Background:Gastrointestinal (GI) tract atresias occur in approximately 1 in 2000 live births and frequently present with associated congenital anomalies. This study aimed to determine the frequency and spectrum of associated anomalies in neonates with GI atresias and provide screening recommendations. Materials and Methods:A retrospective analysis was conducted on 150 neonates with congenital GI atresia at a tertiary pediatric surgery referral center over 7 years. All patients underwent systematic screening, including echocardiography, abdominal ultrasonography, cranial ultrasonography, and radiographic evaluation. Demographics, atresia type, associated anomalies, and in-hospital outcomes were evaluated. Results:The cohort comprised esophageal atresia/tracheoesophageal fistula in 33.3%, anorectal malformations in 34%, duodenal atresia in 18%, jejunoileal atresia in 10%, colonic atresia in 2.7%, and pyloric atresia in 2%. Associated anomalies were present in 87.3% of patients. Cardiovascular anomalies were most common (57.3%), followed by genitourinary (50%), central nervous system (19.3%), and limb (12.7%) anomalies. Atrial septal defect was the most frequent cardiovascular finding. Overall, in-hospital mortality was 14%. Sepsis was the leading cause of death (33%). Prematurity and low birth weight were significant mortality predictors, while the presence of associated anomalies was not. VACTERL association (66% mortality) was identified as a high-risk subgroup. Conclusions:GI atresias are frequently associated with multisystem anomalies, particularly involving the cardiovascular and genitourinary systems. Systematic screening for associated anomalies is recommended in all neonates with GI atresia for comprehensive care planning. While anomalies are highly prevalent, prematurity and low birth weight remain the primary determinants of mortality.

The transanal endorectal pull-through (TEPT) procedure has become the preferred technique for Hirschsprung disease (HD). Long-term functional outcomes beyond five years remain underreported, particularly from Middle Eastern centers. This study evaluated surgical and long-term functional outcomes of TEPT at a single tertiary center over 17 years, with emphasis on surgical expertise and structured follow-up. Patients with HD who underwent TEPT between January 2005 and December 2021 were retrospectively reviewed. More than 90

Background. Ovarian tumors are rare in children, accounting for 1-2% of all pediatric malignancies. Recent trends emphasize fertility preservation, but data on the evolution of practice and outcomes remain limited. This study examines changes in surgical management and outcomes of pediatric ovarian tumors over two decades. Methods. All children who underwent surgery for ovarian pathologies at a tertiary pediatric surgery center between 2002 and 2021 were reviewed. Patients with histopathologically confirmed ovarian tumors were included. Clinical characteristics, surgical approaches, histopathology, and outcomes were analyzed. Patients were divided into two 10-year periods to evaluate trends over time, and age-based subgroup analysis compared prepubertal (≤12 years) and pubertal (>12 years) patients. Results. Of 324 children undergoing ovarian surgery, 87 had histologically confirmed tumors. The most common histological type was mature cystic teratoma (54.0%). Eighteen tumors (20.7%) were malignant. Ovarian-sparing surgery (OSS) increased from 20.0% (6/30) to 61.4% (35/57) (p

The aim of this study was to evaluate the differences in physical examination and radiologic findings of patients with proximal hypospadias in terms of Disorders of Sex Development (DSD) groups. The ages, physical examination and radiological findings and diagnoses of the cases aged 0–18 years who were admitted to our hospital due to proximal hypospadias between 2005 and 2022 and whose male gender was determined because of their evaluation for DSD were evaluated. The study population included 43 patients with a median age of 4 months (1 day-14 years): 19 presented with penoscrotal, 13 with scrotal, and 11 with perineal hypospadias. All cases exhibited severe ventral chordee, with micropenis observed in most patients. 46,XY DSD represented most cases, followed by sex chromosome DSD, 46,XX DSD, and other karyotype anomalies. Most patients in the DSD group had undescended testes and/or micropenis. Penoscrotal hypospadias was seen only in the 46,XY DSD group and no uterine remnants were seen in this group. Patients with proximal hypospadias accompanied by undescended testis and/or micropenis should be evaluated in detail before any surgical intervention. We believe that especially in cases with scrotal and perineal hypospadias should be investigated for possible uterine remnants.

