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The safety of the laparoscopic treatment of intestinal malrotation remains controversial. This study compared the outcomes of laparoscopic and open surgical treatment of intestinal malrotation. A multicentric retrospective study included pediatric cases of intestinal malrotation operated on between 2005 and 2016. This study included 227 children with a median age of 17 days (0–17.2 years), including 161 with a midgut volvulus. Forty-six(20.3%) procedures were started by laparoscopy and 181(79.7%) by laparotomy. Laparoscopy was more frequent for elective surgery (45.9%) than for emergency procedures (10.8%, p < 0.001). Conversions were significantly more frequent during emergency procedures (66.7% vs 17.9%)(p = 0.001). Considering only 61 elective surgeries, the mean hospital stay was significantly shorter after laparoscopy (5.3 days +/−5.2 vs 10.1 days +/−13, p = 0.01), the overall complication rate was comparable (15.8% vs 21.7%, p = 0.7) but post-operative volvulus was significantly more frequent after laparoscopy (13% vs 0%, p = 0.04). Outcomes of the two approaches were not significantly different after 166 emergency procedures. Laparoscopy can be performed by experienced team for the treatment of selected cases of intestinal malrotation. Conversion to open surgery should be done with a low threshold, as the rate of volvulus recurrence is concerning. Level III. [ABSTRACT FROM AUTHOR]

Objective This preliminary qualitative study evaluates the efficacy of cup suction in the correction of pectus excavatum (PE), and examines the place of this system as a strategic treatment and as an alternative to surgery. Materials and methods Between October 2011 and June 2014, a total of 84 patients (children and adult) presenting with PE were treated by cup suction, in our chest wall deformities unit. On first consultation, the patients with typical PE and with at least partial correction during the first application of cup suction and a maximal suction pressure for correction of less than 300 mbar (millibars) were included in this study. 11 patients were excluded from the present study as they presented with a complex carinatum/excavatum. The remaining 73 patients were divided into two groups: Group I, adult patients ≥ 18 year old, 17 patients. The mean age was 22.8 years old. Group II, pediatric patients < 18 years old, 56 patients. The mean age was 11.5 years old. Medical photographic documentation was collected systematically. In addition, the depth of PE was measured. The management protocol involved: adjustment of cup suction, strengthening exercises, and clinical follow-up every two to three months. The evaluation criteria during, and on the completion of the trial were: depth of the PE, morbidity and treatment compliance. Partial and final results were evaluated by the patients, their parents, and doctor, using a qualitative scoring scale. Results A total of 73 patients presenting typical PE (symmetric in 52 cases and asymmetric in 21 cases) were treated by cup suction. The mean depth of PE was 23 mm (9–44). Of the 73 patients, one adult abandoned treatment and three children abandoned follow-up. The mean time of use of the device was 4 h daily. At six months of treatment, the mean depth of PE was 9 mm (0–30) across all patients. 23 patients completed the treatment and exhibited flattening of the sternum. These patients were considered to have an excellent aesthetic result. The mean treatment duration to normal reshape was achieved at 10 months (4–21). The remaining patients are improving under continuing active treatment. The mean depth of PE in this group was 12 mm (4–30), after a mean treatment duration of 9 months (2–22). Conclusions Treatment using cup suction is a promising useful alternative in selected cases of symmetric and asymmetric PE, providing that the thorax is flexible. Treatment duration is directly linked to age, severity and the frequency of use. It is becoming a well-recognized therapy, which improves the self-image of those patients whose anterior chest wall is still pliable. The cup suction can be used for pediatrics and young adults waiting for a treatment, possibly surgery, however, the long-term effect of this procedure remains unclear. [ABSTRACT FROM AUTHOR]

