Introduction:This study aimed to present rare findings encountered during laparoscopic inguinal hernia repair in children. Methods:The study included children who underwent laparoscopic surgery for inguinal hernia (IH). The focus was on unexpected intraoperative findings other than a typical inguinal hernia. These included direct and femoral hernias, various hernia variants, and other unusual presentations. Results:A total of 790 children were included in the study. Unexpected laparoscopic findings were observed in 22 cases. The mean age of the patients was 33 months (range: 1-168 months), and the mean weight was 12.5 kg (range: 2-46 kg). Direct hernias were identified in seven children. Four children had an incarcerated appendix within the hernia sac, one of whom required an appendectomy. Omental incarceration was noted in three children, and no hernia was found in two cases. Additionally, single cases of femoral hernia, Spigelian hernia, pantaloon hernia, intraabdominal spermatic cord cyst, suspicious gonadal structure, and incarcerated uterus with ovary was observed. Direct inguinal hernia was identified in seven children; four were repaired laparoscopically, whereas three underwent open repair. No intraoperative or postoperative complications were reported. Conclusions:The advantages provided by the laparoscopic approach include comprehensive visualization of the intraabdominal cavity allowing for prompt identification and safer management of rare or atypical findings.

The aim of this study was to compare the clinical efficacy, diagnostic concordance, and recurrence rates of open high ligation versus laparoscopic percutaneous internal ring suturing (PIRS) in adolescent inguinal hernia repair. A retrospective review was conducted of 87 adolescent patients who underwent inguinal hernia repair via open high ligation (n = 44) or laparoscopic PIRS (n = 43) between 2012 and 2024 at a single tertiary care center. Demographic data, postoperative complications, recurrence, diagnostic concordance (kappa), and follow-up duration were analyzed. The median age in both groups was 12 years (range 10–17). Intraoperative diagnostic laparoscopy was performed in 44 patients in the open surgery group to evaluate the contralateral inguinal region, and contralateral hernia was detected and repaired simultaneously in one patient. Diagnostic concordance was perfect in the open group (κ = 0.945) and near-perfect in the PIRS group (κ = 0.885), both statistically significant (p < 0.001). No recurrences were observed in the open group, whereas recurrence occurred in one patient in the laparoscopic group (p = 0.99). The mean follow-up duration was 103.8 months (range 11–150) and 31.7 months (range 4–137) in the open and laparoscopic group, respectively. Laparoscopic PIRS repair in adolescents demonstrated outcomes comparable to open high ligation in terms of recurrence and complication rates.

Objective: To investigate the incidence of fistula formation following distal hypospadias repair and the recurrence rate after fistula correction within a 15-year period. Material and Method: Postoperative fistula development rates of patients who underwent primary distal hypospadias repair between the years 2007-2022 were analyzed. The rates of recurrence of fistula after fistula repair were examined. Results: A total of 417 patients were included in the study. Fistula developed in 54 patients (13%) after the first surgery. The mean age of the patients at the time of the first operation was 39 months. It was observed that there was fistula approximately 10 months after the operation. Re-fistula formation was observed in 14 (25%) of 54 patients who underwent fistula repair. Re-fistula occurrence time after fistula repair was 5 days-18 months. The most common fistula location after the first operation was the coronal level (53%), with 28 patients where as the most location after the fistula repair was also coronal level (71% with 10 patients). Conclusions: In patients who develop fistula after distal hypospadias repair, the risk of developing a fistula after the repair is higher than the risk of developing a fistula after the primary repair. These results may be related to the techniques and methods used in primary repair.

PURPOSE:Guidelines of the Pediatric American Thyroid Association (ATA) serve as a vital reference for managing the rare thyroid cancers in childhood. This study evaluates differentiated thyroid cancer (DTC) patients using the ATA guidelines, dynamic risk stratification (DRS), and other established risk classification systems. METHODS:Pediatric patients with DTC under observation after total thyroidectomy were included in the study. We assessed preoperative and postoperative features based on the ATA guidelines, other risk scoring systems (TNM; De Groot staging; metastasis, age, completeness of resection, invasion, and tumor size; and combined risk), and the DRS. RESULTS:A total of 41 patients was enrolled in the study, with a median follow-up duration of 5.14±3.94 years. Of the patients who underwent total thyroidectomy, 33 were diagnosed with papillary carcinoma and 8 with follicular thyroid carcinoma. During follow-up, cervical metastases were detected in 27 patients, and one had distant metastasis. All patients underwent total thyroidectomy, and 68% received lymph node dissection. Additionally, 16 patients received radioactive iodine therapy. Of the postoperative patients, 85.3% were classified as low risk. Based on DRS, patients were classified as having no evidence of disease (n=29, 70.7%), biochemical evidence of persistent disease (n=5, 12.2%), structural evidence of persistent disease (n=6, 14.6%), and recurrent disease (n=1, 2.5%). Notably, 98% of the patients showed no evidence of disease during their latest follow-up. CONCLUSION:Persistent disease in patients classified as low risk according to the ATA guidelines resolved following radioactive iodine therapy, emphasizing the importance of risk stratification in postoperative care.

