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Introduction: The aim of this study was to prospectively evaluate parents’/guardians’ late recall of surgical procedures and risks of elective surgery after pre-operative interview with surgeons. Materials and Methods: All parents/guardians of patients

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Resumen Introduccion La tasa de complicaciones a largo plazo tras la reparacion del hipospadias distal puede ascender al 20%, y aun no disponemos de directrices sobre la colocacion de la sonda en la uretroplastia distal. Hemos analizado de forma retrospectiva la tasa de reintervencion de la uretroplastia a medio plazo y los resultados esteticos tras un estudio piloto de 2 anos sobre las uretroplastias distales con colocacion de sonda o sin ella. Materiales y metodos Un cirujano pediatrico realizo 11 procedimientos con la tecnica de Snodgrass con colocacion de sonda (grupo A) y 17 sin colocacion de sonda (grupo B) en nuestra institucion (2011-2013). La mediana de edad de los pacientes en la cirugia fue de 2,1 anos (rango 1-8,5). Los criterios de inclusion fueron: defecto distal primitivo, un unico cirujano en ambos procedimientos y alta sin sonda. La mediana de seguimiento fue de 6,4 anos (rango 1,5-8,1). Los resultados clinicos y esteticos postoperatorios fueron evaluados al menos una vez mediante la herramienta HOSE (Hypospadias Objective Scoring Evaluation). El objetivo de nuestro estudio fue comparar las complicaciones y las tasas de repeticion de la uretroplastia a medio plazo antes de iniciar un estudio aleatorizado. Se hizo un analisis retrospectivo. Se utilizo la prueba exacta de Fisher (p Resultados De los 28 del total, 5 complicaciones requirieron una segunda cirugia: 2/11 casos con sonda, 3/17 sin sonda. Los resultados esteticos fueron satisfactorios en ambos grupos. Los resultados no alcanzaron significacion estadistica (p = 1.000). Conclusion El seguimiento a largo plazo es necesario para conocer las tasas de repeticion de la uretroplastia y los resultados esteticos tras la reparacion distal con la colocacion de sonda o sin ella. Se necesitan mas estudios para conocer el papel del sondaje y el resultado definitivo en la uretroplastia distal.

BACKGROUND Circumcision refers to the removal of the skin covering the tip of the penis and is one of the most common surgical procedures performed in childhood. Even though circumcision is a well-standardized operation, several minor and major complications may be experienced by paediatric surgeons. Glans ischemia (GI) has been widely reported in the paediatric literature as a complication following circumcision. Nonetheless, etiopathogenesis of GI is not well defined and management guidelines are lacking. CASE SUMMARY We describe our experience with this rare and scary complication using subcutaneous enoxaparin alone or in association with a topical vasodilator. CONCLUSION Hypothetical causes and different management strategies are discussed.

INTRODUCTIONThe management of primary spontaneous pneumothorax (PSP) in pediatrics remains controversial. Due to a lack of standardized guidelines, it is based on evidence from adult patients. The aim of this study was to investigate difference in the length of stay (LOS) between various treatment options, the risk of recurrence after non-surgical treatment versus surgery, and the role of computed tomography (CT) in the management of PSP. METHODS We retrospectively reviewed patients admitted to our Pediatric Surgery Unit for an episode of PSP between June 2009 and July 2020. Medical records including clinical presentation at admission, diagnostics, treatments, complications, and LOS were collected. RESULTS Twenty-three patients (22 males and 1 female) were included in this study. Median age was 15.65 (range 9-18). Chest X-rays were performed in all patients and showed 5 small (22%) and 18 large (78%) PSP. Eleven patients (48%) were managed non-operatively with observation alone and a recurrence rate of 18%, chest drain was used in 11 patients with a recurrence rate of 36%, and surgery was deemed necessary as a first treatment choice in one case. Six patients (27%) had an episode of relapse after non-operative management or chest drain placement. Following surgery, a relapse occurred in 2 of the 6 patients.CONCLUSIONSAccording to our experience, small PSP or clinically stable larger PSP can be treated conservatively with observation alone. Operative management should be taken into consideration in children with large symptomatic PSP, persistent air leak, and/or relapse after chest drain insertion. Prospective studies with a greater number of patients are encouraged to establish evidence-based guidelines in the pediatric population.

