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Objectives: Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly of the diaphragm with pulmonary hypoplasia and persistent pulmonary hypertension and has serious consequences. Despite recent diagnosis and treatment strategies, CDH is still a challenging condition. We aim to present our clinical experiences of CDH, and review of the literature. Methods: Data of CDH patients who were operated in our clinic between January 2010 and September 2018 were obtained from the patient's chart. The clinical course and results of the patients with Bochdalek type CDH were reviewed. Results: We performed diaphragmatic closure in 16 patients with Bochdalek CDH during study period. Fourteen (82%) cases were diagnosed antenatally. In 5 (29%) patients, preoperative pulmonary hypertension developed and nitric oxide was administered. Twelve of the sixteen patients (75%) underwent primary repair and 4 of them underwent prosthetic patch. Three patients were repaired thoracoscopically. Five (31%) patients died due to severe persistent pulmonary hypertension on postoperative period. There was no recurrence in our patients who were followed-up for a mean of 27 months. Conclusion: In the management of Bochdalek CDH, the clinical success has been increasing in parallel with the important developments with the application of new treatment modalities in the neonatal intensive care units and new surgical techniques in recent years.

Objective: Phimosis is define as unretractable prepuce and has two different clinical presentation; pathological (PaP) and physiological. Physiological phimosis (PhP) is a common condition in children that does not require treatment. In our study, we aimed to determine the actual requirement for circumcision in patients with phimosis who were recommended circumcision. Material and Methods: Children who were offered circumcision due to phimosis between July 2019 and January 2020 and applied to the pediatric surgery and pediatric urology outpatient clinic were included in the study. They were evaluated in terms of referring physicians, genital examination findings and requirement for circumcision. Results: Between the study dates, 199 patients applied for circumcision due to phimosis. 126 patients are under one year old, 73 patients are over one year old. PhP was present in 194 of the patients and PaP in 5 of them. While PaP is not detected in patients under one year of age, there are 5 patients with PaP over one year of age (2%). There was no requirement for urgent circumcision in any of the patients. Genital examination revealed incidentally undescended testicle in 3 patients and hydrocele in 12 children. Conclusion: Male genital system examination and pathological findings are not well known by physicians. We think that there is a need for detailed training for physicians regarding PhP and childhood testicle pathologies.

Objectives: The benefits of circumcision, which is one of the most frequently performed surgical procedures, are controversial. In our study, before and after circumcision, uroflowmetry parameters were compared to evaluate the effects of circumcision on voiding. Methods: Children between the ages of 5-15 years who applied to the outpatient clinic for voluntary circumcision and who did not have underlying diseases and voiding problems were included in the study. Circumcision was performed by specialist in sterile conditions under general anesthesia. Uroflowmetry was evaluated by voiding volume, voiding time, maximum flow rate, average flow rate, shape of the curve. The pre-circumcision and post-circumcision uroflowmetry results were compared statistically. Results: Fifty patients with a median age of seven years (range: 5-10 years) were included in the study. When uroflow parameters were compared in our study, the maximum flow rate, mean flow rate and the time to maximum flow rate were found significantly different (p < 0.05). The plateau pattern was detected in 30% of patients before circumcision, while in 8% of patients after circumcision. Conclusions: Circumcision performed by specialists under sterile conditions has positive effects on uroflow parameters.

Objective Persistent Mullerian duct syndrome (PMDS) is a rare congenital disease characterized by the presence of rudimentary Mullerian structures within an intra-abdominal or hernial sac in a virilized male, often presenting as undescended testes. In this study, we aim to present a series of the PMDS patients who were managed by orchiopexy without removal of Mullerian remnants (MR). Material and methods Between May 2010 and June 2017, we treated six cases diagnosed as PMDS in our department. Laparoscopy and gonadal biopsy were performed in all patients, and vessel ligation was done in four patients for the first session of Stephen-Fowler orchiopexy. After initial diagnosis, genetic analyses and endocrine investigations were performed. Demographic and clinical features of the patients, operative methods and follow-up data were analyzed retrospectively. Results Mean age of the patients was 5.5 years. Three boys had undergone inguinal surgery due to hernia or undescended testis, while others were diagnosed during laparoscopic investigation of nonpalpable testis. As a definitive operation, testes and MR were completely removed in an adult patient, and the remaining patients were treated with laparoscopic or open orchiopexy with or without utero-cervical splitting and the MRs were left in situ. Two testes atrophied during follow-up period. Conclusion The goal of the approach in PMDS patients is to preserve testes, as well as carry them to their natural location. Leaving the MR in place is a suitable option for blood circulation of the testes but the long-term results are still unknown.

