ABSTRACT
Objective: The aim of this study was to compare the outcomes of high ligation in adolescentswith varicocele between open and laparoscopic surgical approaches. Design: Retrospectivestudy. Setting: The study was conducted from January 2012 to January 2018, with medianfollow-up of 36 months, in the division of pediatric surgery at tertiary-care hospital. Patients:Data of 537 adolescents who underwent varicocelectomy were classified into two groups,depending on surgical approach. Intervention: Open or laparoscopic varicocelectomy. Mainoutcome measures: Indications for surgery, complications, duration of surgery, hospitalstay, and recurrences rate. Results: The median age of the patients was 15 years. Themedian (IQR) duration of surgery was 12 (11,15.3) min in laparoscopic and 25 (10,30) min inopen group (P<0.001). The most common complication was hydrocele (n=29), which wasmore common in open group (6.8% vs 1.4%; P=0.01). A total of 16 recurrences wererecorded, all in open group (P=0.049). In both groups, sperm concentration (P<0.001),morphology (P<0.001) and motility (laparoscopy, P=0.001; P=0.02; open varicocelectomy,P=0.001; P=0.04) improved six months after surgery in patients with varicocele stage I and II.In stage III there was an improvement in sperm concentration (P=0.002; P=0.001) andmorphology (P=0.03; P=0.06), while sperm motility (P=0.15; P=0.2) did not significantlyrecover in either of the groups. Conclusions: Laparoscopic and open varicocelectomy areequally effective and result in significant improvement of testicular volume, disappearance ofpain, and sperm parameters in adolescents. Based on our findings laparoscopicvaricocelectomy is associated with shorter operating time, shorter hospitalization, fasterrecovery, and fewer complications and recurrences
ABSTRACT
Objective: Aim of this study was to examine the changes in incidence of pediatriccholecystectomies. Methods:Based on a review of hospital-records, children were dividedinto two groups regarding year of surgery (Group I: 1998-2007; Group II: 2008-2017) and theircharacteristics were compared. Results: Number of cholecystecomies increased from 11 to34. Median age increased from 11 to 15.5 years and mean BMI increased from 19.2 kg/m2 to23.0 kg/m2. Hereditary spherocytosis decreased from 63.6% to 11.8% (P=0.001) ofindications for cholecystectomy, while proportion of cholesterol stones increased from 27.3%to 70.6% (P=0.006). Frequency of laparoscopic cholecystectomy increased from 36.4% to85.3% (P=0.001). Duration of hospital stay shortened from 8 to 4 days (P=0.008).Conclusions: Number of pediatric cholecystectomies has significantly increased in the last20 years, as well as average BMI of the observed population This probably signifies acorrelation between rising obesity rates and increase in frequency of symptomaticcholelithiasis in children
ABSTRACT
Objective: To compare the outcomes of treatment in childrenwith acute appendicitis between laparoscopic and open surgicalapproaches.Design: Retrospective study.Setting: Division of Pediatric Surgery at a tertiary-care hospitalin Croatia between January 2012 to December 2016.Patients: 834 children [median (IQR) age 13 (11,15)] whounderwent appendectomy; 301 in the laparoscopic group and 533in the open group.Main outcome measures: Postoperative complications,duration of hospitalization, re-operation, and the quantity ofanalgesics used.Results: The median length of hospital stay was 3 days inlaparoscopic group compared to 6 days in open group (P<0.001).The amount of analgesics used was lower in patients withlaparoscopic appendectomy compared to patients whounderwent open procedure (P=0.042). Significantly highernumber of wound infections was recorded in the open group(n=21; 3.9%) compared to laparoscopic group (n=3; 1%)(P=0.014). The frequency of re-operation in both groups wasequal (1.3%). The median duration of surgery was shorter in thegroup of patients with laparoscopic appendectomy compared tothe open approach (30 vs. 45 min; P<0.001). In five-year period,the proportion of laparoscopic appendectomies increased by21.5%.Conclusion: Laparoscopic appendectomy was safe andeffective in children. Advantages of laparoscopic approachwere shorter hospital stay, lower number of wound infectionsand lower usage of analgesics.