Thyroid Surgery in Children: A 5-Year Retrospective Study at a Single Paediatric Surgical Center and Systematic Review.

The aim of this study was to analyse and evaluate our 5-year experience in paediatric thyroid surgery, as well as the specificities of this kind of surgery in the literature. This retrospective study was based on 19 operations in 17 patients aged from 5 to 17 years who were operated on due to thyroid pathology from 2017 until 2022. We presented data on surgical procedures and complications following surgery. Most of the patients were adolescent girls. The most common clinical presentations included enlarged thyroid gland, followed by thyroid nodules and hyperthyroidism. Eight total thyroidectomies, five left lobectomies, five right lobectomies, and three central neck dissections were performed. The most common histopathological diagnosis was hyperplastic diffuse colloid goitre, followed by papillary carcinoma, cystic nodule, follicular adenoma, Hashimoto thyroiditis and toxic adenoma. Postoperative course was uneventful, with four mild complications (one wound infection, one manifest hypocalcaemia, and two transitory recurrent laryngeal nerve paralysis). In our literature review, eighteen full-text articles were included and analysed. This study demonstrated that thyroid surgery in paediatric population is a safe and efficient procedure. Thyroid pathology in children significantly differs from that in the adults, and paediatric surgeons should be included into the team managing such cases.

Comparison of the Standard vs. Thoracoscopic Extrapleural Modification of the Nuss Procedure-Two Centers' Experiences.

Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive surgery. The aim of this paper is to compare the preliminary results of pectus excavatum repair in two University Centers with a moderate number of patients using the standard Nuss procedure and its modification, the extrapleural thoracoscopic approach. The statistical analysis showed no significant difference for the patient's age (14.52 ± 3.70 vs. 14.57 ± 1.86; p = 0.95) and the CT Haller index (4.17 ± 1.58 vs. 3.78 ± 0.95; p = 0.32). A statistically significant difference was noted for the duration of a pectus bar implant (2.16 ± 0.24 vs. 2.48 ± 0.68; p = 0.03) between the Maribor and Novi Sad Center. We report 14 complications (28%), including dislocation of the pectus bar (10%), pleural effusion (8%), wound inflammation (6%), pericarditis (2%) and an allergic reaction to the pectus bar (2%). Standard and thoracoscopic extrapleural Nuss procedures are both safe and effective procedures used to correct a pectus excavatum deformity. The choice of surgical procedure should be made according to a surgeon's reliability in performing a particular procedure. Our study found no advantages of one procedure over the other.

Laparoscopic-Endoscopic "Rendezvous" Procedure in Pediatric Gastrointestinal Surgery-Case Series.

Laparoscopic-endoscopic "rendezvous" procedures were introduced in surgery for common bile duct stone treatment but are now widely used in other fields of abdominal surgery. An endoscopist navigates a surgeon during the same operative procedure and, thus, enables a better visualization of the location, resection margins, bleeding control, less thermal damage, etc. Here, we present case series of 11 patients that were treated using a "rendezvous" procedure for gastrointestinal lesions on different parts of the gastrointestinal tract such as juvenile polyps on the colon (transversum, ascendens, cecum, sigma), leiomyomatosis of the stomach, Peutz-Jeghers intestinal polyposis, hyperplastic gastric polyp, ectopic pancreatic tissue in the stomach, gastric trichobezoar, and gastric schwannoma. "Rendezvous" procedures are suitable for intestinal lesions that could not be resected endoscopically due to their size, morphology and/or location. In our experience this procedure should be used for endoscopically unresectable lesions as it decreases the time of surgery, possibility of iatrogenic injury, bleeding and technical inability. Furthermore, this procedure has been shown to better navigate the surgeon during laparoscopic surgery, especially in treating polyps in particularly difficult locations such as the duodenum or cecum, and it decreases conversion rates. However, conversion is sometimes necessary, in order to assure all oncological principals are respected, and the best option in some cases.

Corrigendum to "Impalpable Testis: Evaluation of Diagnostic and Treatment Procedures and Our Treatment Protocol".

[This corrects the article DOI: 10.1155/2018/3143412.].

Impalpable Testis: Evaluation of Diagnostic and Treatment Procedures and Our Treatment Protocol.

