ÖZAmaç: Posterior Üretral Valv (PUV) konjenital obstrüktif üropatinin en sık nedenidir.PUV tanısında Voiding Sistoüretrogram (VCUG) altın standart olarak kabul edilse de duyarlılığı % 79-100 arasında değişmektedir.Üretral oran (UO) endoskopik valv ablasyonunun başarısını ölçmek için kullanılmıştır.Çalışmanın amacı PUV tanısında UO'nun cut-off değerini belirlemektir.Gereç ve Yöntemler : Kliniğimizde VCUG ve sistoüretroskopi uygulanan PUV'i olan ve olmayan hastaların kayıtları geriye dönük olarak incelendi.Posterior üretra çapını Anterior üretra çapına bölünerek üretral oranı hesaplandı.Antenatal hidronefraz, vezikoüreteral reflü birlikteliği, kan üre nitrojeni, serum kreatinin değerleri ve glomerüler filtrasyon hızları kaydedildi.İstatistiksel analiz olarak Ki-kare ve Mann-Whitney U testleri kullanıldı.ÜO'ın cut-off değerini belirlemek için receiver-operator curves (ROC) analizi ile spesifite ve sensitivite hesaplandı.Bulgular : PUV tanılı 35 hastanın (ortalama yaş 29,37 ± 43,25 ay) ve PUV olmayan 22 hastanın (ortalama yaş 15,68 ± 30,74 ay) ortalama ÜO değerleri sırasıyla 2,73 ± 1,08 ve 1,61 ± 0,47 idi.İki grubun ortalama ÜO'ı arasındaki fark istatistiksel olarak anlamlı bulundu (p = 0.001).ROC analizinde hesaplanan en iyi ÜO cut-off değeri 1,69 olarak saptandı.Sonuç : Çalışmamızda tanımlanan ÜO cut-off değerinin kullanımı, PUV tanısında VCUG'nin yorumlanmasında görülen tutarsızlıkların azaltılmasında faydalı olabilecektir.
Aim: COVID-19 was declared pandemic in March 2020.Turkish government issued stay-at-home orders and hospitals cancelled non-emergent surgeries.Our aim was to assess the impact of the COVID-19 pandemic on the presentation and management of pediatric appendicitis.Materials and Methods: All appendicitis admissions between 01/03/2019-01/03/2021 were reviewed.Two groups were created: 12 months before COVID-19 (Nonpandemic Group) and 12 months after the date elective surgeries were postponed in TURKEY (01/03/2020) for COVID-19 (Pandemic Group).Patient demographics, symptoms, laboratory and imaging results, perforation status, intraoperative and pathological findings, and postoperative outcomes were analyzed.Results: A total of 471 patients (264 Non-pandemic, 207 Pandemic) were evaluated.Age and gender of both groups did not differ significantly.There was significant increase in time between onset of symptoms and presentation to the hospital in Pandemic-group (1.0±1.8 vs 2.0±1.8days, p<0.001).Symptoms reported at presentation included fever, abdominal pain, vomiting and anorexia; fever was more common in non-pandemic group being the only symptom significantly more prevalent (63.3% vs 36.7%, p =0.014).The proportion of patients diagnosed with complicated appendicitis was significantly higher during the COVID-19 pandemic (69.3% vs 79.7% p=0.03).CRP levels (50.4±63.8vs77.87±79.3,p<0.001) and diagnostic sensitivity of abdominal USG (53% vs 66.7% p<0.05) was higher in pandemic group.Although standard therapy protocol was not changed mean length of hospitalization after surgery in Non-pandemic group was significantly lower (3.0±2.1 vs 3.0±1.3daysp< 0.001). Conclusion:The pandemic resulted in higher proportion of complicated appendicitis, most likely as a result of parents' delay in seeking medical care due to fear of Covid-19.Although complicated appendicitis numbers were higher and time of hospitalization was lower in pandemic group there was no significant difference in number and types of complications following surgery Despite presenting later during COVID-19, pediatric patients with appendicitis were treated expediently with good outcomes.
Aim: Esophageal atresia (EA) is the disconnection of the proximal and distal parts of the esophagus and is a pathology that needs to be surgically corrected.With the technological and technical developments in recent years, thoracoscopic repair of EA can be performed.In this study, it was aimed to evaluate the thoracoscopic repair of EA videos published on YouTube.Methods: Videos obtained by searching YouTube for "Thoracoscopic repair of esophageal atresia" on July 6, 2020 were evaluated according to criterias of LAP-VEGaS and critical view of safety (CVS).Results: 23 videos were included in this study.The median (IQR) (%) of the videos conforming to the criterias of LAP-VEGaS was 24% (18-37%).The median (IQR) (%) of the videos conforming to the criterias of CVS was 85% (85-100%).A strong correlation was found between video length and CVS conformity percentage (p<0,01).It was determined that 71% of the CVS criteria were 100% complied with. Conclusion:Despite the high conformity of the videos to CVS, their conformity to LAP-VEGaS was low.For this reason, it was concluded that the trainees who will watch the video should also check whether the video is refereed or quality controlled.
