A Mantovani

Testicular Catch-up Growth After Varicocelectomy: Does Surgical Technique Make a Difference?

OBJECTIVES Catch-up growth of the affected testis in adolescents after varicocele repair has been well documented. Many investigators have found evidence that testicular hypotrophy related to varicocele can be reversed by early intervention. The aim of this study was to analyze the testicular catch-up growth rate in pediatric patients, correlating it with patient age at surgery, varicocele size, procedures used, and semen quality. METHODS Between March 1990 and September 2006, a total of 465 varicocelectomies were performed at our department. We evaluated the mean testicular volume before and after varicocelectomy in patients aged 9-14 years. Two procedures were used: laparoscopic artery-preserving varicocelectomy (group 1) and open inguinal microscopic artery-preserving varicocelectomy with a venous-venous bypass (group 2). The testicular volume was measured before and after surgery using ultrasonography, and the mean testicular catch-up growth was recorded. RESULTS Although the overall catch-up growth rate for both groups was 80%, after 18 months, only 45% of patients in group 1 and 34% of patients in group 2 had equal bilateral testicular volume. None of these procedures showed a statistically significant correlation with age at surgery, varicocele size, or catch-up rate. The semen analysis results did not show statistically significant differences between the 2 groups. CONCLUSIONS Although 80% of patients demonstrated testicular catch-up, with a different distribution depending on the procedure type used but without statistically significant differences, only 32% of patients had complete and real testicular volume catch-up.

Transumbilical laparoscopic treatment of Congenital Infantile Fibrosarcoma of the Ileum.

Congenital-Infantile Fibrosarcoma (CIF) is a malignant mesenchymal tumor representing 10-20% of soft-tissue tumors. Complete surgical resection is generally the treatment of choice. The most recurrent cytogenetic abnormality was identified as the traslocation t(12;15)(p13:q25), which bears the fusion of Tel gene EVT6 with TrkC gene. This study describes a case of infantile fibrosarcoma of the ileum in a female newborn examined for intestinal occlusion and its laparoscopic treatment.

Trichobezoars in children: therapeutic complications

Trichobezoars are concretions formed by the accumulation of hair or fibers in the gastrointestinal tract, usually associated with underlying psychiatric disorders in females between 13 and 20 years old. Endoscopy, the gold standard for diagnosis, brings some additional advantages: sample taking, size reducing and, rarely, mass removal. This study shows that endoscopy can cause severe complications resulting in a surgical emergency.

PS-068 Varicocele And Adolescent: The Role Of Elastosonography In The Evaluation Of Testes

Background Varicocele is the first cause of male sub-fertility and it is well know its correlation with testicular growth arrest. In paediatric age testicular hypotrophy is the main indication for surgical treatment. The aim of this study is to evaluate the role of elastosonography in the evaluation of testicular elasticity as predictive sign of testicular damage. Materials and methods 13 boys (9–13 years old) with untreated varicocele (bilateral in 3 boys and left unilateral in 10) and 12 age-matched healthy subjects underwent elastosonography. Varicocele was classified following the Dubin and Amelar classification and spermatic vein reflux was classified following a modified Hirsch classification (as short, medium and continuous spermatic vein reflux). The testicular elasticity was expressed as a three-point scale (1: normal; 2: slightly to moderately stiffer than normal; 3: severely stiffer than normal). None had testicular hypotrophy. Statistical analysis was performed by means of the Student’s t-test. Results 2 patients had grade I varicocele, II in 9 patients had grade II varicocele and 5 patients had grade III varicocele; 3 cases had “short£ spermatic vein reflux, 6 patients had “medium” spermatic vein reflux and 7 patients had continuous spermatic vein reflux. The elasticity was 1 in all 34 normal testes; in the testes with varicocele it was graded 2 in 9 cases and 3 in 7 cases. The differences in the degree of elasticity between normal testes and testes with varicocele and between continuous and medium/short spermatic vein reflux were highly significant (p < 0.001 in both cases); the difference between stage III and stages I/II varicocele was just below significance (p = 0.053). Conclusion Testes with varicocele are significantly stiffer than normal ones, with a positive correlation to the clinical grade and significantly to the duration of spermatic vein reflux.

