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Background: Dysphagia refers to feeding or swallowing disorders characterized by challenges with the placement, reception, maintenance, and transmission of food and liquids from the oral cavity to the esophagus and stomach. Purpose: To evaluate the socioeconomic and medical impact of percutaneous endoscopic gastrostomy in children suffering from neurological digestive disorders. Patients & methods: This was a follow up prospective study performed on thirty children who had neurological swallowing difficulties that was predetermined at the Outpatient Clinic of the Pediatric Gastroenterology Unit and the Inpatient of the Pediatric department, Faculty of Medicine, Al-Azhar University Hospitals, from January 2022 to January 2024. Results: Our results showed that regarding demographic data of the studied group. The patients age was 7.25±4.290 years. Male were 17while female were 13. Distribution of studied sample according to manifestations it shows that 21 had Intractable convulsions, 13 with Frequent chocking, 11patients complaining from recurrent pneumonia, regarding to complications of PEG Major Complications show that one patient had Buried bumper syndrome. Minor Complications 12(40.0%) had Local infection, 9(30.0%) had Accidental removal, 1(3.3%) had Leakage and 1(3.3%) had Fistula formation. Our study revealed, significant decrease in all medical outcomes except neurological signs, Also, there was statistically significant improvement of family social impact of PEG and it shows that 25(83.3%) had good family's satisfaction, 30(100.0%) of caregiver had no difficulties in finding a place to feed outside the home, Also there was significant positive economic impact where the majority of patients had reduce the costs of repeatedly hospitalizing. Conclusion: PEG had a positive medical improvement for children with neurological swallowing difficulties and a positive socioeconomic impact on both the child and the caregiver. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendectomy is among the most common surgical procedures. Needlescopic appendectomy (NA) is an acceptable, safe technique in children, but with many drawbacks such as a high conversion rate and long operative time. We present a new technique for NA in children using only a single port, Mediflex® facial closure needle, and vascular access cannula (VAC). Patients and Methods: Single-port NA was attempted in 117 patients (51 boys, 66 girls). Under general anesthesia, a 5-mm camera port was inserted through the umbilicus. Two Mediflex needles and a 14-gauge VAC were introduced. The appendix was grasped and dissected from the surrounding tissues using Mediflex needles. In case of a mobile cecum, the appendix was pulled through the umbilical port, then an extracorporeal appendectomy was performed. In cases with a fixed cecum or severely inflamed appendix, a complete intracorporeal appendectomy was done. The suture was knotted in a sliding reef knot using a single instrument. Results: NA was completed in 117 patients (51 boys, 66 girls) with an average age of 10 years. Thirty patients underwent extracorporeal appendectomy. Eighty seven patients were treated by intracorporeal appendectomy. The mean operative time was 15 ± 3 and 25 ± 4 minutes for extracorporeal and intracorporeal appendectomy respectively. The hospital stay was 1.2 days on average (ranging 8 hours to 2 days). There was no single case of conversion. Family satisfaction was achieved in 97% of cases. Conclusion: The presented unique method for single-port NA using Mediflex® appears to be a safe, acceptable technique for appendectomy in children that allows for excellent cosmetic results. [ABSTRACT FROM AUTHOR]

Background: Atypical presentation of intestinal malrotation provide a diagnostic and therapeutic dilemma for the surgeon to answer the question is it wisdom to operate or not? Upper gastrointestinal (UGI) contrast study is essential for diagnosis; however, 'soft' radiologic findings place the responsibility of excluding malrotation directly on the surgeon. Recently, minimally invasive surgical techniques would be able to accomplish the identical evaluation and treatment of this group of patients.Patients and Methods: A total of 40 patients (25 male, 15 female), age of 2-14 years, presented with symptoms of chronic abdominal pain, intermittent upper intestinal obstruction, recurrent bilious vomiting and failure to thrive. On clinical examination, none of the patients had signs of acute abdominal emergency. UGI contrast study was done and it was equivocal. All patients underwent laparoscopic evaluation.Results: A total of 36 patients (90%) were found on laparoscopy to have a discrepant finding of chronic intestinal malrotation. With narrow mesenteric base which put them at significant risk of midgut volvulus. Two patients (5%) were found to have chronic appendicitis with extensive adhesion at the right iliac fossa, one patient (2.5%) has annular pancreas and one patient has negative laparoscopic exploration. Laparoscopic findings of chronic intestinal malrotation includes, huge dilated stomach and the first part of duodenum, ectopic site of caecum central in the abdomen or under the liver, medial and low position of duodenojejunal junction, congested mesenteric veins with lymphatic oedema, generalised mesenteric lymphadenopathy, reversed relation of superior mesenteric artery and vein, right-sided small bowel.Conclusion: Laparoscopic diagnostic finding permits direct evaluation and treatment of undocumented malrotation in children, with equivocal UGI contrast study. Furthermore, laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children with a narrow base should undergo laparoscopic Ladd procedure to avoid catastrophic midgut volvulus. [ABSTRACT FROM AUTHOR]

