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Uvod: AutoCart je novija metoda liječenja osteohondralnih lezija lokomotornog sustava. Cilj ovoga preglednog članka jest prikazati indikacije i rezultate ishoda liječenja ovom metodom kod pedijatrijske populacije. Ispitanici i metode: U ovom članku prikazano je šest pacijenata liječenih AutoCart metodom u razdoblju od ožujka 2022. do siječnja 2023. godine. Svi pacijenti su imali simptomatske lezije koljena i talusa trećeg i četvrtog stupnja. Lezije na koljenu su operirane artroskopskim putem, a lezije talusa klasičnim, otvorenim načinom. Rezultat liječenja je procijenjen putem upitnika kojim se ocjenjivala kvaliteta života prije i nakon operacije. Također je procijenjena skala boli prije i nakon operacije kao važan pokazatelj uspješnosti ove metode liječenja. Rezultati: Prosječna dob bolesnika je bila 13,6 godina. Trojica bolesnika (50%) bila su muškog spola, a tri (50%) ženskog. Kod troje bolesnika (50%) bila je lezija talusa kao i kod lezije koljena (50%). Kod četvoro pacijenta postojao je jasan mehanizam ozljede (66%), a kod dvoje bez jasnog mehanizma (33%). Medijan vremena od simptoma do operacijskog zahvata je bio 6,6 mjeseci za koljeno, a 7,3 mjeseca za talus. Kvaliteta života kod pacijenata prije operacije bila je 7,67, a nakon operacije 1,00. Zaključci: Ova metoda liječenja kod pravilno postavljene indikacije pokazuje značajno kliničko i subjektivno poboljšanje. Također daje odličan cost benefit u odnosu na metodu transplantacije uzgojene hrskavice, jer se provodi u jednom aktu. Budući da je riječ o novoj metodi liječenja, ipak treba vremena za detaljniju evaluaciju ove kirurške metode.

Uvod: Pectus excavatum, stečeno ili kongenitalno udubljenje prednje stijenke prsnog koša, najčešći je deformitet stijenke prsnog koša. Ljevkasta prsa zajedno s kokošjim prsima najčešći su deformiteti prsnog koša (oko 90%) s učestalosti od 1:400 novorođene djece. Ti pacijenti doživljavaju bitne psihosocijalne poteškoće i moguće fiziološke poremećaje s kardiopulmonalne strane. Liječenje ljevkastih prsa može biti provedeno na dva načina: kiruškim pristupom i nekirurškim. Tradicionalna procedura popravka ljevkastog prsnog koša izvodi se velikom otvorenom operacijom po Ravitchu i njegovim modifikacijama. Od 1998. dr. Donald Nuss publicirao je minimalno invazivnu tehniku operacije ljevkastih prsa koja koristi torakoskopsku vizualizaciju s malim postraničnim rezovima i privremeno postavljanje modelirane metalne šipke iza prsne kosti. Ova tehnika je bila brzo prihvaćena od mnogih kirurga, što je rezultiralo značajnim porastom broja operacija. Minimalno invazivni pristup za popravak ljevkastih prsa prihvaćen je u mnogim centrima kao metoda izbora, prvenstveno zbog povećane svijesti pacijenta i dobroga dugoročnog ishoda. U početku je ova procedura pokazala moguće rizike i komplikacije te su napravljene važne tehničke modifikacije koje su umanjile rizik i poboljšale ukupni rezultat. Cilj ovog rada je prikazati metodu liječenja minimalno invazivne kiruške korekcije ljevkastih prsa u pedijatrijskih bolesnika po Nussovoj metodi. Kod nekirurškog liječenja ljevkastih prsa koristi se vakuum zvono koje se postavi na prednju stijenku prsnog koša i uz pomoć pumpice učini vakuum koji prednju stijenku prsnog koša izvlači prema naprijed. Zaključci: Procedura po Nussu je uspješna metoda kiruškog liječenja ljevkastih prsa u djece i odraslih. Operacijsko liječenje ljevkastih prsa po Nussovoj metodi daje uglavnom odlične estetske rezultate te subjektivno zadovoljstvo pacijenta.