Twin obstructive megaureters associated with duplex renal system is a rare malformation, particularly when a giant ureter dilation is present. We report an original case, initially misinterpreted, of a right incomplete duplex renal system with huge disproportion between the upper pole giant megaureter and the lower pole moderate megaureter, with severe obstruction at the uretero-ureteral junction and minor obstruction at the uretero-vesical junction. Uromagnetic resonance imaging allowed conclusive diagnosis and the laparoscopic approach was effective for definitive, successful treatment.

The aim of our study is to share a single pediatric institution’s experience with complicated Meckel’s diverticulum. The clinical records of a series of 15 cases treated between January 2006 and December 2020 were reviewed. Patients were divided according to the presenting symptoms (obstructive versus painful bleeding) and subcategorised according to demographic details, intraoperative findings, surgical technique, histological examination and length of stay. Patients older than 17 years of age were excluded from the study. Males were more prone to present with complicated Meckel’s diverticulum than females, and obstructive symptoms were the most frequent presentation (60%). Median age at presentation was 9 years. The surgical technique of choice was an explorative laparoscopy in 12 cases, even though 25% of patients required conversion to laparotomy. There was no statistically significant difference between groups in terms of length of stay. Results are discussed with reference to current literature.

Non-parasitic splenic cysts are an uncommon finding in pediatric patients. We report on a 14-year-old male presenting with a giant abdominal mass. Imaging documented a giant splenic cyst, and preoperative blood tests revealed high levels of CA125. Minimally invasive unroofing of the cyst was performed. Notably, the cyst content was hematic, but histopathological studies described a mesothelial cyst lining. To date, no recurrence has been noted. Laparoscopic spleen-preserving surgery appears to be a valid and safe treatment option in children with complex non-parasitic splenic cyst to preserve the splenic parenchyma.

Herein, we report our experience with an adolescent girl presenting with persistent fever, abdominal pain, and elevated levels of inflammatory blood markers. A huge pelvic collection was found at imaging studies. Occult source of infection in patients with prolonged fever and elevated levels of inflammatory blood markers must always be suspected, and in complicated cases a surgical exploration may be required.

Tauber antegrade sclerotherapy can be considered an established procedure for the treatment of varicocele in paediatric age. Herein, we share our experience with this technique and its tricks. The choice of the spermatic vein should be very accurate during the Tauber procedure, and a correct intraoperative phlebography is mandatory to avoid complications.

Background Sactosalpinx means a collection of fluid (serum, blood or pus) in the fallopian tube. CAH (Congenital Adrenal Hyperplasia) is a typical 46XX DSD (Disorder of Sex Development) due to a steroidogenic enzymatic defect. Both conditions are rare and can lead to reduced fertility rate. Case presentation We describe two post-menarche virgin girls with CAH who were hospitalized for acute abdomen due to laparoscopically confirmed sactosalpinx. Case 1 recovered after conservative management, case 2 after a second-look and bilateral salpingectomy. The first case consisted of right sactosalpinx and previous peritonitis reported; the second one of bilateral symptomatic pyosalpinx and previous vaginal stenosis. Recurrent abdominal pain persisted at follow-up in Case 1: post-operative MRI (Magnetic Resonance Imaging) showed bilateral hydrosapinx that disappeared at a following ultrasound scan control. Follow-up was uneventful 36 months after surgery in Case 2, except for the surgical revision of the vaginal introitus. Conclusions CAH-sactosalpinx association is a very rare but not negligible event. We suggest a conservative approach for sactosalpinx if tubal and/or ovary torsion can be excluded. Pyosalpinx is more challenging to treat, but during pediatric age we suggest starting with a conservative approach, especially in patients with CAH who have a potential low fertility rate. Careful gynecological follow-up after menarche is recommended to rule out any further causes of infertility.

