Ergun Ergün

Balloon dilatation in esophageal strictures in epidermolysis bullosa and the role of anesthesia.

Esophageal involvement, which causes stricture, is a complication in epidermolysis bullosa. This causes dysphagia and malnutrition and leads to deterioration of skin lesions in these patients. The charts of 11 patients with epidermolysis bullosa and esophageal stricture who were included into dilatation program between 2003 and 2015 were retrospectively reviewed. Seven of the patients were female and four were male. The median age was 14 (2-32) years. The mean body weight of patients was 27.8 (9-51) kg. The location and number of strictured parts of the esophagus were previously evaluated with upper gastrointestinal contrast study and after that flexible endoscopy was used for dilatation. Eight patients had middle esophageal, three patients had proximal esophageal and one of them had both proximal and middle esophageal strictures. The strictures were dilated 56 times in total (mean 5 times). One patient underwent gastrostomy and was medically followed-up after a perforation occurrence during the dilatation procedure. In a 32-year-old female patient, colon interposition was performed after four dilatations since optimal nutritional and developmental status could not be achieved. The dilatation program of nine patients is still in progress. Seven of them can easily swallow solid food but two of them have some difficulties in swallowing between dilatations. One patient rejected the program and quitted, while one patient refused colon interposition and died because of complications related to amyloidosis during the dilatation program. After resolution of the swallowing problem, skin lesions were observed to heal quickly. Epidermolysis bullosa is a rare cause of dysphagia. Esophageal balloon dilatation with flexible endoscopy is a safe and efficient method in patients with this condition.

Hormone therapy in hypospadias surgery: a survey on the current practice in Turkey

BACKGROUND/AIM Nowadays surgical intervention is possible in smaller phalluses and younger children with hypospadias disease. Different hormone treatments with different doses, modalities, indications, and treatment times come along with some disputes. The aim of this study is to evaluate the management approaches in hypospadias surgery of surgeons in regards to hormone preparations. MATERIALS AND METHODS Questionnaires were sent via e-mail to 110 actively working pediatric surgeons and urologists. The answers of 99 surgeons were evaluated (90%). Two surgeons declared that they did not perform hypospadias surgery. RESULTS When testosterone usage in penile surgery was questioned, 44.4% of participants (n = 44) answered positively. Small-short penis glans, narrow urethral plate, chordee, disorders of sexual development, buccal mucosa-graft operations, slight tissue, and defective ventral skin were the indications for usage. Forty of forty-four surgeons stated usage in proximal hypospadias, 18 of them in penile hypospadias, and 15 of them in distal hypospadias. The most common form was dihydrotestosterone (62%). According to the respondents, fistulas (83%), infections (78%), and wound dehiscence (77%) were reduced. Fifty-six percent of the surgeons stated that bleeding was increased and 39% stated easier dissection. CONCLUSION As a result of this questionnaire we can understand that there is no standard usage of testosterone in Turkey. Optimal points of usage can be introduced by increasing prospective randomized trials and education programs can ensure similar effective usage.

Effective management of cricopharyngeal achalasia in infants and children with dilatation alone

AIM Cricopharyngeal achalasia (CPA) is a rare clinical condition that is characterized by aspiration, choking, and nasopharyngeal regurgitation. The aim of this study is to introduce the outcomes of dilatation alone in children with CPA. PATIENTS AND METHOD After the evaluation of upper esophageal sphincter with endoscopy, dilatation was performed. All patients underwent videofluoroscopic evaluation and swallowing therapy after the surgical procedure. A retrospective chart review was performed in children with CPA. RESULTS Thirty children who were videofluoroscopically proven to have CPA were included in the study. Their age range was 15days-7years (median 11months). Twenty-one of them were neurologically impaired. Two children were lost to follow-up. Nineteen patients (68%) had a total resolution of CPA and were symptom-free with 1-6 dilatations (median 2). Three of the children (11%) who were severely neurologically impaired had resistant CPA. Three children (11%) treated recently with short follow-up were added to the group. Their VFS evaluations demonstrated improvement, thus we accepted their result as successful. There were two perforations in the series. Three patients died; one 2-month-old (2500g) baby who was accepted from the intensive care unit passed away on postoperative on the 7th day. Two other babies who were unresponsive to dilatation therapy died on follow-up. CONCLUSION Dilatation can be a safe and effective method on children who are correctly diagnosed to have CPA.