Uvod: Jednodnevna kirurgija danas je naširoko prihvaćena za brojne elektivne laparoskopske postupke u djece. Cilj ove studije jest procijeniti sigurnost i učinkovitost otpuštanja iz bolnice unutar 24 sata kod djece koja su apendektomirana laparoskopskim putem zbog nekompliciranoga akutnog apendicitisa. Ispitanici i metode: U ovu prospektivnu studiju uključeno je ukupno 180 djece od 1. ožujka 2021. do 1. svibnja 2022. koji su otpušteni s bolničkog liječenja unutar 24 sata nakon laparoskopske apendektomije zbog nekompliciranog apendicitisa. Primarni ishod bila je sigurnost otpusta unutar 24 sata nakon laparoskopske apendektomije zbog nekompliciranog apendicitisa, kao i zadovoljstvo roditelja ovim protokolom. Sekundarni ishodi uključivali su stopu ponovnog prijma ili neplanirani povratak u operacijsku salu, stopu komplikacija i analizu isplativosti. Za svakog ispitanika zabilježeni su demografski podatci, prijeoperacijska evaluacija (fizikalni pregled, laboratorijski podatci, slikovne pretrage), trajanje operacije, intraoperativne i poslijeoperacijske komplikacije, trajanje boravka u bolnici i razina boli, kao i zadovoljstvo roditelja. Rezultati: Medijan dobi ispitanika je 11 godina [interkvartilni raspon (IQR) 10,14]. Većina ispitanika (63,8%) bili su muškog spola. Medijan trajanja boravka u bolnici nakon operacije bio je 15 sati (IQR 12,19). Najveću razinu zadovoljstva otpustom iskazala je većina ispitanika (n=155; 86,1%), dok je preostalih 25 (13,9%) izrazilo umjerenu razinu zadovoljstva. Medijani za razinu boli, prema vizualnoj analognoj ljestvici za sve poslijoperacijske dane, bili su niski (raspon 0–4). U četiri bolesnika (2,2%) zabilježen je neplanirani ponovni prijam prije sedmoga poslijoperacijskog dana zbog intraabdominalnog apscesa. Svi bolesnici s apscesom liječeni su konzervativno. Većina roditelja (n=175; 97,2%) iskazala je najveću razinu zadovoljstva sedmoga poslijeoperacijskog dana pri kontrolnom pregledu u poliklinici. Zaključci: Otpust unutar prvog dana nakon laparoskopske apendektomije zbog jednostavnog apendicitisa u djece siguran je i provediv. Zadovoljstvo roditelja ovim protokolom bilo je vrlo visoko. Uz pravilan protokol i edukaciju roditelja, djeca koja su podvrgnuta laparoskopskoj apendektomiji zbog nekompliciranoga akutnog apendicitisa mogu se uspješno liječiti na ovaj način.

Background: This study aims to compare outcomes of treatment, in terms of early and late complications, between the Snodgrass and meatal mobilization (MEMO) techniques in children operated on because of distal hypospadias. Methods: The medical records of 127 children who underwent glandular, coronal, or subcoronal hypospadias repair between 1 January 2019 and 31 December 2023 were retrospectively reviewed. A total of 105 children met the inclusion criteria and were included in further analysis. The inclusion criteria were pediatric patients who underwent glandular, coronal, or subcoronal hypospadias repair using MEMO (n = 49) or the Snodgrass technique (n = 56) as a comparative group. The primary outcome of this study was the incidence of early and late complications with two different surgical techniques. Secondary outcomes were the duration of surgery, the length of hospital stay, the number of readmissions or unplanned returns to the operating room, and repeat surgeries between groups. Results: The median age of all patients was 17 (interquartile range, IQR 13, 29) months, with a median follow-up of 26 (IQR 17, 34) months. Regarding the type of hypospadias, the majority of patients in both groups were categorized as coronal and subroronal hypospadias. Regarding the incidence of postoperative complications, a significantly lower incidence of postoperative complications was found in the MEMO group compared to the Snodgrass group (n = 4; 8.2% vs. n = 14; 25%; p = 0.037). An urethrocutaneous fistula was the most common complication in the Snodgrass group (n = 8; 14.3%), while in the MEMO group, only one patient (2%) developed a fistula (p = 0.034). The incidence of meatal stenosis (p = 0.621) and wound infections (p > 0.999) was low in both groups. No further complications were recorded during the follow-up period. Duration of surgery (41 min (IQR 38, 47) vs. 51 min (IQR 45.5, 61); p < 0.001), duration of hospitalization (1 day (IQR 1, 2) vs. 3 days (IQR 2, 6); p < 0.001), and time to catheter removal (3 days (IQR 2.5, 5) vs. 6 days (IQR 6, 8); p < 0.001) were significantly lower in patients operated on with MEMO compared to the Snodgrass technique. Only one case of readmission due to severe wound infection which led to suturing line dehiscence was recorded in the Snodgrass group. The incidence of redo surgery was significantly lower in the MEMO group than in the Snodgrass group (n = 3; 6.1% vs. n = 11; 19.6%; p = 0.048). Conclusions: MEMO is a safe and effective technique that can be used for the treatment of distal hypospadias. It showed excellent outcomes, cosmetic results, and a low incidence of complications as well as a significantly shorter duration of surgery compared to the Snodgrass technique.

