Abstract Introduction Laparoscopic appendectomy is an ideal procedure for acquiring laparoscopic skills through simulation. Nevertheless, technical training is time consuming for surgical trainers to provide constructive feedback, but this could be improved by the development of validated tools that enable appropriate formative self-assessment. For this reason, we developed a structured assessment scale for a laparoscopic appendectomy exercise using a low-fidelity simulator. The objective of this study was to validate the scale for use in formative self-assessment. Methods During laparoscopic simulation sessions in 2025–2026, participants with varying levels of experience performed a standardized laparoscopic appendectomy (LAP) exercise on a low-fidelity simulator. Performance was assessed through formative self- and external assessment using a specific scale derived from the OSATS (Objective Structured Assessment of Technical Skills) score. Content and construct validity, internal consistency, reproducibility, and reliability in both hetero- and self-assessment were analyzed. Results Thirty-two participants were included in the validation study of the LAP scale, including 7 medical students, 17 residents in pediatric, visceral, urological, and gynecological surgery, and 8 practicing surgeons. The content of the scale was deemed relevant by 80% of the users. It demonstrated excellent construct validity, with scores increasing according to level of experience: 9.9 ± 0.7 among students, 12.7 ± 3.3 among junior residents, 16.6 ± 3.3 among experienced residents, and 18.8 ± 0.9 among practicing surgeons (p < 0.0001). Reproducibility and internal consistency were significant, while inter- and intra-rater reliability were excellent (correlation coefficients r = 0.90 and 0.91; p < 0.0001), as was the correlation between external and self-assessment (r = 0.81; p < 0.0001). Self-assessment was more reliable among experienced learners than among novices. Conclusion This standardized LAP scale is validated for both external and self-assessment, the latter requiring prior training to be reliable and formative.

Background: The aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France. Methods: Retrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared. Results: 139 patients were included, with a median age of 8 [1e16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients. Conclusions: Diaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence. ClinicalTrials: NCT04862494, April 28, 2021. Level of evidence: level III treatment study. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Ovarian mature teratomas (OMTs) are the most common benign ovarian tumors in pediatric patients. Management in adolescents can be performed by pediatric (PSs) or gynecologic surgeons (GSs). The aim of this study was to assess the differences in OMT management and the repercussions according to the risk of secondary events. DESIGN:Based on a multicentric study, we compared patients aged 14 to 18 who underwent surgery for OMT between 2009 and 2022 from the French national pediatric database of OMTs with patients managed by GSs. RESULTS:In total, 119 patients were included (80 by PSs, 39 by GSs). Differences between teams were noted: (i) tumor marker analysis is systematic by PSs (80%, n=72) but rare by GSs (18%, n=7) (P<0.001), (ii) PSs mostly carried out a laparotomy (78%, n=62), whereas GSs preferred laparoscopy (90%, n=35) (P<0.001), (iii) peroperative rupture was more frequent by GSs (56%, n=22) than PSs (10%, n=8) (P<0.001), (iv) median duration of follow-up increased by PSs (20months) versus 1month by GSs (P=0.001). Ten second events (13% by GSs [n=5], 6% by PSs [n=5]) occurred in nine patients, without significant differences (P=0.151). CONCLUSION:A notable difference exists in the management of OMTs between PSs and GSs in our study, GSs may overlook a malignant component in germ cell tumors in adolescents and the risk of metachronous recurrence, reported up to 10-20%. We recommend a compliance to SIOPE 2020 guidelines (Sessa et al., 2020) to avoid rupture of potential malignant tumor and to preserve fertility.

Objectives: To evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests. Methods: Retrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history and outcomes of patients with or without undernutrition (body mass index (BMI) z-score < -2 SD) at the age of 6-9 years were compared. Results: Of the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 +/- 0.4. At birth, 13 (65%) of them where preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p=0.002), and 60% of them required pulmonary treatments (vs 32%, p=0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio OR=6.0), hernia/cryptorchidism surgery (OR=5.2), a restrictive syndrome (OR=3.3) and pulmonary crisis treatment use (OR=2.7) as risk factors for undernutrition. Conclusions: In contrast to intestinal and esophageal surgeries, the respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study was funded by the University Hospital Centre of Angers (grant number 49RC19\_0185\_2), the non-profit sector associations "Institut de Recherche en Sante Respiratoire des Pays de la Loire (IRSR-PdL)" and the "Filiere des Maladies rares Abdomino-THOraciques (FIMATHO)". ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of the University Hospital Center of Angers gave ethical approvel for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

