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Purpose: Undescended testis is one of the most common pathologies encountered by pediatric surgeons. In traditional orchidopexy operation, PPV is dissected from testicular vessels and spermatic cord. In this study, it was aimed to compare the results of undescended testis patients with and without PPV closure in terms of recurrence and atrophy Methods: After the approval of the local ethics committee, patients who were operated for undescended testis between January 2007 and December 2022 were evaluated. Patients were determined in two groups. first group was with PPV ligation (n=171), second group was without PPV ligation (n=1637). Results: Inguinal hernia was not observed after operation in 15 years of follow-up. There were 23 recurrences (%13,4) in group 1 and 48 recurrences (%2,9) in group 2. According to the preoperative evaluation; A decrease in testicular size was detected in 5 patients (2.9%) in Group 1 and 8 patients (0.4%) in Group 2 in the postoperative follow-up. Conclusion: There is no need to ligate the PPV with additional dissection and open the external oblique fascia if it is predicted that the spermatic cord and testicular vessels may come to scrotum without tension in patients who underwent orchiopexy surgery. Key Words: undescended testis, orchidopexy, processus vajinalis

Objective: Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods: Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results: This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p< 0.001), total hospitalization time (< 0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion: Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.

Introduction :In inguinal hernia, standard procedure has been considered open repair for a long time, the number of pediatric surgeons who prefer laparoscopic techniques is increasing day by day. In this study, it was aimed to determine how pediatric surgeons in our country approach patients with inguinal hernia and manage the treatment process. Methods :Controversial issues on inguinal hernia repair were identified and a questionnaire was prepared to reveal the current situation. The questionnaire was delivered to members of Turkish Association of Pediatric Surgery on the official website of the association.Results :The survey was directed to 420 people, 92 people returned with the answers to the questionnaire. Thirty six of the surgeons prefer the laparoscopic method for inguinal hernia repair. The reason for choosing open surgery was questionned, the most frequent answer was to be more experienced and to have more cumulative knowledge on open repair method. According to survey, the greatest advantage of laparoscopy was stated to be the better evaluation of the contralateral inguinal canal (n=16, %44,4). Twelve of surgeons who performed laparoscopic treatment in the selection of patients stated that gender is important and prefer laparoscopic surgery for female patients. Thirty percent (n = 11) of the participants stated that they prefer laparoscopy in patients between 3 months and 13 years old, while the rest prefer laparoscopy at all ages. In conclusion thirty nine percent of surgeons in Turkey prefer laparoscopic repair. Open repair is stil preferred in our country. There is still no consensus on perfect method and patient selection yet.

Objective An important part of laparoscopic Nissen's fundoplication (LNF) is a proper wrap, which may only be possible with proper dissection of esophagus and hiatus. However, too much dissection of esophagus and hiatus to gain sufficient length of esophagus increases morbidity. The aim of this study is to analyze the effect of minimal esophagus dissection in LNF on recurrence and post-operative hiatal hernia. Methods The present study includes the children (0-18 years) who underwent LNF with minimal esophagus dissection and without hiatal closure between 2008 and 2016. The charts of the patients analyzed retrospectively and evaluated in terms of recurrence and post-operative hiatal hernia. Results There were 143 children. Mean age was 4.5±4.6 year (20 days-17 years). About 54% of the children (n=78) were neurologically impaired. There were two temporary intestinal obstructions which did not require surgery, one esophageal tightness which resolved with one dilatation session and one recurrence with hiatal hernia which required reoperation. Conclusion Minimal esophagus dissection without hiatal closure in LNF avoids dysphagia with no increase in the rate of recurrence and complications.

Introduction Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention. Materials and Methods Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ–Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social–emotional problems, respectively. Results Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal–social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal–social skills. Conclusion Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

Objectives:In the last decade, video-assisted thoracoscopic surgery (VATS) is gaining broad popularity in pediatric surgery. The purpose of this study is to analyze the clinical and histopathological results of VATS in pediatric population in a minimum 1-year follow-up period.Materials and Methods:All patients undergoing an elective lobectomy or segmentectomy with VATS were enrolled for the study. Medical charts of the enrolled patients were retrospectively evaluated and the data of the patients who met the inclusion criteria were extracted for the final analysis. Patients’ demographics including gender and age, indications for VATS and past surgical history, preoperative investigations, comorbidities, intraoperative findings, operative data, postoperative course including any morbidity and mortality were recorded.Results:There were 26 patients (13 males, 13 females). The main indication for VATS was congenital pulmonary airway malformation (10 patients). There were only two segmentectomies. The remaining 24 patients had undergone lobectomies. Only two patients had multi-lobectomies. In four patients, conversion to thoracotomy was required because of bleeding and inadequate exposure. The mean operation time was 107 mins. Chest tube was placed in all of the patients and removed between the postoperative 2nd and 10th days (median=4 days) and the average discharge time was 5.7 days (3-12 days).Conclusion:VATS is a safe and effective surgical procedure not only for the adults but also for the pediatric population. It has low complication rates with faster recovery time especially for the pediatric cases that have malignancies.

