Peritoneal Dialysis Catheter Placement in Children: Initial Experience with a "2+1"-Port Laparoscopic-Assisted Technique.

The placement of a peritoneal dialysis catheter (PDC) is currently a common procedure in pediatric surgeon practice, and the search for the ultimate technique never stops. The purpose of this study is to evaluate our experience with the laparoscopic PDC placement approach, performing a "2+1" ("two plus one") technique, where the "+1" trocar is placed in an oblique manner, pointing toward the Douglas pouch when passing through the abdominal wall. This tunnel is further used to place and maintain the proper position of the PDC. MATERIALS AND METHODS: We assessed a cohort of five children who underwent laparoscopic-assisted PDC placement between 2018 and 2022. RESULTS: This procedure is a simple, relatively quick, and safe technique for PDC placement. Furthermore, in our experience, concomitant omentectomy is necessary to reduce the risk of catheter obstruction and migration due to omental wrapping. CONCLUSIONS: The laparoscopic approach allows for improved visualization and more accurate placement of a catheter inside the abdominal cavity. Concomitant omental excision is necessary to prevent PDC malfunction and migration.

Role of imagistic techniques in diagnosing soft-tissue vascular anomalies in pediatric population - a 5-year experience.

Soft-tissue vascular anomalies have a worldwide estimated prevalence of 4.5% in the pediatric population. From January 1, 2014 until December 31, 2018, imagistic and histological evaluations were performed in 214 patients aged between one day and 18 years old, who were diagnosed with different soft-tissue vascular anomalies in our Center. From the 214 patients included in the study, 36.45% (n=78) were males, 63.55% (n=136) were females and 37.38% (n=80) of the patients were less than one year of age at time of admission. Infantile hemangioma was the most frequent type of soft-tissue vascular anomaly (35.51%) and the face was the most frequent affected region (25.7%). Ultrasound (US) examination is the most used imaging technique due to its wide accessibility and for providing valuable information about the anatomical localization of the lesions, the type of vessels involved, distribution and density of vascularization. Magnetic resonance imaging (MRI) can be used for assessing the extent of deep or large lesions, but it usually requires anesthesia. Computed tomography (CT) is useful when patients present contraindications to anesthesia and it has the advantage of a shorter image acquisition time. Histological studies have an important role in establishing the diagnosis even for the atypical cases of soft-tissue vascular anomalies. Furthermore, the prognosis depends on the histological type. In conclusion, there is a need for collaboration between the clinician, radiologist, pathologist and surgeon in order to establish a precise diagnosis and therapeutic strategy for each patient.