BACKGROUND:Minimally invasive surgery seems particularly suited to adolescents in view of the cosmetic improvements it provides. This study reports on our first experience of single-incision laparoscopic surgery for adjustable gastric banding (SILS-AGB) using a single-trocar approach and evaluates its safety and efficacy as compared with conventional four-trocar laparoscopy. METHODS:The data of adolescent patients who underwent SILS-AGB or conventional laparoscopy for adjustable gastric banding (CL-AGB) between 2014 and 2019 in our center were reviewed. Pre- and postoperative data on weight- and obesity-associated comorbidities were used to assess the efficacy of the surgical intervention. Perioperative and postoperative data on the duration of surgery, use of analgesics, hospital stay, and complications were compared between the SILS and CL groups along with an assessment of scar quality. RESULTS:Overall, 12 patients, with a mean body mass index (BMI) of 43.3 kg/m-² (37.0-55.5) at surgery were included in the SILS-AGB group and compared with 14 patients who underwent classic laparoscopy (CL-AGB group) and had an initial BMI of 39.5 kg/m-² (32.0-49.8). Median surgery time was 82 min (55-140) in the CL-AGB group and 106 min (75-159) in the SILS-AGB group (p = 0.04). Postoperative recovery was better in the SILS-AGB group with a mean duration of level-3 intravenous analgesia of 1.8 ± 0.4 days (vs. 2.4 ± 0.6 days, p = 0.02) and a median duration of hospitalization of 2 days (2-3) versus 3 days (2-5) (p = 0.0005). Mid-term follow-up showed equivalent efficacy in terms of weight loss, with a mean BMI at 12 months of 38.5 ± 6.0 kg m-1kg m-1² in both groups, and resolution of hyperinsulinism (92.3 % before surgery vs. 48 % at 6 months). CONCLUSION:SILS for AGB placement appears to be as safe and effective as CL despite a slightly longer operative time. SILS was associated with faster recovery and better cosmetic results with a single scar.

OBJECTIVES:To evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests at school-age. METHODS:Retrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history, and outcomes of patients with or without undernutrition (body mass index [BMI] z-score < -2 SD) at the age of 6-9 years were compared. RESULTS:Of the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 ± 0.4. At birth, 13 (65%) of them were preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs. 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p = 0.002), and 60% of them required pulmonary treatments (vs. 32%, p = 0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio [OR] = 6.0), hernia/cryptorchidism surgery (OR = 5.2), a restrictive syndrome (OR = 3.3) and pulmonary crisis treatment use (OR = 2.7) as associated with undernutrition. CONCLUSIONS:In contrast to intestinal and esophageal surgeries, respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA. CLINICAL TRIAL REGISTRATION:NCT04136795. (https://clinicaltrials.gov/study/NCT04136795?term=RestriMIS&rank=1).

Introduction: This study compares various surgical approaches for treating congenital diaphragmatic eventration (CDE) in children to identify the most effective and safest method. Methods: we conducted a retrospective analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021. The different surgical approaches, including robot-assisted thoracoscopic surgery (RATS), and their outcomes were compared. (Clinical Trials NCT04862494). Results: 112 patients, aged 12 [5 – 21] months, underwent diaphragmatic plication. Thoracoscopy or RATS was performed in 69 (62%) cases, postero-lateral thoracotomy (PLT) in 15 (13%) and an abdominal approach in 28 (25%), based on surgeons’ choice. Symptom relief was achieved in 88% of patients, and 90% showed radiographic improvement. There were 31 peri- or early postoperative complications (28%), mainly including pleural effusions, infections and lobar atelectasis, and eight recurrences of eventration (7%), with no significant correlation between these complications and the surgical approach. Compared to other approaches, thoracotomy multiplied the duration of intravenous analgesia by three (96 vs 36h, p<0.0001), and hospital stay length by two (8 vs 4d, p = 0.002). RATS, although comparable to thoracoscopy in short-term outcomes, had a higher incidence of perioperative hepatic injuries and long-term complications, including persistent symptoms in all 5 patients and chest wall deformities in two. Conclusions: Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. Further research is required to establish potential added risks of RATS as compared to thoracoscopy in this indication.