BACKGROUND The aim of this study is to determine whether pentraxin 3 (PTX3) levels can be used in the diagnosis of appendicitis in children. METHODS Fifteen children under 18 years old, who gave blood samples for reasons other than inflammatory conditions, and 40 children who were proved to have appendicitis (non-perforated or perforated) between August 2017 and January 2018, were enrolled in the study. Patients were classified into subgroups: group 1 (healthy children without any sign of inflammation, n = 15), group 2 (non-perforated appendicitis, n = 25), and group 3 (perforated appendicitis, n = 15). RESULTS The median PTX3 value was 1.01 ng/mL (minimum value: 0.82, maximum: 1.28) in the control group. The median PTX3 values prior to surgery were 20.68 ng/mL (minimum: 1.02, maximum: 28.471) and 1.46 (minimum: 1.05, maximum: 23.421) ng/mL for non-perforated appendicitis and perforated appendicitis respectively. The PTX3 levels were significantly higher in groups 2 and 3 than in group 1 (P

In this study, a case of candidemia caused by Candida hellenica as the first report in our country was presented. Fluconazole and liposomal amphotericin B treatment was initiated in a 20-year-old male patient in October 2018 due to the diagnosis of candidemia following esophageal surgery. The patient had a history of multiple esophageal operations. The patient was discharged during the last 24 hours due to the lack of fever, improvement in general condition and lack of growth in blood cultures. Germination tube test of the Candida isolate grown in blood culture was negative and the colony morphology in corn meal tween 80 agar was not defining. It was identified as C.hellenica according to the profile obtained from the ID32C® (bioMerieux, France) method based on carbohydrate assimilation. The target ITS regions of the rRNA genes were amplified by polymerase chain reaction and sequenced using suitable primers for the confirmation of the identification on species level. The DNA sequences obtained were searched by using the "National Center for Biotechnology Information (BLAST)" (http://www.ncbi.nlm.nih.gov/ BLAST/) database and the isolate was identified as C.hellenica with a 99% homology with GenBank sequences. MALDI-TOF (Vitek MS, bioMerieux) could not identify the yeast isolate. The reference microdilution method was performed according to the recommendations of the Clinical and Laboratory Standards Institute in order to test the antifungal susceptibility. The minimal inhibitory concentrations for the isolate, determined after 24-hour incubation were 0.25 µg/ml for amphotericin B, 8 µg/ml for fluconazole, 0.25 µg/ml for voriconazole, and 0.25 µg/ml for itraconazole. As our case had a previous history of gastrointestinal tract surgery it was thought that gastrointestinal tract was the endogenous source of candidemia by leading to mucosal disruption and this mucosal disruption might facilitate the translocation of Candida. The carbohydrate assimilation test ID32C®, was able identify the causative agent of candidaemia at the species level in this case. However, uncommon or previously unrecognized organisms may be misidentified by commercial systems. While the phenotypic definition is sufficient in routine laboratories, it is mandatory to confirm the microorganism species definition by DNA sequence analysis, as done in this case. We have presented a correctly identifed and successfully treated candidemia case. Although the candidemia was not mortal in our patient, the mortality rate of candidemia which is 50%, should be remembered. A total of two C.hellenica infections have been reported in the literature, including one candidaemia and one respiratory tract colonization. Our successfully treated case was presented to draw attention to this rare infectious agent.

A rare case of accessory scrotum and penoscrotal transposition with co-occuring anal atresia is reported because of it’s infrequency. Diagnosis, management and result of one-day-old newborn with high anorectal anomaly and perineal lipoma bearing accessory scrotum aimed to be presented in the light of literature screening.

Objectives:Pediatric tracheostomy has undergone notable changes and percutaneous tracheostomy (PT) has taken place of surgical tracheostomy. The aim of this study is to show a facilitation in a previously described technique.Materials and Methods:A retrospective review of 35 patients who underwent PT was performed. Demographic data of the children and outcomes of the procedures were analyzed.Results:Among total of 35 children, there were 14 girls and 21 boys. Mean age was 54.8 months (2-207) and mean weight was 15.8 kg (3-42). The mean follow up time was 11.4 (1-22 months). There were no complications intraoperatively or in early postoperative period (1 week).Conclusion:Cannula placement through a frozen feeding tube is a new and facilitating method in rigid bronchoscopy guided tracheostomy cannula placement in children.

Background: Interstitial lung disease (ILD) represents a spectrum of lung diseases that may contain different levels of fibrosis and inflammation. Sometimes, the clinical picture and imaging studies are insufficient to determine the diagnosis and lung biopsy becomes crucial, which may be performed in a thoracoscopic or open manner. The aim of this study was to present a new minimally invasive biopsy method that seems to be technically easy, safe, and inexpensive. Herein, we present a minimally invasive method for thoracoscopic lung biopsy using a Vicryl loop. Methods: The charts of patients with suspected ILD who underwent thoracoscopic lung biopsy using a Vicryl loop between 2007 and 2017 were analyzed retrospectively. Results: Nine patients were identified, four were boys and five were girls. The median age was 76 months. The mean weight of the patients was 10.9 kg. The mean chest tube removal time was 3.8 days. The mean surgical time was 37 minutes. There was an air leakage for 13 days in one child postoperatively. Conclusions: Thoracoscopic lung biopsy with a knot and scissors is an easily applicable and minimally invasive method that may be performed in children with suspected ILD.

Our country has hosted various civilizations and is situated in a rich geography, where many cultures live together. This cultural

p.p1 {margin: 0.0px 0.0px 2.9px 0.0px; text-align: justify; font: 9.0px 'Helvetica Neue Light'} Sag aberrant subclavian arter (ARSA), nadir gorulen ve genellikle asemptomatik seyreden konjenital bir anomalidir (populasyonun %0.5-1.8’i). Bu calismada supraklavikular insizyon ile basarili bir sekilde tedavi edilen uc kiz hastanin sunulmasi amaclandi. Ameliyat sirasinda ortanca yas 15’di (aralik: 10-18 yas). Ameliyat sirasinda ve sonrasinda komplikasyon izlenmedi. Bilateral ulnar ve radyal pulsasyonlari ameliyat sonrasi normaldi. Ameliyat sonrasinda beslenme ile ilgili problem gozlenmedi. Supraklavikuler insizyon ile ARSA’ nin uc yan anastomozu, disfaji lusoriasi olan cocuklar icin uygulanabilir ve minimal invaziv bir yontem olarak dusunulmelidir.

