Management of esophageal atresia and early predictive factors of mortality and morbidity in a developing country.

The aim of this study is to investigate management and outcome in esophageal atresia (EA) and to identify early predictive factors of morbidity and mortality in a developing country. Charts of neonates with repaired EA from 2007 to 2016 were reviewed. Patients' characteristics, operative details, and postoperative outcomes were collected. Statistical analyses were performed to identify predictors of complicated evolution. Forty-two cases were collected. There were 14 girls and 28 boys. Only one patient had antenatal diagnosis (2.3%). The mean gestational age was 38 weeks. Nine patients (21.4%) weighed less than 2.5 kg. Seventeen (40.4%) patients had associated malformations most commonly cardiac (9/17). Thirteen patients had delayed diagnosis (30.9%). Thirty-nine (92.8%) patients underwent primary esophageal anastomosis. Overall survival was 76.2%. Nineteen patients (57% of survivals) had complicated evolution before the age of one year and 15 patients (46.8% of survivals) developed complications after the age of one year. Perinatal variables associated with mortality were prematurity (p = 0.004, OR = 5.4, IC95% = [1.13-25.80]), low birth weight (p = 0.023, OR = 7, IC95% = [1.38-35.47]), cardiac malformations (p = 0.006, OR = 10.5, IC95% = [2.03-54.27]) and delayed diagnosis (p = 0.005, OR = 10.11, IC95% = [2.005-50.980]). Variables associated with short-term and middle-term complications were duration of intubation (p = 0.019, OR = 0.118, IC95% = [0.019-0.713]) and the presence of short-term complications (p = 0.016, OR = 7.33, IC95% = [1.467-36.664]) respectively. These factors may be used to identify patients who will benefit from more intensive follow-up program.

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia.

Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.

Hybrid laparoendoscopic single-site (LESS) pyeloplasty: Initial experience in children.

BACKGROUND AND OBJECTIVE: Mini-invasive surgery is still evolving to get better surgical conditions for patients with ureteropelvic junction obstruction. We used technical modifications (hybrid pyeloplasty) that simplify surgical steps of laparoendoscopic single-site pyeloplasty in children. Our aim was to compare hybrid pyeloplasty to laparoendoscopic single-site pyeloplasty and to open pyeloplasty. PATIENTS AND METHODS: We retrospectively reviewed records of patients with ureteropelvic junction obstruction aged<14years undergoing pyeloplasty at our institute from January 2011 to December 2015. Demographic data, laterality, operative time, length of hospital stay, drainage tubes, and postoperative complications were recorded. Surgical outcomes were evaluated based on renal sonography and Lasix diuretic renography. RESULTS: Among 38 patients, 17 underwent open pyeloplasty (group I), 10 had laparoendoscopic single-site pyeloplasty (group II) and 11 had hybrid pyeloplasty (group III). The mean age at the time of operation was 55 months. The operative time in group III was significantly shorter than that in group I and group II (P<0.001). The shortest median hospital stay was noted in the group III. The mean follow-up period was 26 months (range: 6-52 months). CONCLUSION: The hybrid pyeloplasty using LESS combine the successful outcomes of open surgery and advantages of minimally invasive surgery. It offers small incision surgery, good working space, short operation time, secure anastomosis and good cosmetic results. LEVEL OF EVIDENCE: 5.

Percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia: Review of three cases.

Morgagni hernias are uncommon, accounting for only 1-2% of all congenital diaphragmatic hernia. Minimally invasive surgery is today the gold standard treatment. We present a technique using percutaneous suturing and single-site umbilical laparoscopic repair of Morgagni hernia in three children. Recovery was uneventful in all three patients. There was no recurrence and the chest radiograph remained normal during the postoperative follow-up. The percutaneous suturing technique and single-site umbilical laparoscopic repair of a Morgagni hernia is an easy and effective alternative to standard laparoscopic repair.

[Comparison of the inguinal and scrotal approaches for the treatment of cryptorchidism in children]. / Traitement chirurgical de la cryptorchidie chez l'enfant : comparaison des voies d'abord scrotale (Bianchi) et inguinale.

INTRODUCTION: The single scrotal incision orchidopexy was described by Bianchi in 1989. Despite its popularity, the place of this technique in the treatment of cryptorchidism in children is still unclear. AIM OF THE STUDY: To evaluate and compare the outcomes of the conventional inguinal approach and the scrotal approach for the treatment of palpable undescended testis in children. METHODS: A prospective study for all patients with palpable undescended testis undergoing orchidopexy between January 2011 and December 2013 was conducted. Totally 200 patients were randomly divided into two groups: group 1: two incisions inguinal approach (80 patients, 100 testis); group 2: single scrotal incision approach (89 patients, 100 testis). MAIN RESULTS: The patients' mean age was 53.9±13 months in group 1 and 45.8±9 months in group 2. There was no statistical difference between the two groups in terms of patient age (P=0.8) and location of the undescended testis (P=0.359). Operative time was statistically significantly lower in the scrotal group (P<0.05). There was a significant difference in the complications rates between the two groups. CONCLUSION: The single scrotal incision orchidopexy is safe and effective for undescended testicles palpable in the inguinal canal or in high scrotal position.

