Laryngeal Mask Airway Versus Tracheal Intubation for Laparoscopic Hernia Repair in Children: Analysis of Respiratory Complications.

Purpose: The aim of this study was to compare the perioperative and postoperative respiratory complications between laryngeal mask (LM) airway and tracheal intubation (TI) in children undergoing percutaneous internal ring suturing (PIRS) for inguinal hernia. Patients and Methods: From October 2015 to February 2019, 135 pediatric patients (97 males and 38 females) with median age of 4 years, who underwent PIRS for inguinal hernia, were included in study. Patients were divided in two groups. In group I (n = 94) LM airway was used, and in group II (n = 41) TI was performed. Demographic data, surgical and anesthesia times, American Society of Anesthesiologists (ASA) classification, muscle relaxation, level of pneumoperitoneum, and complications of anesthesia were compared between the groups. Results: No significant differences among compared groups regarding age (P = .435), sex (P = .306), body mass index (P = .548), ASA classification (P = .506), level of pneumoperitoneum (P = .968), and duration of surgery (P = .968) were found. Duration of anesthesia was significantly shorter when LM was used compared to TI (25 minutes versus 36 minutes; P < .00001). During recovery from anesthesia, the incidences of desaturation (n = 1 versus n = 5; P = .003), laryngospasm (n = 2 versus n = 5; P = .015), and cough (n = 0 versus n = 4; P = .002) were significantly lower when LM airway was used for securing of the airway. Postoperative incidences of sore throat (P = .543), bronchospasm (P = .128), and aspiration (P = .128) did not differ between LM and TI. Conclusions: The use of LM in pediatric anesthesia results in a decrease in a number of common complications and significantly shortened patient anesthesia time. It is therefore a valuable device for the management of the pediatric airway for laparoscopic hernia repair in children.

Late-Onset Hypertrophic Pyloric Stenosis in a 14-Weeks-Old Full Term Male Infant.

BACKGROUND: Hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in infants, and classically presents at 2 to 6 weeks of age. Delayed presentation is an extremely rare occurrence after early infancy. CASE REPORT: A 14-weeks-old full term male infant presented with non-bilious vomiting, dehydration and hypocloremic metabolic alkalosis. Abdominal ultrasonography revealed tubular mass 20 mm in lenght. Because of unusual age, diagnosis was confirmed with upper gastrointestinal contrast study. Laparoscopic pyloromyotomy was performed. After surgery the child was free of symptoms, had gained weight, and was tolerating a regular diet. Message: Despite the age hypertrophic pyloric stenosis should be kept in mind in any child who presents with non-bilious vomiting.

Laparoscopic Varicocelectomy Using Polymeric Ligating Clips and Its Effect on Semen Parameters in Pediatric Population with Symptomatic Varicocele: A 5-Year Single Surgeon Experience.

BACKGROUND: The aim of this study was to evaluate demographic and clinical characteristics of the children undergoing laparoscopic varicocelectomy by using polymeric ligating clips and to evaluate postoperative outcomes and analyze semen according to the grade of varicocele after surgery. PATIENTS AND METHODS: The case records of 120 pediatric patients who underwent laparoscopic varicocelectomy were retrospectively reviewed. The following parameters were examined: age, grade of varicocele, lateralization, diameter of spermatic veins, indications for surgery, duration and outcomes of surgery, complications, and recurrence rate. For patients older than 16 years of age, semen analyses were obtained before and after the surgery and were compared according to the clinical grade of varicocele. RESULTS: The median age of the patients was 15 years. Of the total number of patients, left-sided varicocele was found in 119 patients and bilateral varicocele was found in 1 patient. Of the 120 varicoceles, 8 (6.7%) were grade I, 58 (48.3%) were grade II, and 54 (45%) were grade III. There were no major intraoperative complications. Hydrocele was found in 2 (1.6%) patients. There were no cases of recurrence recorded. Sperm concentration (P < .01), morphology (P < .01), and motility (P < .01; P = .02) improved 6 months after surgery in patients with varicocele grades of I and II, respectively. In grade III varicocele, only sperm concentration (P < .01) and morphology (P = .03) improved whereas motility (P = .150) did not change significantly. CONCLUSION: Laparoscopic varicocelectomy using polymeric ligating clips is a safe, feasible, and cost-effective technique, with a low rate of postoperative complications and recurrence and it significantly improves sperm parameters in adolescents.