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Background: Long-gap esophageal atresia remains a challenging condition. There are no standard guidelines on the optimal surgical approach or the optimal management strategy for the potential postoperative complications. We report a case of long-gap EA treated by staged thoracoscopic repair in which the chest drain caused a complication. Case report: A female with prenatal diagnosis of polyhydramnios and a small stomach suspicious for esophageal atresia was delivered by cesarean section at 33 weeks of gestation. The orogastric tube remained coiled in the upper esophagus, confirming the diagnosis of esophageal atresia. X-rays showed a gasless abdomen, suspicious for a lack of a distal tracheo-esophageal fistula. On the second day of life, the patient underwent a tracheoscopy, which confirmed the absence of a tracheo-esophageal fistula. A gastrostomy was done at the same time. At 1 month of age the patient underwent a fluoroscopic study, and the esophageal gap was found to be 3.5 vertebral bodies. At 2 months of age she underwent a thoracoscopic placement of internal traction sutures. Five days later she underwent a thoracoscopic esophageal anastomosis, which was under moderate tension. A chest tube was left in place. Seven days after the operation a routine esophagram showed that the chest tube had slipped into the esophagus through the anastomosis. We pulled the chest tube back under direct endoscopic vision. There was also a tight stenosis at the anastomosis. We placed a trans-anastomotic tube for feedings and a naso-esophageal tube to suction the secretions of the upper esophagus. Forty-for days later we repeated the esophagram and confirmed the persistence of the tight stenosis. The patient underwent serial dilations every 2 weeks for 3 months and a Nissen fundoplication, after which the stricture completely resolved. Conclusion: Although rare, the chest tubes used after the repair of an esophageal atresia can cause complication at the anastomotic site.

This study reports the complication and disease recurrence rates for ileocecal resection for pediatric and adult Crohn’s disease (CD) and identifies perioperative risk factors for these adverse outcomes in the two groups. Patients who underwent ileocecal resection for CD in a tertiary hospital in Italy (2010–2021) were included. Risk factors for postoperative complications and clinical and surgical disease recurrences were investigated with multivariate models. A total of 96 patients were included (children, 25%). There were no intraoperative complications. Thirty-one (32.3%) patients experienced 35 (36.5%) postoperative complications, and five (5.2%) were severe (Clavien–Dindo III–IV–V), with no intergroup difference for either overall postoperative complication rate (p = 0.257) or severe postoperative complication rate (p = 0.097). Most of these (77.1%) occurred within 30 days after surgery, especially in adults (p = 0.013). The multivariate analysis did not show risk factors for postoperative complications. Clinical and surgical recurrence rates after 5 years were 46.8% and 14.6%, respectively, with no intergroup rate differences. Clinical disease recurrence was positively correlated with previous abdominal surgery (p = 0.047) and negatively correlated with preoperative Hb levels (p = 0.046). A positive correlation was found between perianal disease and both clinical (p = 0.045) and surgical disease recurrences (p = 0.045). Urgent surgery was positively associated with surgical disease recurrence (p = 0.045). Notably, no children underwent urgent surgery in this study. In conclusion, the risk of postoperative complications among CD patients receiving ileocecal resection remains high, but most of them are nonserious. Some factors, such as urgent surgery, may increase the risk of disease recurrences.

Introduction: In children, the association of ipsilateral pyeloureteral junction obstruction (PUJO) and ureterovesical junction obstruction (UVJO) is a rare malformation with a non-standardized treatment. We report a case of PUJO and UVJO treated by a combined minimally invasive surgical treatment to resolve the double urinary obstruction. The current literature was also reviewed. Case report and review: A two-month-old boy, without antenatal and postnatal signs of urinary tract anomalies, was hospitalized presenting right hydronephrosis, perirenal fluid effusion, and ascites. An acute pelvic rupture was suspected, and a retrograde pyelogram was performed, showing a primary obstructive megaureter (POM) associated with a corkscrew pyeloureteral junction. The impossibility to place a double J catheter through the pyeloureteral junction led us to achieve percutaneous nephrostomy and an abdominal drain placement. Three months later, the patient underwent a combined high-pressure balloon ureterovesical junction dilation and retroperitoneoscopic Anderson Hynes one-trocar-assisted pyeloplasty (OTAP). The literature search identified 110 children experiencing double urinary tract obstruction. All authors agreed on the difficulty to diagnose both obstructions preoperatively, but there is still no consensus on which obstruction should be relieved earlier, because the alteration in urinary vascularity during a double surgery could damage the ureter. Conclusions: The simultaneous occurrence of UPJO and UVJO is rare, with a challenging diagnosis. Prompt identification and timely surgical intervention are crucial to mitigate the risk of renal function loss attributable to obstruction and infection. Drawing from our expertise and the analysis of the existing literature, we propose employing a simultaneous double minimally invasive strategy in order to optimize the preservation of ureteral vascularity. This approach entails performing a minimally invasive pyeloplasty for the PUJ and utilizing high-pressure balloon dilatation for the UVJ.

