OBJECTIVE:The aim was to evaluate the outcomes of conventional anorectal manometry (ARMM) testing and biofeedback therapy in adolescents with functional constipation. METHODS:A retrospective analysis of ARMM findings in patients aged 10-18 years with intractable constipation over a 4-year period was conducted. RESULTS:Of the 41 patients (mean age, 13.5±2.44 years) included, 20 (48.7%) were male. Rectoanal inhibitory reflex (RAIR) was positive in all patients. Group 1 had 31 patients with dyssynergic defecation (DD) and Group 2 had 10 patients without DD. Anal canal resting pressure, squeeze test pressure, rectal defecation pressure, and first and urge sensation volumes were similar between the groups. Maximum tolerated volume and the relaxation percentage of RAIR were higher in Group 1 than in Group 2 (p<0.05). Among 31 patients referred for biofeedback therapy, 8 (25.6%) completed the program with complete resolution of their symptoms. The mean follow-up period for these patients was 21±14.7 months. CONCLUSION:DD is relatively common in patients with psychosocial adjustment disorders, and it can be diagnosed via ARMM. Despite the low rate of adherence to the therapy in the presented series, biofeedback therapy was highly effective in resolving the symptoms including soiling.

Amaç: Mezenter kistleri (MK) nadir görülen intraabdominal benign kistik kitlelerdir.Lenfatik, mezenkimal ve enterik doku kaynaklı olabilirler.Bunlara ek olarak ürogenital kistler, dermoid kist ve psödokistler de bu sınıf içinde incelenir.Her yaşta görülebilirler.Bu çalışmada MK konusunda tek merkez cerrahi deneyiminin paylaşılması amaçlanmıştır

Background: Oesophageal colonic interposition in oesophageal atresia (OA) patients is almost exclusively done as a staged operation with an initial oesophagostomy and gastrostomy followed by the definitive surgery months later. This study presents a series of patients in whom a cervical oesophagostomy was not performed before the substitution surgery. Patients and Methods: Records of EA patients were evaluated for those who underwent colon interposition without cervical oesophagostomy. Results: There were five patients: three with pure EA and two with proximal tracheo-oesophageal fistula. A delayed primary repair could not be performed because of intra-abdominally located distal pouch. The mean age at the time of definitive operation was 5.54 (±2.7) months and the mean weight was 6.24 (±1.3) kg. A right or a left colonic segment was used for interposition keeping the proximal anastomosis within the thorax. The post-operative results were quite satisfactory within a median follow-up period of 33.2 months. Conclusion: Avoiding cervical oesophagostomy and its inherent complications and drawbacks is possible in a subset of patients with long-gap EA who underwent colonic substitution surgery. This approach may be seen as an extension of the consensus that the native oesophagus should be preserved whenever possible, because it uses the native oesophagus in its entirety.

The Breast JournalVolume 26, Issue 9 p. 1898-1899 COMMENTARY A retrospective evaluation of pediatric breast fibroadenomas with mid-term follow-up results Çiğdem Ulukaya Durakbaşa MD, Corresponding Author Çiğdem Ulukaya Durakbaşa MD cigdemulukaya@yahoo.com orcid.org/0000-0002-6474-3407 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey Correspondence Cigdem Ulukaya Durakbasa, Dr. Erkin Caddesi, IMU Goztepe EAH, Cocuk Cerrahisi Klinigi, 34722 Istanbul, Turkey. Email: cigdemulukaya@yahoo.comSearch for more papers by this authorGürkan Erkoç MD, Gürkan Erkoç MD orcid.org/0000-0002-9695-7637 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorMeltem Çağlar Oskaylı MD, Meltem Çağlar Oskaylı MD orcid.org/0000-0003-4706-6384 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorHatice Şeneldir MD, Hatice Şeneldir MD orcid.org/0000-0002-1429-6776 Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorMurat Mutuş MD, Murat Mutuş MD orcid.org/0000-0002-0059-1336 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorBurhan Aksu MD, Burhan Aksu MD orcid.org/0000-0003-0416-9906 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorAhmet Pirim MD, Ahmet Pirim MD orcid.org/0000-0002-8427-2913 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this author Çiğdem Ulukaya Durakbaşa MD, Corresponding Author Çiğdem Ulukaya Durakbaşa MD cigdemulukaya@yahoo.com orcid.org/0000-0002-6474-3407 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey Correspondence Cigdem Ulukaya Durakbasa, Dr. Erkin Caddesi, IMU Goztepe EAH, Cocuk Cerrahisi Klinigi, 34722 Istanbul, Turkey. Email: cigdemulukaya@yahoo.comSearch for more papers by this authorGürkan Erkoç MD, Gürkan Erkoç MD orcid.org/0000-0002-9695-7637 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorMeltem Çağlar Oskaylı MD, Meltem Çağlar Oskaylı MD orcid.org/0000-0003-4706-6384 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorHatice Şeneldir MD, Hatice Şeneldir MD orcid.org/0000-0002-1429-6776 Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorMurat Mutuş MD, Murat Mutuş MD orcid.org/0000-0002-0059-1336 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorBurhan Aksu MD, Burhan Aksu MD orcid.org/0000-0003-0416-9906 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this authorAhmet Pirim MD, Ahmet Pirim MD orcid.org/0000-0002-8427-2913 Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, TurkeySearch for more papers by this author First published: 12 April 2020 https://doi.org/10.1111/tbj.13834Read 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. Volume26, Issue9September 2020Pages 1898-1899 RelatedInformation