Objective Aim of the study is to determine the hemostatic techniques among pediatric urologists in Turkey. Material and methods Questionnaire forms were sent to 459 pediatric urologist by e-mail. Results Ninety eight of 459 participants answered the questionnaire forms. Eighty-one (84.4%) of the participants were using tourniquet. The participants who didn't use tourniquet stated their justifications as follows: lack of need (n=10: 66.7%), development of edema, ischemia, delay of wound-graft healing and fistula risk (n=5: 33.3%). The indications of tourniquet use were stated as follows: penile (91.4%: n=74), distal (72.8%: n=59), penoscrotal (55.6%: n=45) hypospadias; fistula repair (33.3%: n=27), cripple hypospadias (33.3%: n=27), repair with flaps (30.9%: n=25), repair with grafts (27.2%: n=22), and isolated penile curvature (21%: n=17). Most commonly used tourniquet material (49.9%) was latex glove. Erection test was applied by 43.8% of participants. Scalp vein set was the most commonly (54.8%) used injector during erection test. Only 9.4% of participants were using adrenaline. Adrenaline dosages used at 1/100.000 dilution by 55.6%, lidocaine with 1/100.000 adrenaline by 44.4% of participants. Conclusion Beside a few experimental ones there is a paucity of studies that can serve as a guideline for using these techniques in the literature. There is a necessity of realizing prospective, randomized studies with long-term follow up to evidence that postoperative complications could develop secondary to hemostatic techniques and also to facilitate safe use of these techniques.

In this study, a case of candidemia caused by Candida hellenica as the first report in our country was presented. Fluconazole and liposomal amphotericin B treatment was initiated in a 20-year-old male patient in October 2018 due to the diagnosis of candidemia following esophageal surgery. The patient had a history of multiple esophageal operations. The patient was discharged during the last 24 hours due to the lack of fever, improvement in general condition and lack of growth in blood cultures. Germination tube test of the Candida isolate grown in blood culture was negative and the colony morphology in corn meal tween 80 agar was not defining. It was identified as C.hellenica according to the profile obtained from the ID32C® (bioMérieux, France) method based on carbohydrate assimilation. The target ITS regions of the rRNA genes were amplified by polymerase chain reaction and sequenced using suitable primers for the confirmation of the identification on species level. The DNA sequences obtained were searched by using the "National Center for Biotechnology Information (BLAST)" (http://www.ncbi.nlm.nih.gov/ BLAST/) database and the isolate was identified as C.hellenica with a 99% homology with GenBank sequences. MALDI-TOF (Vitek MS, bioMerieux) could not identify the yeast isolate. The reference microdilution method was performed according to the recommendations of the Clinical and Laboratory Standards Institute in order to test the antifungal susceptibility. The minimal inhibitory concentrations for the isolate, determined after 24-hour incubation were 0.25 µg/ml for amphotericin B, 8 µg/ml for fluconazole, 0.25 µg/ml for voriconazole, and 0.25 µg/ml for itraconazole. As our case had a previous history of gastrointestinal tract surgery it was thought that gastrointestinal tract was the endogenous source of candidemia by leading to mucosal disruption and this mucosal disruption might facilitate the translocation of Candida. The carbohydrate assimilation test ID32C®, was able identify the causative agent of candidaemia at the species level in this case. However, uncommon or previously unrecognized organisms may be misidentified by commercial systems. While the phenotypic definition is sufficient in routine laboratories, it is mandatory to confirm the microorganism species definition by DNA sequence analysis, as done in this case. We have presented a correctly identifed and successfully treated candidemia case. Although the candidemia was not mortal in our patient, the mortality rate of candidemia which is 50%, should be remembered. A total of two C.hellenica infections have been reported in the literature, including one candidaemia and one respiratory tract colonization. Our successfully treated case was presented to draw attention to this rare infectious agent.

The treatment of MH entails surgical repair either by open abdominal or thoracic approaches or by minimal invasive surgery. The aim of this study is to evaluate the surgical and clinical outcomes of children who underwent laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique. This retrospective study includes pediatric patients who underwent surgery for MH between January 2015 and February 2019. The patients’ demographic data, symptoms, operative findings and technique and postoperative outcomes were recorded. A total of 17 children with MH were treated. There were 13 boys (76.5%) and four (23.5%) girls. Six patients had trisomy 21 (37%). The mean operation time was 40 min (25–90 min). The hernia sac was removed in all patients and there was no need for prosthetic patch in any of the children. Mean time to start feeding was 10 h (6–24 h). The mean hospitalization time was 2 days (1–5 days). There were no complications intraoperatively or postoperatively. The mean follow-up time was 24 months (6–40). No recurrence occurred during the follow-up time. Laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique is a preferable method with excellent outcomes and short hospitalization and feeding time postoperatively. This technique may be performed easily and safely without requiring any additional experience other than basic laparoscopy skills.

