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Purpose The COVID-19 pandemic has led to an unprecedented expansion of telemedicine services worldwide. This study aimed to explore the practice of telemedicine in Pediatric Surgery in Germany, the impact of the pandemic on its development and parents’ and surgeons’ experiences with telemedicine. Methods The study is a cross-sectional analysis using three surveys between 6/2020 and 10/2020: (1) all Pediatric Surgery departments of Germany reported whether they provide telemedicine services. (2) Members of the German Society of Pediatric Surgery and (3) families who participated in an outpatient visit by telephone or video with the Department of Pediatric Surgery and Pediatric Urology of the University Hospital Frankfurt completed an anonymous survey on their experience with telemedicine. Results 21% of the Pediatric Surgery departments in Germany provided telemedicine, of which 57% started due to the pandemic. The lack of physical examination and face-to-face contact seem to be the major limitations to surgeons and parents. 48% of the parents answered that telemedicine is equal to or better than traditional appointments, while 33% thought that telemedicine is worse. Conclusions This study shows that families and doctors alike have had positive experiences with telemedicine and most will continue to use this format after the pandemic.

Purpose Neonatal surgery for abdominal wall defects is not performed in a centralized manner in Germany. The aim of this study was to investigate whether treatment for abdominal wall defects in Germany is equally effective compared to international results despite the decentralized care. Methods All newborn patients who were clients of the major statutory health insurance company in Germany between 2009 and 2013 and who had a diagnosis of gastroschisis or omphalocele were included. Mortality during the first year of life was analysed. Results The 316 patients with gastroschisis were classified as simple (82%) or complex (18%) cases. The main associated anomalies in the 197 patients with omphalocele were trisomy 18/21 (8%), cardiac anomalies (32%) and anomalies of the urinary tract (10%). Overall mortality was 4% for gastroschisis and 16% for omphalocele. Significant factors for non-survival were birth weight below 1500 g for both groups, complex gastroschisis, volvulus and anomalies of the blood supply to the intestine in gastroschisis, and female gender, trisomy 18/21 and lung hypoplasia in omphalocele. Conclusions Despite the fact that paediatric surgical care is organized in a decentralized manner in Germany, the mortality rates for gastroschisis and omphalocele are equal to those reported in international data.

Functional development of the oesophagus is closely related to the development of the oesophageal innervation and blood supply.

3.4 Special Considerations 22 3.4.1 Gastroschisis 22 3.4.2 Omphalocele 23 3.4.3 Pierre Robin Syndrome 23 3.4.4 Choanal Atresia 23 3.4.5 Myelomeningocele 23 3.4.6 Bladder Exstrophy 23 3.4.7 Oesophageal Atresia with Tracheo-Oesophageal Fistula 23 3.4.8 Congenital Diaphragmatic Hernia 24 3.4.9 Intestinal Obstruction 24 3.4.10 Necrotising Enterocolitis 25

The enteric nervous system (ENS) is the largest and the most complex division of the peripheral nervous system [1]. The ENS contains more neurons than the spinal cord and is capable of mediating reflex activity in the absence of central nervous system. About 80–100 million enteric neurons can be classified into functional distinct subpopulations, including intrinsic primary neurons, interneurons, motor neurons, secretomotor and vasomotor neurons [2]. The ENS plays a crucial role in normal gastrointestinal motility. Therefore insights into the development of the gastrointestinal tract and the ENS are relevant for the understanding of the pathophysiology and treatment of infants and children with motility disorders.

The introduction of rectal suction biopsy, while making the procedure less traumatic for the patient, has made the diagnosis of Hirschsprung’s disease (HD) more difficult for the pathologist. Many histopathologists are reluctant to make a positive diagnosis of HD on the basis of suction rectal biopsy results, using conventional H&E stains. This reluctance stems from doubt as to the amount of submucosa that must be scanned before the absence of ganglion cells can be confirmed, as well as the relative difficulty in accurately identifying smaller and sparse submucosal ganglion cells by comparison with the more compact and familiar ganglion cells of the intermuscular plexus.

An sieben oberen Erwachsenenextremitaten sowie zwei kindlichen Oberarmen wurden sichere Weichteilzonen zur Pinimplantation von lateral in der Frontalebene ermittelt. Nach Implantation wurden die Arme prapariert bzw. quergeschnitten und die Pin-Weichteilkanale dargestellt, um eine Gefahrdung anatomischer Leitungsbahnen auszuschliesen. Anhand dieser Untersuchungen lassen sich sowohl am proximalen als auch am distalen Anteil des Humerusschaftes relativ sichere Weichteilzonen definieren. Diese finden sich proximal bei lateraler Implantation unterhalb des Tuberculum minus und distal im Bereich des distalen Funftels des Humerus, unmittelbar proximal des Epicondylus lateralis humeri. Neben der eindeutigen Indikationsstellung zur operativen Versorgung von Oberarmschaftfrakturen ist eine genaue Kenntnis der anatomischen Verhaltnisse und eine genaue Operationstechnik unbedingt notwendig.

Fur die klinisch-anatomische Studie standen untere Extremitaten aus Prapariersaalmaterial zur Verfugung. Es wurden jeweils 2 Pins in unilateraler Implantationstechnik proximal und distal metadiaphysar eingebracht. Die Implantation erfolgte am Oberschenkel ausschlieslich von lateral in der Frontalebene und am Unterschenkel, von ventral in der Sagittalebene. Zur Darstellung der Pin-Weichteilkanale wurden die Extremitaten prapariert und in Querschnitten aufgearbeitet. Es gilt festzustellen, das die laterale Implantation am Oberschenkel und die ventrale Implantation am Unterschenkel hinsichtlich der Gefahrdung anatomischer Leitungsbahnen risikolos ist und unbedenklich empfohlen werden kann. Die klinisch auffallige Beugehemmung im Kniegelenk resultiert aus einer Sperrwirkung der implantierten Pins.