Recently, fluorescent guided surgical procedures have been increasingly used in pediatric surgery and urology.This method is based on the principle that fluorochrome molecules produce radiation at a different wavelength when exposed to laser or near-infrared light of a certain wavelength.Thus, both the vascularization -perfusion of the tissues can be evaluated and the contrast difference in the tissue allows tissues to be distinguished.Today, fluorescent guided surgical procedures are performed with indocyanine green (ICG) and nearinfrared fluorescence (NIRF) imaging systems.This technology is used for various purposes such as determining the intersegmental planes of lungs during the operation, imaging the bile ducts, determining the borders of tumors, metastases, and ischemic tissue, evaluating the perfusion of the anastomotic lines.Many surgical procedures are performed more safely and quickly owing to ICG/NIRF imaging.The aim of this article is to summarize the basic features of the ICG/NIRF imaging method, use in pediatric surgery and urology, advantages, limitations, and our experimental experience on this subject in the light of the literature.
Introduction: Adolescent pregnancy (AP) is defined as pregnancy in girls between the ages of 13-19 while adolescent motherhood (AM) describes adolescents who become mothers during this period.The current study aimed to gather the opinions of surgeons working in Pediatric Surgery, General Surgery, Gynaecology, and Urology in Turkey on which departments and specialists should perform the surgical management of these patients.Methods: A questionnaire designed to gather the opinions of Turkish surgeons working in Pediatric Surgery, General Surgery, Gynaecology, and Urology on the management of non-obstetric surgical diseases that occur in AP and AM was distributed using Google Forms.Results: The questionnaires were answered by pediatric surgeons (n=80), gynaecologists (n=62), general surgeons (n=45) and urologists (n=37).As seen in the responses, while 62,2% of general surgeons believed that all patients under the age of 18 should be considered as children and treated by pediatric surgeons, 88,5% of gynaecologists, 56,8% of urologists, and 52,5% of pediatric surgeons disagreed.The differences between the responses were also found to be significant (p<0.001). Conclusion:The results indicated that most pediatric surgeons working in Turkey -and a significant number of adult surgeons from other specialisms --believed that the surgical treatment of AP and AM patients should not be managed exclusively by pediatric surgeons.Further, the results suggested that in Turkey, pediatric surgeons and adult surgeons failed to agree on this issue, and thus, additional legal regulations are required to guide medical professionals on this issue to mitigate instances of malpractice cases and improve child safety in medical settings.Ultimately, we believe that the best solution is to reduce the number of adolescents becoming pregnant via education on abstinence and/or contraception
Retrograde intrarenal surgery has become the primary approach for the treatment of renal stones among many centers.The excessive use of irrigation fluids during procedures may cause an increase in intrarenal pressure; hence leading to their perirenal extravasation.This case report aims to emphasize the significant steps of anesthesia management of a 4.5 year old male pediatric patient who, despite achieving adequate depth of anesthesia while undergoing intrarenal surgery due to cystine stones, was reported to have tachycardia, hypertension, increased lung pressure and a significant decrease in his right kidney regional oxygen saturation index measured by near infrared spectroscopy.
Aim: This study aimed to reveal the changes in the clinical status and results of pediatric cases with acute appendicitis during the COVID-19 pandemic. Materials and Methods:The data of pediatric patients who underwent appendectomy for acute appendicitis between March 1 and May 31, 2019 (group B) and March 1 and May 31, 2020 (group A) in our city were reviewed retrospectively.All data were evaluated and the groups were statistically compared. Results:The mean age of group A (n=29, 9 female, 20 male) was 12.69 years, and the mean age of group B (n=65, 21 female, 44 male) was 11.12 years.It was found that the number of patients undergoing appendectomy decreased significantly during the COVID-19 pandemic compared to the same period of the previous year.The mean duration of symptoms was significantly longer in group A compared to group B (p<0.001).The late admission rate was higher in Group A compared to Group B (p=0.012).While the mean white blood cell (WBC) count did not differ between the two groups, mean C-Reactive Protein (CRP) levels were significantly higher in group A compared to group B (p<0.001).Complicated appendicitis was observed in 7 patients in group A and 10 patients in group B (p=0.532).Duration of surgery was significantly higher in group A (49.82±19.09min and 40.15±11.61min).The rate of patients who underwent postoperative drainage was significantly higher In group A (4 patients) compared to group B (1 patient). Conclusion:The results of this study showed that the number of patients with acute appendicitis who applied to our hospital decreased significantly during the COVID-19 pandemic, and the incidence of complicated appendicitis and more severe clinical symptoms increased due to late admission to healthcare institutions.