Summary The aim of this study is to review the experience on managing foreign body ingestion in children with special emphasis on the endoscopic techniques and specific retrieval devices used for foreign body (FB) extraction. The charts of 341 children were reviewed retrospectively. Demographic data, ingested material, removal technique and tool, level of FB, complications, and outcomes were recorded. A total of 364 FBs were removed from 341 children. Among these, 56.5% (n: 206) were entrapped in esophagus, 39% (n: 142) were in stomach, and 4.5% (n: 16) in duodenum and intestine. The most frequently ingested items were coin (42.5%), button batteries (20.6%), and safety pins (12%). Optical forceps (37.9%) were the most commonly used tool and they were used during retrieval of esophageal FB by rigid endoscopy. Retrieval net (20.7%) was the second most common tool and the most common one during flexible endoscopy. Depending on our experience, we strongly advocate rigid endoscopy for esophageal FBs and food impaction in children because it allows both to use optical forceps with a strong grasping ability for blunt FBs and to position sharp and pointed objects inside the rigid endoscope. We recommend retrieval net as the first tool for the extraction of blunt objects and rat tooth retrieval forceps is the best tool for sharp and pointed FBs in stomach.

WOS: 000455930500002 PubMed ID: 30413832 ObjectivesAim of this study is to evaluate success rates and complications related with symphyseal miniplate anchorage systems used for treatment of Class2 and Class3 deformities.MethodsAtotal of 58miniplates applied to 29growing patients were evaluated. The first group comprised 24symphyseal miniplates applied to 12patients and Forsus Fatigue Resistant Devices were attached to the head of the miniplates for mandibular advancement. The second group consisted of 34symphyseal miniplates applied to 17patients and intermaxillary elastics were applied between acrylic appliances placed on the maxillary dental arch and the symphyseal miniplates for maxillary protraction. Success rate and complications of the symphyseal plate-screw anchorage system were evaluated.ResultsThe overall success rate of symphseal miniplates was 87.9%. Six miniplates showed severe mobility and 2miniplates broke during orthodontic treatment. Infection, miniplate mobility and mucosal hypertrophy were statistically different between the two groups.ConclusionsSymphyseal miniplates were generally used as successful anchorage units in most patients. Infection, mobility, and mucosal hypertrophy occurred more frequently in Class2 deformity correction. However, the success rates regarding the two treatment modalities were comparable. Ziele Ziel der vorliegenden Studie ist es, Erfolgsraten und Komplikationen im Zusammenhang mit symphysealen Miniplattenverankerungssystemen zur Behandlung von Klasse-II- und -III-Anomalien zu bewerten. Methoden Ausgewertet wurden insgesamt 58 Miniplatten, die bei 29 Patienten im Wachstum inseriert wurden. In der ersten Gruppe wurden 24 symphyseale Miniplatten bei 12 Patienten inseriert. Zur Korrektur der Unterkieferrücklage wurden Forsus-Apparaturen an den Miniplatten verankert. In der zweiten Gruppe wurden 34 symphyseale Miniplatten bei 17 Patienten inseriert. Zur Protraktion des Oberkiefers wurden intermaxilläre Elastics verwendet, die zwischen Acrylgeräten im Oberkiefer und den symphysealen Miniplatten eingehängt wurden. Untersucht wurden Erfolgs- und Komplikationsraten des symphysealen Platten-Schrauben-Verankerungssystems. Ergebnisse Die Gesamterfolgsrate der symphsealen Miniplatten betrug 87,9%. Bei 6 Miniplatten zeigte sich eine hohe Mobilität, 2 frakturierten während der kieferorthopädischen Behandlung. Das Auftreten von Infektion, Miniplattenmobilität und Schleimhauthypertrophie war zwischen den beiden Gruppen statistisch unterschiedlich. Schlussfolgerungen Symphyseale Miniplatten wurden in der Regel bei den meisten Patienten als erfolgreiche Verankerungseinheiten eingesetzt. Infektion, Mobilität und Schleimhauthypertrophie traten häufiger bei Klasse-2-Korrekturen auf, die Ergebnisse beider Behandlungsmethoden unterschieden sich jedoch nur geringfügig.

Aim:Laparoscopic-assisted transanal pull-through (LATP) is a procedure that has gained increasing popularity in the management of Hirschsprung’s disease. The purpose of this study was to compare outcomes of patients treated with LATP and transanal pull-through (TPT).Methods:Records of 45 patients with Hirschsprung’s disease who underwent surgery between 2006 and 2017 were retrospectively evaluated.Results:LATP was performed in 16 patients [13 male (81%), three female (19%)]. The median age of the patients was four months (7 days-84 months). Twenty nine patients [21 male (72.4%), eight female (27.6%)] underwent TPT. The median age of the patients was 11 months (10 days-90 months). The mean time to start feeding in LATP and TPT groups was two days (one-three days) and 2.6 days, respectively (p=0.074). The mean operative time was 2.6 hours in the LATP group (two-four hours) and 2.7 hours in the TPT group (p=0.971). The mean length of hospital stay in for LATP and TPT groups was 4.8 days (two-nine days) and six days (3-14 days), respectively (p=0.305).Conclusion:The advantages of LATP include multiple sample collection from several segments of the colonn at the same time as well as shorter time to frozen section diagnosis. In addition, the possibility of intraabdominal dissection allows transanal surgery to be faster and more effective.