OBJECTIVE:The aim of this study was to describe the clinical, radiologic, surgical and pathologic features of solid breast masses in girls and to evaluate the follow-up and surgical treatment results of these patients. METHODS:Girls aged <18 years who were presented with a solid breast mass between 2004 and 2022 were included. Demographic characteristics, complaints at presentation, examination and imaging findings, surgical and pathology results and follow-up were evaluated. The masses were grouped as right, left and bilateral tumors and those operated and followed up. ROC curve was created for the possibility of tumor size reduction. P<0.05 was considered statistically significant. RESULTS:There were 156 female patients with a mean age of 15.2±1.8 years. 79.5% of the patients had a single breast tumor and the mean tumor size was 2.3±1.5 cm. The masses were localized in 43.6% right breast, 38.5% left breast and 17.9% bilaterally. In 54 cases (34.6%), the mass size shrank or disappeared after a median follow-up of 6 months, ROC curve was constructed, and the cut-off point for tumor size was determined as 3cm. Thirty-nine cases (25%) were operated, 92.3% were fibroadenomas. CONCLUSION:Given the low malignancy rate in childhood breast masses, a conservative approach should be considered first. The most common breast tumor in childhood is fibroadenoma and it has been found that breast masses up to 3cm in size are likely to shrink or disappear completely during follow-up.

The aim of this study was to determine the treatment options for pulmonary hydatid cysts (HC) in children according to the size and location of the cyst and the presentation of the patients. Children with HC treated between 2004 and 2022 were evaluated. Patients were grouped according to the size of the HC and those with ruptured and intact cysts at the time of admission, and the data were compared. ROC curve was created to determine the HC size limit in operated patients. P < 0.05 was considered statistically significant. A total of 72 patients with a mean age of 8.9 ± 3.4 years were included in the study. HC sizes 2.5–18 cm, and half of the patients had bronchial/pleural ruptures at presentation. Forty-six patients (64

BACKGROUND:Intestinal perforation (IP) is one of the most critical surgical emergencies in neonates. It most often occurs in premature infants, with necrotizing enterocolitis (NEC) as the leading cause. Hirschsprung's disease (HD) is another important etiology. In this study, we aimed to investigate the frequency of HD among neonates with non-NEC IP and assessed the value of performing rectal biopsy in these patients. METHODS:Neonates who were treated for non-NEC IPs between 2005 and 2021 were evaluated retrospectively. Demographic data, clinical features, operative details, and rectal biopsy results were collected. These features were compared according to the histopathological results of rectal biopsy (aganglionic versus ganglionic). RESULTS:Rectal biopsies were performed in 48 neonates with non-NEC IP (33 preterm [68.8%], 15 term [31.2%]). The most common perforation site was the ileum (52.4%). Rectal biopsy revealed aganglionosis in 12.5% of the patients. Gestational age was higher in aganglionic than ganglionic cases (36.7 versus 32.5 weeks; P = .026). The perforations were colonic in all aganglionic cases (n = 6) and 47.6% (n = 20) of the ganglionic cases (P = .025). CONCLUSION:This study highlights the importance of considering HD in the differential diagnosis of neonatal IPs. Rectal biopsy should be considered in non-NEC perforations; particularly in term (or near-term) neonates and in cases of colonic perforation, to help identify underlying aganglionosis and guide timely management. LEVEL OF EVIDENCE:Level 3 b.

Pediatric testicular tumors are rare entities accounting for only 1–2

PURPOSE:To evaluate the relationship between nutritional status and surgical outcomes in patients with esophageal atresia (EA) from the Turkish Esophageal Atresia Registry (TEAR). METHODS:Between 2015 and 2024, 713 patients with the complete data of neonatal period and first year of life were included. According to FENTON, growth charts and patients were grouped as small for gestational age (SGA, < 10 percentiles), medium SGA (percentiles = 10-20), appropriate for gestational age (AGA, percentiles = 20-90) and large for gestational age (LGA, percentiles > 90) at birth. The z scores for height-for-weight were reevaluated at 6th and 12th months of age. RESULTS:Among 713 patients, 56% were boys. 23.7% of patients were SGA. There was no difference among groups for demographic features, outcomes, and mortality (p > 0.05). Patients with SGA had a higher rate of karyotype anomalies (23.1%, p < 0.05). At the 6th month, 20% of patients had improved nutritional status, 46.2% unchanged, and 33.5% worsened. At the 12th month, it was 31.6%, 50.2%, and 18.3%, respectively. 32.8% of the SGA patients had severe malnutrition at the 6th month, while this rate decreased to 10.2% at the end of the first year of life. Patients with worsened nutritional status had a significantly higher rate of mortality (10.2%) than patients with unchanged and improved nutritional status (3.7%, 2%, respectively, p < 0.05). There was no statistical difference between nutritional status and surgical outcomes at the 6th and 12th months (p > 0.05). CONCLUSIONS:The incidence of SGA was significantly higher in EA patients with karyotype anomalies. While 20% of patients improved nutritional status at the 6th month, only one-third of patients improved nutritional status at the end of the first year. Closer follow-up is needed in patients with EA to avoid malnutrition, which can lead to poor growth, developmental delay, and impaired immune function.

