Single incision pediatric endoscopic surgery: advantages of a relatively large incision

To describe Single Incision Pediatric Endoscopic Surgery [SIPES] performed on children with various diagnoses, emphasizing its advantages. An observational case series. Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014. A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed. SIPES was performed on 45 patients [21 girls, 24 boys]. Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2 cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO[2] could be ensured. All of the patients/parents were satisfied with the cosmesis. SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO[2], allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision

Management of postoperative pulmonary hypertension by inhaled nitric oxide in a newborn with congenital diaphragmatic hernia

Postero-lateral congenital diaphragmatic hernia [CDH] is a life threatening anomaly characterized by diaphragmatic defect and intrathoracic herniation of abdominal viscera. In patients with CDH, the lungs are hypoplastic and persistent pulmonary hypertension develops in most cases. Although, inhaled nitric oxide [iNO] results in a reduction in pulmonary hypertension with improvement in oxygenation, its benefit in the patients with CDH remains controversial. In this report, the authors present successful management of postoperative pulmonary hypertension by iNO in a newborn with CDH

11-year experience with gastroschisis: factors affecting mortality and morbidity

The aim of the study was the evaluation of patients treated with a diagnosis of gastroschisis and to establish the factors which affected the morbidity and mortality. Twenty-nine patients, managed for gastroschisis during 2000-2010 were reviewed retrospectively. Patients were analysed in respect to gestational age, birth weight, associated anomalies, type of delivery, operative procedures, postoperative complications, total parenteral nutrition [TPN] related complications. The factors affecting mortality and morbidity were determined. Associated abnormalities were present in 24% of the patients. Eleven patients underwent elective reduction in the incubator [Bianchi procedure] without anaesthesia. Eight patients had delayed reduction with silo and ten patients had primary closure. Although the type of delivery had an effect on morbidity but not mortality, gestational age, birth weight, and the operative procedure performed had no effect on morbidity or mortality. Duration until tolerance of oral intake, and of TPN and hospitalization were found to be statistically significantly shorter in the group of babies delivered by caesarean section. The mortality of gastroschisis is reported to be decreasing with the development of antenatal care, neonatal intensive care and TPN. In our study the most important cause of mortality was the abdominal compartment syndrome and multi-organ failure in the early years. Long hospitalization periods and sepsis were the main causes of mortality in recent years