Morgagni-Larrey hernias represent a subgroup of Congenital diaphragmatic hernias (CDHs), involving the anterior part of the muscle. They are complex developmental defects often representing a diagnostic and treatment challenge for both pediatricians and pediatric surgeons. We report our first case of a robot-assisted laparoscopic repair of a Morgagni hernia in an 8.3 kg 14-month-old girl with the use of the Da Vinci® Surgical System (Intuitive Surgical®, Sunnyvale, CA, USA)

Background: A major worry of juvenile penile LS is potential malignant degeneration to spinocellular carcinoma (SCC) in adulthood. LS is characterized by increased CD8+ and CD57+ cells, dermal sclerosis, epidermal atrophy, and hyperkeratosis. p53 and Ki67 are reliable premalignant markers. Our aim was to define the LS immunohistochemical profile of foreskin in children, focusing on tissue immune response and cell proliferation. Methods: Thirty specimens of foreskins removed from pediatric patients during circumcision were included: six from ritual operation (A), twelve from phimosis (B), and twelve from phimosis with LS (C). Formalin-fixed paraffin-embedded sections were stained for histomorphology and immunohistochemistry. A quantitative evaluation for CD8, CD57, p53, and Ki-67 and a statistical analysis were performed. Results: As compared to groups A and B, the samples from group C patients showed an acanthotic epidermis, a dermal band of lymphoid infiltrate with a significant enhancement of CD8+ CD57+ lymphocytes, and a keratinocytic hyperplasia with an overexpression of Ki67+ and p53+ cells. Conclusions: Immunohistological findings confirmed an immune reaction and proliferative behavior in juvenile LS of foreskin. We believe that radical circumcision should be the first treatment of choice in pediatric patients with clinical suspicious of LS for the potential risk of transformation to SCC in adulthood.

Abstract Background The urachus is an embryological structure of the urogenital sinus and allantoid that connects the allantois to the early bladder in fetal life and then remains as the median umbilical ligament connecting the umbilicus to the dome of the bladder. An early laparoscopic procedure could trigger a quiescent urachal remnant to become symptomatic, causing a lesion or infection either during carbon oxide contamination or insufflation or a periumbilical or suprapubic port placement. Case presentation A 15-year-old girl complaining of supra-pubic abdominal pain. About 2 months previously, she had undergone laparoscopic appendectomy for acute appendicitis, and early postoperative period was uneventful. She underwent a robotic-assisted excision of a urachal cyst. Conclusions It has been suggested that early laparoscopic procedures could trigger previously asymptomatic urachal remnants to become symptomatic. Robot-assisted excision of a urachal cyst is a safe, effective alternative to open surgery in children.

Robotic surgery, defined as minimally invasive surgery (MIS) with the assistance of tele manipulators, was developed to increase the surgeon’s skills, accuracy and high precision during complex surgery. In a relatively short amount of time, robotic minimally invasive surgery has been rapidly adopted for a wide variety of surgical procedures in adult patients across a broad spectrum of surgical specialties, included pediatric surgery. The first case of robotic minimally invasive surgery in children was a Nissen fundoplication that was performed in July 2000 and since then, robotic techniques have been slowly adopted by select pediatric surgical specialists. The real innovation, especially for children, is that robotic surgery permits previously intangible minimal access surgical approaches for complex reconstructive procedures. But, unfortunately, there are some limitations, that slow down the spread of this technology in pediatric field such as the size and the higher costs, that needs to be overcome. The use of robotic-assisted surgery is increasing even in younger children, infants, and neonates. However, more strong studies are needed in order to assess the scientific evidence of this approach versus the conventional open or laparoscopic techniques.