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Background/Purpose Epidermolysis bullosa (EB) is a rare disease of skin and mucosa which may causes surgical complications. We review these in a large patient cohort from Saudi Arabia. Methods A retrospective study was conducted at 21 centers between 2003 and 2020. Demographic data and information on EB type [Simplex (EBA), Dystrophic (DEB) and Junctional (JEB)]. The dataset included clinical features, operations, surgical complications, and treatment. Results There were 152 (63 male) children with EB [EBS n = 93 (61.2%); DEB n = 30 (19.7%); JEB n = 25 (16.4%), and Kindler syndrome n = 4, (2.6%)]. Children with JEB and DEB tended to have a higher frequency of skin and musculoskeletal system complications (skin cancer, pseudosyndactyly and recurrent skin infection). Esophageal strictures were mostly seen in DEB (n = 19, 63%) and to a lesser extent in EBS (n = 20, 21%) and JEB (n = 4, 16%). Pyloric atresia was uncommon (n = 4) and limited to those with JEB. Percutaneous gastrostomy for feeding support was used in all types. Ankyloglossia was common but often recurred (76%) after division. Circumcision was usually safe and complication-free in male children except in those with severe JEB. Phimosis was reported in 10% of uncircumcised patients. Conclusions Our series showed that surgeons play a key role in the management of some complications associated with EB. It is also important to be aware of the particular sub-type as this can predict the natural history and likely response to treatment. Level of Evidence 2

Background: Coronavirus (COVID-19) is the newest pandemic disease. The surgical management of acute appendicitis was the gold standard, but new studies suggest the safety of antibiotics treatment alone. NOTA avoid surgery, risks of general anesthesia; long hospital stay and risk of corona virus exposure. We aim to study the safety, cost effectiveness and outcome of NOTA during Covid-19 pandemic and compare it to Single incision pediatric endo-surgery appendectomy (SIPESA) Methods A prospective cohort study for NOTA of patients from 6–12 years old in Covid-19 pandemic period from 1st April 2020 to 30th April 2021. Patients divided in 2 groups: Group S managed by SIPESA; group N managed by NOTA. Family education and assurance with detailed explanation was done for early detection of any complication and we continue monitoring of the patients until complete recovery. Results sixty patients were managed. Group S had 24 cases (40%), mean age 9.3 years. Group N had 36 cases (60%), mean age 9.1 years. six cases (17%) in group N were converted to surgical management in first 6 month of study. Mean length of hospital stay dropped from 72 hours to 18 hours. The mean cost dropped from 2736$/day to 400$/day. Mean psychological stress for the children improved from 4.4 in April to 2 in September. Mean follow up was 3.5 months. Conclusions NOTA is safe and cost-effective. we recommend it especially during the COVID-19 pandemic. Level of evidence: Cost Effectiveness Study: Level II

Background: The outcome of SIPESA performed by surgical residents is explored once in the literature. To the best of our knowledge, there are no published studies comparing the outcome of SIPESA versus CLA performed by the surgical residents.Aim: To assess the outcome of SIPESA at King Fahd Armed Forces Hospital (KFAFH), Jeddah versus CLA at Prince Sultan Military Medical City (PSMMC), Riyadh performed by surgical residents. Material & Methods: A retrospective comparative study of the outcome of SIPESA versus CLA conducted in two centers from January 2011 to July 2018. The two groups were compared for age, seniority of operating surgeon, mean operative time (MOT), perioperative complications and length of hospital stay (LOS).Results: 136 appendectomies (83(61%) SIPESA & 53(39%) CLA) were performed by residents between January 2011 and July 2018 in both centers. Postoperative complications were reported in 3.8% of CLA and 3.6% of SIPESA. There was no significant difference in postoperative complications between the two groups. The MOT of SIPESA and CLA was 92.25 minutes & 87.85 minutes respectively. Conclusion: SIPESA and CLA performed by residents are equally safe and feasible with no added morbidity. We believe that this good outcome is related to the adequate supervision of residents by experienced surgeons in conjunction with a properly structured training program. There was no significant difference in the outcome of both groups.

