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© 2022 Wiley Periodicals LLC.Objectives: Postoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. Study Design: Among the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. Results: Among 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. Conclusion: We demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.

Introduction The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the outcome of very low birth weight (VLBW) and low BW (LWB) infants with esophageal atresia (EA). Materials and Methods The data registered by 24 centers between 2014 and 2018 were evaluated for demographic features, prenatal findings, associated anomalies, surgical treatment, and outcome. Patients were enrolled in three groups according to their BWs (VLBW 2,500 g). Results Among the 389 cases, there were 37 patients (9.5%) in the VLBW group, 165 patients (42.4%) in the LBW group, and 187 patients (48.1%) in the NBW group. Prenatal diagnosis rates were similar among the three groups (29.7, 34.5, and 24.6%, respectively). The standard primary anastomosis was achieved at a significantly higher rate in NWB cases than in the other groups (p Conclusion The national data of TEAR demonstrates that the developmental and feeding parameters are better in NBW patients. Although VLBW patients have higher risk of developing fistula canalization than the LBW and NBW groups, long-term complications, such as anastomotic strictures, weight, and height values, after 1 year are similar in both groups. According to our results, associated anomalies and LBWs are still significant risk factors for mortality in cases with EA.

Aim: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. Methods: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fis-tula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. Results: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p < 0.05). The rates of primary anastomosis and ten-sioned anastomosis were similar in both groups (p > 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the re-quirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) Conclusion: The data in the TEAR demonstrated that preserving the AV during EA repair led to no sig-nificant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory com-plications. (c) 2020 Elsevier Inc. All rights reserved.

Aim The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the survival rate and risk factors of mortality in infants with esophageal atresia (EA). Methods The data of 389 cases registered by 23 centers between 2014 and 2018 were evaluated for demographic features, associated anomalies, surgical treatment and mortality-related outcome. Each parameter was evaluated for cases with mortality (CM) and compared with the results of survivors. Also, prognostic factors were investigated in CM. Results The overall survival rate was 81.09% and the mortality was 19.02% (n = 74). The male/female ratio was 1:1 in CM and 1.2:1 in survivors. The mean weight and height measurements in CM were lower than in survivors (1956 ± 658 g- 43.2 ± 5.7 cm vs 2534 ± 609 g-46.4 ± 4.3 cm) (P 0.05). Tube feeding was more common in CM and the incidence of full oral feedings was significantly higher in survivors (P Conclusion The majority of national TEAR data comes from tertiary healthcare centers in Turkey. Therefore, the slightly increased mortality rates could be related to the inclusion of more complex and complicated cases. Birth weight–height, associated anomalies, and Spitz classification are significant risk factors of mortality in cases with EA.

Mesenteric cystic lymphangiomas are benign congenital tumors characterized by proliferation of lymphatic channels. They are an uncommon disorder and constitutes 0.5 % of all lymphangiomas and can cause fatal complications such as volvulus, intestinal obstruction and traumatic or spontaneous rupture, requiring emergency surgery. For this reason, prenatal diagnosis is important. We present a three day old newborn with multiple cystic abdominal lymphangioma treated with resection anastomosis through prenatal diagnosis.

Background and objectives: Laparoscopic surgery has become a popular surgical tool when compared to traditional open surgery. There are limited data on pediatric patients regarding whether pneumoperitoneum affects cerebral oxygenation although end-tidal CO2 concentration remains normal. Therefore, this study was designed to evaluate the changes of cerebral oxygen saturation using near-infrared spectroscope during laparoscopic surgery in children. Methods: The study comprised forty children who were scheduled for laparoscopic (Group L, n = 20) or open (Group O, n = 20) appendectomy. Hemodynamic variables, right and left regional cerebral oxygen saturation (RrSO2 and LrSO2), fraction of inspired oxygen, end-tidal carbon dioxide pressure (PETCO2), peak inspiratory pressure (Ppeak), respiratory minute volume, inspiratory and end-tidal concentrations of sevoflurane and body temperature were recorded. All parameters were recorded after anesthesia induction and before start of surgery (T0, baseline), 15 min after start of surgery (T1), 30 min after start of surgery (T2), 45 min after start of surgery (T3), 60 min after start of surgery (T4) and end of the surgery (T5). Results: There were progressive decreases in both RrSO2 and LrSO2 levels in both groups, which were not statistically significant at T1, T2, T3, T4. The RrSO2 levels of Group L at T5 were significantly lower than that of Group O. One patient in Group L had an rSO2 value