OBJECTIVES:Percutaneous tracheostomy is rarely performed in children, especially in infants. In the present study, we aimed to evaluate the complications and outcomes of PT via the Griggs technique according to the age and size of pediatric patients. METHODS:This study included 110 PICU patients who underwent PT using the Griggs technique between 2012 and 2020. The patients were divided into six groups according to their age, demographic data, primary disease, mean duration of intubation before PT, mean duration of PICU and hospitalization after PT, complications, and decannulation outcomes were compared between these groups. RESULTS:The mean age and mean weight of the patients were 43.6 ± 58.9 months (1 month-207 months) and 14.6 ± 14.9 kg (2.6-65 kg), respectively. Mean intubation times before the procedures were 64.6 ± 40 days and 38.6 ± 37.9. Thirty-seven (33.6%) infants were under 6 months of age(Group 1). There were no intraoperative complications. Tracheostomy site stenosis was significantly greater in Group 1 than in the other age groups (p = 0.032). Granuloma formation and dermatitis incidence were similar in all age groups. CONCLUSION:PT is a safe and feasible procedure even in small infants. The accidental decannulation risk is lower than standard tracheostomy. Interacting with rigid bronchoscopy guidance is essential to perform a safer procedure. The first tracheostomy change after PT in small infants under 6 months of age, the possibility of tracheostomy site (stoma) stenosis should be considered. LEVEL OF EVIDENCE:3 Laryngoscope, 135:416-422, 2025.

Undescended testis is one of the most common pathologies encountered by pediatric surgeons. In traditional orchidopexy operation, patent processus vaginalis (PPV) is dissected from testicular vessels and spermatic cord. In this study, it was aimed to compare the results of undescended testis patients with and without PPV closure in terms of recurrence and atrophy. After the approval of the local ethics committee, patients who were operated for undescended testis between January 2007 and December 2022 were evaluated. Patients were determined in two groups. first group was with PPV ligation (n=171), second group was without PPV ligation (n=1637). Inguinal hernia was not observed after operation in 15 years of follow-up. There were 23 recurrences (%13,4) in group 1 and 48 recurrences (%2,9) in group 2. According to the preoperative evaluation; A decrease in testicular size was detected in 5 patients (2.9%) in Group 1 and 8 patients (0.4%) in Group 2 in the postoperative follow-up. There is no need to ligate the PPV with additional dissection and open the external oblique fascia if it is predicted that the spermatic cord and testicular vessels may come to scrotum without tension in patients who underwent orchiopexy surgery.

Objectives: Endoscopic balloon dilation (EBD) is a frequently used method in the treatment of esophageal strictures in patients with esophageal atresia.The aim of this article is to convey our 19 years of experience in EBD performed in patients with esophageal atresia. Materials and Methods:Thirty-seven patients with esophageal atresia who developed esophageal stricture and underwent EBD between 2003 and 2022 were included in the study.The number of EBD sessions, the time elapsed between dilations, the size of the dilated balloon, the development of complications after the procedure, additional surgical intervention and the follow-up periods were evaluated. Results:In patients with esophageal atresia, EBD was performed at an average of 0.72-month (2 weeks-29 months) intervals, average of 3.3 months after the primary repair.EBD was performed only one time in 6 patients (16.2%), after the single procedure, the patients did not have clinical symptoms or need for dilation.Time between two last dilation procedure is 4.5 months (1-48).Esophageal perforation was seen in 7 cases (8.8%) and was managed with conservative treatment.In 14 of the patients, it was observed that the need for dilation was continued. Conclusion:EBD is minimally invasive and safe method for esophageal strictures after primary esophageal atresia repair.It prolongs the time required for dilation with a higher success rate in anastomotic strictures.The optimal number of dilations should be determined and accompanying comorbidities should be treated primarily.