Simple renal cysts (SRC) in children are uncommon, usually asymptomatic, and discovered incidentally during investigation for other urinary or abdominal symptoms. The management of SRC in children depends on the symptoms and imaging. Patients can be followed by ultrasonography or other imaging or may be decided an intervention. The available procedures for the treatment of symptomatic cysts are percutaneous aspiration with or without sclerotherapy and open or laparoscopic approaches of the lesions. Only a few small series have been published SRC in children, and is not sufficient data available regarding laparoscopic approach. In this case report, we present a case of symptomatic SRC who underwent laparoscopic unroofing.

AIM To present cross-sectional imaging, surgical findings, and follow-up results of diaphragmatic mesothelial cysts. MATERIALS AND METHODS Radiological findings for location, size, shape, and internal structure of cysts were reviewed retrospectively. For patients that underwent surgery, surgical reports and laparoscopy images were reviewed. In conservatively managed patients, changes in size and imaging findings of the cyst were assessed during follow-up visits. RESULTS A total of 13 paediatric cases with an imaging and/or pathological diagnosis of diaphragmatic mesothelial cyst were identified. In all cases, the cystic lesions were located between the diaphragm and the posterolateral aspect of the right lobe of the liver. Eleven lesions (84.6%) had a bi-lobulate shape. Eight of these cases underwent laparoscopic cyst aspiration/unroofing. The postoperative course was uneventful and there were no cases of recurrence. The remaining five cases were managed conservatively with follow-up available in four cases. In three cases (75%), there was reduction in the size of the cysts with a mean volume reduction of 55%. CONCLUSION Diaphragmatic mesothelial cysts are congenital cystic lesions that are usually detected incidentally. A common pitfall is incorrect interpretation of the lesion as a hepatic cyst. Conservative management with imaging follow-up can be adopted in asymptomatic cases with typical imaging findings.

Objective: Temporary enterostomies are life-saving in neonatal surgery, however, causing loss of fluid electrolyte, delays in distal bowel adaptation and thus delayed growth of newborns. In this st...

Introduction: Intestinal malrotation is an anomaly that often manifests in newborn and infant childhood. This anomaly, which is rarely seen in older children and adults, is usually detected incidentally during imaging studies or during laparotomy. This article is presented with the aim of emphasizing the Computarised Tomography (CT) imaging for intestinal malrotation an adolescent patient with mesenteric volvulus. Case Report: A sixteen-year-old male patient presented with epigastric pain and bilious vomiting after feeding. In ultrasonography (US), intestinal loops were surrounding along the superior mesenteric artery (SMA) and venous (SMV) vessels tract. In CT, it was noted that SMA marks a whirl sign in the midline of the abdomen. At laparotomy, there were found 360° torsion of small intestine, due to intestinal malrotation. Ladd procedure was performed. Conclusion: In cases of intestinal malrotation, preoperative diagnosis can be difficult because of the lack of specific findings in the physical examination. The delayed diagnosis may be lead to volvulus and intestinal necrosis. The diagnosis of malrotation can brought to mind at an early age but it may be delayed in later ages. In practiced hand, the evaluation of vessels traseries by detailed US and contrast-enhanced CT are characteristics of malrotation diagnosis.

Omphalocele, exstrophy of cloaca, imperforate anus and spinal defect (OEIS Complex) is an extremely rare combination of serious defects, which was firstly described by Carey and colleagues. Surgical repair of cloacal exctrophy in patients with OEIS complex can be performed at one stage, but it can also be performed safely as staged to minimize the potential complications. In this case report, we aimed to present our early approach to the OEIS complex.