BackgroundThe aim of this study was to determine ovarian reserve using serum anti-Mullerian hormone (AMH) level in children who had undergone either ovarian-preserving surgery or oophorectomy because of ovarian torsion. MethodsPatients aged > 10 years who had undergone surgery for unilateral ovarian torsion were contacted for the study with ethics committee approval. Seventeen patients agreed to be included. ResultsA total of 10 patients had undergone ovarian detorsion and seven had undergone oophorectomy. Mean age at operation was 11.6 2.23 years (range, 8-15 years) and 13.2 +/- 2.17 years (range, 10-16 years), respectively (P = 0.46). Ovarian torsion was isolated in four patients in the first group, and in three in the second. The remainder had associated benign masses. At the time of this study, mean patient age was 18 +/- 2.11 years (range, 14-21 years) with a mean postoperative follow up of 5.9 +/- 2.8 years (range, 2-10.5 years). Echogenicity of all preserved ovaries was normal on pelvic Doppler ultrasonography, with presence of antral follicles in six. Three ovaries were smaller than expected for age, although two of these had antral follicles. Mean AMH was 5.54 +/- 2.25 ng/mL in the detorsion group and 2.70 +/- 2.11 ng/mL in the oophorectomy group (P = 0.04). ConclusionsThe presence of follicles in preserved ovaries after detorsion has been reported previously. AMH is expressed in granulosa cells of growing follicles and its serum level is valuable in assessing the quantitative aspects of ovarian reserve. Preservation of the ovary in children with torsion is justified in terms of future ovarian reserve.

Abstract Aim This study presents a single institutional experience with H-type tracheoesophageal fistula (H-TEF). Methods Esophageal atresia (EA) patients who underwent primary surgery in a single center between 2006 and 2018 were retrospectively evaluated. Results Among 110 EA patients, 7 (6.4%) had H-TEF. There were 5 males and 2 females. The primary complaints were choking, cyanosis, and/or apnea with feeding, swallowing difficulty, recurrent bronchopneumonia, or bile in endotracheal tube. The relevant symptoms began during neonatal period with varying degrees of severity in all. The initial diagnosis was proximal esophageal web as demonstrated by contrast swallow and endoscopy in one patient; H-TEF was diagnosed during the course of treatment for the web. Hydrocephalus with severe neurological sequela unrelated to H-TEF and cardiac malformation were present in one. Contrast esophagography was employed in three patients for diagnosis two of which were diagnostic. All underwent diagnostic bronchoscopy. Delayed diagnosis (after 30 days of life) occurred in five (71%). The median age at operation was 3.8 months (11 days–33 months). The level of the fistulas was between C5 and T3. Preoperative bronchoscopic cannulation was successful in all but one. The operation was done via a right cervical approach in six patients and thoracotomy in one. All patients were followed up for at least one year and there was one recurrence detected five months after the first operation. She underwent a secondary surgery with a successful outcome. Right vocal cord paralysis was detected postoperatively in the patient with hydrocephalus. Conclusions H-TEF is a rare subtype of EA malformations with a delay in diagnosis in most cases. Suggestive clinical findings, especially neonatal respiratory symptoms should always be regarded as an indication for further investigations. Although contrast esophagograms may reveal the diagnosis, bronchoscopy is the gold standard diagnostic test in our practice. It should be done preoperatively in every patient not only for diagnostic confirmation but also for cannulation of the fistula to ease the operation. H-TEF might be considered a relatively innocent EA variant but its surgery is not devoid of complications. The patients should be followed up for recurrence and recurrent laryngeal nerve injury on the long term.

Background/purpose: Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic. Methods: PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6 months ago were done for the long-term results, including coherence to regional hair care. Results: There were 268 patients with a median age of 16 years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3 months (7 days-49 months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6-63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences. Conclusions: Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences. (c) 2017 Elsevier Inc. All rights reserved.