Background. The most common indication for cholecystectomy in children is cholelithiasis, and routine histopathological examination is performed on all gallbladder specimens. Currently, selective histopathological examination is suggested instead of routine examination due to the low frequency of gallbladder cancer in adults. The purpose of this study was to evaluate the indications, clinical, laboratory and histopathological findings of the cholecystectomy in children. We also questioned the contribution and cost-effectiveness of routine histopathological evaluation in diagnosis and treatment. Methods. A total of 114 children underwent cholecystectomy between the years 2008 and 2022. The clinical findings, laboratory, and imaging results of the patients and histopathological findings of the gallbladder specimens were evaluated retrospectively. Results. Cholelithiasis were diagnosed in 71%, choledochal malformation in 15.8%, hydrops of gallbladder and/or biliary sludge in 12.3%, and hypoplasia of gallbladder in 0.9% of the patients. Histopathologically significant findings were observed in only 3 patients (2.6%); adenomyomatosis in 2 and angiodysplasia and pyloric metaplasia in 1. While the cost of a cholecystectomy and histopathologic examination combined amounted to 27.77% of the minimum wage in Türkiye in 2024, the histopathologic examination alone constitutes just 0.67% of the minimum wage and 2.4% of the operation fee. Conclusion. In children undergoing cholecystectomy, histopathological examination does not provide any significant contribution to the patient’s diagnosis and follow-up management. In children, selective gallbladder histopathological examination might reduce health costs and save time for pathologists.

Despite being a common condition in puberty, only 5–10

Background: Varicocele is characterized by abnormal dilatation of the pampiniform plexus veins and is seen in 14-20% of adolescent males. Treatment options are laparoscopic Palomo varicocele ligation (LPV) and microsurgical subinguinal varicocelectomy (MV). It is aimed to evaluate the results of patients who underwent surgical treatment for adolescent varicocele. Methods: The data of patients operated on for varicocele between 2012-2021 were analyzed retrospectively. The patients were grouped as LPV and MV according to the surgical method applied and evaluated in terms of treatment and follow-up results. Results: Forty-three patients aged 14.6 +/- 1.8 years were operated on for left-sided varicocele. LPV was applied to 29 (67.4%) and MV to 14 (32.6%). Operation duration was 54.4 +/- 15.3 minutes in LPV and 98.9 +/- 36.8 minutes in MV (p<0.0001). No intraoperative complications were seen. The mean follow-up duration was two years (6 months-5 years). In 62.5% of the patients with preoperative testicular atrophy, the operated testicle caught the size of the right testicle in 12 months. Testicular atrophy was not seen in any patients. Scrotal pain regressed in all. Four patients (9.3%) developed complications. Hydrocele was seen in one patient after MV and two patients after LPV. Recurrence was detected in one patient. The two groups had no statistical difference regarding complications (p=1,000). Conclusion: With surgical treatment of adolescent varicoceles, it is possible to eliminate the symptoms related to varicocele, such as pain, and reverse the atrophy process in the testicle. While operative durations are shorter and easy to apply in LPV, MV has lower complication rates.