Many methods of laparoscopic gastrostomy have been described, but in the majority of these, purse-string sutures and fixation of the stomach to the abdominal wall are not performed simultaneously. In this study, we aim to present a new laparoscopic gastrostomy tube (GT) placement method developed in accordance with the classical Stamm method.Intracorporeal purse-string suture is placed at the anterior wall of the stomach where the GT is intended to be placed. While purse-string sutures are being placed, in each bite, the needle is passed through from a loop thread prepared by extracorporeal and the two threads are suspended outside. The stomach is punctured with the hook cautery, the GT is inserted, and both threads are knotted outside the abdomen.We prospectively placed GT by using our method in 16 patients with an average age of 5 years and most of them with neurological developmental delay. Fundoplication was performed in most of the cases in the same session. No complications were encountered.Our method is a feasible approach for GT placement by the purse-string suturing and the fixation of the stomach to the abdominal wall without extending the port incision.

The gastrointestinal duplication of stomach is uncommon congenital anomalies of gastrointestinal tract. Herein a rare case of gastric duplication with newborn is being reported. A 14-day-old term female baby was admitted to our clinic with intermittent bilious vomiting and abdominal distention. In evaluation, abdominal cystic mass was detected in the left upper quadrant. The cyst which was attached to both the pancreatic duct and spinal cord was removed totally by laparotomy. A histologic examination showed gastric duplication cyst. The postoperative course was uneventful. There were no any complications at the 8-month follow-up period. This rare entity should be included in the differential diagnosis of cystic masses of the gastrointestinal tract and treated surgically by complete resection due to the risk of malignant transformation and other complications. This is the first case report that the gastric duplication cyst has a connection with both the pancreatic duct and spinal cord.

Objectives. The acute scrotum frequently presents a diagnostic and therapeutic challenge. In cases where the testicular torsion cannot be excluded, a surgical exploration is recommended. The aim of the study was to present the results of our management in the patients with acute scrotum. Methods. We reviewed the medical records of 33 patients suffering from acute scrotal pain underwent scrotal exploration between 2011 and 2016. Anamnestic data (age of patient, duration of anamnesis prior to admission and the side that was involved), scrotal color Doppler ultrasound (SCDUS) results, intraoperative findings, mode of operative treatment, and the clinical outcomes were analyzed. Results. Patients aged from several hours up to 17 years of age (average 11.9 years). The duration of symptoms prior to admission ranged from 3 h to 4 days, (average 32 h). Acute scrotum was found 18 in right side, 15 in left side. SCDUS was diagnostic for testicular pathologies in 19 (51%) of 30 patients. In patients who underwent scrotal exploration, 18 (54%) had a testicular torsion, 11 (33%) had a torsion of the appendix testis, and 4 (12%) had an orchio-epididymitis. Three patients who found testicular torsion required an orchidectomy immediately because of necrosis. The rest had detorsion and ipsilateral fixation of testis. Three patients underwent second look, and orchiectomy was performed in 2 of them. In 2 of detorsioned testes, two testicular atrophies developed on follow-up period. Conclusion. Regardless of the etiology, the management of the patients with acute scrotum by urgent surgical intervention allows the salvage of a possible testicular torsion.

Aim: The appropriate anesthetic technique to be used in cases of proximal hypospadias in children is a subject of debate. Local or regional anesthesia as well as intubation can be used. In this study, it was aimed to evaluate retrospectively the different anesthesia and surgery techniques used and their perioperative outcomes in the cases of proximal hypospadias consulting our hospital.Materials and Methods: The hospital files of 30 cases operated on for proximal hypospadias were scanned retrospectively to evaluate the different methods of anesthesia and repair surgery implemented. The patients operated under general anesthesia were grouped on the basis of the airway equipment used for anesthesia as Laryngeal mask airway (Group 1) and endotracheal intubation (Group 2). Routine penile block implementation, effectiveness of anesthesia, side effects, hemodynamic changes and complications in all patients were recorded. Results: A total of 56 sessions of operations on 28 patients were carried out. In 26 of the session’s laryngeal mask and in 30 sessions endotracheal intubation were used. When the data of Group 1 and Group 2 were compared, the groups did not differ significantly with respect to age, anesthesia methods and duration, hypospadias repair methods, duration and sessions, intraoperative parameters, hospital stay and complications (all p>0.05). The two groups differed on the ASA physical status classification values with Group 2 values being significantly higher (p0.05).Conclusion: Effectiveness of anesthesia by using LMA or endotracheal intubation were perioperatively equivalent during repair of proximal hypospadias with different methods of surgery.

