Nihat Sever

Do open repair and different laparoscopic techniques in pediatric inguinal hernia repairs affect the vascularization of testes

PURPOSE The aim of this study was to evaluate, using Doppler ultrasonography, the effects of different hernia repair techniques on testicular perfusion in the pediatric age group. METHODS This study was based on a prospective clinical trial of 72 pediatric patients over 2 years of age with unilateral inguinal hernia. They were operated on using 1 of 3 different techniques. Group 1 included 26 patients who were treated with a conventional open hernia repair technique. Group 2 included 22 patients who underwent Schier intracorporeal laparoscopic suture technique. Group 3 included 24 patients who underwent the laparoscopic partial excision and purse-string technique described by Montupet. In all cases, blood flow index of the centripetal and capsular arteries of the testes, including peak systolic velocity (PSV) and resistivity index (RI), were examined by using Doppler ultrasound preoperatively and early and late postoperatively. RESULT The conventional open technique group (group 1) had transient temporary changes in PSV and RI values compared with preoperative findings; however, these changes were not statistically significant. No such changes were observed in the 2 laparoscopic groups. CONCLUSION Neither conventional open nor laparoscopic hernia repair techniques impaired testes vascularization. Surgical manipulations performed using the conventional open repair technique caused transient, but not significant, changes in PSV and RI values.

Ultrasound-guided hydrostatic reduction of intussusception with saline: Safe and effective.

PURPOSE The study was undertaken to assess the efficacy of ultrasound-guided saline enema in reducing intussusception and to determine the role of age and duration of symptoms on this event. METHODS The case records of patients who were treated for intussusception at our institutions over the past 10 years were retrospectively analyzed. A total of 419 patients were treated for intussusception and 375 of them were included into the study. Patients were excluded if they had symptoms and signs of acute abdominal disease and required surgery as an initial treatment. RESULTS Hydrostatic reduction was successful in 313 of the 375 patients (83.46%). The procedure-related complication rate was nil. There were 29 episodes of recurrences in 23 patients, and recurrence rates did not differ between patients who responded to hydrostatic reduction and those who required surgery. Younger age [median (range); 11 months (3-108 months) vs. 20 months (1-180 months); p<0.05], rectal bleeding (p<0.01) and long duration of symptoms [mean (range); 1.95 days (1-7 days) vs. 1.44 days (1-10 days); p<0.01] were significantly associated with failed hydrostatic reduction. CONCLUSION Ultrasound-guided hydrostatic reduction is an easy, safe and effective method for the treatment of intussusception in the absence of acute abdominal findings.

A retrospective review of the adnexal outcome after detorsion in premenarchal girls

Background: The aim of this study was to report our results on premenarchal girls with adnexal torsion who were treated with different approaches. Materials and Methods: Twenty-six adnexal torsions in children were analysed retrospectively. Group 1 included cases of oophorectomy for the twisted adnexa. Group 2 contained the patients with adnexal torsion who untwisted either with a laparoscopic or open approach. Postoperative restoration of ovarian function was evaluated by Doppler ultrasound at the 6 th month. All oophorectomy and biopsy specimens were also evaluated. Results: Group 1 consisted of eleven cases that underwent oophorectomy due to gangrenous change and haemorrhagic infarction. Histology was of a mature teratoma in two cases and haemorrhagic necrosis due to torsion in seven. Group 2 consisted of 15 patients. In 10 out of 15 patients, preoperative biopsy is performed in which their histology revealed haemorrhagic necrosis in eight cases, and simple cyst with a benign nature in two cases. In all of the 10 untwisted adnexas, postoperative radiological imaging showed complete recovery with normal follicular development. No malignancy or increased tumour markers were noted in both groups. Conclusion: Adnexas can be left in place regardless of the preoperative degree of necrosis. Biopsy can be added to the procedure to rule out malignancy.

Wilms’ Tumor: A 24-year Retrospective Study from a Single Center

Medical records of 71 children with Wilms’ tumor at Sisli Etfal Education and Research Hospital between 1990 and 2014 were reviewed. Mean age at diagnosis was 3.11 years (2 days–7 years). Male to female ratio was M/F = 6/10. The incidence of associated anomaly was 16.9%. Clinical manifestations included abdominal mass (89%), hematuria (30%), hypertansion (25%), abdominal pain (15%), fever (5%), restlessness (2%), weight loss (2%), varicocele (1%). Ultrasound (USG) was the most often initial study in a child presenting with abdominal mass. Doppler USG was also made to evaluate the inferior vena cava (IVC) for the presence of tumor extension in children with renal mass. The left kidney was affected in 33 patients (46.5%), the right was affected in 31 patients (43.7%). Two patients was extrarenal (2.8%). And 5 patients (7.04%) were bilateral on the presentation. Preoperative chemotheraphy was done in 14 cases. In 63 patients with unilateral Wilm tm, unilateral radical nefrectomy is performed. In one patient with solitary kidney, nephron sparing surgery (NSS) is performed. In 3 patients with bilateral tm NSS is performed and in 2 patients with bilateral Wilms’ tm NSS is performed in one side and nefrectomy on the other side. Out of 71 Wilms tumor (WT) patients, 17 of them has been out of our follow. And 4 of them are died. Ten of them has metastases. Forty children are under follow with no metastases. Patients with WT needs a multimodal, multidisiplinary treatment with the cooperation of pediatric oncologist and pediatric surgeon and needs close follow-up.