Acute abdominal pain remains a major diagnostic challenge to date. Omental torsion is an infrequent cause of abdominal pain in children, which usually presents with non-specific symptoms. Herein, we report a case of persistent abdominal pain after a minor abdominal trauma. A solid mass was found in the lower abdomen at ultrasound imaging evaluation. Surgical exploration demonstrated an omental torsion secondary to a rare neoplasm of childhood.

Pyogenic granuloma (PG) is an acquired benign vascular hyperplasia. Even though PG is not so rare, its etiology is still unclear. Assuredly, an association between vascular anomalies and PG is an extremely rare finding, and a proper management of these cases is not well standardized to date. Herein, we report our experience with a giant PG arising spontaneously within a port-wine stain of the thorax. Previous cases reported in the pediatric literature and strategies of treatment are also discussed.

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Introduction Long-term complication rates after distal hypospadias repair can be close to 20%. There are no available guidelines regarding the need for a catheter in distal urethroplasty. We report a retrospective analysis on medium-term redo-urethroplasty rate and cosmetic results after a two-years pilot study on stented/un-stented distal urethroplasties. Materials and methods A total of 11 stented (Group A) and 17 un-stented (Group B) Snodgrass-procedures were performed by the same pediatric surgeon at our Institution (2011–2013). The median age at surgery was 2.1 years (range 1–8.5). Inclusion criteria were primitive distal defect, same surgeon in both interventions, catheter-free discharge. The median follow-up was 6.4 years (range 1.5−8.1). All patients received at least one post-operative clinical-cosmetic examination (HOSE). The aim of our study was to compare medium-term complications and redo-urethroplasty rates before starting a randomized study. A retrospective analysis was performed. We used Fisher's exact-test (P Results Of 28 complications, 5 required redo-surgery: 2/11 stented-cases, 3/17 un-stented. Cosmetic results were satisfactory in both groups. These results were not statistically significant (P = 1.000). Conclusion Long-term follow-up is mandatory to know redo-urethroplasty rate and cosmetic outcome after distal stented/un-stented repair. Further studies are needed to evaluate the role of catheter placement and the definitive outcome in distal urethroplasty.

Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.

Introduction A fast surgical treatment is the gold standard when a testicular torsion is diagnosed. However, an early diagnosis of torsion may not be feasible in case of torsion associated with undescended testis in the patients affected by cerebropalsy. Case presentation A Bolivian 16 year old male with acquired cerebropalsy and spastic neuromuscular disease was admitted to our Institute for a right inguinal swelling observed by the father in the morning. Indeed, the father had reported that the swelling had may be started two days before without pain or any other symptoms apparently. Two episodes of vomiting were only reported. At the general examination the patient, apparently, seemed to laugh repeatedly and a spastic movements increase were observed. The child had an infrainguinal bilateral cryptorchidism. An urgent left infrainguinal orchyectomy had been performed in the past and controlateral cryptorchidism was not corrected. At the right inguinal exploration, a complete twist of the spermatic chord was observed and a right orchyectomy was then performed. Discussion Testicular torsion in the inguinal canal is a rare reported condition that usually can involve patients with spastic neuromuscular disease. Processing, communication and verbalization of a chronic or acute pain seems to be different in a child with or without intellectual disability. It could be a lot more difficult to correct pain interpretation, with an important repercussion on pain accurate assessment and management. Conclusion In the patients with intellectual disability, a control of the testicles, it should always be done, mostly in case of atypical behaviour., Highlights • An early diagnosis of a testicular torsion may not be feasible in case of torsion associated with undescended testis in the patients affected by intellectual disability. • Processing, communication and verbalization of a chronic or acute pain seems to be different in a child with or without intellectual disability. • Atypical behaviour could be present in the children without capacity to verbalize the pain. • In the patients with intellectual disability, a control of the testicles should always be carried out, mostly in case of atypical behaviour.