Posterior urethral valve is the most frequently seen congenital obstructive uropathy in male neonates with antenatal hydronephrosis.We aim to present a rare complication of antenatal vesicoamniotic shunt (VAS) dislodgement in a male neonate with antenatal bilateral hydroureteronephrosis and megacystitis.Thirty three weeks-old male neonate who has been followed for antenatal bilateral hydronephrosis and olygohydramniosis, delivered by an urgent cesarean section at 33 weeks due to anhydramniosis.He had a history of vesicoamniotic shunt placement at 27th week of gestation for prenatal diagnosis of obstructive uropathy.A protruding abdominal mass was detected after birth and urgent laparotomy was performed.Vesicoamniotic shunting is preferred to protect upper urinary tract from effects of bladder outlet obstruction and help respiratory development.The method has some probable maternal and fetal complications.It should be kept in mind that abdominal organ prolapse can be seen with dislocation of shunt and patient may need a laparotomy soon after birth.
Background: Enuresis Nocturna (EN) is a common problem in children and stresses the child and family.The aim of the study is to determine the frequency of EN in primary school children in Balikesir city center and to investigate the demographic data, sociocultural levels and accompanying factors of enuretic children.The research data were collected from the parents of primary school age children schools in Balikesir city center, which were allowed by the Provincial Directorate of National Education.Number of children (research universe) is 12,027.When multi-stage stratified-cluster sampling, which is one of the probabilistic sampling methods, is performed, it is aimed to reach 373 student families from 5 primary schools. Results:The frequency of EN in primary school children in Balikesir is 18% (n:468).When the enuretic and non-enuretic students were compared according to the frequency of some variables; Sacral hair, encopresis, urinary incontinence, running to the toilet suddenly, and the presence of EN in the parents were significantly higher in children with enuretics. Conclusion:Physicians, teachers and families should keep in mind that EN is a complaint.This problem may disappear with the maturation of the child over time, or it may be the first symptom of an organic problem.According to the detailed anamnesis and the answers to the questions that have a purpose, it should be understood which type of problem should be addressed, and it should be kept in mind that in the presence of daytime findings, it is necessary to apply for further examinations.
Aim: Duhamel operation is widely used in the definitive treatment of Hirschsprung disease (HD) because of its many advantages.However, various modifications of Duhamel's classical technique have been developed to eliminate the blind rectal pouch.In this series, we present our modification of the Duhamel-Martin technique. Materials and Methods:A new modification was applied to eliminate the blind rectal pouch in seven consecutive patients.After using a stapler between the pulledthrough colon and the aganglionic rectum, mucosectomy was performed at the proximal end of the aganglionic blind pouch, and an acceptable small rectal ampullary volume was obtained.Results: Radiologically, the rectal aganglionic blind pouch was eliminated, and no complications were observed during the follow-up period. Conclusion:This new, simple, and promising modification eliminates the aganglionic pouch and its complications, which is a significant disadvantage of Duhamel's operation.
Introduction:Children, for whose well-being we work for in Pediatric Surgery, have always been important in the life of Mustafa Kemal Atatürk, including even the conditions of war.The aim of the study is to present his perspective and actions towards children. Materials and Methods:Texts obtained from books, newspapers and magazines were examined.Atatürk pictures obtained from personal collections and various auctions were used. Results:Institutions have been established to protect children and to ensure that they receive good education.Children's Day began to be celebrated for the first time in the world.Mustafa Kemal Atatürk is a leader who gives children the right to speak and takes their ideas into consideration. Conclusion:He entrusted his greatest work, the Republic of Turkey, to children and youth, whom he describes as the assurance of the future.It should be ensured that children are protected from all kinds of neglect and abuse, that they do not forget the importance of being hardworking besides their intelligence, and that they do not give up in the face of any difficulties.It is these little ladies and gentlemen who will raise and sustain the Republic.