Background Inguinal hernia repair using a percutaneous internal ring suturing technique is an effective alternative technique to conventional laparoscopic hernia repair. It is one of the most commonly used approaches for laparoscopic hernia repair in children. However, most percutaneous techniques have utilized extracorporeal knotting of the suture and burying the knot subcutaneously. This approach has several drawbacks. The aim of this study is to present a modified technique for single cannula needlescopic assisted hernia repair in children. Patients and methods Three-hundred and fifty-seven patients with 397 indirect inguinal hernias underwent a one port needlescopic assisted inguinal hernia repair. The open internal inguinal ring [IIR] was closed using an 18-gauge epidural needle [EN], a 14-gauge venous access cannula [VAC], and a homemade suture device. Saline was injected extraperitoneally around the IIR for hydrodissection. The main outcome measurements were: feasibility, safety of the technique, operative time, recurrence rate, and cosmetic results. Results This prospective study was conducted on 357 patients at Al-Azhar, Alexandria, and Mansoura University Hospitals during the period from June 2012 to October 2015. There were 286 males and 71 females. The mean age was 2.6 ± 1.3 years (range = 4 months to 6 years). One-hundred and ninety-eight patients presented with a right-sided inguinal hernia, 119 patients with a left-sided hernia, and 40 patients with bilateral inguinal hernia. The mean operative time was 12.6 ± 1.7 min (range = 8–15 min) for unilateral cases and 18.6 ± 1.7 min (range = 14–20 min) for the bilateral repairs. No wound complications or umbilical hernias developed. The mean follow-up period was 18.6 ± 1.2 months (range = 11–36 months). During the follow-up period, no recurrence was detected, and the scars were nearly invisible. Conclusion This preliminary study shows that a single port needlescopic assisted hernia repair in infants and children is a very promising technique to achieve nearly scarless surgery. The procedure is very safe, rapid, easy to learn, and reproducible. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic inguinal hernia repair (LIHR) is gaining popularity with more studies validating its feasibility, safety, and efficacy. The aim of this work is to review our experience with LIHR in infants and children during the past 15 years, and present and evaluate our innovations of laparoscopic techniques.Patients and Methods: A retrospective study of 1284 patients with congenital inguinal hernia (CIH) subjected to different techniques of LIHR from October 2000 to October 2015. The main outcome measurements included the following: operative time, hospital stay, hernia recurrence, hydrocele formation, testicular atrophy, iatrogenic ascent of the testis, and cosmetic results.Inclusion Criteria: All patients with CIH who were managed by LIHR during the period of study. They were bilateral cases, recurrent hernias, unilateral hernia in obese child, unilateral hernia with associated infantile umbilical hernia, and unilateral hernia with questionable contralateral side.Results: A total of 1284 patients with CIH were corrected with different laparoscopic procedures. They were 918 males and 366 females. The age range was variable from 6 to 78 months (mean 28.32 ± 24.46 months). All cases were completed laparoscopically without major intraoperative complications. Contralateral hernial defects were found in 294 patients (22.90%), a direct inguinal hernia (IH) was discovered in 15 patients (1.17%), and a femoral hernia was discovered in 3 patients (0.23%). Recurrence occurred in 9 boys (0.98%) who were among the early cases; however, in later group, no recurrence had been detected. Hydrocele occurred in 19 cases (males) (2.07%), without detection of testicular atrophy or iatrogenic ascent of the testis.Conclusion: Our results lead us to believe that LIHR by expert hands is safe and effective. It enables the surgeon to discover and repair contralateral hernia and all forms of IHs. One should be able to tailor a suitable technique for each case according to the resources and expertise. [ABSTRACT FROM AUTHOR]