In extremely low birth weight (ELBW) infants, i.e. < 1000 g, with esophageal atresia (EA) and tracheoesophageal fistula (TEF), surgical treatment is a real challenge. High morbidity is associated with primary repair of EA on these patients. We report our recent experience with three cases of ELBW infants with EA and TEF treated by lower esophageal banding (LEB). From September 2012 to January 2013, three ELBW infants with EA/TEF were born prematurely with severe respiratory distress. One of them had VACTER association with anorectal malformation (ARM). The gestational age was between 25 and 27 weeks, and the mean birth weight was 690 g (500–790). All were treated by LEB and gastrostomy, followed by delayed primary thoracoscopy reconstruction. One baby died in the postoperative period because of intraventricular hemorrhage at 7 days after initial surgery. Among the 2 others cases, one of them required ligation without section of the TEF with removal of LEB by thoracoscopy at 30 days old and 1300 g. Delayed primary thoracoscopy reconstruction and section of TEF were performed by thoracoscopy at 70 and 80 days old and 2100 g and 2200 g respectively without early complication. The follow-up was 12 months. One baby presented a stenosis requiring one dilation of lower esophagus with uneventful course. LEB is a life saving practice in ELBW babies with EA and TEF. The esophagus can tolerate the ligation even with a thread without having a long time major complication. Thoracoscopic reconstruction of the esophagus is possible in these babies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim was to report a multicentric study with a longer follow-up to evaluate the laparoscopic radical nephrectomy in children with renal cancer. Material and methods: This was a retrospective multicentric study, from October 2005 to January 2012, of children who underwent a laparoscopic radical nephrectomy for small renal malignant tumors. Results: Seventeen children were included in this study. Sixteen underwent chemotherapy before surgery according the SIOP (Société Internationale d'Oncologie Pédiatrique) protocol and one was treated by surgery only for a carcinoma. All except one could be treated by laparoscopy; the biggest tumoral size was 8 cm. The median hospital stay was 3 days (2–10). The pathologic examination showed 15 Wilms' tumors, one clear cell sarcoma and one TFE3 renal cell carcinoma. With a median follow-up of 42 months (range 12 and 77 months) after laparoscopic radical nephrectomy, 15 children had no oncological complications (port site or local recurrence, pulmonary metastasis) and one had a local recurrence without intraoperative tumoral rupture. The child with TFE3 renal cell carcinoma died 4 years after surgery from brain and lung metastases without local recurrence. No small bowel obstruction occurred. Conclusions: Radical nephrectomy in children for Wilms' tumor or other renal cancer can be safely performed laparoscopically and our indications can be summarized, for trained laparoscopic surgeons, by small tumors under about 8 cm diameter, especially without crossing the lateral edge of the vertebra on the CT scan at the time of surgery. [Copyright &y& Elsevier]

Abstract: INTRODUCTION: Intestinal malrotations are rare and may be asymptomatic until adulthood. There are only a few descriptions of gastric bypass with intestinal malrotation. If the duodenojejunal angle is not correctly seen, as is generally the case, there is a risk of creating an antiperistaltic anastomosis. PRESENTATION OF CASE: We describe required attitude and cases of gastric bypass performed on two patients who had a complete common mesentery. In both of our patients, the transverse colon was not running across the abdomen and the duodenojejunal angle was “absent”. We therefore looked for the caecum in order to unravel all of the small intestine. We were able to carry out Roux en Y gas- 42 tric bypass with uncomplicated post-operative courses for both 43 patients. The result in weight loss was perfect and identical to that of patients without anatomical abnormality. DISCUSSION: In our cases, ultrasound to investigate for gallstones did not provide a pre-operative diagnosis. It is extremely difficult to investigate for the mesenteric vessels by ultrasound in obese patients and for this reason the finding was not made preoperatively. The most important thing to do is make the diagnosis of malrotation preoperatively. For this reason the golden rule in performing a gastric bypass is to clearly visualise the duodenojejunal angle which allows an unknown bowel malrotation to be identified. Following these cases, the study of the oeso-gastro-jejeunal transit is now part of our pre-operative assessment. CONCLUSION: Bariatric surgeons need to be aware of these abnormalities. If a common mesentery is present the gastric bypass can still be performed. [Copyright &y& Elsevier]

Abstract: Background: Surgeons are at risk for developing work-related musculoskeletal symptoms (WMS). The present study aims to examine the physical factors and their association with WMS among pediatric laparoscopic surgeons. Methods: A questionnaire consisting of 21 questions was created and mailed to 25 pediatric laparoscopic surgeons (LG). 23/25 surgeons (92%) completed the survey. The questionnaire was analyzed and then split into 2 groups. Group 1 (LG1) included surgeons with greater laparoscopic experience, and group 2 (LG2) included surgeons with less important laparoscopic experience. In addition, we constructed and sent to the same surgeons a similar questionnaire focused on WMS after an open procedure (OG) with the aim to compare results of LG with OG. Results: The prevalence rate of WMS with shoulder symptoms was 78.2% in surgeons that performed laparoscopy for more than 10years, with 60.8% also reporting other pain. In 66.6% this pain is evident only after a long-lasting procedure. Forty-four percent of these surgeons require painkillers at least twice a week. Fifty percent of these surgeons also suffer at home. Fifty-five and one half percent of surgeons indicate that this pain is related to their laparoscopic activity. Forty-three and a half percent think that laparoscopy is beneficial only for the patient but has a bad ergonomic effect for surgeons. Sixty-five and two-tenths percent think that robotic surgery can be helpful to improve ergonomics. Comparing the groups, WMS occur more frequently in LG (78.2%) than in OG (56.5%), but this difference was not statistically significant (χ2 =0.05). In addition, WMS occur more frequently in LG1 (84.6%) than in LG2 (70%), but this difference was not statistically significant (χ2 =0.05). Conclusions: These results confirmed a strong association between WMS and the number of laparoscopic procedures performed. Skilled laparoscopic surgeons have more pain than less skilled laparoscopic surgeons. WMS in the same group of surgeons are more frequent after laparoscopy than after open procedures. The majority of surgeons refer to shoulder symptoms. [Copyright &y& Elsevier]