ResumoJustificativa e objetivosA cirurgia laparoscópica se tornou uma ferramenta cirúrgica popular em comparação com a cirurgia aberta tradicional. Há poucos dados sobre pacientes pediátricos no que se refere ao pneumoperitônio afetar a oxigenação cerebral enquanto a concentração de CO2 no fim da expiração continua normal. Portanto, este estudo teve como objetivo avaliar as alterações da saturação de oxigênio cerebral com espectroscopia de infravermelho próximo durante cirurgia laparoscópica em crianças.MétodosO estudo recrutou 40 crianças programadas para apendicectomia laparoscópica (Grupo L, n=20) ou aberta (Grupo A, n=20). Variáveis hemodinâmicas, saturação de oxigênio cerebral regional direita e esquerda (RrSO2 e LrSO2), fração inspirada de oxigênio, pressão expiratória final de dióxido de carbono (PETCO2), pico de pressão inspiratória (Ppico), volume minuto respiratório, concentrações de sevoflurano inspirado e expirado e temperatura corporal foram registrados. Todos os parâmetros foram registrados após a indução da anestesia e antes do início da cirurgia (T0, basal), 15 minutos após o início da cirurgia (T1), 30 minutos após o início da cirurgia (T2), 45 minutos após o início da cirurgia (T3), 60minutos após o início da cirurgia (T4) e no fim da cirurgia (T5).ResultadosHouve diminuição progressiva em ambos os níveis de RrSO2 e LrSO2 nos dois grupos, mas não foi estatisticamente significativa em T1, T2, T3, T4. Os níveis de RrSO2 do Grupo L em T5 foram significativamente menores do que os do Grupo A. Um paciente do Grupo L apresentou um valor rSO2

Purpose This study evaluates the effect of peritoneal irrigation and drainage on postoperative morbidity when used together for perforated appendicitis. Material and methods This study was conducted on children undergoing open appendectomy for perforated appendicitis. Sixty-one children with perforated appendicitis operated on with irrigation and drainage between July 1998 and September 2001 (group DI) and 173 children with perforated appendicitis who underwent surgery without irrigation and drainage (group NDI) between October 2001 and November 2011 were retrospectively evaluated (a total of 234 patients). All patients were treated and followed up by the same pediatric surgeon using the same protocol. Both groups were compared in respect to postoperative complications, including wound infection, wound dehiscence, intraabdominal abscess, prolonged ileus, the presence of small bowel obstruction requiring surgery, operative time, and length of postoperative hospital stay. Results Of the total 234 patients, 151 were male and 83 were female with a mean age of 8.9 ± 3.7 years (range, 1.5-15 years). The wound infection rates were 4.9% in group DI and 1.7% in group NDI ( P = .184). Wound dehiscence was seen in 1.6% vs 0%, prolonged ileus in 8% vs 2.3%, intraabdominal abscess in 4.9% vs 1.7%, and small bowel obstruction requiring surgery in 1.6% vs 0.6% of the patients ( P = .261, P = .054, P = .184, and P = .454, respectively). No statistically significant difference in postoperative infectious complications was found between both groups. The length of postoperative hospital stay was 9.9 ± 4.1 days in group DI vs 6.3 ± 2.4 days in group NDI ( P P Conclusion This study demonstrates that peritoneal irrigation and drainage in children with perforated appendicitis is not required, and in fact, these procedures cause an increase in operative time.

Background Hernia uteri inguinale (HUI), or uterus-containing inguinal hernia, is an extremely rare condition in which the uterus and uterine adnexa are found in the inguinal hernial sac in female infants. The uterus may be free within the sac adherent to the wall by adhesions or a true sliding component. However, in true sliding-type HUI, one of the walls of the hernia sac is formed by the uterus itself. Patients and Methods The medical records for all female children with inguinal hernia who were operated from 1999 through 2010 were reviewed retrospectively (n=3100). Results Among these patients, we identified seven cases of HUI in infants with a normal female karyotype. The incidence of HUI was 0.23%. Patients were discharged on the postoperative 1st day with no complications. Conclusions Surgeons should be aware of the possibility of presence of the uterus or another organ in the hernial sac in phenotypic female children, and sliding components should be replaced carefully into the abdomen to prevent any damage.