PO-0923 Varicocele Treatment In Paediatric Age: Report Of Different Techniques

Background Varicocele is the first andrological disease in adolescent male. The aim of this study is to report our experience in varicocele treatment in paediatric age. Materials and methods We analysed patients treated with different techniques between January 2005 and January 2013. Inclusion criteria for the study were created. Patients were treated with different techniques based on the type of spermatic vein reflux detected on Doppler velocimetry. Type I spermatic vein reflux mini-invasive approaches, type II and III vein reflux open approaches. The following rates were considered as study endpoints: hydrocele rate; rate of relapses; rate of persistence; rate of testicular atrophy. Results During the study period 522 surgical varicocelectomies were performed. 345 cases were treated with videolaparoscopy (66,1%), 115 cases with an open inguinal technique (22,1%), 47 cases (9%) received a subinguinal technique (trans-scrotal technique in 18 cases and subinguinal technique in 29 cases) and 15 cases (2,8%) were treated with the one-trocar transumbilical technique. The laparoscopic technique and the subinguinal techniques showed a lower rate of hydrocele. Laparoscopic technique had less rate of relapses. Conclusions The laparoscopic techniques had less rate of relapses respect to other technique; this results could be related to the technique chosen respect to the type of spermatic vein reflux.

PO-0924 Elastosonography Of The Corpus Spongiosum: Comparison Between Normal And Hypospadic Anatomy

Background Elastosonography analyses the variable elasticity of a tissue by recording the changes of RF pulses from a structure, before and after manual compression. The aim of this study is to apply the elastosonography on normal and hypospadic penis to verify the structural differences in tissues composition and stiffness. Materials and methods 28 subjects were enrolled, mean age 24 months: 17 patients on post-operative follow-up for distal hypospadia and 11 age-matched subjects as control group. Elastosonography recorded antero-posterior and transverse diameters of the cavernous corpora, urethral and corpus spongiosum diameters, elastographic index of elasticity of the corpus spongiosum. The latter was defined as soft, medium-hard or hard. We assigned the value 1 to soft tissue, 2 and 3 to medium-hard and hard respectively. All scan were performed at the base of the penis, as far as possible from the region involved in the surgical procedure. Results Average antero-posterior and transverse diameters of the cavernous corpora were 4.2 mm (DS 0.83) and 6.5 mm (DS 1.12) for hypospadic group and 7.3 mm (DS 1.28) and 9.0 mm (DS 1.67) for control group. These data showed statistically significant difference between the two groups for both the diameters (p < 0.05). Corpus spongiosum diameter was 1.9 (DS 0.33) for hypospadic group and 2.7 mm (DS 0.73) for control group (p < 0.05). Elastography showed a corpus spongiosum stiffness defined as medium-hard or hard in all cases of the pathologic group and soft in all the subjects of the control group (p < 0.05). No significant difference was found for urethra diameter between the two groups. Conclusions Elastosonography showed how the hypospadia anatomy is deeply altered, even in an anatomical area far from meatal abnormality: corpus spongiosum in hypospadic penis seems to be globally stiffer and less elastic. Moreover, cavernous corpora are less developed. These preliminary results suggest the feasibility of the elastosonography for the evaluation of hypospadic penis. It could be useful during surgical plan to have a better definition of the calibres and quality of the tissues, especially in proximal hypospadia. We believe that this methodic could also be important during the early post-operative follow-up.