Objective: To evaluate the demographics and characteristics of children with Meckel’s diverticulum (MD). Material and Methods: In this retrospective study, we analyzed the medical records of all children who were treated for MD in the department of pediatric surgery of Tepecik Training and Research Hospital over a period of 10 years (1995-2004). Age, gender, clinical manifestations, diagnostic approaches, and histopathological reports were documented. Results: In total, 57 children were diagnosed with MD. Of these, 40 children were treated surgically. Furthermore, 26 had acute abdomen, 15 had intestinal obstruction, 10 had rectal bleeding, and 6 had some other diagnosis. The mean age of the boys (n=43) was 4.77±3.82 years, whereas that of the girls (n=14) was 3.85±3.67 years. Histopathological examination revealed ectopic mucosa in 9 patients, omphalomesenteric duct remnants in 4 patients, diverticulitis in 24 patients, and ulcerations in 14 patients. Conclusion: The prevalence of MD was 1.6%. Boys were approximately 3 times more commonly affected than girls. In most cases, the initial diagnosis was acute abdomen and the presenting symptoms on admission were intestinal obstruction and rectal bleeding.

Background. The experience with laparoscopic cholecystectomy in children remains limited. Therefore, we aimed to present our experience with this procedure. Methods. Between April 2011 and June 2016, retrospectively, data points of children who underwent laparoscopic cholecystectomy reviewed included demographics properties, indication for cholecystectomy, surgical technique, operative time, complications, and length of hospital stay. Results. Twenty-four children (5 were males with ages ranging from 2 to 17 years, mean: 10.5 years) underwent laparoscopic cholecystectomy. The indication for surgery was associated to symptomatic gallstones in all patients. The surgery was performed under general anesthesia and classical 4-port approach was done in twenty-two patients, and 2-port approach in combination with 2 portless 2.3-mm percutaneous graspers was used in two patients. The operating time ranged between 45 and 90 minutes (mean: 60 minutes). Two patients ended by open surgery. No complications occurred. Hospital stays ranged from 1-3 days. Conclusion. Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adults series.

Background: The purpose of this study is to determine the prevalence of nocturnal enuresis and its association with sociodemographic factors in 6- to 14-year-old children in the central district of Bursa, located in western Turkey. Methods: A cross sectional epidemiological study was performed among the 125,843 primary schoolchildren. In total, 3270 students aged 6-14 years participated (response rate 98.0%). Data were collected via a questionnaire completed by parents. The relationships between the prevalence of enuresis and various sociodemographic variables were assessed. Results: The overall prevalence of nocturnal enuresis was 23.5%, and the prevalence of the condition was higher in males than in females (52.5% vs. 47.5%). Of the students positive for nocturnal enuresis, 59.1% had primary and 41.9% had secondary enuresis. Male gender, history of enuresis, deep sleep, and constipation were significantly associated with enuresis. Conclusions: The prevalence of nocturnal enuresis may be higher than in previous studies in Turkey, a finding that may be due to the relatively low socioeconomic status of the families in this study. [TAF Prev Med Bull 2012; 11(2.000): 139-144]

Various techniques have been described to repair Morgagni–Larrey hernia. There is still concerns on the sufficiency of a simple laparoscopic anterior abdominal wall fixation. We aim to report of two children undergoingthe laparoscopic-assisted anterior abdominal wall repair for Morgagni–Larrey hernia, and to discuss this method.Keywords: diaphragm, laparoscopy, Morgagni–Larrey hernia

One of the main issues in the penile surgery is wound dressing. There are several varied methods have been reported for circumcision or hypospadias dressing. We aim to report our experiment with Coban™ dressing in penile surgery.

Intussusception is a well-known disease, and one of the most frequent causes of acute bowel obstruction in children aged 3-18 months, with an incidence of 0.1-0.4% of live births. Although idiopathic intussusception has not been considered a genetic disease, it has also been reported in families and relatives (1-4). Herein, we present the first case report in the English literature of simultaneous occurring intussusception in monozygotic twins.