Stuck tunneled central venous catheters in children: four cases removed by angiography assistance

Ateş U, Taştekin NY, Mammadov F, Ergün E, Göllü G, Can ÖS, Uçar T, Bingöl-Koloğlu M, Yağmurlu A, Aktuğ T. Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance. Turk J Pediatr 2018; 60: 221-224. Adherent tunneled catheters can usually be removed by a surgical cut down, but in some cases the line can become stuck to the wall of the central veins. In such cases, forceful traction can cause vascular injury, or fracture of the catheter. We present four cases of fixated cuffed tunneled catheters. Three children had acute lymphoblastic leukemia and one had an immunodeficiency syndrome. All catheters were made from polyurethane. Indwelling times were 12-24 months. All patients` catheters were removed with great difficulty by trans-femoral access. The angiography-assisted technique is safe and easily-applied for the removal of stuck catheters in pediatric patients. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous catheters (CVCs) in children.

Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results

Obesity is one of the most rapidly increasing health problems in children. Laparoscopic sleeve gastrectomy (LSG) is one of the best treatment options and is feasible and safe in children. The aim of this study was to present the short‐term results of a laparoscopic sleeve gastrectomy series in children.

Laparoscopic proctocolectomy with ileal j-pouch anal anastomosis in children

BACKGROUND/AIMS We aimed to evaluate postoperative fecal incontinence scales of children who underwent laparoscopic proctocolectomy and ileal J-pouch anastomosis for familial adenomateous polyposis (FAP) and inflammatory bowel disease (IBD). MATERIALS AND METHODS Fecal incontinence scores were collected at 3 months post-surgery. A retrospective chart review was also performed to obtain the demographic data and operative technical details. RESULTS The postoperative Wexner Fecal Incontinence Score was 0 in 9 of 11 patients and satisfactory in the remaining two. None of the children had a major complication. CONCLUSION Even though the presented study does not have any comparable data, it seems that laparoscopic total proctocolectomy with ileal J-pouch anal anastomosis (TP IPAA) might be the best choice of surgery because it provides good continence with low complication rates.

Laparoscopy is the Gold Standard in Ovarian Pathologies in Childhood: Clinical Evaluation and Literature Review

OBJECTIVE: Ovarian cysts and related torsions are the most common adnexial pathologies in childhood. Diagnostic laparoscopy is the gold standard approach for differential diagnosis. It is aimed to evaluate the data of patients who had surgery for ovarian pathology. STUDY DESIGN: Fifty-three girls of ten years are included the study. Demographic data, medical history, physical examination, laboratory and radiologic investigations, surgical procedure, histopathology, complications and follow up periods are recorded. RESULTS: The median age of children was 13. Excluding the patients who were diagnosed in intrauterine period (n=4), all of the patients had abdominal pain (92%). Laparoscopic cystectomy (56.7%), detorsion and cystectomy (16.9%) and oopherectomy (16.9%) were performed in patients with cysts. Diagnostic laparoscopy (3,8%) and laparoscopic detorsion (5.7%) were performed in patients without cyst. Dermoid cysts were found in three children and teratomas in two. Patients were discharged in postoperative second day. CONCLUSION: Diagnostic laparoscopy is the gold standard approach for differential diagnosis. Laparoscopic approach should be chosen because of shorter hospital stay, shorter healing period, and better cosmetic results. Besides, less pelvic adhesions compared to laparotomy in laparoscopy is important for further fertility.