimed to assess whether deferential reflux in pediatric and adolescent varicocele can be successfully treated laparoscopically. Materials and Methods: Since 2001 at our institution, 148 boys were evaluated for a left varicocele. Preoperatively,all the patients underwent ultrasound scan assessment of testicular volume and color-Doppler US (CDUS)to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boys with isolated deferential reflux or associated to ISV reflux were laparoscopically managed adding to the former procedure, coagulation or clipping of refluxing deferential veins. Results: Reflux in both the ISV and the deferential vein was observed in 21 (14.1%) out 148 boys with varicocele.Only one case (0.6%) of varicocele was caused by an isolated deferential reflux. No reflux in the cremasteric vein was observed. After a median follow up period of 2 years (range, 6 months-5 years), none of our patients with deferential reflux experienced varicocele recurrence either clinically or according to CDUS scanning.No testicular atrophy was observed. Conclusion: Our diagnostic approach is a rigorous standard for identifying all the venous systems concurring with the varicocele. Our proposed technique with laparoscopic interruption or coagulation of deferential veins when proved by CDUS to be refluxing may allow successful treatment for most varicoceles. This method allows reduction in recurrence of varicocele due to a missed deferential reflux. [ABSTRACT FROM AUTHOR]