Background Diaphragmatic plication is the most widely used surgical approach for treating congenital diaphragmatic eventration (CDE) in children. This study aims to assess current surgical practice for this pathology in children.Methods Retrospective data analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021. Comparative description of the different surgical approaches and their outcomes, including robot-assisted thoracoscopic surgery (RATS). (Clinical Trials [NCT04862494][1]).Results 112 patients, aged 12 [5 – 21] months, were operated on for CDE. Diaphragmatic plication was performed using thoracoscopy or RATS in 69 (62%) cases, postero-lateral thoracotomy (PLT) in 15 (13%), and using an abdominal approach in 28 (25%). Relief of symptoms and improvement in the diaphragmatic level on chest radiographs were obtained in 88% and 90% of the cases, respectively. We recorded 32 peri- or early postoperative complications (29%) and eight recurrences of eventration (7%), but found no correlation between these complications and the surgical approach used. Compared to other approaches, PLT multiplied the duration of intravenous analgesia by three (96 vs 36h, p<0.0001), and the length of hospital stay by two (8 vs 4d, p = 0.002). Compared to thoracoscopy, RATS provided more perioperative hepatic injuries and equivalent short-term results, but all five patients remained symptomatic and two of them experienced chest wall deformities in long-term follow-up.Conclusions Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. RATS emerges as a promising surgical approach, but further is required to confirm that it is, at least, not inferior to thoracoscopy.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study did not receive any funding### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The ethics committee of the University Hospital Center of Angers gave ethial approval for this workI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][2]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04862494&atom=%2Fmedrxiv%2Fearly%2F2024%2F02%2F15%2F2024.02.15.24302855.atom [2]: http://ClinicalTrials.gov

Les hémangiomes infantiles (HI) segmentaires peuvent être associés à des malformations locorégionales, comme dans le syndrome PELVIS, et à un certain nombre de complications cutanées dont la survenue d’ulcérations nécrotiques. Nous rapportons une observation de syndrome PELVIS compliqué de nécroses cutanées extensives, sa prise en charge et son évolution chez une petite fille. À la naissance à terme, on constatait des lésions érythémateuses du siège et du membre inférieur droit (MID) avec ulcération du dos du pied. L’enfant avait un diagnostic anténatal d’uropathie malformative et de moelle attachée basse. L’aspect initial de cutis marmorata telangiectatica congenita (CMTC) se modifiait en quelques jours avec la survenue d’un HI segmentaire du siège et du MID confirmé par la positivité du marquage GLUT1. Du fait de l’association à une uropathie malformative et une moelle attachée basse, le diagnostic de syndrome PELVIS était retenu. Le propranolol était introduit à 18 jours de vie à la posologie d’1 mg/kg/j, puis augmenté jusqu’à 2 mg/kg/j à 1,mois et demi. À l’âge d’1 an et 3 mois survenaient brutalement des lésions nécrotiques puis ulcérées très douloureuses glutéales, pubiennes, vulvo-anales et sur le MID. Le propranolol était alors arrêté par crainte d’une action vasoconstrictrice délétère, sans amélioration des lésions. Une sténose ou une dysplasie artérielle segmentaire associée au PELVIS étaient éliminées. L’aggravation des plaies requérait une hospitalisation suite à une surinfection et la nécessité de réfection des pansements par les plasticiens. Les ulcérations vulvo-anales nécessitaient une dérivation digestive puis urinaire préventive pour permettre la cicatrisation. Le propranolol était finalement réintroduit à 1 mg/kg/j après avis en RCP nationale. L’évolution était ensuite très lentement favorable avec la cicatrisation de certaines plaies au niveau du périnée, mais la persistance de plaies des membres inférieurs pendant 1 an. Le propranolol était arrêté à l’âge de 5,5 ans sans reprise évolutive de l’HI. La patiente a aujourd’hui 7 ans ; ses lésions ont totalement régressé. Seules persistent des cicatrices sur le MID et une discrète asymétrie (par lipoatrophie) des 2 MI. Nous avons retenu le diagnostic d’hémangiome réticulaire compliquant un syndrome PELVIS. L’hémangiome réticulaire (HR) est une présentation rarissime d’HI avec aspect télangiectasique et livédoïde initial pouvant être compliqué par la survenue de nécroses cutanées extensives. L’HR a été rapporté dans la littérature à 2 reprises : par Mulliken d’abord en 2007 puis par Bessis qui l’a associé à une lipoatrophie. Le cadre nosologique reste encore à déterminer, en particulier pour ce qui concerne l’association constante à un hémangiome segmentaire. La physiopathologie des ulcérations nécrotiques reste inconnue. Le traitement des patients de Mulliken par corticoïdes, avant l’avènement du propranolol, avec évolution rapidement favorable en plusieurs semaines, est d’interprétation difficile. Dans notre cas, l’évolution de l’hémangiome a paru totalement indépendante du traitement par propranolol. Le pronostic à long terme de l’HR est bon, en accord avec l’histoire naturelle d’un hémangiome infantile, et ceci doit être indiqué aux parents pendant la prise en charge symptomatique des complications.