Objective: Rectal prolapse is common in children below the age of 4 years.A significant number of children undergo spontaneous resolution over time, hence upfront surgical treatment is not commonly offered to these patients, resulting in prolonged sufferring in symptomatic children while hoping for a spontaneous resolution.Abdominal rectopexy involves extensive mobilization of the rectum followed by its fixation to the presacral fascia(1) thereby increasing the risk of damage to the nervi erigentes, with resultant postoperative constipation, bladder and sexual dysfunction.The present study was done on the premise that the pathophysiology of prolapse begins with intussusception and hence can be prevented by pexing the start point that is the rectosigmoid instead of the rectum.Methods: Our study included patients over a period of six years who underwent upfront surgery for full thickness rectal prolapse.The surgery performed was a modification of the Well's procedure, by avoiding rectal mobilisation completely and by fixing the rectosigmoid to the presacral fascia using an absorbable mesh.Results: 17 patients (mean age -7 years) underwent surgery.Early recurrence occurred in one patient.There was no prolonged constipation, bladder dysfunction or mesh related complications.Conclusion: Upfront surgery for complete rectal prolapse stops the suffering a child has to undergo each time the child passes stools, while the parents are hoping for a spontaneous resolution with some form of conservative management.The surgical technique we followed is effective and avoids complications arising due to denervation of the rectum during mobilization.
Objective: Recent studies have focused on approaches based on clinical parameters rather than predetermined therapy.The clinical outcomes based on setting of protocols are limited.In 2020, our institutional protocol was revised to standardize management of appendicitis.We aim to present the clinical outcomes of setting standardization in the management of appendicitis.Methods: A retrospective study was conducted in patients who were diagnosed with appendicitis and underwent appendectomy according to the settled preoperative, operative and postoperative standards, between April 2020 and October 2020.The results of the same number of patients treated before standardization (Pre-S) and those treated after standardization (Post-S) were compared.Results: 17 patients (mean age -7 years) underwent surgery.Early recurrence occurred in one patient.There was no prolonged constipation, bladder dysfunction or mesh related complications.Results: The data of 388 patients were analyzed, 13/188 (7%) patients in the Pre-S group and 5/188 (3%) in the Post-S group were found to have negative laparotomy and were excluded from the groups.There was no difference between the groups in terms of demographic, clinical and operative characteristics (p>.05).It was found that the length of hospital stay decreased in Posy-S patients, but the difference was not significant (p>0.05).In cases with perforated appendicitis, a significant decrease was found in the Post-S group in terms of total number of complications and re-admission to the hospital (p<0.05). Conclusion:It was concluded that setting standards in the approach to appendicitis in children improve clinical outcomes, especially in patients with perforated appendicitis.Children with appendicitis managed with standard protocols may benefit more from treatments.We recommend the development and implementation of standards in terms of fewer negative laparotomies, fewer complications, and fewer re-admissions.
Tracheoesophageal (TE) malformations represent a real challenge to all paediatric surgeons and paediatric intensivists even in advanced paediatric surgical facilities.These anomalies include a wide spectrum of anatomical alterations resulting in respiratory difficulties and feeding impairment most commonly in the first few hours after birth.The third most common configuration of which is diagnosed when an isolated TE fistula happened without any esophageal discontinuity, this is called H-type, Vogt IV, and Gross E. Usual clinical presentation is recurrent aspirations, choking, and cyanosis after feeding.A high index of suspicion accompanied by an experienced radiologist, and rigid bronchoscopy could usually lead to the diagnosis.The classical surgical approach is usually via the right cervical route rather than thoracotomy, and more recently, the thoracoscopic repair.In this report, we describe a successful repair of an isolated TE fistula in a 11-month-old male infant presented with history of frequent chocking upon feeding and recurrent pneumonia.Five days of nasogastric feeding and stabilization were enough to make this patient fit for right thoracoscopy under general anaesthesia.Hem-o-lok polymer clips were applied on each side of the fistula, then the fistula was divided with scissors.Smooth postoperative period at our paediatric ICU, and the patient was sent home with full feeding on the 6th postoperative day.Then follow up visits were scheduled to see the patient within 10 days, one month, two months, four months, and one year and two years, he was completely free from any respiratory complaints, and he is thriving well.In conclusion, despite being infrequent, isolated TE fistula represents a real diagnostic and therapeutic challenge in paediatric surgery.Thoracoscopic repair becomes increasingly used in many centres globally with obvious safety.Hem-o-lok polymer clips can be a safe option to seal both ends of TE fistula before its division thoracoscopically.