1608 The Role of Transthoracic Ultrasounds to Assess Patients with Pectus Excavatum

Introduction Pectus excavatum is the most common congenital malformation of the anterior chest wall; the purpose of this study is to assess the role of thoracic ultrasounds in the preoperative workup of patients affected by pectus excavatum. Materials and Methods An observational study was carried out ibetween january and september 2011. patients aged between 4 and 14 years of age were divided into 4 study groups. group a: healthy patients without pectus excavatum; group b: healthy patients with different grades of untreated pectus excavatum; group c: patients with pectus excavatum treated with nuss bar; group d: patients surgically treated with removed bar. Results Patients with deeper anatomical depression showed a differential value between inspiration and expiration lower than healthy patients or patients with shallower depression (p<0.05) in any age range considered; a depression deeper than 2.8 cm was associated with lower elasticity of the chest wall; chest dynamicity of patients treated with open techniques showed almost immobility of the parasternal region, with a differential value close to zero, and a differential value inferior to 0.5 cm at the level of the anterior axillary line. Conclusions Study results confirm that the use of ultrasounds should be introduced as a standard preliminary test. patients with pectus excavatum have altered chest dynamicity if compared to healthy patients. The study also confirms that the most suitable area of the chest for bar insertion in terms of dynamicity is between the fourth and sixth intercostal space: not necessarily near the deepest point of depression.

283 The Role of Peritoneal Drainage in Bell’s Stage 2 of Necrotizinf Enterocolitis

Introduction Necrotizing enterocolitis (NEC) has become the most common perinatal gastrointestinal emergency. In literature there is an ongoing discussion on which surgical approach is the most efficient to maximise patients’ survival: laparotomy or percutaneous drainage in case of intestinal perforation. The aim of this study is to identify the preventive role of the peritoneal drain. Materials and Methods Between September 2007 and September 2011 a prospective study was carried out at our Hospital. Informed consent were obtained by parents before treatment; Inclusion criteria were created. Group A: placement of abdominal drainage in stage 2; Group B: surgical treatment only with perforation. Efficacy of early treatment (absence of subsequent intestinal perforation) was the primary end point; Survival at one month after drainage placement, Hospitalization, Mortality and Morbidity were considered for analysis. Results 43 infants with stage II NEC were observed. At the end of the study the results shows that: 16 patients were treated with preventive peritoneal drain; 4 of these patients (25%) underwent surgery for advanced NEC (intestinal perforation). Of the other 27 patients, 10 patients (37%) developed advanced NEC, with intestinal perforation. (p<0.05) in each group Patients with advanced NEC showed longer time of meconium evacuation if compared to the others (mean 5 vs. 2 days, p<0.05). Only 25% of patients treated with PPD underwent laparotomy for bowel perforation (p<0.05). Conclusions The use of peritoneal drain in stage II NEC seems to be a safe alternative and treatment for these patients.

463 Isolated Torsion of Infundibulum of the Right Fallopian Tube in A 12-Year-Old Girl

Introduction Isolated torsion of fallopian tube is a rare cause of acute abdominal pain. It can happen in different portions of the oviduct: in our patient a torsion at the level of the infundibulum occurred. Case report A 12-year-old post-menarchal girl presented at our Pediatric Surgery Unit with a two days history of lower abdominal pain on right side. Blood exams showed rise of CRP (19 mg/L) and normal WBC. An ultrasound performed in the A&E department was normal. Because of the persistence of pain, we repeated an ultrasound the day after that showed an anechogenic uniloculated 18 mm cyst at the level of the right ovary. The report was of functional follicular cyst. After two days of observation and worsening of the symptoms, laparoscopy was performed: a necrosis of the fimbriae due to torsion at the right fallopian tube infundibulum was found. The ischaemic fimbriae were removed according to Kroener fimbriectomy. Hystological analysis described fimbriae characterized by oedema and vascular congestion. Discussion Torsion of infundibulum could mimic a functional annessial cyst, with a normal echogenic appearance, while a torsion of the whole Fallopian tube can be more easily detected and suspected, avoiding delayed treatment. In our case, to base the management on clinical symptoms was mandatory. Conclusions Isolated torsion of infundibulum of Fallopian tube is a challenging diagnosis. It should be considered in case of acute lower abdominal pain in young girls. Early laparoscopy seems to be the best approach for diagnosis and treatment.