Background: Thyroid nodules are rare in children and the risk of malignancy rate is considerably higher than in adults. In this study, we aimed to evaluate the patients who admitted to our hospital with thyroid nodules and underwent thyroid surgery examine the distributions of pathologies, changes in treatment protocols and results. Methods: Pediatric patients < 18-year-old, who presented with thyroid nodules and underwent thyroid surgery at our clinic between 2005 and 2018, were retrospectively examined. Demographic characteristics, complaints at presentation, ultrasonography findings, surgical method, histopathological results, and postoperative complications were evaluated. Data were compared between two time periods: before and after 2014. Results: A total of 52 thyroid surgeries were performed on 45 patients with a female/male ratio of 3:1 and an average age of 14.1 +/- 2.6 years. Differentiated thyroid carcinoma was detected in 12 (26.7 %) of the patients. The incidence of malignant tumors increased from 18.2 % to 26.7 % after 2014. Transient hypocalcemia was detected in 11 (21.1 %) patients. The risk of postoperative hypocalcemia was significantly increased in patients with bilateral resection (p < 0.01). Parathyroid hormone level measured at 6-12 h postoperatively is useful in predicting hypocalcemia (p = 0.001). No significant relationship was found between high body mass index and thyroid malignancy. Fine needle aspiration biopsy results were found to be significant in predicting malignancy (p = 0.041). Conclusion: We assert the critical importance of vigilant postoperative monitoring for hypocalcemia, particularly following total thyroidectomy and completion thyroidectomy. Since the incidence of thyroid pathologies requiring surgical intervention in children is relatively low, we think that such cases should be performed in comprehensive pediatric hospitals where a multidisciplinary approach is adopted.

Introduction Anastomotic stricture (AS) is the second most common complication after esophageal atresia (EA) repair. We aimed to evaluate the data in the Turkish Esophageal Atresia Registry to determine the risk factors for AS development after EA repair in a large national cohort of patients. Methods The data between 2015 and 2021 were evaluated. Patients were enrolled into two groups according to the occurrence of AS. Patients with AS (AS group) and without AS (non-AS group) were compared according to demographic and operative features, postoperative intubation status, and postoperative complications, such as anastomotic leaks, fistula recanalization, and the presence of gastroesophageal reflux (GER). A multivariable logistic regression analysis was performed to define the risk factors for the development of AS after EA repair. Results Among the 713 cases, 144 patients (20.19%) were enrolled into the AS group and 569 (79.81%) in the non-AS group. The multivariable logistic regression showed that, being a term baby (odds ratio [OR]: 1.706; p = 0.006), having a birth weight over 2,500 g (OR: 1.72; p = 0.006), presence of GER (OR: 5.267; p < 0.001), or having a recurrent tracheoesophageal fistula (TEF, OR: 4.363; p = 0.006) were the risk factors for the development of AS. Conclusions The results of our national registry demonstrate that 20% of EA patients developed AS within their first year of life. In patients with early primary anastomosis, birth weight greater than 2,500 g and presence of GER were risk factors for developing AS. When patients with delayed anastomosis were included, in addition to the previous risk factors, being a term baby, and having recurrent TEF also became risk factors.

ObjectivesPostoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. Study DesignAmong the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. ResultsAmong 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. ConclusionWe demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.

Introduction: Acute appendicitis (AA) is a leading cause morbidity and mortality in childhood. Unfortunately AA can be difficult to distinguish from other clinical conditions during the early course of the disease. Biomarkers are molecular indicators of a disease process, diagnosis, prognosis and can be used to monitor the effects of disease management. We aimed to determine which of the demographic, clinical or laboratory data is more predictive for complicated AA. Materials and Methods: A hundred fourty five consecutive patients aged 1 month to 18 years diagnosed with AA were retrospectively analyzed. Age, gender, body temperature (degrees C), laboratory data and symptom duration (days) of the patients were recorded. Results: A total of 145 children with AA, 38 in group 1 and 107 in group 2, were included in the study. Group 1 was perforated appendicitis and group 2 was nonperforated appendicitis. Plasma sodium value was lower in group 1 than group 2, and C-reactive protein (CRP) values were significantly lower in group 2 compared to group 1. Conclusion: Laboratory values can guess complicated appendicitis in children with appendicitis. CRP level and presence of hyponatremia may be more predictive than white blood cell count for the the diagnosis of perforated appendicitis.

Introduction: Sacrococcygeal teratomas are the most frequent tumors in neonates. However, a teratoma in the retroperitoneal region is quite rare. Case: A 39-week-old baby with a cyanotic congenital heart disease was hospitalized after birth, and an intraabdominal mass was detected with an abdominal ultrasonographic evaluation, incidentally. Surgical approach was made on the 24th postnatal day, and a large mass containing solid and cystic components was completely excised from the retroperitoneal region. Pathological assessment revealed that the mass was a grade 2 immature teratoma, including neuroepithelial tissue. Conclusion: Retroperitoneum contains main vessels, nerves, and vital organs; excision of tumors in the retroperitoneum is crucial, especially in neonates. Because of the possibility of malignant transformation, the correct timing of the surgery, meticulous excision and careful pathological evaluation should be done.