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

La apendicectomía es la intervención digestiva más frecuente en el niño. Sin embargo, a veces resulta difícil hacer el diagnóstico formal de apendicitis o peritonitis apendicular, y la morbilidad de esta afección está lejos de ser despreciable. El diagnóstico se basa esencialmente en la exploración física, un análisis biológico simple (hemograma completo y proteína C-reactiva) y la ecografía. La tomografía computarizada se reserva para las dudas diagnósticas. Una vez hecho el diagnóstico, el tratamiento de referencia es la apendicectomía, por laparotomía o por laparoscopia, asociada a una antibioticoterapia adaptada a la gravedad de la infección. La apendicitis, en particular si está perforada, puede complicarse con abscesos de pared o abscesos intraperitoneales, que se tratan con antibióticos, en ocasiones asociados a un drenaje quirúrgico o percutáneo.

Background and ObjectivesPatients with Hirschsprung's disease are at risk of developing Hirschsprung-associated enterocolitis, especially in the first 2 years of life. The pathophysiology of this inflammatory disease remains unclear, and intestinal dysbiosis has been proposed in the last decade. The primary objective of this study was to evaluate in a large cohort if Hirschsprung-associated enterocolitis was associated with alterations of fecal bacterial composition compared with HD without enterocolitis in different age groups.MethodsWe analyzed the fecal microbiota structure of 103 Hirschsprung patients from 3 months to 16 years of age, all of whom had completed definitive surgery for rectosigmoid Hirschsprung. 16S rRNA gene sequencing allowed us to compare the microbiota composition between Hirschsprung's disease patients with (HAEC group) or without enterocolitis (HD group) in different age groups (0–2, 2–6, 6–12, and 12–16 years).ResultsRichness and diversity increased with age group but did not differ between HD and HAEC patients, irrespective of the age group. Relative abundance of Actinobacteria was lower in HAEC than in HD patients under 2 years of age (−66%, P = 0.045). Multivariate analysis by linear models (MaAsLin) considering sex, medications, birth mode, breast-feeding, and the Bristol stool scale, as well as surgery parameters, highlighted Flavonifractor plautii and Eggerthella lenta, as well as Ruminococcus gnavus group, as positively associated with Hirschsprung-associated enterocolitis in the 0–2 years age group.ConclusionHirschsprung-associated enterocolitis was associated with features of intestinal dysbiosis in infants (0–2 years) but not in older patients. This could explain the highest rate of enterocolitis in this age group.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT02857205, MICROPRUNG, NCT02857205, 02/08/2016.

Los politraumatismos en niños son situaciones poco frecuentes, pero constituyen la primera causa de muerte en el niño mayor de 1 año. Situaciones recientes como la comisión de atentados y la consiguiente afluencia masiva de pacientes ponen de manifiesto la importancia de actualizar los conocimientos y habilidades propios de estas situaciones, a menudo alejadas de la práctica cotidiana. El tratamiento debe seguir una secuencia bien establecida, con la colaboración multidisciplinaria de equipos preparados para prevenir el riesgo de muerte que, en alrededor del 50% de los casos, se produce en la hora que sigue al traumatismo. Resulta indispensable conocer las especificidades anatómicas y fisiológicas del niño, a fin de optimizar este tratamiento. Las secuelas posteriores al traumatismo son complejas y no deben descuidarse en el niño en crecimiento.

Objectives: The present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France. Methods: Retrospective cross-sectional study of patients ages 6-30 years that had been surgically treated for ARM. Patient and ARM characteristics (eg, level, surgical approach) and functional outcomes were assessed in the different age groups. Results: Among 367 patients, there were 155 females (42.2%) and 212 males (57.8%), 188 (51.2%) cases with, and 179 (48.8%) higher forms without, perineal fistula. Univariate and multivariate statistical analyses with logistic regression showed correlation between the level of the rectal blind pouch and voluntary bowel movements (odds ratio [OR] = 1.84 [1.31-2.57], P < 0.001), or soiling (OR = 1.72 [1.31-2.25], P < 0.001), which was also associated with the inability to discriminate between stool and gas (OR = 2.45 [1.28-4.67], P = 0.007) and the presence of constipation (OR = 2.97 [1.74-5.08], P < 0.001). Risk factors for constipation were sacral abnormalities [OR = 2.26 [1.23-4.25], P = 0.01) and surgical procedures without an abdominal approach (OR = 2.98 [1.29-6.87], P = 0.01). Only the holding of voluntary bowel movements and soiling rates improved with age. Conclusion: This cross-sectional study confirms a strong association between anatomical status and functional outcomes in patients surgically treated for ARM. It specifically highlights the need for long-term follow-up of all patients to help them with supportive care.