BACKGROUND Obesity is one of the most rapidly increasing health problems in children. Laparoscopic sleeve gastrectomy (LSG) is one of the best treatment options and is feasible and safe in children. The aim of this study was to present the short-term results of a laparoscopic sleeve gastrectomy series in children. METHODS Children who underwent LSG in 2014-2017 were included in the study. Charts were investigated retrospectively and short-term weight loss was analyzed. RESULTS Patients who had surgery in 2014-2017 were included in the study. There were six girls and two boys, and the median age was 15 years (range, 11-18 years). Mean weight was 159.25 ± 19.78 kg, and mean body mass index was 61.05 ± 8.5 kg/m2 . Mean operation time was 70 min (range, 65-90 min), mean hospital stay was 5.1 days (range, 3-7 days), and mean follow up was 19.2 months (range, 1-43 months). Of these patients, five had hypertension and were under medication and two of these five also had hyperinsulinemia. One of the five children had Bardet-Biedl syndrome and one had bronchial asthma. After operation, medication was stopped in four of the eight children. At the time of writing, six patients were doing well without postoperative complications, or the need for reoperation. CONCLUSION Even though the follow-up period was short and the number of patients was small, LSG was a feasible and promising surgical method for morbidly obese children. A multidisciplinary approach and lifelong behavior therapy are key steps for success.

Introduction Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. Patients and methods This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. Results This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12–20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1–14) days. Mean follow up was 44.6 (8–82) months for primary excision and closure group and 8.1 (1–19) months for phenol group. Conclusion Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. Treatment study Level III

Background/aims We aimed to evaluate postoperative fecal incontinence scales of children who underwent laparoscopic proctocolectomy and ileal J-pouch anastomosis for familial adenomateous polyposis (FAP) and inflammatory bowel disease (IBD). Materials and methods Fecal incontinence scores were collected at 3 months post-surgery. A retrospective chart review was also performed to obtain the demographic data and operative technical details. Results The postoperative Wexner Fecal Incontinence Score was 0 in 9 of 11 patients and satisfactory in the remaining two. None of the children had a major complication. Conclusion Even though the presented study does not have any comparable data, it seems that laparoscopic total proctocolectomy with ileal J-pouch anal anastomosis (TP IPAA) might be the best choice of surgery because it provides good continence with low complication rates.

Objective: Laparoscopic inguinal hernia surgery has recently been a preferred surgical approach among pediatric surgeons. The aim of this study is to compare open and laparoscopic inguinal hernia repair techniques in terms of complications and recurrences in children. Method: Patients whose inguinal hernias were operated with laparoscopic percutaneous internal ring suturing technique and open high ligation technique were included in the study. Dermographic data, surgical details and postoperative complications of the patients were reviewed retrospectively. Results: A total of 246 patients were included in the study. Among them 113 patients underwent laparoscopic inguinal hernia repair and 133 patients open inguinal hernia repair. The mean age of patients in the laparoscopic group was 27.7 months (1-192 months) and the mean age of patients in the open surgery group was 27.5 months (1-156 months). Diagnostic laparoscopy was performed in 104 patients who underwent open surgery, and the contralateral inguinal hernia repair was performed in 33 of the patients after hernia was detected on the contralateral side. Recurrence was observed in 2.6% (n=3) of the patients who underwent laparoscopic surgery and 3.7%(n=5) of the patients undergoing open surgery. In 2 of the patients who underwent laparos- copic surgery had hematomas that resolved without intervention and 1 had hydrocele. On the other hand 4 of the patients who underwent open surgery had iatrogenic undescended testis and 1 had hydrocele. The follow-up periods of the patients who underwent laparoscopic or open surgery were 13.2, and 74 months, respectively. Conclusion: Laparoscopic inguinal hernia repair has results comparable to open repair in terms of recurrence and complications. The advantage of the laparoscopic method can be considered as the ability to evaluate the contralateral side in all cases without increase in the risk of recur- rence and complications, and the ability to operate without scarring , but with good cosmetic results.

OBJECTIVE:Ovarian cysts and related torsions are the most common adnexial pathologies in childhood. Diagnostic laparoscopy is the gold standard approach for differential diagnosis. It is aimed to evaluate the data of patients who had surgery for ovarian pathology. STUDY DESIGN: Fifty-three girls of ten years are included the study. Demographic data, medical history, physical examination, laboratory and radiologic investigations, surgical procedure, histopathology, complications and follow up periods are recorded.RESULTS: The median age of children was 13. Excluding the patients who were diagnosed in intrauterine period (n=4), all of the patients had abdominal pain (92%). Laparoscopic cystectomy (56.7%), detorsion and cystectomy (16.9%) and oopherectomy (16.9%) were performed in patients with cysts. Diagnostic laparoscopy (3,8%) and laparoscopic detorsion (5.7%) were performed in patients without cyst. Dermoid cysts were found in three children and teratomas in two. Patients were discharged in postoperative second day. CONCLUSION: Diagnostic laparoscopy is the gold standard approach for differential diagnosis. Laparoscopic approach should be chosen because of shorter hospital stay, shorter healing period, and better cosmetic results. Besides, less pelvic adhesions compared to laparotomy in laparoscopy is important for further fertility.

Aim Cricopharyngeal achalasia (CPA) is a rare clinical condition that is characterized by aspiration, choking, and nasopharyngeal regurgitation. The aim of this study is to introduce the outcomes of dilatation alone in children with CPA. Patients and method After the evaluation of upper esophageal sphincter with endoscopy, dilatation was performed. All patients underwent videofluoroscopic evaluation and swallowing therapy after the surgical procedure. A retrospective chart review was performed in children with CPA. Results Thirty children who were videofluoroscopically proven to have CPA were included in the study. Their age range was 15days–7years (median 11months). Twenty-one of them were neurologically impaired. Two children were lost to follow-up. Nineteen patients (68%) had a total resolution of CPA and were symptom-free with 1–6 dilatations (median 2). Three of the children (11%) who were severely neurologically impaired had resistant CPA. Three children (11%) treated recently with short follow-up were added to the group. Their VFS evaluations demonstrated improvement, thus we accepted their result as successful. There were two perforations in the series. Three patients died; one 2-month-old (2500g) baby who was accepted from the intensive care unit passed away on postoperative on the 7th day. Two other babies who were unresponsive to dilatation therapy died on follow-up. Conclusion Dilatation can be a safe and effective method on children who are correctly diagnosed to have CPA.

