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.

To evaluate outcomes of laparoscopic hiatal hernia repair with Nissen fundoplication in children, comparing infants (≤ 12 months) and older children (> 12 months). Pediatric patients who underwent laparoscopic hiatal hernia repair with Nissen fundoplication between 2008 and 2025 were retrospectively reviewed. Patients were classified by age at surgery into ≤ 12 months and > 12 months. Outcomes included postoperative complications, recurrence, length of hospital stay, and follow-up. Nineteen patients were included in this study (10 boys, 9 girls); of which 9 were ≤ 12 months and the remaining 10 were > 12 months. Age-stratified postoperative outcome comparisons were performed in 17 patients after exclusion of 2 patients (

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.

PURPOSE:Vacuum bell therapy is increasingly used as a nonoperative treatment for mild-to-moderate pectus excavatum (PE). However, evidence comparing different vacuum systems remains limited. In this study, we compared the short-term outcomes of dynamic vacuum therapy (DVT) and standard vacuum therapy (SVT) as primary nonoperative treatment approaches for PE. METHODS:This retrospective comparative cohort study included 78 patients with PE treated with vacuum therapy between 2024 and 2026, of whom 38 received DVT and 40 received SVT. Deformity depth was measured at baseline and again at 6 months. The primary outcomes were absolute improvement in deformity depth, complete or near-complete correction (residual deformity depth ≤0.5 cm), a marked response (reduction of ≥1 cm from baseline), treatment continuation, patient satisfaction, and device-related adverse events. RESULTS:Patients in the DVT group were older than those in the SVT group (p = 0.009) and had greater baseline deformity depth (2.01 ± 0.58 vs. 1.43 ± 0.60 cm, p < 0.001). Mean correction at 6 months was similar between the two groups (p = 0.184). Complete or near-complete correction was more common in the SVT group. In contrast, a reduction of ≥1 cm was more common in the DVT group (47.4% vs. 25.0%, p = 0.040; OR, 2.70; 95% CI, 1.04-7.04). Treatment discontinuation occurred only in the SVT group (0.0% vs. 15.0%, p = 0.026). Patient satisfaction was similar between groups. Skin-related complaints were more frequent with DVT, although all adverse events were minor. CONCLUSION:Both systems provided short-term improvement in PE. SVT more often achieved a residual depth ≤0.5 cm, likely reflecting lower baseline severity, whereas DVT showed a higher unadjusted ≥1 cm response rate and better treatment continuation. These findings should be interpreted cautiously because of baseline differences between groups and the absence of full confounder adjustment. Prospective studies are needed to confirm whether DVT provides a sustained clinical advantage.

The anatomy and variations of the inguinal canal significantly influence outcomes of laparoscopic inguinal hernia (IH) repair in pediatric patients. Male anatomy, with the spermatic cord and vascular structures, presents greater surgical complexity and risk. Although laparoscopy improves anatomical visualization, few studies have explored its impact on pediatric outcomes. This retrospective study analyzed 158 male children who underwent laparoscopic IH repair between November 2019 and December 2023. Data included age, hernia side, internal ring shape, inferior epigastric artery (IEA) configuration, lipoma, and peritoneal band presence. Of 207 hernias, 59.5

BACKGROUND:Pilonidal sinus disease (PSD) is a common condition in adolescents, often resulting in recurrence, prolonged recovery, and significant discomfort. Although multiple surgical approaches exist, the optimal treatment for pediatric patients remains unclear. This study aimed to compare the short-term outcomes of endoscopic pilonidal sinus treatment combined with platelet-rich plasma application (EPSIT + PRP) and excision with primary closure (EPC) in children and adolescents with PSD. MATERIAL AND METHODS:This retrospective comparative cohort study analyzed two historical cohorts of pediatric patients with pilonidal sinus disease treated during different time periods at the same institution. A total of 104 patients under 18 years of age were included. EPC was performed in 73 patients between 2010 and 2015, with data retrospectively analyzed. Starting in 2024, 31 newly diagnosed patients were prospectively treated with EPSIT + PRP. PRP was prepared by centrifuging 15 mL of autologous blood at 4000 rpm for 10 min. Patients were evaluated based on demographic features, length of hospital stay, recurrence and complication rates, analgesic use, return to daily life, cosmetic outcomes, and satisfaction. RESULTS:Of the 104 patients, 65.4 % were male and 34.6 % female. Median age was 16 years in the EPC group and 17 years in the EPSIT + PRP group. Hospital stay was significantly shorter in the EPSIT + PRP group (same-day discharge vs. mean 2.79 days; p < 0.05). In the postoperative 1st year follow-up, recurrence rates were 13.7 % (EPC) and 9.7 % (EPSIT + PRP), not statistically significant (p = 0.750). Cosmetic satisfaction and return to social life favored the EPSIT + PRP group (p = 0.031). CONCLUSION:EPSIT + PRP appears to be a feasible and well-tolerated minimally invasive alternative to EPC in the treatment of PSD in children and adolescents. Despite differences in follow-up duration and study design, short-term outcomes suggest lower recurrence, faster recovery, and better cosmetic satisfaction with EPSIT + PRP.