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Isolated epispadias is rare congenital anomaly. An uncommon variation of this anomaly may present with intact prepuce, and it may not be recognized until later during childhood. Herein, we aim to report a case of isolated epispadias with intact prepuce who underwent modified Cantwell-Ransley repair because of rarity.

Background / purpose The aim of the study was to present our clinical experience with the laparoscopic approach in patients with nonpalpable testes (NPTs) and review the literature on laparoscopic classifications. Materials and methods Between May 2010 and August 2012, 30 boys with NPT (mean age 3.9 years) underwent laparoscopy as a part of diagnosis and treatment in our clinic. The laparoscopic findings were classified into four types according to Castilho. The patients were managed according to the presence or position of the testes and testicular vessels. Results Six patients were excluded from the study. Twenty-six testicular units (19 left, three right, and four bilateral units) in 24 patients were managed laparoscopically. Laparoscopy was terminated in eight patients in whom blind-ending cord structures were detected intra-abdominally. An inguinal canal exploration was performed in 10 cases in whom cord structures were seen entering the internal inguinal ring. No viable testis was found, and testicular remnants were excised for histopathologic examination. Four canalicular testes (peeping) were treated with open orchiopexy. Laparoscopy-assisted orchiopexy without vascular ligation was performed in two testes. Fowler-Stephens orchiopexy in single stage was performed in one testicular unit and in two stages in another unit. All patients were discharged on the same day. The testes were normal in size and found in the scrotum after a mean follow-up period of 14 months. Conclusion The laparoscopic findings in NPT had an important influence on treatment decisions. To be able to interpret the definitive surgery relative to the laparoscopic classification, collaborative studies are required. Keywords : laparoscopy, nonpalpable testis, nubbin, orchiopexy, vas deferens

Objective The aim of this study was to present the outcomes of children with distal hypospadias who were operated on outpatient basis. Methods Atotal of 47 consecutive children underwent surgical repair of distal hypospadias in our department. Urethroplasties were performed by the following techniques: stentless meatal advancement-glanuloplasty (MAGPI) or glans approximation procedure (GAP) for glanular hypospadias (14) and tubularized incised plate (TIP) urethroplasty for coronal, subcoronal and midpenil hypospadias with an indwelling urethral catheter or short stent (33). The indwelling urinary catheters were managed by the double diaper technique. Patients were discharged within 6 h after operation. Dressings and catheters were removed on the postoperative day 2 and 6, respectively. Results Voiding difficulty and urinary retention on early postoperative period were observed in 8 patients. Except meatal stenosis in 4 cases and meatal retractions in 2 cases, there were no major complications in any of our patients during the follow-up period, no postoperative fistula or urethral stricture. Conclusion In children, repair of distal penile hypospadias on outpatient basis is feasible. Catheters, urethral stents, drug therapy and dressing are not justifications for hospitalization in such cases. Keywords: hospital stay, hypospadias, outpatient, urethroplasty, wound dressing

In nonpalpable testis cases, laparoscopically blind-ending vas deferens and testicular vessels prior to entering the internal ring is sufficient to diagnose a “vanishing” testis, which requires no further exploration. Laparoscopic identification of cord structures entering the internal ring is required the exploration of the inguinal canal to find a testis or to rule out a “vanishing” testis".However, the need for further investigation in cases that identified the blindending cord structures on inguinal canal is questioned. Herein, we present a case of the scrotal nubbin along with blind ending cord structures during inguinal exploration.

The goal of renal trauma management is preservation of functional renal parenchyma with minimal morbidity. In children with grade IV renal injury, the role and timing of surgical or endourologic intervention is less established and remains controversial. We report a case of a urinary extravasation after blunt renal trauma treated by internal ureteral stenting.

Although the bladder diverticula in children are seen commonly which is association with infravesical obstruction or neurogenic bladder function, the case of giant congenital bladder diverticula are rare. In this paper, an 11 years old boy with giant bladder diverticula presenting urinary infections is evaluated in terms of diagnosis and management by current literature.