P. Repetto

Italian multicenter survey on laparoscopic treatment of gastro-esophageal reflux disease in children

Background: Skepticism is still present today about the laparoscopic treatment of gastro-esophageal reflux (GER) in children. We present the prospective experience and short-term results of eight Italian pediatric surgical units. Methods: We included all the children with complicated GER, operated after January 1998 by single surgeons from eight different centers. Diagnostic aspects, type of fundoplication, and complications were considered. All the patients were followed for a minimum period of 6 months in order to detect complications or recurrences. Results: 288 children were prospectively included. Mean age was 4.8 years (3 m–14 y). Nissen fundoplication was done in 25%, floppy Nissen in 63%, Toupet in 1.7%, and anterior procedures (Lortat Jacob, Thal) in 10%. Gastrostomy was associated, if neurological impairment or feeding disorders were present. Mean follow-up was 15 months and reoperation was necessary in 3.8% of cases. Conclusions: This experience underlines that minimal invasive access surgery in children is safe and that the laparoscopic approach is considered in eight centers the golden standard for surgical repair of gastro-esophageal reflux disease maintaining the same indications and techniques of the open approach.

Complications of mechanical suturing in pediatric patients

BACKGROUND/PURPOSE Although it is widely accepted that staplers are effective in reducing operating time, potential complications related to their use in the pediatric population are not well defined yet. The aim of this study is to evaluate the safety of mechanical suturing. METHODS Between 1996 and 2001, 174 procedures were performed using circular staplers in gastrointestinal anastomosis, whereas linear staplers were used in gastrointestinal and lung resection. Intraoperative and early complications of each intervention were recorded. RESULTS Overall, 12 complications occurred (6.9%). Two were caused by technical problems: In one case the stapler broke, in the other the anvil detached from the instrument shaft. Ten (5.7%) were major complications: 2 cases of leakage and 3 of bleeding in gastrointestinal procedures, and one case of bronchopleural fistula and 4 cases of bleeding during lung surgery. There was a significant correlation (P <.05) between type of stapler used and development of complications, suggesting a safer use of endoscopic staplers compared with conventional linear ones. CONCLUSIONS Mechanical suturing in children is not used frequently, but some procedures could be used more widely because they are fast and safe.

Three small testes in left hemiscrotum: a rarer caseof polyorchidism

Polyorchidism is a rare congenital anomaly. A review of literature has yielded about 100 cases. We describe a rarer case of polyorchidism consisting of 3 testes on left hemiscrotum and one normal testis in right hemiscrotum. Diagnosis and management are discussed.

Medium-term results after cholecystectomy in patients younger than 10 years

Background: Gallbladder stones are a well-known and widely studied problem in children. Hematological disorders are the most common diseases that can cause cholelithiasis. However, in the last few years, the proportion of children with idiopathic cholelithiasis has increased 50%. Herein, we present a prospective study on laparoscopic cholecystectomy in a selected group of patients aged < 10 years. Methods: Fifty-eight patients aged < 10 years underwent laparoscopic cholecystectomy for stones in the period 1992‐99. The female/male ratio was 1.5, the mean age was 8 years (range, 2‐10), and the mean weight was 30 kg. In all patients, parenteral nutrition, fasting state, and prolonged use of antibiotics had been suspended for

Bilateral xanthogranulomatous funiculitis and orchiepididymitis in a 13-year-old adolescent boy

6 months, and conservative treatment had been tried for

A case of frozen pelvis: Primary actinomycosis of urinary bladder in a young boy

12 months in the absence of symptoms of stone migration. All the patients were followed up after surgery: clinically at 1,6,12, and 36 months and by ultrasound at 1, 12, and 36 months. Liver function and hematological tests were performed in case of symptoms or if hemolytic disorders were the cause of stones. Results: The mean operative time was 63 min (range, 30‐ 12) in children undergoing cholecystectomy alone and 150 min in children undergoing associated splenectomy. There were no major complications or reoperations. Minor complications included bleeding from accessory cystic artery ( n 4 3) and insufflation of the omentum (n 4 2). One case was converted to an open procedure due to technical problems. All the children were followed up and no complications were observed. Conclusion: We consider the laparoscopic approach the gold standard for cholecystectomy in children. This procedure does not have a complication rate any higher than open

Necessity for surgery in children with gastrooesophageal reflux and supraoesophageal symptoms

Xanthogranulomatous orchitis is an extremely rare inflammatory nonneoplastic lesion of the testis. We report a case of a 13-year-old adolescent boy who presented a painless left hemiscrotal swelling. The subsequent ultrasonography and magnetic resonance imaging revealed the presence of abnormal expanding tissue located in both testes and spermatic cord, reaching the internal inguinal ring. Testicular tumor markers were normal. The frozen section examination of the surgical specimen showed only inflammatory tissue and not neoplastic tissue. No orchiectomy was performed. Definitive histopathologic diagnosis was xanthogranulomatous inflammation. To our knowledge, this is the youngest case of xanthogranulomatous orchiepididymitis and funiculitis found in medical literature.

Once-daily intrapleural urokinase treatment of complicated parapneumonic effusion in pediatric patients.

We report a case of urinary bladder actinomycosis in childhood. In children abdominal actinomycosis is rare and unlikely involves the urinary tract, so it is often misdiagnosed. An 7-year-old boy was referred to a secondary level hospital because of abdominal pain and dysuria. Physical examination revealed a left hypochondrial mass. Hypothesizing a pelvic rhabdomyosarcoma, a biopsy with mini-laparotomy access was performed. The first histopathological analysis did not show any malignant cells, and a 14-day antibiotic course was ineffective. Reoperation and biopsy was needed, and the histopathological examination made the diagnosis possible.