Single-port laparoscopic ovarian transposition in an 11-year-old girl.

Ovarian transposition was the first procedure proposed for children with cancer to preserve ovarian function from damage caused by abdominal and pelvic radiotherapy. In this paper, we describe the first pediatric case of single-port laparoscopic ovarian transposition.

[Neonatal renal candidiasis: a case report]. / Candidose rénale chez le nouveau-né : à propos d'une observation.

UNLABELLED: Neonatal renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. CASE REPORT: a female infant was born by cesarian section at 30 weeks' gestation to a mother whose pregnancy had been complicated by rupture of membranes for 5 days. The infant was admitted at birth, maternofetal bacterial infection was suspected, and intravenous antibiotics were prescribed. The patient developed sepsis caused by Klebsiella pneumoniae at the age of 13 days. She was referred to our hospital at the age of 50 days because of renal abscess. At admission, the baby presented with hypothermia and abdominal distention. Renal ultrasonography findings were compatible with fungal disease. Blood, urine, and cerebrospinal fluid cultures were negative for fungi; however, galactomannan antigen blood levels were increased. Amphotericin B was administered for 6 weeks. End-organ evaluation of the heart, brain, and eyes did not demonstrate disseminated infection. The patient was discharged with a prescription for oral fluconazole and remained well at follow-up.

[Nutcracker syndrome: a rare cause of hematuria]. / Le syndrome casse-noisette (Nutcracker) : une cause rare d'hématurie.

Nutcracker syndrome is a rare cause of hematuria in children. Clinical signs relate to compression of the left renal vein between the aorta and the superior mesenteric artery. The diagnosis is suggested on cystoscopy, which reveals unilateral hematuria, and confirmed by imaging. We report the case of a 4-year-old child who presented nutcracker syndrome confirmed by CT angiography of the abdomen after excluding the other causes of hematuria. Through this observation, we emphasize the reality of this syndrome in children and the value of imaging in the evaluation of this rare affection.

Are there any predictive factors of metachronous inguinal hernias in children with unilateral inguinal hernia?

PURPOSE: This study was done to identify risk factors for metachronous manifestation of contralateral inguinal hernia in children with unilateral inguinal hernia. METHODS: This is a retrospective study of 565 patients with inguinal hernia during a nine-year period at a single institution. Age, sex, and side of the hernia at presentation were recorded. The incidence of metachronous inguinal hernia and its risk factors were analyzed. RESULTS: Of 565 children, 62 (11%) were presented with synchronous bilateral hernias. Of the remaining 503, a metachronous contralateral hernia developed in 22 (4.4%). The age at hernia repair of the patients with contralateral manifestation (18 ± 3.67 months; mean ± SD), was significantly younger than observed in the control patients (34 ± 1.34 months; p = 0.000). There was no significant difference between the groups in other factors such as the age at hernia presentation, the initial side of the hernia, birth weight. and the percentage of patients who had experienced incarceration. CONCLUSION: We believe that the incidence is still too low to recommend routine contralateral exploration. Therefore, infants younger than 18 months appear to be a higher-risk subpopulation and should receive closer follow-up over this time period.

Pediatric urolithiasis in Tunisia: a multi-centric study of 525 patients.

PURPOSE: To investigate retrospectively the clinical and epidemiological characteristics, and method of treatment of childhood urolithiasis, a major urological problem in Tunisia. MATERIALS AND METHODS: The records of 525 children with urolithiasis treated in Tunisia between 1990 and 2004 were reviewed in a multi-centric study with regard to age at diagnosis, sex, history, and physical, laboratory, and radiologic findings. Metabolic evaluation when performed included serum electrolytes, calcium, phosphorus, uric acid, 24-h urine collection for calcium and creatinine, and a sodium nitroprusside test for cystine. In all cases urine specimens were sent for culture. RESULTS: The stone was located in the upper tract in 420 (80%) and lower tract in 105 children. Of the urine cultures, 40% were positive. Metabolic investigation was performed in 201 patients and was normal in 170 (84%). Urinary stasis secondary to a urinary tract anomaly that led to the formation of stones was found in 77 patients. Stones were treated by surgery (80%), extracorporeal shock wave lithotripsy (ESWL) (5%) and ureteroscopic extraction (4%), and percutaneous nephrolithotomy was performed in 10 patients (2%). The stone passed spontaneously in 9% of cases. CONCLUSION: The use of ESWL and endourological methods of treatment for childhood urolithiasis must be generalized, with open surgery being reserved for particular and complex cases.

[Post-traumatic intrasplenic arteriovenous fistula in a child. Spontaneous regression]. / Fistule artério-veineuse intrasplénique post-traumatique chez un enfant. Régression spontanée.

We report on an 11-year-old boy who developed splenic arteriovenous fistula resulting from blunt abdominal trauma. This fistula disappeared spontaneously after 8 months of follow-up without any complication.