Background The purpose of surgeries performed for congenital anomalies in children is to increase the survival rates and provide a developmental comparison to that of their peers. Aim The objective of this study was to investigate the development of children following surgery for congenital anomalies and the risk factors affecting their development. Methods Our study included 33 children who underwent surgery for gastrointestinal anomalies in our clinic between 2011 and 2016, and did not have any syndrome, chromosomal abnormality, or additional abnormality. Developmental levels were evaluated using the Ages and Stages Questionnaire (ASQ) and the ASQ: Social–Emotional (ASQ: SE) scales adapted for the use on Turkish children. Data on patient history were obtained retrospectively from patient files. Results The study included 33 patients, including 11 with esophageal atresia, 6 with intestinal atresia, 11 with anorectal malformation, and 5 with Hirschsprung's disease. Developmental delay was found in the ASQ of 72.7% of the patients and the ASQ: SE tool was 27% of the patients. The rate of patients with scores below the threshold from each parameter of ASQ was higher than that of the normal population ( p < 0.05). Development delay was detected using the ASQ scale in 100% of those with microcephaly at birth, in 91% of premature infants born between 1500 and 2500 g, and in 83.3% of those with low birth weight to gestational age. Conclusions In children who underwent surgery due to congenital anomalies, an evaluation through developmental tests, a post-surgical follow-up process, and a referral to the relevant disciplines when necessary may increase the success of surgery as well as increase the life quality of the patient.

This study aimed to measure the effects of the upper or lower limit of the carbon dioxide (CO2) insufflation pressure applied in children who underwent laparoscopic and thoracoscopic interventions, on the changes in the brain and kidney Near Infrared Spectrometry (NIRS) values. Demographic information, carbon dioxide insufflation pressure and the operation time data were recorded. During the procedure the NIRS probes monitored the brain and left kidney during laparoscopic procedures and the brain only during thoracoscopic procedures. Basal NIRS values were recorded after anesthesia induction, after CO2 insufflation-beginning of insufflation, near the end of the procedure-end of insufflation, and after carbon dioxide desufflation. During the procedure, when ≥20

Objectives: The aim of this study is to determine efficacy, safety, and feasibility of video-assisted thoracoscopic surgery (VATS) in childhood empyema with two port technique. Materials and Methods: 34 patients under 17 years of age were included to the study. Demographic and clinical data of the patients were recorded retrospectively. Results: 34 patients under 17 years of age were included in the study. The first time the complaints started was 12 days. VATS was performed on mean 12 (2-46) days after the complaints of the patients started. The empyemas were in right hemithorax in 21 children and left in 11. Two patients underwent bilateral decortication Mean of chest tube removal time was 9.70 (2-26) days. While the postoperative stay was 23.50 (4-120) days, the total hospital stay was 32.50 (7-142) days. Emphysema developed in 7 patients in the following period. Chest tube revision was performed in a patient. Emphysema spontaneously regressed at follow-up in 6 patients. Two children had died due to 1- arrest and 2 – after liver transplant. Conclusion: VATS is a feasible method with good results pleural empyema in children. The results are satisfactory in the early or late period of disease.

Introduction: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. Methods: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. Results: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). Conclusion: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.

The focus of esophageal atresia treatment is now on reducing hospitalization and common morbidities and to prevent complications such as anastomotic leak and esophageal stricture formation. The objective of this study was to compare the perioperative and postoperative outcome measures such as operation times, anastomotic leak and stricture formation in children who underwent thoracoscopic and open repair of esophageal atresia/tracheoesophageal fistula as newborns in a single institution. Children who underwent surgery for esophageal atresia/tracheoesophageal fistula between 2014 and 2020 were enrolled to the study. Charts of patients were reviewed retrospectively for demographic and perioperative data. Postoperative outcome endpoints such as stricture formation rates, anastomotic leak more than 1 week, and of the chest tube were compared. There were 22 children in the study, of which 14 underwent thoracoscopic repair and 8 underwent open repair. Both groups were similar in terms of gestational age, birth weight and associated major anomalies. Operative times were similar (thoracoscopic repair: 169 and open repair: 175 min). Stricture formation was observed in three children in thoracoscopic group (21%) and four children in open group (50%). Anastomotic leak persisted for more than a week in three children in thoracoscopic group (25%) and two in open group (25%). Stricture rates and anastomotic leak for more than one week rates were statistically similar between groups. The azygous veins were preserved in 11 of 14 children in thoracoscopic group while none in the eight children that were operated in open group. Thoracoscopic repair is comparative to open repair regarding operative time and postoperative outcome endpoints such as esophageal stricture formation and anastomotic leak more than 1 week in the study. Thoracoscopic repairs are as feasible as open repairs with the advantage of preserving the azygos vein.