Prevention and management of complications represent essential responsibilities of every pediatric surgeon. “Things just don’t happen,” but complications can be anticipated (by awareness, education), can be avoided (by training, experience), and must be managed well (on a mastery level). Especially in pediatric minimally invasive surgery (MIS), the spectrum of techniques ranges from neonatal to adolescent and from thoracic, abdominal, urological, to oncological procedures (and many others). All of these techniques imply a specific learning curve and a variety of complications. The following article shall deal with general complications of pediatric MIS, while procedure-specific challenges are dealt with in the corresponding chapters.

Any kind of procedure can be divided in different steps. This is a standard rule for programming and performing operative procedures not only in surgery. Generally we talk about preoperative, intraoperative and post-operative steps. Each step has its own characteristics and principles. As in any procedural process, a standard approach is desirable. To guarantee this standardisation, the procedure is defined and divided in different steps, and the process needs to be well defined, described and reproducible. This reproducibility is absolutely necessary for guaranteeing a standard and gives the basis for any kind of evaluation on complications, outcome and results [1]. The basis for the preparation of a reproducible procedure is in most cases a checklist. Checklists are almost present in any kind of procedure not only in medicine. The checklist is the basis for guaranteeing the preparation of all single processes of a procedure.

A 2870 g male infant was born at 36+1 weeks’ gestation by cesarean section due to mild polyhydramnios and a non-reassuring cardiotocography. An ultrasound at 31 weeks demonstrated transient hyperechogenic fetal bowel (HFB). At birth, the Apgar scores were 9 and 10. The abdominal examination was unremarkable. He spontaneously passed meconium. After 20 hours, he developed left hemiabdominal distension with visible dilated bowel loop sign (figure 1) and bile-stained vomiting. Figure 1 ‘Bowel loop sign’ on abdominal wall due to a segmental intestinal dilatation. Abdominal radiography showed …

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Benign intra-abdominal cystic masses in infancy are fairly uncommon and their etiopathogenesis, histology and clinical presentation differ significantly. Our aim is to report our experience in their treatment in order to discuss the best diagnostic and treatment modality. The medical records of 5 children (2M, 3F) with cystic intraabdominal masses referred to our hospital between November 2012 and September 2016, were retrospectively reviewed. All patients underwent open surgery and subsequent histopathologic analysis. Different clinical presentations, localizations of the masses, diagnostic tools, surgical approaches, histological examinations and outcomes were reviewed. Patients mean age was 5.4 years (range: 8 months-9 years). Two patients presented recurrent abdominal pain and abdominal distension, 1 patient had a palpable mass discovered incidentally and 2 complained acute abdominal pain. Routine laboratory tests, tumor markers and abdominal ultrasound were immediately done in all patients. Three patients underwent MRI and 1 abdominal CT. At laparotomy 2 hepatic cysts, 2 mesenteric cyst and 1 retroperitoneal cyst were discovered. Histology reports described: 1 hepatobiliary cystadenoma, 1 benign hepatic hamartoma and 3 cystic lymphangiomas (1 retroperitoneal and 2 mesenteric). There were no major postoperative complications, deaths, or recurrences in our series (follow-up 3-24 months). Despite the rarity of these lesions, benign cystic abdominal masses in children are not so uncommon and should be considered as causes of acute abdominal pain. The differential diagnosis is not always possible preoperatively. In our series, radical excision of the lesions was possible in all cases, allowing reliable histological results and avoiding recurrences.