Aim: Triclosan is an antiseptic substance that has been shown in preclinical studies to reduce bacterial load in the wound and slow bacterial growth by inhibiting fatty acid synthesis. It is claimed that the coating protects against colonization of the tissue around the suture. This study aimed to compare the safety and efficacy of triclosan-coated polydioxanone versus uncoated polydioxanone sutures for the prevention of surgical site infections (SSIs) following hypospadias repair in children. Methods: The medical records of 550 children who underwent hypospadias repair between 1 January 2014 and 31 December 2023 were retrospectively analyzed. The patients included in the study were divided into two groups. The first group consisted of the patients in whom polydioxanone (PDS II) was used (n = 262), while in the patients of the second group (n = 288), triclosan-coated polydioxanone (PDS Plus) was used for hypospadias repair. Secondary outcomes were defined as the occurrence of early and late complications, the number of readmissions within 30 days after surgery (ReAd), unplanned return to the operating room (uROR), and repeat operations. Results: The median age of all children enrolled in the study was 16 (IQR 14, 20) months. The patients in whom PDS Plus was used for hypospadias repair had a significantly lower number of SSIs than the patients in whom PDS II was used (n = 18 (6.9%) vs. n = 4 (1.4%), p < 0.001). Wound infection led to wound dehiscence in 10 of 18 patients from the PDS II group, while all four wound infections from the PDS Plus group led to wound dehiscence (p = 0.07). The number of postoperative urethrocutaneous fistulas was significantly lower in the patients in whom PDS Plus was used (13.7% vs. 8.3%, p = 0.042). The incidence of late complications did not differ between the study groups: meatal stenosis (p = 0.944), residual chordee (p = 0.107), urethral stricture (p = 0.196), scarring (p = 0.351) and urinary discomfort (p = 0.713). There were no cases of uROR in either group. The ReAd rate was low in both groups (n = 5 (1.9%) vs. n = 2 (0.6%), p = 0.266). The frequency of reoperations was lower in the group of patients treated with PDS Plus than in the group of patients treated with PDS II (11.1% vs. 20.6%; p = 0.03). Conclusion: The use of PDS Plus in hypospadias surgery significantly reduces the incidence of SSI, postoperative fistulas, and reoperation rates compared to PDS II.

(1) Background: One-day surgery has been widely adopted for many elective laparoscopic procedures in pediatric patients. Recently, the same protocol has been investigated for some emergency procedures, such as laparoscopic appendectomy. This study aimed to evaluate the safety and effectiveness of discharge from hospital within 24 h in pediatric patients who received laparoscopic appendectomy for uncomplicated acute appendicitis. (2) Methods: From 1 March 2021 to 1 May 2022, a total of 180 pediatric patients who were discharged from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis were included in this prospective single-center study. The primary outcome of this study was the safety of discharge from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis, as well as the parental satisfaction with this protocol. Secondary outcomes included the rate of readmission or unplanned return to the operating room, the complication rate and a cost-effectiveness analysis. For each patient, demographic data, preoperative evaluation (physical examination, laboratory data, imaging), duration of surgery, intraoperative and postoperative complications, length of hospital stay and pain levels, as well as parental satisfaction with this protocol, were recorded. (3) Results: The median age was 11 years (interquartile range (IQR) 10, 14). The majority of the patients (63.8%) were males. The median length of hospital stay after surgery was 15 h (IQR 12, 19). The highest level of satisfaction, at discharge, was recorded in most of the respondents (n = 155, 86.1%), while the remaining 25 (13.9%) expressed moderate levels of satisfaction. The median pain levels according to a visual analogue scale for all postoperative days were low (range 0–4). In four patients (2.2%), unplanned readmission before the seventh postoperative day because of postoperative intraabdominal abscess was recorded. All patients with abscess formation were treated conservatively. The majority of the parents (n = 175; 97.2%) expressed the highest level of satisfaction during the outpatient follow-up examination on the seventh postoperative day. (4) Conclusions: Same-day discharge after laparoscopic appendectomy for simple appendicitis in pediatric patients was safe and feasible. Parental satisfaction with this protocol was very high. With the right protocol and parent education, pediatric patients who underwent laparoscopic appendectomy because of non-complicated acute appendicitis may be successfully treated in this way.