Objective The aim of this study is to report prospective data of pediatric cases that underwent percutaneous tracheostomy (PT) to show that PT is a safe and feasible procedure in children even in small infants. Patients and methods PT was done in 51 consecutive patients. Demographic data, indications, complications and outcome were recorded prospectively. Initial 6 PT was done by Giaglia technique whereas the Griggs technique was used in the consecutive 45 patients. Results Fifty-one patients with mean age of 38±54months (1month–17years) and, mean weight of 12.4±13kg underwent PT. The only major complication was perforation of esophagus ( n =1, 2%) which was recognized early and immediately repaired by cervical approach. This complication occurred in the 6th case done with the Giaglia technique. After conversion to the Griggs technique no major complication was encountered in the consecutive 45 procedures. The mean period of follow up was 21±13.7months. Narrowing of the stoma site requiring simple dilation was developed in 3 (5.8%) patients. Conclusion PT is a safe and easy procedure and a less invasive alternative to surgical tracheostomy even in small infants. We strongly recommend PT done by Griggs technique in children. It is important that it should be done in an operating room setting and under rigid bronchoscopic guidance.

Hydrofluoric acid (HF) is a colorless and odorless solution of the hydrogen fluoride in water. It is used in some household products. The rapid onset of severe toxicity and death after the ingestion of HF is not reported often. Also, there is no reported fatal pediatric case after HF ingestion. In this case report, we present a 3.5-year-old girls who unintentionally drunk a rust remover that contained 8% HF. She died in a short period as a result of refractory ventricular fibrillation, which was developed due to fluoride intoxication.

Necrotizing enterocolitis (NEC) is the most important gastrointestinal emergency affecting especially preterm infants and causes severe morbidities and mortality. However, there is no cure. Oxidant stress, inflammation, apoptosis, as well as prematurity are believed to responsible in the pathogenesis of the disease. Ginger and its compounds have anti-inflammatory, antimicrobial, anti-oxidant properties and immunomodulatory, cytoprotective/regenerative actions.This study aimed to evaluate the beneficial effects of ginger on the intestinal damage in an experimental rat model of NEC.Thirty newborn Wistar rats were divided into three groups: NEC, NEC + ginger and control in this experimental study. NEC was induced by injection of intraperitoneal lipopolysaccharide, feeding with enteral formula, hypoxia-hyperoxia and cold stress exposure. The pups in the NEC + ginger group were orally administered ginger at a dose of 1000 mg/kg/day. Proximal colon and ileum were excised. Histopathological, immunohistochemical (TUNEL for apoptosis, caspase 3 and 8) and biochemical assays including xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malonaldehyde (MDA) and myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin1β (IL-1β), and interleukin 6 (IL-6) activity were evaluated.Compared with the NEC group, the rat pups in the NEC + ginger group had better clinical disease scores and weight gain (p 0.05). Macroscopic evaluation, Histopathologic and apoptosis assessment (TUNEL, caspase 3 and 8) releaved that severity of intestinal damage were significantly lower in the NEC + ginger group (p 0.05). The levels of TNF-α, IL-1β and IL-6 in the ginger treated group were significantly decreased (P 0.05). The GSH-Px and SOD levels of the ginger treated group were significantly preserved in the NEC + ginger group (p 0.05). The tissue XO, MDA and MPO levels of the NEC + ginger group were significantly lower than those in the NEC group (P 0.05).Ginger therapy efficiently ameliorated the severity of intestinal damage in NEC and may be a promising treatment option.

Mediastinal teratomlar çocuklarda tüm germ hücreli tümörler içinde % 4.3 oranında görülen, germ hücreli tümörlerin ender bir tipidir. Mediastinal tümörleri olan hastaların çoğunda herhangi bir semptom görülmez (%53) ve kitle genellikle rutin akciğer grafileri sırasında tesadüfen saptanır. Literatürde mediastinal teratomların tedavisinde cerrahi eksizyonun sonuçları tartışmalıdır. Çalışmada, sık tekrarlayan üst solunum yolu enfeksiyonları ile bulgu veren, perikardiyuma yapışık benign matür teratom tanısı alan bir yaşındaki erkek çocuğun sunulması planlandı. Teratom cerrahi olarak eksize edildi. Sonuç olarak, akciğer grafisinde mediastinumda kitle ya da opasite görülen hastaların ayırıcı tanısında anterior mediastinum yerleşimli teratomlar akılda bulundurulmalıdır. Mediastinal teratomlar genellikle benign ve total rezeksiyona iyi yanıt verirler. Torakotomi uygun cerrahi yaklaşımlardan biridir., Mediastinal teratomas, a rare form of germ cell tumors in children, account for only 4.3% of all germ cell tumors. In most cases, patients with mediastinum tumors have no symptoms (53%), and their masses are frequently diagnosed incidentally on routine chest radiography. In the literature, the outcomes of surgical excision for the treatment of mediastinal teratomas and the results are inconclusive. We present a one-year old male child who experienced recurrent upper respiratory tract infections and was diagnosed with a benign mature teratoma adherent to the pericardium. The child underwent surgical excision. In conclusion, mediastinal teratomas located in the anterior mediastinum should be kept in mind in the differential diagnosis in children whose chest x-rays reveal a mass or unspecific opacity in the mediastinum. These are usually benign with a good response to total resection. Thoracotomy is one of the appropriate surgical approaches

Objectives Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy. Methods The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse-string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally. Results There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day-18 years), and the average body weight was 13 kg (2300 gr-65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate. Conclusion The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.