Background We present the midterm results of the novel technique of two-stage laparoscopic traction orchiopexy (SLTO) for the high intraabdominal testis (IAT) for elongation of the testicular vessels without division. Patients and methods Boys with IAT proven by laparoscopy were selected for the technique between September 2009 and April 2013 in 2 Egyptian pediatric surgery units. Boys < 6 months or > 9 years were excluded. The technique entails fixation of the testis to a point one inch above and medial to the contralateral anterior superior iliac spine for 12 weeks. Subdartos orchiopexy is then done at the second stage. Both stages are laparoscopically assisted. Results SLTO was used in 124 boys (140 testis units) with IAT. Mean follow-up period was 16 (range 6–36) months. Scrotal testes were achieved in 105 (84%) of 125 followed cases. Success was correlated with patient age at operation and with distance of IAT from the internal inguinal ring with higher success in younger patients and in testes nearer to internal inguinal ring. Conclusion The novel technique of two-stage laparoscopic traction-orchiopexy is useful in IAT not amenable to one-stage laparoscopic-assisted orchiopexy; it resulted in significant elongation of testicular vessels without atrophy. It is a safe and valid alternative to two-stage laparoscopic Fowler–Stephens technique, which entails division of the main testicular vessels. [ABSTRACT FROM AUTHOR]

Background Open repair of recurrent inguinal hernias [RIH] in infancy and childhood is difficult and there is definite risk of damaging the vas deferens and testicular vessels. Laparoscopic repair of RIH has the benefit of avoiding the previous operative site. The aim of this study is to present our experience with laparoscopic repair of RIH either after open or laparoscopic hernia repair with stress on technical refinements to prevent recurrence. Patients and methods This is a retrospective study of laparoscopic repair of RIH. Records of 38 patients with 42 recurrent hernial defects that have been subjected to laparoscopic inguinal hernia repair [LIHR] for RIH were reviewed and evaluated. The primary outcome measurements of this study include; operative time and recurrence rate. The secondary outcomes include intraoperative and postoperative complications, hydrocele formation and testicular atrophy. Results In this study 38 children with 42 recurrent hernial defects [4 patients had bilateral recurrent hernia] were operated upon laparoscopically. They were 34 males and 4 females with a mean age of 2.54 ± 1.989 years (range = 0.58–10.00 years). In 35 hernial defects the recurrence developed after open herniotomy, while in 7 hernial defects it occurred after laparoscopic repair. All procedures were completed laparoscopically without any conversion and there were no intraoperative or postoperative complications during this study. Mean operating time was 15 ± 2.3 minutes for unilateral and 20 ± 1.7 minutes for bilateral inguinal hernia. All patients achieved full recovery and were discharged on the same day of admission. Two patients developed hydroceles that responded well to conservative management. At mean follow-up of 12.7 ± 2 months (range = 8–38.4 months), there was no recurrence, no testicular atrophy. Conclusion Laparoscopic repair of RIH in infancy and childhood is an attractive option that avoids the difficulties of redo surgery in scarred operative field with delicate structures liable to injury even with expert operator. [ABSTRACT FROM AUTHOR]