Few centers worldwide have advanced single-incision pediatric endosurgery (SIPES) splenectomy. The safety and feasibility of SIPES performed by trainees were not assessed before. SIPES splenectomy is a demanding technique that needs high level of skills. This is the largest series of 39 SIPES splenectomies performed by 14 trainees in one single center.To assess the safety, feasibility, and technical challenges of SIPES splenectomy performed by trainees and to compare it with other published series.Retrospective study of all patients operated with SIPES splenectomy for 7 years. SIPES port was inserted through 1.5 cm umbilical incision. One type of port and straight regular instruments were used in all cases.Forty-nine patients underwent SIPES splenectomy. Eighty percent was done by our trainees. Six cholecystectomies were done simultaneously. Forty-five patients with sickle cell disease, two with thalassemia, one spherocytosis, and one Fanconi's anemia. Mean operative time (MOT) for splenectomy was 182 minutes (130-190) and 251 minutes for splenectomy with cholecystectomy (230-270) depending on severity of adhesions and size of the spleen; P value.001. Two conversions have to be opened due to bleeding. There is neither wound infection nor incisional hernia up to date.SIPES splenectomy is safe and feasible when performed by surgical trainees without adding any morbidity to the patient. Learning curve can quickly improve with more exposure of trainee to different SIPES procedures and hands-on workshops. More than one procedure could be done at the same time. It has excellent cosmesis and almost invisible scar.

Aim We aimed to examine the social impact of clean intermittent catheterization (CIC) on children with a neurogenic bladder and to compare the impact of urethral CIC with Mitrofanoff catheterization. Methods Questionnaires containing 29 questions about the social impact of CIC on the children and their families were administered with their parents or caregivers of 50 children (34 boys and 16 girls) using CIC. The mean (standard deviation [SD]) age of the children was 9.6 (4.32) years and duration on CIC was 6.1 (3.97) years. Results Seventeen children were using Mitrofanoff catheterization (group I) and 33 children urethral catheterization (group II). Of the respondents, 54% respondents reported that their children accept the use of CIC, 30% respondents reported that they do not like it, and 16% respondents reported that they always refuse and resist it. There was no difference in the level of acceptance between the two groups. Both groups reported that children were social (90%) and had close friends (88%). However, 50% felt that CIC affected mood, with 30% of the children displaying bad temper. Mitrofanoff catheterization was associated with fewer episodes of frequent urinary tract infection (p = 0.004) and greater adherence. All children from group I, who were older than 6 years, were attending school compared with 78% from group II. School performance was significantly better in group I (p = 0.022). Conclusion There was acceptance of CIC by most children but Mitrofanoff catheterization seemed to have a lower social impact in terms of school performance, adherence to therapy, and complications.

Fetal uropathies can be identified by obstetric ultrasound (US) examination, permitting treatment before their clinical manifestation. To evaluate the justification for prenatal US screening for urinary-tract malformations (UTM), the outcome of occult UTMs in 23,000 babies born in our hospital between 1992 and 1998 was examined retrospectively. A prenatal US examination was performed on 19,400 newborns; 128 (0.7%) had an abnormal urinary tract, leading to surgery in 38 cases. The overall incidence of UTMs requiring either medical or surgical therapy was 0.2% (45:19,400); 3,600 pregnancies were not screened by prenatal US. To date, 7 of the newborns have presented with urosepsis (2 with renal impairment) and 2 additional case of posterior urethral valves were identified by routine postnatal US. The incidence of significant UTMs was similar in both groups, but complications occurred in the unscreened group. Prenatal US to detect occult UTMs is thus beneficial, fulfilling the criteria for a population-screening test. We recommend postnatal US urinary-tract screening for newborns with no prenatal US examination.

Meckel’s diverticulum occurs in 2% of the population. Of these, 4% may present as intestinal bleeding, intussusception, diverticulitis, volvulus, or perforation at any age, including neonates. We describe a 3-month-old baby whose giant Meckel’s diverticulum had probably perforated in utero, leading to the formation of a large intra-abdominal pseudocyst.

The authors describe a case of supradiaphragmatic accessory liver seen on prenatal ultrasound examinations, mimicking fetal hydrothorax and causing life-threatening respiratory failure after birth. The accessory liver with a transdiaphragmatic pedicle to the caudate lobe of the normal liver was found at throracotomy after failure to expand the lung by chest drainage. The "hydrothorax" turned out to be multilocular mesothelial cyst collection surrounding the ectopic liver. This is the first report of the development of a thoracic accessory liver followed by obstetric ultrasound examinations.