Study Objective: To evaluate the outcomes of treatment with minimal invasive surgery in children with benign ovarian cysts. Design: Retrospective chart review. Settings: Maternity and children hospital. Patients: Between May 2007 and May 2011, 21 children were treated by laparoscopic method for ovarian cysts at our clinic. The age, symptoms, ultrasonographic findings, operation records and follow-up times were retrospectively evaluated. Results: The mean age was 13.2 years. One patient presented with findings of torsion and another presented with findings of rupture; both were urgently operated on. The other patients presented with intermittent abdominal pain and were operated on under elective basis. The mean cyst size was 8.4 cm (5-13 cm). One patient with necrotic ovary and salpinx due to torsion underwent salpingo-oophorectomy while the others were administered ovary-preserving cystectomy. Only 4 patients required iv paracetamol as an analgesic in the postoperative period. Two patients were discharged on the second postoperative day while the remaining 19 patients were discharged on the first postoperative day. During a mean follow-up of 14 months, no recurrence was seen in this period. Cosmetic appearance was good in all patients. Conclusion: The authors demonstrated that laparoscopic cystectomy was a technically feasible and safe method in the treatment of benign ovarian cysts, associated with short hospitalization, minimal analgesic requirement, and a good cosmetic appearance.

Laparoscopic repair is gaining attention as a minimally invasive surgical option for children with Morgagni hernias. There are very few reports in the literature in which different suturing techniques are described. In this report, the authors detail a new, easy, and safe suturing technique used in the laparoscopic repair of a Morgagni hernia in a five-and-a-half-month-old baby.

Introduction The purpose of this study was to evaluate the technical feasibility and other advantages of closing the appendicular stump with a polymeric clip in laparoscopic appendectomy (LA). Methods In this study, 121 pediatric patients who underwent LA between July 2009 and July 2011 were included. Age and gender of the patients, the number of clips, operative time and length of hospitalization, complications, and follow-up periods were evaluated retrospectively. Results Of appendicular stump of a total of 121 patients who were underwent LA, 71 were closed with double polymeric clips and 50 were closed with a single polymeric clip. Patients were between the ages of 3 and 15 years (mean 8.3 years). Out of the 121 patients, 54 were female and 67 were male. The duration of the operation was ranged from 13 to 55 minutes (mean 28 minutes). Of these, 83 patients were discharged in less than 24 hours. The cost of a single clip was 10 USD. The follow-up period of patients were ranged between 1 and 23 months (mean 13 months). No operative or postoperative complications occurred depending on the application of the polymeric clip. Conclusion LA using polymeric clip/s to close appendicular stump in children is a safe, feasible, and inexpensive method.

Even in countries where it is considered endemic, splenic hydatid cyst is a very rare disease in childhood. Partial or total splenectomy has generally been the treatment of choice for this condition. This is the first report of laparoscopic cystectomy as treatment of isolated splenic hydatid cyst in childhood. A 10-year-old girl with isolated splenic hydatid cyst was successfully treated by laparoscopic cystectomy and splenic preservation. The authors have demonstrated that laparoscopic cystectomy for an isolated splenic hydatid cyst is technically feasible, safe, and is associated with a shorter hospital stay and good cosmetic appearance.

Purpose The purpose of this study is to demonstrate that digital photos and video images taken by a parent can provide a definite diagnosis and makes some diagnostic procedures (eg, air contrast enema, sigmoidoscopy) unnecessary for anal swelling and anal protrusions in children with normal physical examination. Methods In a 41-month period (September 2007-January 2011), 23 parents brought their children to the clinic, stating that they saw a swelling in the anal region and/or that something protruded from the anus while their children were defecating. If the visual inspection of the anal region and digital rectal examination of the patients were normal, parents were asked to take photos or record videos when the lesion occurred to make a diagnosis and avoid the need for air contrast enema and/or sigmoidoscopy. The parents were also asked either to send these images to the surgeon via e-mail or bring an image or the camera to the surgeon's office. The patients age, sex, symptoms, medical history, results of their first physical examination, photos and video records, and the diagnosis and treatment were recorded. All of these information were retrospectively reviewed. Results The photos provided by 20 parents and the video records from 3 parents were assessed, and the diagnoses of all patients were confirmed. Of these 23 patients, a definitive diagnosis of rectal prolapse in 8, hemorrhoids in 10, rectal polyps in 3, and sentinel skin tag in 2 was made. In addition, the photographic and video evidence gave the clinicians an idea of the degree of rectal prolapse in patients for whom this was a problem. Three patients diagnosed with a rectal polyp underwent polyp excision. One patient with rectal prolapse who was unresponsive to medical treatment underwent laparoscopic posterior rectopexy, and all other patients received medical treatment. Conclusion When a swelling or protruding anal lesion in a child is discovered by parents and visual inspection of the anal region and digital rectal examination is normal, parents should be encouraged to take photos or videos of the anal region before performing air contrast enema and/or sigmoidoscopy. These photos and videos can provide a definitive diagnosis and prevent unnecessary diagnostic procedures.

