BACKGROUND:Laparoscopic splenectomy (LS), a treatment for both benign and malignant splenic diseases, can prove technically challenging in patients with massive splenomegaly. In particular, the optimal surgical modality for treating massive splenomegaly in children remains controversial. METHODS:The clinicopathologic data of 289 pediatric patients undergoing splenectomy for massive splenomegaly were studied in a retrospective analysis. Accordingly, the patients were classified into the LS surgery group and open splenectomy (OS) surgery group. In the laparoscopy cohort, they were separated into two subgroups according to the method of surgery: the multi-incision laparoscopic splenectomy (MILS) and the single-incision laparoscopic splenectomy (SILS) surgery groups, respectively. Patient demographics, clinical data, surgery, complications, and postoperative recovery underwent analysis. Concurrently, we compared the risk of adverse laparoscopic splenectomy outcomes utilizing univariable and multivariable logistic regression. RESULTS:The total operation time proved remarkably shorter in the OS group in contrast to the LS group (149.87 ± 61.44 versus 188.20 ± 52.51 min, P < 0.001). Relative to the OS group, the LS group exhibited lowered postoperative pain scores, bowel recovery time, and postoperative hospitalization time (P < 0.001). No remarkable difference existed in post-operation complications or mortality (P > 0.05). Nevertheless, the operation duration was remarkably longer in the SILS surgery group than in the MILS surgery group (200 ± 46.11 versus 171.39 ± 40.30 min, P = 0.02). Meanwhile, the operative duration of MILS and SILS displayed a remarkable positive association with splenic length. Moreover, the operative duration of SILS displayed a remarkable positive association with the age, weight, and height of the sick children. Splenic length proved an independent risk factor of adverse outcomes (P < 0.001, OR 1.378). CONCLUSIONS:For pediatric patients with massive splenomegaly who can tolerate prolonged anesthesia and operative procedures, LS surgery proves the optimal treatment regimen. SILS remains a novel surgery therapy which may be deemed a substitutional surgery approach for treating massive splenomegaly.

Background:Single-incision laparoscopic splenectomy (SILS) remains a challenging procedure because of the technical difficulty. In this prospective study, we aimed to evaluate the efficacy and safety of SILS in children with massive splenomegaly.Methods:Pediatric patients with massive splenomegaly were recruited for SILS in a university-affiliated hospital. The data on patient demographics, clinical features, operative variables, and perioperative outcomes were collected prospectively and analyzed. According to the different surgical instruments, the patients were randomly assigned into two groups: the SILS with straight surgical instrument (SILS-S) group and the SILS with curved surgical instrument (SILS-C) group. A two-group comparative analysis was conducted using perioperative data from the different surgical instrumentation systems.Results:A total of 120 patients were included, of which 103 patients (success group, 85.83%) had complete SILS, the other 17 (failure group, 14.17%) patients were converted to open (n = 4, 3.33%) or multi-incision laparoscopic surgery (n = 13, 10.83%). The major cause for surgical failure is uncontrollable bleeding (n = 14, 82.35%), and age, height, and weight were the risk factors for failure of SILS, but none of the parameters were independent risk factors. The blood loss in the success group was less than that in the failure group, but no significant differences in other operative and outcome indicators. For SILS, the mean (±SD) operative time was 188 (±48.70) minutes, the median intraoperative blood loss (min, max) was 20 (5, 290) ml, the mean (±SD) time of first anal exhaust was 23.9 (±7.73) hours, and the mean (±SD) postoperative hospital stay was 4.72 (±1.03) days. The median pain score was 3 on 1 day, and 1 on 3 days after the operation. Postoperative complications were identified in 8 (7.77%) cases. However, there were no peri-operative deaths in this series. The SILS-C group had a significantly shorter operation time than the SILS-S group (mean ± SD, 172 ± 44.21 vs. 205 ± 47.90 min). There were no significant differences between the two groups in other perioperative data (P < 0.05).Conclusion:SILS is a safe and feasible treatment in pediatric patients with massive splenomegaly, and curved surgical instrumentation has contributed to developing surgical manipulation.