Pectus excavatum (PE) is the most common congenital chest wall deformity. While often perceived as a cosmetic issue, PE can impair cardiopulmonary function. Surgical correction has evolved from the Ravitch procedure to the minimally invasive Nuss technique, which offers reduced surgical risks and improved postoperative outcomes. However, diagnostic and therapeutic variability persists, highlighting the need for expert consensus. A 31-question web-based survey was distributed to CWIG members and PE specialists between November 2024 and January 2025. The survey explored five key domains: demographics, preoperative evaluation, surgical indications and timing, operative technique, and postoperative management. Responses from 100 international surgeons were analyzed. The most common indications for surgery were severe deformity (88.9

Urethral stones are rare in children, accounting for only 0.3% of all pediatric urinary stones. An eight-year-old boy was admitted with a history of penoscrotal hypospadias repair in whom urethral diverticulum with stones was developed. After a prolonged treatment process, the patient did not attend follow-up visits for nearly five years, as there were no recurring complaints. The patient initially presented with meatal stricture and a scrotal ultrasound revealed a calcified stone. Surgical removal was performed with excision of the diverticulum and two-layer urethral repair. Postoperative crystallographic analysis result was reported as struvite. In conclusion, urethral stones, although uncommon, may develop in children with conditions such as hypospadias that promote urinary stasis. Surgical intervention is crucial to prevent recurrence, and stone analysis helps guide future treatment.

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.

Purpose Hydrocele is a result of intraperitoneal fluid filling into the scrotum through the patent processus vaginalis (PPV). While the traditional approach of pediatric hydrocele has been open repair (OR) for years, laparoscopic repair (LR) of hydrocele has been accepted worldwide after the proven efficacy of laparoscopy. The purpose is to compare the outcomes of both techniques in a single center. Methods We retrospectively analyzed the clinical data of all the patients who underwent hydrocele repair from August 2016 to November 2022. In our center, the standard approach was OR in hydrocele until the November of 2021. Starting from this date, LR has begun to be preferred, as the experience has increased and its success has been observed. In the LR group, single-port percutaneous internal ring suturing technique was performed. Results The data of 113 patients (OR 58.4% ( n = 66), LR 41.6% ( n = 47)) were collected. In preoperative examination, 12.4% ( n = 14) patients were diagnosed as communicating and 87.6% ( n = 99) non-communicating hydrocele. Intraoperatively, 65.5% ( n = 74) patients were communicating and 34.5% ( n = 39) were non-communicating. Total recurrence rate was 7% ( n = 8). The OR group experienced a recurrence rate of 10.6% ( n = 7), while the LR group experienced 2.12% ( n = 1). Conclusion Laparoscopy may reveal intrabdominal connection of hydrocele better than open approach. It provides a high quality view of both inguinal rings and has the advantages of minimally invasive surgery.

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: Testicular torsion is a common surgical emergency in pediatric surgery and urology practice.The timing of surgery and the degree of torsion are the factors affecting testicular salvage.The aim of this study is to investigate the efficiency of Pentraxin 3 (PTX 3) levels as a diagnostic marker in an experimental rat testicular torsion model. Materials and Methods:A total of 17 Wistar albino male rats were randomly divided into two groups: seven rats in Sham group (Group S), ten rats in testicular torsion group (Group TT).Blood was taken at the 4 th and 4 th , 24 th and 72 nd hours following testicular torsion for group S and group TT, respectively.Histopathological evaluation was performed.PTX 3 levels were measured for each rat. Results:The median plasma levels of PTX 3 were 1,409 ng/mL at the 4 th hour in group S and 1,393 ng/mL, 1,283 ng/mL, 1,094 ng/mL at the 4 th , 24 th and 72 nd hours, respectively in group TT.There was a statistically significant difference between the 72 nd -hour plasma levels and group S (p=0.004). Conclusion:PTX 3 levels decreased at the 72 nd hour in the experimental rat testicular torsion model.But the diagnosis should be made within 6 hours from the beginning of the symptoms to protect the testes.PTX 3 levels do not seem to be helpful in clinical practice as a useful marker for early diagnosis of testicular torsion.

