The "cut and push" method of removing percutaneous endoscopic gastrostomy tube is not safe in paediatric patients.

PURPOSE: A "cut and push" (CP) approach has been described in the literature for removal of percutaneous endoscopic gastrostomy (PEG) tubes. The aim of this study is to investigate the safety profile of this method in children. METHOD: Our study included all children who underwent CP procedure for either removal or replacement of Freka PEG tube at our centre between January 2016 and August 2021. Parents contacted to establish if the internal component had been seen in the stools post-procedure. If not seen, a plain film of chest, abdomen and pelvis was arranged followed by computerised tomography (CT) scan. The presence of the internal component as a retained foreign body on imaging was evaluated along with any complication. RESULTS: Of the 27 patients included, six (22.2%) patients had the internal component seen in the stool. Five (18.5%) patients in total had a retained internal component with three (11.1%) patients had major complications requiring complex surgical interventions, and two (7.4%) patients required endoscopic retrieval. CONCLUSION: Our study reports more severe complications that required complex surgical interventions compared to the previous studies. We believe that this method of removal is not safe in children and should be abandoned. Also, patients with Down syndrome might be at higher risk of retention and complications.

Perinatal Testicular Torsion in Northern Ireland: A Nationwide 10-Year Review.

INTRODUCTION: Perinatal or neonatal testicular torsion (PTT) is defined as testicular torsion within the first 30 days of life. PTT is a rare event, and bilateral PTT is even rarer. However, recent articles have advocated emergency bilateral exploration to exclude the catastrophic possibility of asymptomatic contralateral testicular torsion leading to anorchia. The aim of this study is to evaluate PTT in Northern Ireland (NI) using a nationwide population-based retrospective observational study. METHODS: All boys in NI who underwent emergency scrotal exploration within their first 30 days of life for possible testicular torsion over a 10-year period (January 2010-December 2019 inclusive) were included. Intraoperative findings primarily evaluated included diagnosis and presence of synchronous or asynchronous (metachronous) contralateral testicular torsion. Secondary outcomes included correlation between intraoperative findings and any preoperative ultrasound scan (USS), and scrotal examination findings during postoperative outpatient follow-up. RESULTS: A total of 19 patients who underwent emergency scrotal exploration in the study period were included. An intraoperative finding confirming the diagnosis of PTT was reported in 14 (73.7%) patients. The incidence of PTT was calculated as 11.3 per 100,000 per male live births in NI, with bilateral PTT accounting for two patients (14.2% of all PTTs), divided equally between synchronous and asynchronous PTTs. Of two affected testes where preservation was felt appropriate intraoperatively, only one was still palpable at follow-up, producing a testicular salvage rate after PTT of only 7.1%. Testicular findings on preoperative USS were confirmed intraoperatively in five out of six patients, producing a concordance rate of 83.3%. CONCLUSION: This is the first nationwide population-based study to calculate more accurately the incidence of PTT, and bilateral synchronous and asynchronous bilateral PTTs, all of which seem to be significantly higher than previously estimated. However, in keeping with previous reports, this study confirms the poor salvage rate of testes undergoing perinatal torsion, and suboptimal concordance between preoperative USS findings and intraoperative diagnosis.

Ascending testis: A congenital predetermined condition.

INTRODUCTION: About 0.8% of boys have undescended testes at 1 year of age. However, the overall rate of orchidopexy is 2.5 times that expected. While studies have shown ascending testes accounting for a proportion of such discrepancy, the aetiology of this ascent remains controversial. In this study, intra-operative findings of patients underwent orchidopexy for ascending testes are evaluated to infer aetiology. METHODS: Patients with confirmed ascending testes from a single paediatric surgery unit over a four-year period from June 2015 till June 2019 were included in this observational study. During orchidopexy procedure, intra-operative findings in terms of gubernacular attachment, and the degree of epididymal attachment to the upper pole of the testicle were primarily evaluated. Secondary findings including the presence and length of patent processus vaginalis (PPV), and the presence of any long looping vas or hydatid of morgangi were also noted. RESULTS: Eighty-three children (median age = 79 months [range 38-149]) were included in this study. Two boys had bilateral ascending testes leading to a total of 85 orchidopexy cases performed. All patients were found to have a gubernacular attachment proximal to the junction between the upper lateral wall of scrotum and the medial part of the thigh. PPV was present in all cases, with its length measured from the deep inguinal ring after retracting the conjoint tendon ranging from 4 to 15 mm 84 cases (98.8%) demonstrated complete or partial separation between the head of epididymis and the upper pole of the testicle. Hydatid of morgagni was present in 82 cases (96.4%), and none of the operated testicles demonstrated looping vas. DISCUSSION: The varying degrees of PPV length demonstrated during orchiodpexy for ascending testes in this study casts a doubt on the role of processus vaginalis in such ascent. Also, there is considerably a wide-range of reported incidence (13-78%) in literature for PPV in ascending testes. In this study, intra-operative findings demonstrated an abnormal gubernaculum attachment in all ascending testes in keeping with previous reports, and support the hypothesis that ascending testis has always been undescended, yet acquired more apparent undescended position with child age and growth. CONCLUSION: Patients with ascending testes seem to share similar intra-operative findings with patients who have true undescended testes. The universal abnormal attachment of the gubernaculum and the omnipresent testicular-epididymal fusion anomalies may indicate that ascending testis is a congenital predetermined condition, and that these testes have always been congenitally undescended, yet obtained a more noticeable position with the child growth.