Background: Biliary atresia (BA) is one of the most fatal hepatobiliary diseases in infants and young children, and is easy to cause obstructive jaundice in infants and children, and liver transplantation in children. BA and infantile hepatitis syndrome are the main causes of cholestatic jaundice. The early clinical manifestations are extremely similar, and timely identification is difficult. Therefore, early and differential diagnosis of BA is crucial. At present, there are many imaging diagnosis methods for BA, such as ultrasound examination and nuclear magnetic resonance. Ultrasound elastography (USE) is the most popular method. However, the application of USE in BA is still in the exploratory stage. Methods: PubMed, Web of Science, Embase, Cochrane Library; and other databases were searched for articles on USE diagnosis of pediatric surgical BA. Later, the articles were screened, and the included articles should meet the following requirements: the research objects were children with BA; the intervention measures were USE diagnosis; the control group was diagnosed by other methods than USE. RevMan5.3 was adopted for quality assessment, and forest maps and summary receiver operating characteristic (SROC) curves were constructed. Results: Finally, seven articles covering 490 patients were included. There were 120 patients in the control group. The included articles showed good quality and there was no obvious bias. The area under the SROC curve (AUC) for USE diagnosis of BA was 0.93, the sensitivity was 0.93 (95% CI: 0.72-1.00), and the specificity was 0.95 (95% CI: 0.74-1.00). Discussion: USE showed high diagnostic value for pediatric surgical biliary tract closure.

Objective To explore the experiences of diagnosing and treating giant omphalocele in children so as to improve its cognition among pediatric surgeons.Methods The clinical data were collected from one 9-year-old child with giant ompbalocde.The databases of Pubmed,SpringerLink,Google Scholar,CBM,CNKI,Wanfang and CQVIP were searched for the relevant publications using such key words as giant omphalocele,children and delayed.Also a systematic review of literatures was performed.Results For 9 eligible children,the age range was 17 to 180 months.The largest area of abdominal wall defect was 35.0 cm × 25.0 cm and the minimum 9.4 cm × 7.7 cm.Concurrent conditions included tetralogy of the Fallot & bilateral inguinal hernia (n =1),patent ductus arteriosus (n =1),pelvic ectopic kidney & sternal division (n =1),right breast deficiency & dysplasia of right thoracic muscle (n =1).Repairing was one-stage (n =7) and staged (n =2).A tissue expander was placed in intra-abdominal compartment in one case while another case covered with biomaterial patch.One case experienced transient hypertension while another required postoperative mechanical ventilation for 10 days.Conclusions The treatment options for giant omphalocele are diverse.When one-stage procedure is not feasible or carries a high risk,topical care of omphalocele sac is more reasonable.Surgery should be performed immediately upon a complete epithelialization of omphalocele sac.The goal is to utilize proper materials for reconstructing abdominal wall to optimize function and appearance.

Objective To explore the safety and feasibility of transumbilical single channel laparoscopic cryp-torchidopexy with conventional instruments in treatment of cryptorchidism in children. Methods Thirty-five children with cryptorchidism were treated by transumbilical single channel laparoscopic cryptorchidopexy with conventional instru-ments from November 2017 to March 2018 at Department of Pediatric Surgery,the First Affiliated Hospital of Guangxi Medical University. Clinical data were recorded including the general information,operation time,intraoperative blood loss,postoperative testicular position and postoperative complications,etc. Results All 35 patients completed the cryptorchidopexy in one operation. Among those 35 patients,28 patients had unilateral lesions and 7 patients had bilateral lesions,with a total of 42 sides. Twenty - six patients were of groin type( 33 sides),9 patients abdominal type( 9 sides). The average operation time was(40. 4 ± 8. 2)min for unilateral lesion,and(62. 5 ± 15. 3)min for bilateral le-sions;the average intraoperative blood loss was(3. 0 ± 1. 8)mL;and the average postoperative hospital stay was(6. 4 ± 2. 1)h. Testis of 32 patients(40 sides)were fixed in the middle and bottoms of the scrotum,and testis of 2 patients (2 sides)were fixed on the top of the scrotum. One case had poor healing of naval incision,which was recovered in 1 week after dressing change. There were no postoperative complications such as scrotum hematoma,infection of incision, testicular epididymitis,testicular necrosis,testicular retraction or testicular atrophy,etc. No obvious visible scar was found in the abdomen review 2 weeks postoperatively,with the incidence of complications was 2. 9%(1/35 cases). Conclusions Transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism is characterized by small trauma,quick recovery,low complication rate and visible scar free result, which is worthy of clinical promotion,but the operation is relatively complex and the correct procedures are required.

To evaluate the effect of modified penoplasty in the management of concealed penis.