No agreed recommendations exist for timing of urethral stent removal, after distal hypospadias surgery. We compared our preliminary case series with outcomes from literature: 18/44 patients were treated with catheter and 26/44 without it. The surgical outcome was comparable in the two groups. After hypospadias surgery, the main advantage of the immediate postoperative catheter removal was the shorter hospital stay without negatively affecting the care and home management.

Background Hypertension (HT) is rarely reported in patients affected by Neuroblastoma (NB), and management guidelines are lacking. Clinical features and perioperative medical treatment in such patients were reviewed to 1) ascertain whether a shared treatment strategy exists among centers and 2) if possible, propose some recommendations for the perioperative management of HT in NB patients. Methods A retrospective multicenter survey was conducted on patients affected by NB who presented HT symptoms. Results From 2006 to 2014, 1126 children were registered in the Italian Registry of Neuroblastoma (RINB). Of these, 21 with HT (1.8%) were included in our analysis. Pre- and intraoperative HT management was somewhat dissimilar among the participating centers, apart from a certain consistency in the intraoperative use of the alpha-1 blocker urapidil. Six of the 21 patients (28%) needed persistent antihypertensive treatment at a median follow-up of 36months (range 4–96months) despite tumor removal. Involvement of the renal pedicle was the only risk factor constantly associated to HT persistency following surgery. A correlation between the presence of HT and the secretion of specific catecholamines and/or compression of the renal vascular pedicle could not be demonstrated. Conclusion Based on this retrospective review of NB patients with HT, no definite therapeutic protocol can be recommended owing to heterogeneity of adopted treatments in different centers. A proposal of perioperative HT management in NB patients is however presented. Level of evidence IV.

There is a high variety of causes and complications leading to gastric bleeding and perforation in any age group. For the newborn group, some typical clinical situations might occur, while in the elder group, gastric perforation is very rare. For all groups and situations, some rules concerning diagnostic and therapeutic procedures can be established. The present chapter will deal with the most typical entities in detail.

BACKGROUND: To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series. METHODS: This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents&rsquo, opinion. RESULTS: Eighty-four gastrostomies were placed in total (35 F, 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients, late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux, five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile, the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube. CONCLUSION: This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive.

Hepatic pulmonary fusion is a rare malformation associated with right congenital diaphragmatic hernia (CDH), often only discovered during surgical repair of the defect. Fourteen previous cases have been reported in the literature. We describe a case of a full term male newborn with prenatal ultrasound diagnosis of right CDH who underwent a thoracoscopy converted to a thoracotomy, due to this rare aforementioned intraoperative incidental finding. We reviewed the previous reported literature, especially focusing on the chosen surgical approach, concluding that an early and appropriate preoperative imaging investigation may be crucial for the best management of these kinds of patients.