Kocaoğlu C, Kocaoğlu Ç, Akkoyun İ, Karaniş İE. A case report with sacral appendage: Is it accessory penis or human tail? Turk J Pediatr 2017; 59: 335-337. Lumbo-sacro-coccygeal appendages are very rare congenital anomalies. It is difficult to say that they are a evolutionary inheritance (tail) from our ancestors or an anomaly (pseudotail) occuring during embrional development. If it is a true tail, this lesion contains adipose and connective tissue, striated muscle, blood vessel and nerves, and is covered by skin. However, if this lesion is a pseudotail, it may be an anomalous prolongation of the coccygeal vertebra, lipoma, teratoma, condrodystrophy or parasitic fetus. We present an infant with a sacral appendage resembling a penis, and its clinical and pathologic differential diagnosis and management are discussed based on literature. Sacral appendages, such as asaccessory penis or human tail, are treated through simple surgical excision. However, patients must be carefully evaluated regarding teratoma and spinal cord pathology.

Lipoblastoma is an uncommon tumor of adipose tissue that usually occurs in infancy and early childhood. They predominantly locate in the extremities, but are less frequently found in the head and neck region, trunk and various other locations. The most common sign is a rapidly growing mass. In spite of their potential for local invasion and rapid growth, they are benign tumors and have no distant metastasis. Although more than 180 cases of lipoblastoma distributed over various parts of the body have been reported, only nine cases were located in the thoracic wall. We present the case of a two-year-old girl with lipoblastomatosis of the chest wall that was identified by histologic examination. In this article, the English literature on this disorder is briefly reviewed.

The etiology of sirenomelia sequence is still obscure. The role of maternal diabetes and a vascular steal phenomenon have been discussed [Gurakan et al. (1996) Turk J Pediatr 38:393-397]. Discordant monozygotic twin sirenomelia has been commonly reported but only rarely in dizygotic twins. The family of the presented twins had a high risk of diabetes mellitus. One of the twins has type 1 sirenomelia and the other had only an imperforate anus.

PURPOSE The purpose of this study was to present the possibility of laparoscopic appendectomy (LA) in children as an outpatient procedure. METHODS A total of 129 pediatric patients underwent LA at our clinic from July 2009 to September 2011. As, in our treatment protocol, patients with gangrenous and perforated appendicitis would not be placed in an early-discharge list, patients who had gangrenous and perforated appendicitis (37 cases) were excluded from this study because these patients usually receive inpatient intravenous antibiotic therapy for 48 to 72 hours. Finally, 92 pediatric patients who had undergone LA for the treatment of uncomplicated appendicitis were evaluated retrospectively. RESULTS Eighty-five of 92 patients (92.4%) were discharged in

Background: Cyst of the canal of Nuck is a rare cause of inguinal swelling in female infants and children. Aim: The purpose of this study is to discuss the clinical, radiological, and histopathological findings, differential diagnosis, and surgical treatment of this disease in the light of our experience. Materials and Methods: This study was conducted in six children who were operated on with cyst of the canal of Nuck at the pediatric surgery clinic in July 1998-March 2013. All information was collected from patient's files and computer records retrospectively. Results: Patients were between the ages of 1 and 12 years. Size of the cysts has varied between 23 mm and 55.2 mm. In all cases, cyst was on the right side. In physical examination while five cases had palpable, well-circumscribed, mobile and painless mass, in one case the mass was immobile. In one patient, the mass was reducible; in the other 5 patients the mass was non-reducible. First patient was operated immediately with the early diagnosis of incarcerated inguinal hernia, the second one was operated under elective conditions with early diagnosis of inguinal hernia and it was diagnosed during operation, and in the last 4 patients pre-operative true diagnosis was possible. Conclusions: As clinical findings of the cyst of the canal of Nuck are variable, pre-operative true diagnosis can only be related to increasing experience.

Intestinal atresia is a well-recognized cause of bowel obstruction in the newborn. The aim of this study was to examine the serial regarding the intestinal atresia and stenosis patients in a period of 28 years in a developing country and to display our progress in treatment and survival rates today. In this study, a total of 141 intestinal atresia and stenosis cases were retrospectively evaluated. The cases were categorized in two groups as 45 cases before the 1990 (group 1) when it was impossible for total parenteral nutrition (TPN) solutions to be used regularly, without complication and for a long time and 96 cases after 1990 (group 2) when this was possible. While the survival rate before 1990 was 55%, after 1990 it was 94%. As a result, long-term regular TPN usage significantly improved survival in newborns with intestinal atresia and stenosis in a developing country.