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Purpose: Our aim was to explore the applicability of the definition of "large" primary spontaneous pneumothorax (PSP) of adult guidelines to pediatric patients., Methods: We performed a retrospective monocentric analysis of first-episodes of PSP (Period: January 2010-January 2023). We defined large PSP according to French SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines., Inclusion Criteria: age 1-18 years-old, follow-up ≥ 1 year. We performed a comparative analysis between large and nonlarge PSP. We reported the categorical variables as frequencies, and continuous as median and range. We compared categorical variables using Chi-Square or Fisher test, and continuous using U Mann-Whitney test. p < 0.05 was considered significant., Results: The population consisted of 49 patients, 15 (30%) with large PSP. We found no significant differences at presentation between large and nonlarge PSP regarding age, sex, side, BMI, oxygen saturation, respiratory rate and hearth rate. Conservative first-line management was used significantly less for large PSP (26% vs. 82%, p = 0.0003), while drain more (46% vs. 8%, p = 0.005). The groups were similar regarding surgery. Large PSP had a significantly longer hospitalization (7 days vs. 4 days, p = 0.003). The incidence of first-line management failure was similar between the groups. During the follow-up, we found no significant differences regarding ipsilateral recurrence (33% vs. 17%, p = 0.275), and contralateral occurrence (0% vs. 5%, p = 1.000), need for drain (6% vs. 5%, p = 1.000), or surgery (33% vs. 14%, p = 0.246)., Conclusions: In the first-line, large PSP were treated significantly less conservatively and more drained. Radiographic size of the pneumothorax does not seem to have an impact on first-line treatment failure and follow-up outcomes., (© 2024 Wiley Periodicals LLC.)

Background: In patients undergoing appendectomy, postoperative complications are more likely to occur with complicated appendicitis. Abdominal drainage may occasionally be used to prevent such scenarios. It is unclear, though, how abdominal drains help to reduce problems after surgery., Methods: Pediatric patients who underwent appendectomy for complicated appendicitis at a tertiary center between October 2021 and September 2022 were reviewed retrospectively. Following appendectomy, patients with and without peritoneal drains were contrasted in terms of preoperative characteristics and postoperative outcomes., Results: Thirty-seven of 83 patients (44.58%) undergoing emergency laparoscopic appendectomy for complicated appendicitis received abdominal drainage. The drain group had longer hospital stay (9 days [IQR 6-11] vs. 6 days [IQR 4-8], P=0.0002) and longer time to CRP normalization (6 days [IQR 4-9.5] vs. 8 days [7-12], P=0.0222) compared to the no-drain group. The drain group also had a higher complication rate (30.56% vs. 23.81%, P=0.6107), although such finding was not statistically significant., Conclusions: The use of abdominal drains after laparoscopic appendectomy did not significantly prevent postoperative complications in complicated appendicitis. Instead, it was associated with longer hospitalization, although patients in the drain group are likely to have experienced more severe conditions.

Background: Laparoscopic appendectomy followed by postoperative intravenous (IV) antibiotics is the standard of care for acute appendicitis and postoperative prevention of intra-abdominal abscesses. The aim of or study was to determine if intraperitoneal irrigation with antibiotics could help prevent intra-abdominal abscess formation after laparoscopic appendectomy for complicated appendicitis in pediatric patients., Methods: A retrospective study was conducted on consecutive pediatric patients with acute appendicitis who had appendectomy in our Pediatric Surgery Department between August 2020 and February 2022. We compared two groups with similar age and symptoms. The first group (A) was treated with the normal standard of care, i.e., laparoscopic appendectomy and postoperative IV antibiotic therapy. For the second group (B) intraperitoneal cefazoline irrigation was added at the end of the laparoscopic procedure. Postoperative intra-abdominal abscess was diagnosed with ultrasound examination, performed after clinical suspicion/abnormal blood test results., Results: One hundred sixty patients (males:females 109:51; median age 10.5 years [range 3-17 years]) who had laparosopic appendectomy for complicated appendicitis were included, 82 in group A and 78 in group B. In the first 7 days after surgery, 18 patients in group and 5 in group B developed an intra-abdominal abscess (p < 0.005). Drains were positioned in 38 patients in group A vs. 9 in group B. One patient in group A had a different complication which was infection of the surgical incision., Conclusions: Intraperitoneal cefazoline irrigation at the end of the laparoscopic appendectomy in pediatric patients significantly reduces the formation of intra-abdominal abscesses.

Aim: Surgical excision of hyoid bone is the mainstay of thyroglossal duct cyst removal, to prevent recurrences. Bone excision by cut - bone forceps may prove inaccurate and somewhat dangerous. Therefore, use of alternative methods has been advocated., Material and Methods: The proposal of the study is to cut the body of the hyoid bone with the only electric scalpel. Surgical casenotes of 57 pediatric patients operated by our Institution with modified Sistrunk technique and complete dissection of the entire body of hyoid bone and its removal at the cartilage junction with lateral horn with monopolar cauterization were reviewed., Results: The population of our study had a mean age of 59.86 ± 29.57 months; 6/57 patients (10.5%) were under 2 years of age. Mean follow up was 55,04 ± 29,08 months ranging 2 to 115 months. In any patients post-operative bleeding was observed. Mean surgical time was 57,02 ± 11,77 minutes ranging from 35 to 125 minutes; 6 cases required postoperative drain. In 3 patients an immediate local edema was observed and in another one a partial wound dehiscence occurred, no late complications were observed. Cyst-recurrence requiring re-do surgery occurred in 5 patients (8.8%)., Conclusions: The complete hyoid bone section with electric scalpel only ensures the ideal access to the posterior hyoid space and allows a greater and more symmetrical access to the proximal portion of thyroglossal duct in children with still negligible complication and recurrence rate., Key Words: Modified Sistrunk technique, Sistrunk procedure, Thyroglossal duct cyst.