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Aim: To provide a further insight into the usefulness of lung biopsy in children.Methods: Lung biopsies in children from January 2007 to December 2017 were reviewed (n=39). The histology results were categorised as: definitive diagnosis, normal lung parenchyma, inconclusive.Results: Lung biopsy provided a definitive diagnosis in 25 (64%) cases. A suspected diagnosis was confirmed in 16 (41%) and a new diagnosis was found in 9 (23%) children. Histology was inconclusive in 11 (28%) cases and normal in 3 (8%). Fifteen (38%) children had treatment altered due to the biopsy result.Conclusion: Lung biopsy mostly confirmed the suspected diagnosis and was associated with a low procedure related morbidity (n=1) and mortality (n=0). Importantly, the biopsy result identified a pathology which altered treatment in over one third of patients. However, in a number of cases the histology was inconclusive, therefore careful patient selection is recommended to maximise diagnostic yield. [ABSTRACT FROM AUTHOR]

Aim: The study was designed to compare recurrence rates and complications after laparoscopic versus open varicocele surgery in children. Subjects and Methods: A retrospective case-note review of all varicocele surgery over a 10-year period (April 1999-March 2009) in two pediatric surgical centers was performed. Multivariate analysis using logistic regression was performed using SPSS Statistics version 18 (SPSS Inc., Chicago, IL). Results: Thirty-seven patients had varicocele surgery during the study period. The median age at surgery was 14 years (range, 11-16 years). Most children had left-sided Grade 2 varicocele. Twenty-five (68%) primary procedures were laparoscopic (17 artery-sparing), and 12 (32%) procedures were open (9 artery-sparing). Six (16%) children had recurrence, and 6 (16%) had postoperative hydrocele. Recurrence rates after laparoscopic (16%) and open (17%) surgery were similar. Increasing age significantly decreased recurrence (odds ratio, 0.373; 95% confidence interval 0.161-0.862; P=.021). Although laparoscopy was associated with higher rates of postoperative hydrocele (odds ratio, 2.817; 95% confidence interval, 0.035-3.595; P=.380) and artery-sparing ligation was associated with higher rates of recurrence (odds ratio, 2.667; 95% confidence interval, 0.022-4.235; P=.787), these associations were not statistically significant. Conclusions: The best results of varicocele surgery in terms of recurrence and postoperative hydrocele were achieved by open mass ligation; however, larger prospective studies are warranted. [ABSTRACT FROM AUTHOR]

Right thoracotomy for oesophageal atresia (OA) with dextrocardia is technically challenging due to the heart being in the operative field, and also due to the possibility of right-sided aortic arch. We report a neonate with longgap OA with tracheo-oesophageal fistula (TOF), dextrocardia, and left-sided aortic arch who was successfully operated by using right thoracotomy. On the basis of our review of the literature and our experience from this case, we found that conventional right thoracotomy is appropriate for OA+ TOF associated with dextrocardia and left aortic arch, and left thoracotomy in dextrocardia and right aortic arch. [ABSTRACT FROM AUTHOR]

Aim: Pneumatosis intestinalis (PI) is uncommon in school-age children. We studied a cohort of neurologically impaired school-age children with PI to formulate an optimum management plan.Methods: We retrospectively studied all school-age children who were referred to paediatric surgeons with radiological evidence of PI identified between 2011 and 2015. We analysed data on patient demographics, medications, feeding, associated comorbidities, presentation, investigations and treatments.Results: Five patients (3F:2M) with a median age of 7 years (range 5-9) were referred for surgical opinion with the evidence of pneumatosis on their abdominal X-rays. Four of them had associated pneumoperitoneum. All children had neurological impairment significant enough to make them unable to communicate clearly. Four patients were gastrostomy fed, one was jejunally fed. Four children had recurrent episodes of pneumatosis. Four patients had surgery at the initial presentation where colonic pneumatosis was detected; however, there was no evidence of bowel ischaemia or perforation despite of the presence of pneumoperitoneum. Recurrent episodes were successfully managed conservatively even in the presence of pneumoperitoneum.Conclusion: In neurologically impaired school-age children, the presence of pneumatosis and pneumoperitoneum does not mandate bowel ischaemia or perforation and therefore could be successfully managed conservatively without the need for surgery. [ABSTRACT FROM AUTHOR]