Efficacy of Bleomycin-Lauromacrogol Foam in Pediatric Macrocystic Lymphatic Malformations With and Without Intracapsular Hemorrhage.

BACKGROUND: Sclerotherapy is purportedly less effective in patients with hemorrhagic than with non-hemorrhagic lymphatic malformations (LMs). We aimed to compare the efficacy of bleomycin-lauromacrogol foam (BLF) sclerotherapy in the treatment of macrocystic LMs with and without intralesional hemorrhage. METHODS: Fifty-five children with macrocystic LMs admitted to the Pediatric Surgery Department were retrospectively included. The patients were allocated into a hemorrhage group (23 cases) or a non-hemorrhage group (32 cases) based on the occurrence of an intracapsular hemorrhage. The diagnosis was confirmed by physical examination, color ultrasound, magnetic resonance imaging, and puncture findings. BLF was injected into the capsule after draining the cystic fluid under color ultrasound guidance. Patients whose lesions were unchanged or showed minor change after 1 month were treated again using the same method. Changes in lesion size and the number of treatments were recorded. Effectiveness was classified as excellent (volume reduction ≥90%), good (50%≤volume reduction<90%), or poor (volume reduction <50%). RESULTS: In the hemorrhage group, 17, 6, and 0 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 100%. In the non-hemorrhage group, 23, 7, and 2 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 93.8%. There was no significant difference in efficacy rate between groups (P = 0.767). CONCLUSIONS: BLF is an effective and safe treatment for macrocystic LMs with bleeding. The results were similar in patients with and without bleeding. LEVEL OF EVIDENCE: Treatment, Level III.

Systematic review and meta-analysis of the effect of nerve block under ultrasound in ilioinguinal/iliohypogastric in children.

Background: Ilioinguinal/iliohypogastric nerve block (IINB) is a common operation in pediatric surgery. Nerve block under contrast-enhanced ultrasound (CEUS) has the advantages of visualization and noninvasiveness, which creates conditions for its application in nerve block. It can significantly improve the success rate of nerve block and reduce the complications of nerve block. At present, few studies in China have analyzed the effect of nerve block guided by ultrasound technology compared with ordinary treatment. Methods: With "ilioinguinal/iliohypogastric nerve block", "ultrasonic examination of the children", and "ultrasonography for ilioinguinal/iliohypogastric" as the keywords, the related literature published before 2022 was searched. RevMan 5.3 and Stata provided by the Cochrane Collaboration were employed for analysis and evaluation. Begg's risk of bias was utilized to assess the risk bias of the included references. Heterogeneity among studies was evaluated using the Q test and heterogeneity (I2). Results: Six studies were included, with a total of 391 cases. The overall risk (OR) of ilioinguinal/iliosubabdominal complications in children treated with nerve block after ultrasound examination was 0.49, and the complications of ilioventral/iliosubabdominal complications in children treated with nerve block after ultrasound examination were reduced. The OR of inhibiting pain events was 0.35, and the ilioinguinal/iliosubabdominal pain events were reduced after nerve block treatment by ultrasound examination. The OR of inhibiting adverse reactions was 0.45. After ultrasound examination, the adverse reactions of ilioinguinal/iliosubabdominal nerve block treatment were reduced, and there was no heterogeneity among the study groups (I2=0.00%). Conclusions: The results of the meta-analysis confirmed that the complications of nerve block treatment after ultrasound examination were less than those of ordinary treatment. The incidence of pain events and adverse reactions in nerve block treatment were reduced after ultrasonography. Moreover, in terms of pain events, the effect of ultrasound guidance was significant. In short, in clinical studies, CEUS can be used to accurately evaluate complex situations and provide a more accurate reference for subsequent treatment.

Transumbilical endoscopic technique for complete closure of inguinal hernias in female pediatric patients.