Objective Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10% to 20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed. This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. Design A retrospective review of all girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, follow-up second events and their management were retrieved. Results Overall, 350 children were identified. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: 8 cases including one malignant tumor, contralateral: 18 cases, both ovaries: 3 cases). A large palpable mass, bilateral forms at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas type of surgery or approach did not. Conclusion This study is a plea in favor of OSS as the first choice of treatment of OMT when possible. Close follow-up during the first five years is mandatory considering the risk of 8.3% of second events especially in cases with risk factors.

Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10%–20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi‐ or contralateral ovaries. Ovarian‐sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed.

L’obésité, définie par un excès de masse grasse, représente un problème majeur de santé publique. Sa prévalence a fortement augmenté à l’échelle mondiale depuis la seconde moitié du XXe siècle, à tel point que l’on parle « d’épidémie » d’obésité ou encore de « globésité ». Au vu des résultats souvent insuffisamment probants des mesures physiques et nutritionnelles, l’indication de chirurgie bariatrique peut être posée dès l’adolescence pour des cas d’obésité sévère, après échec d’autres stratégies thérapeutiques. L’indication de cette chirurgie pour les patients mineurs est encadrée en France par les recommandations de la Haute Autorité de Santé publiées en 2016. Elle a pu montrer pour cette population son efficacité à court terme sur la réduction de l’Indice de Masse Corporelle, le traitement des comorbidités et une amélioration de la qualité de vie. Cependant la réussite à la chirurgie n’est pas systématique et des données de l’évolution à plus long terme de ces adolescents sont requises pour appréhender au mieux cette chirurgie. Il est primordial de repérer et renforcer des éléments de motivation interne et de capacités d’adaptation du jeune, afin d’affiner la demande et d’améliorer l’efficacité de la chirurgie. Elle s’intègre dans une prise en charge pluridisciplinaire indispensable.

Background/purpose: There is no consensus when it comes to the best procedure or device used for gastrostomy creation in pediatrics. We compared the complications encountered with different gastrostomy techniques. Methods: All paediatric patients having had a gastrostomy procedure between 2004 and 2016 were retrospectively reviewed. Overall, serious and local complication rates at six months were compared between PEG-button (PEG-B), pullPEG tube (PEG-T) and surgical gastrostomies with buttons (SG-B). Results: Complications occurred in 44.6% of the patients. The rate of overall complications (71.4% vs. 50.0%, p = 0.02) as well as minor complications (93.3% vs. 69.0%, p < 0.01) was higher in the PEG-B group (63 patients) compared to the PEG-T group (58 patients) but similar to the SG-B group (83 patients). Serious complications mainly occurred in the PEG-T group (31.0% vs. 6.7%, p < 0.01). Risk factors for overall complications were being a female (Odds ratio (OR) 2.62, p < 0.01) and a concomitant fundoplication (OR 8.94, p = 0.04), whereas serious complications were favoured by the use of a G-tube (OR 3.78, p = 0.01). Conclusions: A PEG-B is a simple and safe way for enteral nutrition, with a slightly higher rate of local, but less serious, complications than the classic pull-PEG technique.

Le urgenze chirurgiche nei bambini piccoli coprono molte patologie, che possono diventare rapidamente pericolose per la vita e che sono, quindi, importanti da conoscere. Richiedono un trattamento appropriato in un ambiente specializzato, seguendo un processo diagnostico rigoroso basato principalmente sull’età del paziente e sui sintomi clinici. Nei neonati, sono causate principalmente da malformazioni congenite toraciche, addominali o urinarie. Il miglioramento della diagnosi prenatale ha completamente cambiato le condizioni dell’assistenza iniziale per la maggior parte di loro e consente alle famiglie di essere informate precocemente. Anche la loro prognosi è molto migliorata negli ultimi anni grazie al progresso delle tecniche di rianimazione neonatale e alla perfetta collaborazione medicochirurgica. Nel lattante, le urgenze chirurgiche sono principalmente digestive, comprese la stenosi pilorica, l’invaginazione intestinale acuta, l’ernia strozzata e, meno frequentemente, l’appendicite acuta. L’esame obiettivo e l’ecografia addominale confermano la diagnosi, evitando qualsiasi ritardo terapeutico e garantendo una guarigione senza sequele.