Introduction Advantages in 3-dimensional (3D) laparoscopy are mostly described in adults for better depth perception, precise visualization of anatomical structures, as well as for complex surgical maneuvers in small spaces. Using Visionsense III stereoscopic endoscopy system (Neuromed Spa), we performed a comparative study between surgical skills achievements using 2-dimensional (2D) and 3D laparoscopic equipment in a pediatric laparoscopic surgery simulator model. Materials and Methods Three skills were evaluated both in 2D and 3D modalities. Pediatric residents ( n = 20) without any previous laparoscopic experience were randomly divided in 2 groups and evaluated doing the established tasks in a laparoscopic simulator validated for pediatric surgery. Switching the type of vision from 2D to 3D or vice versa, we evaluated bimanual dexterity, efficiency, and efficacy. Three tasks were proposed—task 1: transfer of objects (6 pegs transferred one-by-one on a pegboard); task 2: pattern cutting (cutting a paper, following a circular dotted line); and task 3: threading eyelet (transfer, twisting and passing through a eyelet-shaped support, a specific 3D object). Performance was measured using a scoring system rewarding precision and speed. Any physical discomfort related to the 3D vision was recorded. Results Of the 20 participants included, 10 began the skills in the 2D modality and then performed them in 3D, and the other 10 began in 3D and ended in 2D. Overall task 1 performance (time and number of errors) was significantly better using stereoscopic compared with monoscopic visualization. Both groups experienced a 35.6% decrease in the time needed to complete the peg transfer using 3D instead of 2D. In task 2, the 3D performance was superior (less time to correctly cut the paper along the dotted line), but did not reach statistical significance. In task 3, the residents experienced with 3D a 31.7% decrease in the time necessary to complete the passage of the object trough the eyelet. Most participants (65%) "subjectively" defined 3D laparoscopy easier overall; 6 participants (30%) did not experience any issue related to the use of 3D technology; and 1 person (5%) of group 1 found more difficulties using 3D compared with 2D. Headache (25%), nausea (20%), and visual disturbance (1%) were the most common issues reported by the students during 3D procedures. Finally, the results show that residents achieved significantly better results working with 3D vision rather than with 2D vision. Discussion As other studies have demonstrated, there was improvement in the overall performance using the 3D laparoscope. This was the first attempt to verify 3D skills in naive subjects, directly on a simulator conceived exclusively for pediatric surgery; therefore, bias was limited by using a population without surgical experience. Conclusions 3D laparoscopic surgical skills showed superior to 2D, with higher percentages of tasks completion, less time in performing them, and a shorter learning curve. Our results indicate that 3D was subjectively easier than 2D in performing complex tasks in the skills laboratory setting.

Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC.

Increased infertility and smaller volume accompany undescended testis. Timing of orchiopexy is still a matter of debate. We evaluated the growth of non-palpable testes after laparoscopic orchiopexy according to age at surgery, intraoperative findings and type of procedure.Forty-one boys undergoing laparoscopy for nonpalpable testes were retrospectively reviewed and divided into two groups, ≤18 months and18 months, according to their age at surgery.At follow-up, 14 testes in the younger group had normal size, while 3 atrophied either after single (2) or two stage procedure (1). Similarly, in older boys 11 testes grew normally, while 5 atrophied after both procedures.Most of the non-palpable testes grew normally after laparoscopic orchiopexy and the postoperative volume seemed independent from the surgical strategy. Both techniques led to a few cases of testicular hypotrophy. In our experience, the age at surgery did not affect the outcome in terms of testicular growth.

Respiratory failure secondary to pulmonary hypoplasia is the main cause of death in congenital diaphragmatic hernia (CDH). Lung growth is regulated by growth factors (GFs), whose imbalances are reported in pathological conditions. We measured amniotic fluid levels of GFs, regulating lung development, in pregnancies with CDH and compared them with normal gestations.Amniotic fluid was collected at amniocentesis and delivery from 4 women carrying fetuses with CDH and 12 with normal pregnancy. GFs were isolated and quantified. Same GFs were measured in lung biopsies collected during autopsy of three newborns dead of CDH.Impairment expression of lung GFs in the amniotic fluid of CDH pregnancies in comparison with normal was found. Fibroblast growth factor 10 (FGF10), fibroblast growth factor 7, vascular endothelial growth factor and transforming growth factor β (TGFβ) were decreased at amniocentesis, while platelet-derived growth factor (PDGF) increased. While FGF10 and PDGF tended to normalize at delivery, epidermal growth factor increased and TGFβ was still decreased. Same GFs were similarly expressed in both lungs of babies dead of CDH.Anomalies in lung GFs expression of embryos and fetuses with CDH can be detected by measuring their levels in the amniotic fluid during pregnancy. Further investigation would help to correlate prenatal expression of GFs and clinical outcome of babies with CDH after birth.

Tuberculosis (TB) has been described in association with different malignancies including Hodgkin's disease. However, the association with primary pulmonary Hodgkin's disease (PPHD) is hardly reported in literature and in teenage is quite exceptional. We report a case of an 11 years old boy in whom the diagnosis of tuberculosis preceded and delayed the diagnosis of PPHL.

