Laparoscopic cyst enucleation is a promising technique for treatment of gastrointestinal tract duplications in children.

BACKGROUND: Laparoscopic cyst enucleation has its advantages and limitations in treatment of gastrointestinal tract (GIT) duplications. It allows to avoid bowel resection in such locations as ileocecal valve. We introduced laparoscopic cyst enucleation with further bowel plasty using cyst muscle layer and without monopolar coagulation, for cyst dissection we used straight scissors. MATERIALS AND METHODS: Our study included 20 children with GIT duplications, who underwent cyst enucleation from 2018 to 2021. Laparoscopy was performed in all cases with various cyst locations (stomach - 2, duodenum - 3, small bowel - 14, ileocecal area - 1). Mean age of surgery was 40 ± 35,3 days (min 6 days, max 150 days). RESULTS: Mean operation time was 84,4 ± 27,35 min (min - 40 min, max - 160 min). We had no intraoperative complications. All patients received parenteral feeding for 3-5 days after the operation. Postoperative complications occurred in 3 cases: bowel perforation which required enterostomy (10%) and bowel volvulus required resection (5%). To our opinion, perforations occurred due to monopolar coagulation used for cyst enucleation in these children. No complications were observed in patients who underwent enucleation by straight scissors. Mean postoperative hospital stay was 15.6 ± 10.48 days (min - 4 days, max - 58 days). We observed neither stenosis nor any other complications in the long-term follow-up. CONCLUSIONS: Laparoscopic cyst enucleation is a feasible and safe approach for GIT duplications. It allows to avoid bowel resection, and the use of straight scissors instead of monopolar coagulation provides less postoperative complications such as perforation. THE LEVEL OF EVIDENCE: III.

Band neutrophil sign: A strong first-trimester ultrasound marker of combined duodenal and esophageal atresia.

OBJECTIVES: To reveal a first-trimester sonographic marker associated with combined duodenal and esophageal atresia (DA and EA). METHODS: This retrospective study included four patients referred to our department in the first trimester due to fetal stomach anomaly. In the literature, we found 20 additional cases of combined DA and EA with four of them to be revealed at 12 weeks. RESULTS: We present the largest for to date case series of combined DA and pure EA diagnosed in the first trimester including one with additional visualization of the distal esophageal pouch and its communication with the stomach. All our cases and four previously published reports (including two cases of DA and EA with tracheoesophageal fistula [TEF]) were characterized by the presence of "band neutrophil" sign-a symmetrical C-shaped loop in the fetal abdomen, occupying a central position close to the anterior abdominal wall. Similar findings could be seen also later in pregnancy, but they lack the same prognostic value. CONCLUSIONS: Band neutrophil sign is a pathognomonic first-trimester ultrasound marker of combined DA and EA irrespective of the presence of TEF. Nevertheless, it should be further evaluated in prospective studies.