Amaç: Çalışmamızda alt üriner sistem disfonksiyonu nedeniyle mesane Botulinum Toksin-A (BTA) enjeksiyonu tedavisi uygulanan seçilmiş hastaların, tedaviye yanıt düzeyini farklı tanı yöntemleri incelemeyi amaçladık
AVentriculoperitoneal (VP) shunting is the most common method used in the treatment of most types of hydrocephalus.VP shunt complications such as catheter infection or obstruction, abdominal pseudocyst formation, and catheter dysfunction are common, while free migration of the distal catheter into the abdomen is rare.Due to the reasons such as the need for smaller incisions compared to laparotomy, better visualization of the inside of the abdomen, shorter operation time and cosmetic superiority; three cases in which we removed the peritoneal distal peritoneal catheters that were disconnected and fell into the abdomen by laparoscopic method will be presented.
Introduction:The cremasteric reflex, which makes the testicle mobile, and excessive scrotal adipose tissue may mimic scrotal emptiness, leading to the evaluation of cases as undescended testes.Although it has been suggested that the location of the testes cannot be determined by imaging tests, suspicious localization may lead the physician to imaging tests.This study reveals the needlessness of ultrasonography (USG), especially in palpable cases.Methods: In our study, patients who had their initial evaluation and USG performed by a pediatrician were targeted.Finally, a pediatric surgical evaluation was performed by a single pediatric surgeon, and the findings were compared.The cases were divided into two groups, normal and abnormal testicles, based on the pediatrician's distinction.According to this distinction, all cases were evaluated as a whole.Testes that could not maintain their position within the scrotum were considered abnormal.Consistency was sought in intergroup relations with Cohen's Kappa. Results:The study was conducted with 75 patients who met the criteria.In the group with normal localization in the pediatrician examination, pediatric surgical evaluation was compatible in one (2.6%) of the cases reported as abnormal on USG and 38 (100%) of the cases reported as normal on USG.In the group with abnormal localization in the pediatricians' examination, pediatric surgical evaluation was compatible with 32 (40%) of the cases reported as abnormal on USG and four (100%) of the cases reported as normal on USG.Discussion: Radiologic examination of testicles, the localization of which cannot be ascertained by USG, began in the 1970s and is still being practiced.Some institutional bodies and independent researchers express opposing views, and some authors suggest that USG should be used. Conclusion:The popularity of USG does not seem to be ending.In our study, the findings showed that the number of patients referred to surgery by USG was significantly higher.The findings obtained in this study suggest that imaging should be confined to non-palpable cases and USG only, and diagnostic laparotomy should be accepted as the gold standard.Relying on normal pediatric exams and being skeptical of abnormal reports revealed by USG will mean staying on the safe side.
ÖZGiriş: Cinsiyet gelişim kusuru (CGK), hormonal bozukluklar, psikososyal farklılıklar gibi pek çok sorunu içinde barındıran hastalık grubudur.Etyoloji oldukça heterojendir.Endokrin, cerrahi ve psikososyal sorunların yönetimi için erken ve doğru tanı önemlidir.Bu çalışmada CGK'lu hastaların klinik profilinin, etiyolojik sınıflandırmalarının, tanıda yol gösterici hormon parametreleri ile antropometrik ölçümlerinin ve bu hastaların yönetiminin gözden geçirilmesi
Objective: Although malignancy is very rare in paediatric breast lesions, the presence of breast swelling is generally worrying for patients and their families.Breast masses affect approximately 2% to 3% of females in childhood .However, the rate of breast swelling associated with normal pubertal development in children admitted to hospital with a complaint of breast swelling is unknown.This study aimed to retrospectively examine the diagnoses of children presenting with a complaint of breast swelling.Methods: A retrospective sample comprising the medical case records of paediatric patients (N=50; male:13; female: 37; mean age: 13.2 years old) admitted to the Mustafa Kemal University hospital with a complaint of breast swelling between April 2017 and December 2021 was included in the study Results: For males, the most common cause of breast swelling was normal pubertal development (53.8 %; n=7), followed by gynecomastia (30.7%; n=4), and neonatal breast hypertrophy (15.3%; n=2).For females, the most common cause of breast swelling was a mass in the breast (35.1%; n=13), followed by a breast cyst (16.2%; n= 6), normal pubertal development (29.8%; n=11), and finally asymmetric breast development (18.9%; n=7).The majority of cases (86%; n=43) were treated conservatively; the remainder (14%; n=7) underwent surgical treatment. Conclusion:There is a wide spectrum of diagnoses in children presenting with a complaint of breast swelling, most of them are benign.It should be kept in mind that anxious patients who present with a complaint of breast swelling may only be experiencing normal pubertal development.Although all the patient cases examined in the present study involved benign masses, it is important to plan diagnosis and treatment without delay to ensure the early diagnosis of malignant diseases.