Amaç: Robotik cerrahi, minimal invaziv cerrahi konusundaki gelişmelerin en yenisidir. Cerrahların bu konudaki görüşleri farklılık göstermekle beraber robotik cerrahi genel olarak alışma ve yaygınlaşma sürecine girmiştir. Bu yaygınlaşma ve alışma periyodunun belli bir süreçte gerçekleşeceği bildirilmiştir. Bu zaman içerisinde robotik cerrahinin avantajları ve dezavantajlarının gelişim sürecine etki edeceği açıktır. Çalışmanın amacı, robotik cerrahinin Türkiye’deki yaygınlığı ve bunu etkileyen faktörleri ortaya koymaktır.Gereç ve Yöntemler: Robotik cerrahinin üstünlükleri ve kısıtlılıklarını içeren anket hazırlandı. Hazırlanmış olan anket internet üzerinden Survey Monkey Anket Sistemi aracılığıyla aktif olarak robotik cerrahi ile uğraşan 104 cerraha gönderildi. Ankete yanıt veren 41 (%39.4) cerrahın yanıtları incelendi.Bulgular: Kırk bir katılımcının 32’si 10 yıldan fazla süredir uzman doktor olarak çalışmaktaydı. Robotik cerrahi ile uğraşan cerrahların %80’i (n=32) ileri endoskopik cerrahi deneyimine sahip olduğunu belirtti. Otuz bir cerrah endoskopik deneyimin robotik cerrahi uygulamasına geçişte bir üstünlük sağladığını düşünmekteydi. Ankete katılan cerrahların %40’ı (n=15) yurtdışında, %60’ı (n=25) ise yurtiçinde robotik cerrahi eğitimi aldığını belirtti. Yurtdışında eğitim alma gerekliliğini savunan cerrahlar olsa da katılımcıların %80’i yurtiçinde eğitim almanın gerekliliğini savunuyordu. Ankete yanıt verenlerin %22’si (n=9) robotik cerrahi ile toplamda 100 olgunun üzerinde ameliyat gerçekleştirmiş, %60’ı (n=25) ise 25 olgudan daha az ameliyat yapmışlardı. Bu ameliyat sayıları, robotik cerrahinin; cerrahların %73’ünün (n=30) rutin pratiklerinin %10’undan daha azını kapsadığını yansıtıyordu. Cerrahların %90’ı (n=37) hastaya dokunmamayı kısıtlılık olarak görmediğini ifade ediyordu. Katılımcıların %76’sı robotik cerrahi eğitiminin uzmanlık eğitimi tamamlandıktan sonra alınması gerektiğini düşünüyordu. Robotik cerrahinin endoskopik cerrahiye göre üstünlükleri sorgulandığında katılımcıların %83’ü (n=34) üstün olduğunu düşünüyordu. Bu üstünlükler ise şöyle sıralandı: Katılımcıların %98’i (n=40) üç boyutlu ve büyütülmüş görüntü olanağını, %88’i (n=36) kameranın cerrah tarafından kontrol edilmesini, %85’i (n=35) el bileği hareketli enstrümanları en önemli üstünlükler olarak belirledi. Dikiş atmada kolaylık (%75), kamerada ve aletlerde titremenin olmaması (%73), gelişmiş görüntüleme teknikleri (%68) ve ergonomi (%68) ise sırasıyla diğer önemli üstünlükler olarak belirtildi. Robotik cerrahinin kısıtlamaları sorgulandığında ise katılımcıların %63’ü (n=25) endoskopik cerrahiye göre kısıtlamaların olduğunu, %65’i (n=26) açığa dönüşte robotik cerrahinin endoskopik cerrahiye göre daha dezavantajlı olduğunu belirtmiştir. Cerrahların %90’ı (n=37) robotik cerrahinin Türkiye’de yaygınlaşma alanı bulacağını düşünmekteydi. Robotik cerrahinin yaygınlaşmasının önündeki engeller sorgulandığında ise katılımcıların %100’ü (n=41) maliyetin, %66’sı (n=27) sağlık güvencesi geri ödemelerindeki yetersizliklerin yaygınlaşmanın önünde engel olabileceğini savunurken, ön hazırlık zamanının uzun olması (%20), ekip ve ekipman teminindeki zorluklar (%24) da robotik cerrahinin yaygınlaşmasının önünde yer alabilecek engeller olarak belirtildi.Sonuç: Robotik cerrahinin Türkiye’de yaygınlaşma alanı bulacağı düşünülmektedir. Maliyet düzenlemeleri ve yurtiçi eğitim olanaklarının artırılması ile bu sürecin hızlanacağı görülmektedir., Objective: Robotic surgery is the newest of minimal invasive surgery developments. The opinions of surgeons are different about this topic, though robotic surgery is in a widespread period. This period is going to take some time. The advantages and disadvantages of robotic surgery is going to play a role in this period. The aim of this study to reveal the generality of robotic surgery in Turkey and the factors effect that.Material and Methods: A questionnaire on the advantages and disadvantages of robotic surgery was prepared. It was sent to 104 actively working robotic surgeons via the SurveyMonkey System. The answers of the 41 responders (39.4%) were evaluated. Results: Of the 41 responders, 32 had been working as a specialist for more than 10 years. Eighty percent of them (n=32) stated that they had advanced endoscopic surgery experience. Thirty-one stated that endoscopic experience was an advantage for performing robotic surgery. Forty percent of responders (n=15) had received robotic surgery training abroad and sixty percent (n=25) in Turkey. Even though there were some attendees who thought training abroad was important, 80% of the responders believed that training in Turkey was necessary. We found that 22% (n=9) of the responders had performed more than 100 robotic procedures while 60% (n=25) had performed less than 25. These numbers were less than 10% of the routine operations for 73% (n=30) of the participants. Ninety percent (n=37) of the surgeons stated that not touching the patient was not a limitation. Seventy-six percent reported that robotic surgery training should take place after the residency period. When the superiority of robotic to endoscopic surgery was queried, 83% (n=34) stated that robotic surgery was superior. The advantages of robotic surgery were listed as follows; 98% (n=40) three dimensional – magnified imaging, 88% (n=36) surgeon–controlled camera, 85% (n=35) wrist motion instruments, 75% easier suturing, 73% no camera and instrument tremor, 68% advanced imaging techniques and ergonomy. When the limitations of robotic surgery were queried, 63% (n=25) of the participants reported that robotic surgery had some limitations when compared to endoscopic surgery, and 65% stated that robotic surgery was more disadvantageous when it comes to conversion to open surgery. Ninety percent (n=37) of the surgeons thought that robotic surgery would become widespread in Turkey. The obstacles in front of robotic surgery were determined as cost (100%), insufficiency of health insurance paybacks (66%), long preparation time (20%), and the difficulty of assuring the equipment and a team.conclusion: Robotic surgery is considered to have a wide range of usage in Turkey. Arrangements regarding the cost should be done and national training facilities should be increased to accelerate this process