Laparoscopic percutaneous extraperitoneal closure of inguinal hernia with variable devices as an effective technique in minimal-access surgery for pediatric inguinal hernias in children was investigated in the present study. A Veress needle was inserted into the abdomen. Trocars, laparoscope and needle holder were placed through the umbilical incision. Under laparoscopic monitoring, a round needle was introduced into the peritoneal cavity through the anterior abdominal wall. The end of the suture inside the peritoneal cavity was left outside the peritoneal cavity in favor of ligation. The needle was passed through the peritoneum to place an extraperitoneal purse-string suture around the internal inguinal ring, counterclockwise on the left and clockwise on the right. The needle was then passed back into the peritoneal cavity and out through the abdominal wall, and the needle ends of the stitch were cut. The ends of the suture were tied. We described a technique used for transumbilical endoscopic closure of pediatric inguinal hernias in girls. This technique is simple and can be performed quickly. The cosmetic result is excellent because the two umbilical incisions are only 5-mm long, which make it possible to perform surgery without a visible scar. We performed this procedure in over 96 patients and have had no recurrences. Thus, this method may become the laparoscopic repair of choice for females with inguinal hernias.

Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children.

PURPOSE: To describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children. METHODS: In our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8months to 2.5years; median, 15months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent. RESULTS: The TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30min (range, 25-40min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported. CONCLUSIONS: Our preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results.

Treatment of superficial infantile hemangiomas with timolol: Evaluation of short-term efficacy and safety in infants.

Timolol has been demonstrated to be efficacious in the topical treatment of superficial infantile hemangiomas (IHs). We conducted a prospective study to evaluate the short-term efficacy and safety of timolol in the treatment of superficial IH in Chinese infants. From March to November 2012, 124 patients with superficial IHs were included in the prospective study. The patients were divided into two groups: treatment (101 patients, the timolol drops were administered on the surface of the lesions three times daily, and erythromycin ointment was applied around the lesions) and observation (23 patients, without treatment). The results were categorized into three grades: class 1 (ineffective), class 2 (controlled growth) and class 3 (promoted regression). Within one week of the initiation of timolol treatment, a number of the lesions became softer and lighter in color. Four months following the initiation of timolol treatment, the overall response was class 1 in eight patients (7.9%), class 2 in 36 patients (35.6%) and class 3 in 57 patients (56.4%). Complete tumor regression was observed in 12 patients. No adverse effects were recorded during the treatment period. Among the patients in the observation group, there were 15 class 1 patients (65.2%), seven class 2 patients (30.4%) and only one class 3 patient (4.3%). In conclusion, timolol is an effective and safe treatment for superficial IH. In addition, it may be used in the treatment of proliferative superficial IH, particularly in infants within 6 months of age.

Transumbilical endoscopic surgery for completely enclosing inguinal hernias in children.

BACKGROUND/PURPOSE: There has been great interest in natural orifice transluminal endoscopic surgery in recent years. We report another new approach for pediatric inguinal hernia repair: transumbilical endoscopic surgery (TUES). Compared with the natural orifice transluminal endoscopic surgery technique, TUES can obtain similar scarless results on the abdomen. METHODS: In our hospital, 2-trocar TUES was the standard procedure used to repair pediatric inguinal hernias. Through 2 intraumbilical incisions, two 5-mm trocars were inserted into the abdomen under laparoscopic guidance. With the use of a needle-holding forceps, a round needle with 2-0 nonabsorbable suture material was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The orifice of the hernial sac was closed extraperitoneally with a purse-string suture around the internal inguinal ring, and intraperitoneal knot-tying was performed. RESULTS: A total of 76 inguinal repairs were performed in 64 children (age range, 6 months to 9 years; median, 3.8 years; 44 boys, 20 girls). All operations were completed successfully by TUES, with the exception of one case of intraoperative bleeding because the inferior epigastric vein was punctured. The mean operating time was 20 minutes (range, 15-30 minutes). No postoperative bleeding, hydrocele, or scrotal edema in this group of patients was found, and there were no known cases of postoperative testicular atrophy or hypotrophy nor hernia recurrence on the symptomatic side. CONCLUSIONS: Our preliminary experience shows satisfactory outcomes with TUES for completely enclosing inguinal hernias in children. This technique appears to be safe, effective, and reliable. The cosmetic result is excellent.