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Purpose: This study aimed to measure the effects of the upper or lower limit of the carbon dioxide (CO2) insufflation pressure applied in children who underwent laparoscopic and thoracoscopic interventions, on the changes in the brain and kidney Near Infrared Spectrometry (NIRS) values. Patients and Methods: Demographic information, carbon dioxide insufflation pressure and the operation time data were recorded. During the procedure the NIRS probes monitored the brain and left kidney during laparoscopic procedures and the brain only during thoracoscopic procedures. Basal NIRS values were recorded after anesthesia induction, after CO2 insufflation-beginning of insufflation, near the end of the procedure-end of insufflation, and after carbon dioxide desufflation. During the procedure, when ≥20% decrease was observed in the basal value during carbon dioxide insufflation, the carbon dioxide pressure was decreased and the procedure was continued. In case of a decrease of ≥50% in either brain or kidney NIRS it was planned to be recorded as an absolute decrease, and to terminate laparoscopy or thoracoscopy. Results: Two hundred four laparoscopic and 19 thoracoscopic cases were included in the study. The mean age of the patients undergoing laparoscopic procedures was 120 months, the mean body weight was 33 kg, and the mean operative time was 43 minutes; whereas the mean age of the patients undergoing thoracoscopic procedures was 62 months, the mean body weight was 17 kg, and the mean operative time was 80 minutes. No statistically significant difference was found in NIRS values between upper or lower insufflation pressures (p>0.05). Conclusion: The pressures provided at the upper limit of the safe range may expand the surgical area and can help prevent problems that may be encountered due to the limited space during the surgery. In this study, it has been shown that pressures at the upper limit of the safe range do not impair patient brain and kidney oxygenation.

Purpose: Inguinal hernia is one of the most common condition requiring surgical repair in childhood. The recurrence rate is between 1 and 2%. Open repair of recurrent inguinal hernia may be challenging due to the difficulty in dissection of hernia sac from spermatic cord and testicular vessels. On the other hand, laparoscopic approach offers an easier and safer repair without engaging these structures. The aim of this study is to present the experience in laparoscopic repair of recurrent inguinal hernias in children. Methods: The children who underwent laparoscopic inguinal hernia repair between 2015 and 2021 for recurrence after a previous open hernia repair were included in this study. Laparoscopic percutaneous internal ring suturing was performed in all these patients. Results: A total of 24 children (2 girls and 22 boys) were enrolled for analysis. The mean age was 15 months and the mean weight was 21 kg. Fourteen children had right hernia, while 10 had left. Two of patients had a second open surgery for a recurrent hernia. Of the 24 recurrences, 17 developed in the first year following surgery and seven later. No complication was encountered after laparoscopic repair and no recurrence after a mean follow-up of 24.6 months. Conclusion: Laparoscopic-assisted percutaneous internal ring suturing method may be preferred in children with recurrent inguinal hernias who underwent previous open repair in order to avoid possible injury to the cord due to the scars of primary operation.

Background: Nonimmune hydrops fetalis (NIHF) can be caused by different types of etiologies. Some rare intrathoracic lesions are associated with NIHF. Combination of mediastinal teratoma, NIHF, and chylothorax is extremely rare. Mediastinal teratomas which are located in midline should be difficult to be detected. Thoracic imaging should be performed with unknown etiology for hydrops, and in case of chylothorax, the presence of a mass compressing the ductus thoracicus should be considered primarily. Case presentation: An infant was born with a diagnosis of NIHF. Bilateral chest tubes were inserted cause of bilateral pleural effusions. After enteral feeding, the previously clear pleural fluid became chylous. Medium-chain triglyceride infant formula and somatostatin analog octreotide were initiated. A mass was appeared on her neck with the disappearance of skin edema. Magnetic resonance imaging confirmed a large, heterogeneous mass which was suggesting immature teratoma originating from thyroid gland. Complete surgical excision of the mass was performed. Histology confirmed high-grade immature teratoma. The neonate made an uneventful recovery. Following complete cessation of pleural fluid drainage, octreotide was stopped. She was discharged home on exclusive breast milk on day 34 of life. Conclusions: Mediastinal teratomas are rare masses that cause hydrops fetalis. Although the association of NIHF and mediastinal teratoma is rare, thoracic imaging can be performed if an etiology cannot be found despite basic evaluations for hydrops. In case of chylothorax, the presence of a mass compressing the ductus thoracicus should be considered primarily, and thoracic imaging should be performed.

Background: Femoral hernia is very rare in children. Surgical intervention is necessary for treatment. There are many different surgical methods explained before. Laparoscopic single port repair technique is not reported before. Case presentation: A 2.5-year-old girl with left femoral hernia and a 5.5-year-old boy with a right femoral hernia were presented to the hospital with bulging on the groin. Using a 5-mm telescope with optical forceps, the defects of patients were repaired with percutaneous ring suturing technique via spinal needle without excision of the lipoma. No complications developed on the patients in 12 months follow-up. Conclusion: Laparoscopic single port needle assisted repair is a safe and feasible method repairing femoral hernia and excision of the lipoma should be kept in mind to avoid possible recurrences.