In the last century, with the advancement of the diagnostic procedures, hematologic disorders in pediatric age group have been increased dramatically. In parallel with this increase, splenectomy procedures have also been popularized with different techniques and surgical outcomes. Laparoscopic splenectomy (LS) in the pediatric age group is generally accepted as a technically demanding procedure, which needs experience. The purpose of this study is to present the long-term follow-up results of a case series of children who underwent LS for a variety of hematologic disorders, evaluate possible complications and outcomes.All patients who were admitted to the clinic and who were scheduled for LS from 2005 to 2016 were considered for this study. The study parameters were grouped in four categories including socio-demographic data, preoperative evaluation, clinical follow-up and complications.There were 24 male (48.9%) and 25 (51.1%) female patients. The median age and body weight for the study group was 12 years and 35 kg. Most common indications for LS were thalassemia (13; 26.5%) and hereditary spherocytosis (12; 24.4%). As a technical standpoint, 2 patients (4%) underwent singleport LS surgery. The mean time for LS surgeries was found as 80 minutes. The total intraoperative complication rate was 4% (2/57). The mean time for hospital stay was 5 days. Mean follow-up period was 6.4 years (range: 6 months-16 years). There was no long-term complication. Bilirubin levels and need for blood transfusion significantly decreased in the long term follow-up period (p0.05).LS is a powerful tool in the hands of an experienced surgeon. It's a safe and effective procedure in children with hematologic disorders resulting in shorter length of stay and lower complication rates.En el último siglo, con los avances en los procedimientos diagnósticos, los trastornos hemáticos han aumentado drásticamente en la población pediátrica. Paralelamente a este aumento, también se han popularizado las esplenectomías con diversas técnicas y resultados quirúrgicos. La esplenectomía laparoscópica (EL) en la población pediátrica está en general aceptada como un procedimiento técnicamente complejo que requiere de experiencia. El objetivo de este estudio es presentar los resultados del seguimiento a largo plazo de una serie de casos de niños sometidos a una EL por diversos trastornos hemáticos, evaluar las complicaciones posibles y los resultados.Se consideró para este estudio a todos los pacientes ingresados al hospital que tenían programada una EL entre 2005 y 2016. Se agruparon los parámetros del estudio en cuatro categorías: datos sociodemográficos, evaluación prequirúrgica, seguimiento clínico y complicaciones.Los pacientes eran 24 varones (48,9%) y 25 mujeres (51,1%). La mediana de edad y peso corporal del grupo del estudio era 12 años y 35 kg, respectivamente. Las indicaciones más frecuentes de EL fueron talasemia (13; 26,5%) y esferocitosis hereditaria (12; 24,4%). Desde la perspectiva técnica, a dos pacientes (4%) se les realizó una EL con puerto único. La media de duración de la EL fue de 80 minutos. La tasa total de complicaciones intraoperatorias fue del 4% (2/57). La media de duración de la hospitalización fue de 5 días. La media de duración del seguimiento fue de 6,4 años (intervalo: de 6 meses a 16 años). No se observaron complicaciones a largo plazo. La concentración de bilirrubina y la necesidad de transfusiones de sangre disminuyeron significativamente durante el seguimiento a largo plazo (p0,05).La EL es una herramienta poderosa en las manos de cirujanos experimentados. Es un procedimiento seguro y eficaz en los niños con trastornos hemáticos, con una hospitalización más breve y una tasa menor de complicaciones.

An 11-year-old morbidly obese boy was diagnosed with pancreatic pseudocyst. Following fine needle aspiration, the cyst recurred in 1-month follow-up. Therefore, endoscopic drainage and cystoduodenostomy was performed following endosonography. Control ultrasonography (USG) revealed a completely shrunken cyst. During the 3 years of follow-up, the patient was asymptomatic with no evidence of cyst on computerized tomography scans. Endoscopic drainage and cystoduodenostomy is a minimally invasive, effective, and safe approach in the management of pancreatic pseudocysts in children.