Abstract: Introduction: Laparoscopy may have a place in the treatment of vesicoureteral reflux (VUR). We report our initial experience in the treatment of VUR by laparoscopic extravesical transperitoneal approach (LETA) following the Lich-Gregoir technique to describe the evolution and to evaluate the results and benefits of this technique for these patients. Materials and Methods: Between August 2007 and May 2009, 43 renal units in 30 children (23 female and 7 male) with VUR and deterioration of renal function on isotope renography (17 unilateral and 13 bilateral) were treated with LETA. The mean age was 52 (range, 15-183) months. Nine patients had a double total collector system associated with VUR in a lower system. Two of them had a ureterocele with adequate upper polar rein function, and another had a ureterocele with complete deterioration of upper polar rein function. Results: The mean surgical time was 70 (38-120) minutes in unilateral and 124 (100-180) minutes in bilateral VUR. All procedures were successfully completed laparoscopically, and the reflux was corrected in all patients. At the same time, 1 heminephrectomy and 2 ureterocele were removed by laparoscopy and endoscopy, respectively. We had 1 ureter leakage 15 days postoperation that underwent a redo reimplantation. In cases of bilateral VUR, 1 patient presented postoperative bladder emptying difficulty and required temporary urethral catheterization postoperatively. The mean hospital stay was 24 hours. A cystogram was performed systematically in all patients at 45 days postoperation; none of them presented recurrence of VUR. The follow-up was 11 (range, 2-24) months, without recurrence of VUR. Conclusion: Laparoscopic extravesical transperitoneal approach in the treatment of VUR is a safe and effective approach even in unilateral, bilateral simultaneous, and double total collector system. The technique results in a shorter hospital stay, less postoperative discomfort, and reduced recovery period, with a low morbidity to resolve the VUR and with success rates similar to the open technique. [Copyright &y& Elsevier]

Abstract: Purpose: The aim of this study was to evaluate the feasibility of thoracoscopy in neurogenic tumors in infants and children. Materials and Methods: From January 2000 to October 2005, 21 patients aged 7 months to 14 years (mean, 6 years) underwent thoracoscopy for tumor resection in 5 French institutions. One 10-mm optical port and 2 operative 5-mm ports were needed. Selective intubation was required for 3 patients aged about 12 years. Tumor was removed with an endoscopic bag in all cases. Results: All procedures were completed successfully without any incomplete resection or recurrence. One conversion was necessary because of a huge mass. A chest tube was left for a mean of 2 days for 17 children. Two children had not had any drainage. Two postoperative chylothorax required chest drainage for 12 days. Only 5 of the 6 older patients (mean age, 12 years) needed a patient-controlled analgesia. The mean operative time was about 100 minutes. Hospital stay ranged from 4 to 12 days. Tumors were neuroblastoma or ganglioneuroblastoma in 16 cases and ganglioneuroma in the 5 other cases. Conclusion: Thoracoscopy for resection of thoracic neurogenic tumors in children is a feasible, safe, and efficient procedure. The surgeon has a better visualization of the tumor and its anatomic connections. Resection can be as complete as an open procedure without having to complicate the operative technique in the same operating time. It avoids cosmetic and functional disorders because of thoracotomy. It allows a good cosmetic resection without spillage. [Copyright &y& Elsevier]

Objective: Evaluate accuracy of prenatal ultrasound findings in predicting the risk of bowel atresia in patients with gastroschisis.Methods: A retrospective study was conducted on 18 fetuses with a prenatal diagnostic of gastroschisis treated at University hospital of Saint Etienne France between 2002 and 2012. Ultrasound abnormalities were used to classify them into three groups: no ultrasound abnormality (n=4), oligohydramnios (n=9), intra-abdominal bowel dilatation ≥20.5mm (n=5). Postnatal outcomes were compared between groups. The threshold value of 20.5mm for the prediction of atresia was determined through the receiver operator characteristics curve.Results: In the group with oligohydramnios, intra uterine growth restriction were significantly more frequent (p=0.015) and three newborns had serositis including two with secondary complications after the initial surgery. In the group with major intra-abdominal bowel dilatation, all had a narrow defect <10mm significantly more than other fetuses (p=0.002). Intra-abdominal bowel dilatation reaching 20.5mm started at a mean gestational age significantly lower than that of the other fetuses (23.3 versus 29.7 weeks p=0.02). On the five fetuses presented intra-abdominal bowel dilatation ≥20.5mm, four showed atresia and no other newborn has this complication (p=0.0016). The threshold value of 20.5mm has a sensitivity of 100% and a specificity of 92.9%. The area under the curve was equal to 96.4%.Conclusion: Intra-abdominal bowel dilatation ≥20.5mm seems to be associated with the risk of postnatal atresia. MRI could help to clarify a complicated or uncertain ultrasound aspect. [ABSTRACT FROM AUTHOR]