INTRODUCTION: The aim of this study is to present our treatment protocol for impalpable testis. MATERIAL AND METHODS: In a retrospective study we analyzed clinical data including diagnostic procedures, intraoperative findings, final diagnosis, treatment modality, and outcome of patients with impalpable testis who underwent surgery from January 2010 until December 2015. RESULTS: Ninety-one patients were admitted under the diagnosis of impalpable testis. In 39 patients ultrasound detected testis in the inguinal canal and orchidopexy was done. In 25 patients (48.08%) laparoscopy showed the entrance of the spermatic cord into the inguinal canal. Open exploration of the inguinal canal was done, testicular remnant removed, and appropriate testicular prosthesis implanted. Twenty patients (20/52) underwent orchidopexy of the abdominal testis (46.51%), 4 of which underwent Fowler-Stevens procedure in two stages, and in 16 patients deliberation of the testis and spermatic cord was sufficient to place the testis into the scrotum. CONCLUSIONS: Excision of the testicular nubbin is highly recommendable, as well as implantation of the testicular prosthesis at the time of orchiectomy.

Cryptorchidism and pesticides: Is there a connection?

INTRODUCTION: The aim of our study was to compare the level of the most common organophosphate metabolite, dimethyl phosphate, in urine of women giving birth to both boys with cryptorchidism (study group), and healthy boys (control group), as well as to compare the level of dimethyl phosphate in our population with the results obtained in other populations. MATERIAL AND METHODS: After the ethical approval we included thirty women in both study and control groups. All newborns were born between 38 and 42weeks' gestation. Urine samples were taken on 3rd postpartal day. Gas chromatography with flame photometric detection was used to analyze dimethyl phosphate in urine following the method of Wu et al. Statistical analysis was done using Mann-Whitney test to compare the results in the two groups. RESULTS: Geometric mean of dimethyl phosphate in the study group was 7.18±8.26µg/L and the creatinine-corrected level was 5.63±5.95µg/L, and in the control group, the values are 7.98±6.75µg/L and 6.15±7.01µg/L, respectively. There was not a statistically significant difference in levels of dimethyl phosphate between these two groups (p=0.72786). Dimethyl phosphate levels obtained in similar studies are: 14.4µg/L in Israel, 3.7µg/L in Palestine, 10.3µg/L in Jerusalem, 1.60µg/L in Caribbean islands and 2.60µg/L in Canada. CONCLUSIONS: Pregnant women in our country are exposed to organophosphate pesticides, but a correlation between the exposure to organophosphate pesticides and cryptorchidism was not found. LEVEL OF EVIDENCE: I. TYPE OF STUDY: Prognostic study, prospective study.

VALUE OF PROTECTIVE STOMA IN RECTAL CANCER SURGERY.

INTRODUCTION: Anastomotic leakage is the most serious surgical complication in rectal surgery. The aim of this study was to find out whether a protective stoma was capable of lowering the rate of clinical anastomotic leakage and to evaluate the rate of anastomotic leakages requiring resurgery. MATERIAL AND METHODS: A retrospective study included a sample of 149 consecutive patients with rectal cancer who had undergone elective rectal resection with primary anastomosis. After total mesorectal excision, the anastomosis was created using either the single stapling or double stapling anastomotic technique. Anastomotic integrity was verified by transanal air insufflations with the pelvis filled with saline. A protective covering colostomy was added in selected cases and according to the surgeon's preference. RESULTS: A protective stoma was created in 31% of patients. Clinical anastomotic leakage occurred in 6.7% of patients (10/149). Anastomotic leakage occurred in 8.5% of the patients with a protective stoma (4/47) and in 5.9% of those without a protective stoma (6/102), which was not statistically significant. Surgery lasted significantly longer when a stoma had to be created than in case when it was not needed (p=0.024). The overall rate of resurgery due to postoperative surgical complications was 5.3% and in three cases this happened because of anastomotic leakage. All patients with a protective stoma and clinical anastomotic leakage were treated conservatively, compared to 50% of patients without a protective stoma who suffered anastomotic leakage and had to be operated. CONCLUSION: A stoma cannot prevent but it can surely minimize surgical complications related to anastomotic leakage and it does reduce the rate of resurgery.