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.

Bullous lung diseases may cause primary spontaneous pneumothorax (PSP) in children. The microRNAs (miRNAs) are non-coding RNAs that participate in regulation of inflammation and cancer. We hypothesized that children with bullous lung disease and PSP may have altered miRNA expressions in their exhaled breath condensates (EBCs). Therefore, a prospective study was performed to evaluate the miRNA-24 and 21 expression, and the matrix metalloproteinase-7 (MMP-7) levels in EBC of children with PSP. Children with PSP were evaluated for age, gender, clinical features and results of surgical treatment. EBC samples (500-1000 ml) were collected to evaluate the miRNA-21, 24 expressions, and MMP-7, and tissue-inhibitor-MMP-1 (TIMP-1) levels. miRNA expressions and MMP levels of patients were compared with healthy controls (control group (CG),n= 12). Subjects (n= 16) with a mean age of 15 years (10-19 years), and a male-to-female ratio of 14:2 were enrolled in this study. The most common presenting symptom was sudden chest pain (n= 14). In 62.5% of the cases an underlying bullous lung disease were detected. During an average of 16.6 months (1-60 months) follow up period, four subjects relapsed. The mean MMP-7 (1.74-1.57 ng ml-1), and TIMP-1 (1.92-1.84 ng ml-1) levels were similar between both groups (p> 0.05). miRNA-24 expression was significantly decreased in the PSP group, when compared to the CG (0.16-1 2-ΔΔCT,p< 0.05). In addition, the miRNA-21 expression was not different between the two groups (p> 0.05). In conclusion, the miRNA-24 levels were significantly decreased in children with PSP. Taken together, children with PSP, especially those with bullous disease, should be closely monitored in the long-term period.

Background: One of the most challenging operations in children for anesthesiologists and surgeons is foreign body aspiration. Bronchospasm and desaturation may lead to bradycardia and even death. Objectives: The study aimed to evaluate the effect of preoperative dexamethasone and β2 agonist (salbutamol) administration on children who had foreign body aspiration during the rigid bronchoscopy on these undesired complications. Methods: Children were divided into two groups via random numbers table, independent of their clinical conditions. β2 agonist (salbutamol) (2.5 mg < 20 kg, 5 mg > 20 kg) and dexamethasone (0.5 mg/kg) were administrated to group 1, 30 minutes before the operation. The same agents were administrated to group 2 during anesthesia induction. The occurrence of bronchospasm, desaturation, and bradycardia was evaluated. Results: There were 27 children in each group. There was no statistically significant difference between the two groups’ time periods between the onset of the symptoms and procedure (P > 0.05). The two groups were similar in clinical aspects. Clinically, periods of spasm and desaturation were shorter, and patients recovered faster in group 1, but the bronchospasm numbers, desaturation, and bradycardia periods were similar in both groups. Conclusions: The results seem statistically similar. Since the periods of spasm and desaturation were shorter, and patients recovered faster in patients with preoperative administration of β2 agonists (salbutamol) and dexamethasone, we may suggest that a larger data set in future studies may lead to more significant results and a better conclusion.

Purpose The unresolved debate about the management of corrosive ingestion is a major problem both for the patients and healthcare systems. This study aims to demonstrate the presence and the severity of the esophageal burn after caustic substance ingestion can be predicted with complete blood count parameters. Methods A multicenter, national, retrospective cohort study was performed on all caustic substance cases between 2000 and 2018. The classification learner toolbox of MATLAB version R2021a was used for the classification problem. Machine learning algorithms were used to forecast caustic burn. Results Among 1839 patients, 142 patients (7.7%) had burns. The type of the caustic and the PDW (platelet distribution width) values were the most important predictors. In the acid group, the AUC (area under curve) value was 84% while it was 70% in the alkaline group. The external validation had 85.17% accuracy in the acidic group and 91.66% in the alkaline group. Conclusions Artificial intelligence systems have a high potential to be used in the prediction of caustic burns in pediatric age groups.