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Hirschsprung disease is a congenital disease characterized by intestinal aganglionosis of various extents. Most patients are younger than 1 year of age. Though, a minority of cases can be older or even adult. Older the patient the more difficult and prolonged is the endorectal dissection required for the pull-through procedure. Longer surgery leads to longer anal dilatation and trauma with subsequent higher likelihood of continence impairment. The article aims at describing the first case series of robot-assisted Soave procedure, which was adopted as an alternative minimally invasive approach to older patients with Hirschsprung disease. The technical principles are represented by intraoperative seromuscolar leveling biopsies, intracorporeal endorectal cranial dissection, and endorectal pull-through with colo-anal anastomosis. The authors report three procedures that were carried on without complication with a limited requirement for anal dilatation and trauma, given the reduced need for endorectal caudal dissection. The results demonstrate the feasibility of the proposed approach. The robotic approach should be considered as an alternative minimally invasive approach for older children or adults with Hirschsprung disease.

Neurologically impaired children (NIC) have a high risk of recurrence of gastroesophageal reflux (GER) following fundoplication. A postpyloric feeding tube may be useful when gastric emptying disorders occur; however, dislocation and difficulty in feeding management often require more aggressive procedures. Total esophagogastric dissociation (Bianchi's TEGD) is an alternative to the classic fundoplication procedure, whereas laparoscopic gastric bypass is a frequently performed procedure in morbid obesity, improving gastric outlet.The aim of this paper is to present a preliminary experience on the laparoscopic Roux-en-Y gastrojejunal bypass, associated with Nissen fundoplication and gastrostomy, to treat and prevent GER in NIC with gastric emptying disorders.Eight neurologically impaired children underwent surgical treatment because of feeding problems and pulmonary complications. The procedure included: 1) hiatoplasty, 2) Nissen fundoplication, 3) 20-cm Roux-en-Y gastrojejunal anastomosis and jejuno-jejunal anastomosis, and 4) gastrostomy.All cases were fed on postoperative day 3 without any intraoperative complications. One case developed an obstruction of the distal anastomosis due to adhesion and needed reoperation. Outcome was clinically evaluated with serial upper gastrointestinal contrast studies and endoscopies.Laparoscopic proximal Roux-en-Y gastrojejunal diversion, without gastric resection, is a safe, feasible procedure that improves gastric emptying and reduces the risk of GER recurrence. Yet, long-term results still have to be evaluated.

Background: We reviewed our experience with subureteral polytetrafluoroethylene (Teflon) injection (STING) in the treatment of vesicoureteral reflux (VUR), with special emphasis on long-term effectiveness and morbidity. Patients and Methods: From 1984 to 2001, 1916 patients, 488 male and 1428 female (3037 refluxing ureters) with a mean age of 3.7 years (range, 3 months-15 years), were treated endoscopically with STING. Reflux was grade I in 154 (5.1%), II in 509 (16.8%), III in 1450 (47.7%), IV in 743 (24.5%), and V in 181 (6%) ureters. Primary VUR, reflux in duplex systems, and reflux secondary to neuropathic bladder were present in 2778 (91.4%), 205 (6.8%), and 54 (1.8%) ureters, respectively. All patients were followed up for periods ranging from 1 to 18 years, with a median follow-up of 11 years. Results: Reflux resolved in 2032 (66.9%) ureters after one injection, in 776 (25.5%) after two, and in 111 (3.7%) after three injections. VUR improved to grade I after one or two injections in 81 (2.7%) urete...

Operative thoracoscopy is not a new technique in pediatric patients. However, the indications to this approach are not well defined because of the little experience in the technical aspects and of the risks of seeding in case of oncologic procedures. We present a prospective, nonrandomized study, comparing two groups of pediatric patients who had been operated on using the thoracoscopic approach. In the first group, 7 children were included for a diagnostic minimal lung resection; in the second, 5 were resected for lung tumors. The results indicate that the minimally invasive technique is the gold standard in all nononcologic procedures. The reduction of manipulation and of postoperative pain is effective in decreasing the oxygen desaturation. In oncologic patients a thoracotomy (VATS) should be considered to reduce operative time and the risk of tumor seeding.