An unusual foreign body in the bowel lumen causing obstruction in a neonate

Most of the foreign bodies swallowed by children pass the entire gastrointestinal tract without any complication. Neonatal intestinal foreign bodies are extremely rare. A newborn with a small bowel obstruction caused by a fresh grape is reported.

[Should appendectomy be performed in Amyand's hernia?: two case reports].

The presence of appendix vermiformis in an inguinal hernia sac is called Amyands hernia. The disease is named after Claudius Amyand, who performed the first documented and successful appendectomy during a hernioplasty in 1975. Finding an appendix within an inguinal hernia is reported at a rate of 0.51%-1% in the adult population, whereas there is no reported frequency of Amyands hernia in children due to its rare occurrence. Here, we report two cases of Amyands hernia. The first is a newborn, diagnosed with strangulated Amyands hernia by preoperative ultrasound examination of the groin. In this case, the appendix had compromised blood supply, so we performed appendectomy during the hernioplasty. The second patient was diagnosed with Amyands hernia during elective hernioplasty. In this case, the appendix had no evidence of circulatory or inflammatory disorders, so we performed simple hernioplasty and left the appendix in the abdominal cavity. In Amyands hernia, there are no standards in approaching the appendix. Appendectomy is not a necessity unless there are circulatory or inflammatory injuries.

Does percutaneous internal ring suturing contain risk of ilioinguinal nerve entrapment

PurposeIn this study, we aim to assess the alteration of IIN functions in children with inguinal hernias operated on using open or ‘percutaneous internal ring suturing’ (PIRS).MethodsThis study was based on a prospective clinical trial of 60 pediatric patients. They were operated on using PIRS or conventional open hernia repair technique. Group 1 included 35 patients who were treated with PIRS technique. Group 2 included 22 patients who underwent a conventional open hernia repair. The ilioinguinal nerve stimuli in both the operational and non-operational areas were evaluated in patients with peripheral EMG for possible ilioinguinal nerve damage on the hernia side before the operation and to reevaluate ilioinguinal nerve function in the third postoperative week.ResultIn Group 1, 19 cases underwent a preoperative EMG examination and in 35 cases, EMG examination was obtained postoperatively. Pre- and postoperative EMG results were normal in all cases in Group 1 on both the operational and non-operational sides. In Group 2, 15 preoperative and 25 postoperative EMG examinations were obtained. In Group 2, only one case with a right inguinal hernia who had normal preoperative EMG results showed no IIN response in a postoperative EMG evaluation obtained in the third postoperative week, with a normal left-side response. The EMG was repeated at the three-month postoperative third mark and revealed the same result. In a six-year-old female case, there was a negative EMG response on the non-operative side both pre- and postoperatively.

Role of dissemination of microorganisms during laparoscopic appendectomy in abscess formation

BACKGROUND The aim of this study was to investigate the potential contributory role of laparoscopic appendectomy in the occurrence of postoperative intra-abdominal infections. METHODS A prospective single-center study including 48 patients who underwent laparoscopic appendectomy was conducted between August 2010 and September 2011. Two peritoneal samples were obtained from each patient in the pre- and post-appendectomy period. Aerobic and anaerobic microbiological cultures were obtained from the samples. The data were analyzed with statistical methods. RESULTS The mean age of the 48 patients (29 male, 19 female) was 10.9 years. Among the pre-appendectomy aerobic cultures, microorganisms were isolated in 18 of the patients (38%), with Escherichia coli being the most common. In post-appendectomy aerobic cultures, various bacteria were isolated in 7 patients (14.6%), with the numbers of bacteria statistically significantly reduced (p<0.05). Anaerobic microorganisms were isolated in 12 patients (25%) and 4 patients (8.3%) in pre- and post-appendectomy cultures, respectively, with Bacteroides fragilis the most common organism; there was a significant reduction in the bacterial count (p<0.05). Each patient was regarded as their own control. CONCLUSION Our results suggest that laparoscopic appendectomy does not cause an increase in intra-abdominal infections, and particularly not infections associated with anaerobic bacteria.

A Cystic Mass does not Always Mean Hydatid Cyst in Endemic Areas

Within the medical community, there is a tendency to describe all cystic lesions in the liver and lungs as Hydatid disease (HD) in areas with HD endemics. This approach may sometimes cause a misdiagnosis. We have three cases with children aged between seven, seven and ten year old, all of whom had been diagnosed, via radiologic imaging, with HD cysts and started on treatment without confirmation. The true diagnoses of these cases were undifferentiated embryonal sarcoma (UES) in two and oesophageal duplication in one case, respectively. The indirect haemagglutination assays (IHA) were obtained in two of them. Although their results were negative, albendazole treatment was started in all cases. Confirmatory tests should be run in dubious cases. An IHA test can aid the diagnosis, although its effectiveness is limited. The possibility of false positive and negative results always exists, especially in lung cysts. A percutanous biopsy is strongly advised for differential diagnosis.

Giant umbilical cord associated with cord hemangioma

A 6-h-old girl was transferred to the Pediatric Surgery Department of Sisli Childrens Hospital due to a giant umbilical cord. Radiologic and laboratory studies were within normal limits. The umbilical mass excised through an intraumbilical incision and the umbilicus reconstructed. Pathologic investigation demostrated an umbilical cord hemangioma located near the umbilical end, compressing the cord structures externally. The remaining cord consisted of loose, edematous stroma similar to Whartons jelly. The patient was discharged from the hospital on the 5th postoperative day and remains healthy 1 year later. Umbilical cord hemangioma should be considered in the etiology of a giant umbilical cord.