The aim of this study was to analyze the feasibility of laparoscopic repair of Morgagni diaphragmatic hernia. A questionnaire was sent to members of the Groupe d'Etude en Coeliochirurgie Infantile (GECI) in January 2001. Data for 22 cases were collected. The mean age of the patients was 37 months. Associated anomalies were Down's syndrome (five cases) and myopathy (one case). Three trocars were sufficient in most of the cases. Reduction of the contents of the hernia occurred spontaneously in six cases and was easily accomplished in 15 cases. It was difficult in two cases. The sac was removed in 16 cases. The defect was closed without a prosthetic patch in 18 cases and with a prosthetic patch in four. One operation was converted because of a defect that was too wide. In 18 of the 22 patients, extubation could be performed immediately after the operation. The mean hospital stay was 5.4 days. One recurrence developed 3 months after primary closure without resection of the sac. Redo by laparoscopy was success...

Hintergrund. Bei 70–80% aller Patienten mit Morbus Hirschsprung reicht die Aganglionose vom Anus bis in das Colon sigmoideum. In diesem Erfahrungsbericht soll eine einfache, fur den Patienten wenig belastende Operationstechnik dargestellt und hinsichtlich ihrer Ergebnisse, Moglichkeiten und Grenzen evaluiert werden. Patienten. Uber 2 Jahre wurden 12 Kinder (20 Tage–6 Jahre; Median 4 Monate) mit Morbus Hirschsprung operiert.Der Nachbeobachtungszeitraum erstreckte sich auf 6–29 Monate. Methode. Bei allen Kindern wurde der Eingriff transanal durchgefuhrt. 3-mal erfolgte eine zusatzliche Laparoskopie.Nur 1-mal musste aufgrund von postentzundlichen Verwachsungen eine Unterbauchlaparotomie erfolgen. Ein Abszess trat 1-mal auf und erforderte eine Kolostomieanlage.Die Kinder konnten in der Regel ab dem ersten postoperativen Tag oral ernahrt werden.Alle zeigen eine gute Kontinenz bei normaler Stuhlfrequenz. Diskussion. Die Ergebnisse der transanalen Resektionstechnik sind uberzeugend und viel versprechend.Wir halten diese minimalinvasive Operationstechnik fur das Verfahren der Wahl bei den haufigen Formen des Morbus Hirschsprung.Unsere Erfahrungen decken sich mit denen anderer Arbeitsgruppen.

Purpose: Diagnostic laparoscopy (DL) is the technique of choice for exploration of nonpalpable testes (NPT). Nevertheless, groin exploration is necessary to evaluate the cord and gonadal structures entering the internal ring. This retrospective analysis evaluates our hypothesis that hypoplastic cord structures entering the internal ring predicts absence of a viable testicle and a laparoscopic groin exploration in these cases can reduce the number of unnecessarily performed open groin exploration (OGE). Materials: A retrospective review was performed of 23 boys with 26 NPTs who were operated on from June 1998 to October 2000 to evaluate our protocol for NPT using DL and OGE. Results: Of 26 NPTs in 23 boys, 3 bilateral intraabdominal testis were detected (2 Fowler Stephens; 1 standard orchidopexy). Twenty cord structures entered the internal ring. Three appeared normal at DL with a viable testis followed by an orchidopexy. Seventeen were hypoplastic without patent processus. During LGE no viable testis was detected: blind-ending cords, no biopsy (n = 4); testicular regression syndromes (n = 3), early fetal regression (n = 6), no residual testicular structures (n = 4). Conclusions: This experience confirms the authors' hypothesis and criteria for LGE in all cases. The authors conclude that LGE is a helpful tool in the diagnostic workup of NPT to avoid unnecessary OGE and is a further step in the minimally invasive approach to all kinds of findings of NPT. J Pediatr Surg 37:1552-1555. Copyright 2002, Elsevier Science (USA). All rights reserved.