Type IV paraesophageal hiatal hernias are diaphragmatic hernias that are extremely rare in the pediatric age group in which the stomach and other intra-abdominal organs herniate from the esophageal hiatus of the diaphragm into the mediastinum.Since the defect in the hiatus is large, serious complications such as gastric volvulus may develop in these giant hernias as a result of the passage of a large part of the stomach into the thoracic cavity.Patients may present with atypical clinical manifestations such as growth retardation, not gaining weight, and recurrent pulmonary infections.In this report, two cases in the pediatric age group who were admitted with different clinical course and were diagnosed as type IV paraesophageal hiatal hernia who were successfully treated with surgical intervention are presented.

COVID-19 pandemic greatly affected our lives in all areas. Due to the social isolation policies implemented during this period, the majority of parents and all school-age children spent their lives at home. This study aims to investigate the effects of pandemic and isolation on home accidents treated in our center. Foreign body ingestion (gastric foreign bodies: G.FB), foreign body aspiration (respiratory foreign bodies: R.FB), and corrosive substance (CS) ingestion cases admitted to our hospital between March 11, 2019, and March 10, 2021, were retrospectively analyzed. Demographic data, type and cause of home accidents, the time of the accident and the admission to the hospital, the location of the foreign body, and the follow-up data were recorded. The patients were divided into two groups: the pre-pandemic period (11 March 2019–10 March 2020) and the COVID pandemic period (11 March 2020–10 March 2021), and the data were evaluated between two groups as < 6 years old and 6–18 years old. During the 2 years, a total of 982 patients were admitted to our hospital for G.FB, R.FB, or CS. Four hundred and eighty-three of them (49.2%) were in the pre-pandemic period and 499 (50.8%) were in the pandemic period (p = 0.206). The mean age of the patients was 3.63 ± 3.32 years; 82.4% of the patients in the pre-pandemic group and 85.4% of the patients in the pandemic group were children < 6 years old. While the F/M ratio was 1/1.5 during the pre-pandemic period, it was 1/1.1 during the pandemic period. Of the cases, 73.3% were G.FB, 4.6% were R.FB, and 22.1% were CS. Almost half of the accidents occurred between the hours of 16 and 24. During the pandemic period, the accidents increased to occur between 0 and 8 am in children < 6 years old, and between 8 am and 4 pm in children 6–18 years old (p = 0.003). All of the home accidents in the 6–18 age group between 0 and 8 o'clock were girls (p < 0.0001). During the pandemic period, the frequency of button batteries and food products increased in G.FB. Also, the frequency of R.FB increased significantly (p = 0.006) and the most common R.FB was the food products. The frequency of CS increased in girls during the pandemic period, and CSs were brought to the hospital in a shorter time after the accident during the pandemic period (p = 0.007). It can be thought that the main reason why home accidents are common in the 0–6 age group is due to the developmental characteristics of the child rather than the longer time spent at home. The pandemic and isolation increase the frequency of foreign body aspirations and home accidents in girls.

Objectives Laparoscopic inguinal hernia repair in younger infants has not been completely accepted worldwide. The aim of this study was to evaluate the safety and feasiblity of laparoscopic percutaneous internal ring suturing method in children aged younger than 3 months and compare the recurrence and complication rates with open repair; which may still be mentioned as the gold standard procedure. Material and Methods A total of 387 children underwent inguinal hernia repair in the clinic between 2016 and 2019. One hundred and forty of them were under 3 months old and divided into two groups; children who underwent laparoscopic percutaneous internal ring suturing (Group 1) and open surgery (Group 2). Selection of the surgical method was regardless of weight, sex or any patient characteristics other than surgeon's choice. Operation durations, complications and recurrences were compared between the two groups. Results A total of 140 patients underwent surgery due to inguinal hernia. Group 1 included 85 and Group 2 included 55 children. There were two recurrences in each group (p> 0.05). Operative durations were shorter in Group 1 for both; unilateral and bilateral repairs (p <0.0001). There were no intraoperative complications in any group. There was one major postoperative complication in Group 2: iatrogenic undescended testis, and none was observed in Group 1. In the laparoscopic group, 47% of the children who were diagnosed to have unilateral hernia were revealed to have bilateral inguinal hernias (n= 31). Conclusion Laparoscopic percutaneous internal ring suturing method seems favourable in terms of operative time. It also has the advantage of detecting contralateral patent processus vaginalis or asymptomatic contralateral inguinal hernia.