INTRODUCTION:Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention.MATERIALS AND METHODS:Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ-Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social-emotional problems, respectively.RESULTS:Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal-social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal-social skills.CONCLUSION:Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

Background: Nonimmune hydrops fetalis (NIHF) can be caused by different types of etiologies. Some rare intrathoracic lesions are associated with NIHF. Combination of mediastinal teratoma, NIHF, and chylothorax is extremely rare. Mediastinal teratomas which are located in midline should be difficult to be detected. Thoracic imaging should be performed with unknown etiology for hydrops, and in case of chylothorax, the presence of a mass compressing the ductus thoracicus should be considered primarily. Case presentation: An infant was born with a diagnosis of NIHF. Bilateral chest tubes were inserted cause of bilateral pleural effusions. After enteral feeding, the previously clear pleural fluid became chylous. Medium-chain triglyceride infant formula and somatostatin analog octreotide were initiated. A mass was appeared on her neck with the disappearance of skin edema. Magnetic resonance imaging confirmed a large, heterogeneous mass which was suggesting immature teratoma originating from thyroid gland. Complete surgical excision of the mass was performed. Histology confirmed high-grade immature teratoma. The neonate made an uneventful recovery. Following complete cessation of pleural fluid drainage, octreotide was stopped. She was discharged home on exclusive breast milk on day 34 of life. Conclusions: Mediastinal teratomas are rare masses that cause hydrops fetalis. Although the association of NIHF and mediastinal teratoma is rare, thoracic imaging can be performed if an etiology cannot be found despite basic evaluations for hydrops. In case of chylothorax, the presence of a mass compressing the ductus thoracicus should be considered primarily, and thoracic imaging should be performed.

Journal of Paediatrics and Child HealthVolume 58, Issue 9 p. 1669-1671 Case Report Rare cause of ascites and jaundice in infancy: Spontaneous bile duct perforation Anar Tagiyev, Anar Tagiyev orcid.org/0000-0003-1054-7643 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorCeyda Tuna Kırsaçlıoğlu, Ceyda Tuna Kırsaçlıoğlu orcid.org/0000-0002-3551-7267 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorEngin Demir, Engin Demir orcid.org/0000-0001-6263-5915 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorAnar Gurbanov, Anar Gurbanov orcid.org/0000-0003-4138-8809 Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorMeltem Bingöl Koloğlu, Meltem Bingöl Koloğlu orcid.org/0000-0001-7726-7633 Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorAydın Yağmurlu, Aydın Yağmurlu orcid.org/0000-0002-3294-4482 Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorAydan Kansu, Aydan Kansu orcid.org/0000-0002-3133-9846 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorZarife Kuloglu, Corresponding Author Zarife Kuloglu [email protected] orcid.org/0000-0001-9442-7790 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, Turkey Correspondence: Professor Zarife Kuloglu, Children's Hospital, School of Medicine, Ankara University, Cebeci, Mamak/Ankara, Turkey. Fax: +90 (312) 319 14 40; email: [email protected]Search for more papers by this author Anar Tagiyev, Anar Tagiyev orcid.org/0000-0003-1054-7643 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorCeyda Tuna Kırsaçlıoğlu, Ceyda Tuna Kırsaçlıoğlu orcid.org/0000-0002-3551-7267 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorEngin Demir, Engin Demir orcid.org/0000-0001-6263-5915 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorAnar Gurbanov, Anar Gurbanov orcid.org/0000-0003-4138-8809 Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorMeltem Bingöl Koloğlu, Meltem Bingöl Koloğlu orcid.org/0000-0001-7726-7633 Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorAydın Yağmurlu, Aydın Yağmurlu orcid.org/0000-0002-3294-4482 Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorAydan Kansu, Aydan Kansu orcid.org/0000-0002-3133-9846 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, TurkeySearch for more papers by this authorZarife Kuloglu, Corresponding Author Zarife Kuloglu [email protected] orcid.org/0000-0001-9442-7790 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Ankara University, Ankara, Turkey Correspondence: Professor Zarife Kuloglu, Children's Hospital, School of Medicine, Ankara University, Cebeci, Mamak/Ankara, Turkey. Fax: +90 (312) 319 14 40; email: [email protected]Search for more papers by this author First published: 17 January 2022 https://doi.org/10.1111/jpc.15882 Conflict of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume58, Issue9September 2022Pages 1669-1671 RelatedInformation

The coexistence of hypertrophic pyloric stenosis (HPS) and esophageal atresia (EA) is a rare condition. In the literature, also, there are only a few publications written about this rare coexistent condition. In this study, an incidental HPS case, which was discovered during gastric pull-up surgery for long-gap isolated EA, is investigated. A 50-day old girl who had isolated EA applied to our clinic for gastric pull-up surgery, which was planned to replace her currently existing gastrostomy which was performed in the newborn period. During the operation, it was seen that the stomach was larger than expected because of HPS. Pyloromyotomy was carried out before gastric pull-up. Following this, the stomach was pulled upwards from the mediastinum and anastomosed with the proximal esophagus. No complication developed during or after the surgery. In cases where patients with EA come with nutrition problems, and also stricture of the anastomosis line or gastroesophageal reflux are excluded, it should be kept in mind that the reason may be HPS.

Objectives:Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years.Material and Methods:Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes.Results:This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p <0.001), total hospitalization time (p <0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years.Conclusion:Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.