Background The desire to reduce incision related morbidity and pain while achieving improve cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES]. Over the last few years, SIPES has been increasingly used for a variety of procedures; single incision laparoscopic hernia repair [SILHR] is perhaps its common application. Intracorporeal suturing and knot tying during SIPES remain one of the most challenging tasks. The aim of this study is to present a novel technique to avoid excessive purposeless movements during SILHR in children. Patients and methods One-hundred and fifty patients with 170 hernial defects were subjected to SILHR during the period from June 2009 to October 2011. Extraperitoneal saline was injected around internal inguinal ring [IIR] in males. The opened IIR was closed by percutaneous insertion of purse string suture using Reverdin Needle (RN) with intracorporeal suture tie. The main outcome measurements were; feasibility of the technique, tightness of the suture tie, operative time, postoperative hydrocele formation, recurrence rate, and cosmetic results. Results Ages ranged between 6 months and 7 years (mean 2 ± 24.2 years). There were 101 males and 49 females. Eighty-four patients presented with right sided inguinal hernia, 46 patients with left sided hernia, and 20 patients with bilateral hernia. The mean operative time was 12.4 ± 1.7 min for unilateral cases and 18.6 ± 1.7 min for the bilateral cases. On follow-up, there were only 1 case of recurrence and 3 cases of hydrocele and the scar is nearly invisible. Conclusion The preliminary results of this study showed that our technique is very promising to achieve secure closure of IIR and reduced operative time with excellent cosmetic results. [ABSTRACT FROM AUTHOR]

Abstract: Background: Laparoscopic inguinal hernia repair (LIHR) in children has become an alternative to the open procedure. It is gaining popularity with more and more studies supporting its feasibility, safety, and efficacy. This is a retrospective study to present our experience with children who underwent LIHR. Patients and methods: A total of 1184 inguinal hernias were repaired laparoscopically in 874 children. They were 703 boys and 171 girls. Their mean age was 2.9±2.1years (range, 6–108months). Six-hundred and twenty four opened internal inguinal rings (IIRs) were closed by transperitoneal purse string suture technique (TPP) and 560 opened IIRs were closed by percutaneous purse string suture with lateral umbilical ligament enforcement using Reverdin Needle (RN) technique. Results: All cases were completed laparoscopically without conversion. There were no serious intraoperative complications. Mean operating time, in TPP technique, was 15±2.3minutes for unilateral and 20±1.7minutes for bilateral inguinal hernia, while the mean operating time, in RN technique, was 8.7 ±1.18minutes for unilateral and 12.35±2minutes for bilateral hernia repair. The contralateral patent processus vaginalis (PPV) was present in 176 (20% of cases). Follow-up to date is 10–140months (mean 80±2.1months). In the early stage of this study, the recurrence rate was 1.13%. In the last 450 cases, no recurrence occurred. Hydroceles occurred in 0.58% and no testicular atrophy or iatrogenic ascent of the testis. Conclusions: LIHR can be a routine procedure with results comparable to those of open procedures. Both recurrence and operative time are nearly equal or even less than that for the open procedure after gaining a learning curve and modifications of the techniques. [Copyright &y& Elsevier]

Abstract: Purpose: Laparoscopic hernia repair in infancy and childhood is still debatable. There are many techniques available for laparoscopic hernia repair in children. The objective of this study was to compare intracorporeal suturing and knotting with extracorporeal knotting for repair of congenital inguinal hernia in infants and children about operative time, recurrence rate, hydrocele formation, and postoperative cosmetic results. A randomized controlled study was carried out in the Pediatric Surgery Unit of Al-Azhar University Hospitals (Cairo, Egypt) over a 3-year period. Patients and Methods: One hundred fifty patients with congenital inguinal hernia were randomized into 2 equal groups (n = 75). Group A was subjected to intracorporeal purse string suture around the internal inguinal ring (IIR) using 2 needle holders. Group B was subjected to insertion of purse string suture around IIR using a Reverdin needle (RN) and extracorporeal knotting. Inclusion criteria included bilateral inguinal hernia, recurrent hernia, hernia in obese children, incarcerated hernia, and ipsilateral hernia with questionable hernia on the contralateral side. Exclusion criteria included unilateral inguinal hernia and hernia with undescended testicles. The main outcome measurements were operative time, length of hospital stay, postoperative hydrocele formation, recurrence rate, and cosmetic results. Results: There were no significant differences about age, sex, and mode of presentation between both groups. All cases were completed successfully without conversion. There were significant statistical differences in the operative time, recurrence rate, and cosmetic results between the studied groups, whereas there were no significant statistical differences in the hospital stay and postoperative hydrocele formation. Conclusion: Laparoscopic hernia repair by RN is an effective method of hernia repair in infants and children. It resulted in a marked reduction of operative time and excellent cosmetic results with low recurrence. [Copyright &y& Elsevier]