Urethral prolapse is a disease of prepubertal black girls and postmenopausal women with an unknown cause. It may be congenital in origin or an acquired condition. It has never been reported in males. We report a 10-year-old Caucasian boy who presented because of recurrent right undescended testis. He had been operated on for bilateral undescended testes 7 years ago in another hospital, and circumcision was done during the same operation. The boy complained of a weak urinary stream during voiding. The physical examination was consistent with recurrent right undescended testis. Penile examination showed a circumferential urethral prolapse around the meatus. The urethral meatal appearance was apparent right after the circumcision. An orchiopexy operation as well as circumferential excision of the perimeatal urethral tissue with primary repair was done. The pathological examination of the specimen revealed keratinized stratified squamous epithelium consistent with urethral mucosa. The postoperative course was uneventful, and the patient urinates normally at the 8 postoperative month with a normal uroflowmetry study. This is the first report of urethral prolapse in a male. Because circumcision is a widely employed practice in many cultures, it is unlikely to be a predisposing factor. It is a benign condition that can be cured with simple resection and anastomosis.

Study Objective: Ovarian torsion in children is a relatively rare cause of acute abdominal pain. This study evaluates the diagnosis and treatment of ovarian torsion with an emphasis on conservative treatment approaches including the long-term follow-up results.Design and Participants: Patients with surgically treated ovarian torsions between December 2006 and February 2014 were included in this retrospective study. The patient population consisted of 41 patients with 42 ovaries involved. The mean age was 11 3.9 (range, 1-17) years. The most common presenting symptom was abdominal pain.Intervention: All patients underwent preoperative pelvic color Doppler ultrasonography that identified torsion in 34 (81%) ovaries.Results: During surgery, a right-sided torsion was detected in 25 (59.5%), and a left-sided one was detected in 17 (40.5%) ovaries. An excisional surgery was used for 16 (38%) ovaries, and detorsion with conservation of the ovary was used for 26 (62%). A trend toward conservative management was seen over the years. Regular follow-up for those patients who underwent conservative surgery was done in 22 patients for a mean of 25 months (range, 1.5-83 months). Control color Doppler ultrasonographic results were within normal limits in terms of ovarian size and blood supply in 17 (77%) patients. Despite normal parenchymal echogenicity, an involved ovary was smaller in size compared to the other ovary in five patients. Ovarian follicles were present in three of them.Conclusion: The ovary-sparing, conservative surgery is found to be highly successful in the presented series. Although malignancies are rarely encountered in torsed ovaries with associated masses, biopsy samples should be obtained in suspicious cases.

Amac: Bu calismanin amaci izole preaurikular tragusu olan cocuklarda eslik eden bobrek ve kalp malformasyonlarinin gorulme sikligininin belirlenmesi ve buna yonelik rutin inceleme yapilmasinin gerekliliginin ortaya konmasidir. Gerec ve Yontem: 1995-2004 yillari arasinda cocuk cerrahisi poliklinigine izole preaurikular tragus yakinmasi ile basvuran ve sendromik olmayan tum cocuklar prospektif olarak calismaya dahil edilmistir. Butun cocuklara uriner sistem ultrasonografisi (USG) uygulanmis; ayrica kardiak degerlendirme yapilmistir. Bulgular: Calismaya 46 cocuk dahil olmustur. Bu cocuklarin 4’u yenidogandir. Yenidoganlar haric tutuldugunda, ortanca yas 36 aydir (dagilim, 2 ay ile 10 yil). Cocuklarin 36’si (%65) erkek, 16’si (%35) kizdi. USG ile pelvikaliseal sistemde genislemesi olan 2 (%4) hasta tespit edildi. Bunlarin birinde bulgular kendiliginden gerilerken diger hastada ureteropelvik bileske darligi tespit edilerek duzeltici ameliyat yapildi. Kardiak degerlendirme sonucunda 1 (%2) hastada atrial septal defekt tespit edildi. Dogumsal bir kalp malformasyonu olmamakla beraber, bir baska cocukta da Wolf-Parkinson-White sendromu bulundu. Sonuc: Mevcut calismada elde edilen sonuclar izole preaurikular tragusu olan cocuklarda uriner sistemin degerlendirilmesine yonelik olarak rutin USG onerilmesini desteklemektedir. Ancak, bu cocuklarda kardiak degerlendirmenin rutin olarak yapilmasini onermeden once, yapilacak daha fazla prospektif calisma ile olgu sayisinin artirilmasi gerekmektedir. Anahtar Kelimeler: Preaurikular, Trag, Tragus, Renal, Kardiak, Cocuklar

BACKGROUND High prevalence of malnutrition along with the risk for the development of malnutrition in hospitalised children has been reported. However, this problem remains largely unrecognised by healthcare workers. AIMS To determine the prevalence of malnutrition and effectiveness of STRONGkids nutritional risk screening (NRS) tool in the identification of malnutrition risk among pediatric surgical patients. STUDY DESIGN Cross-sectional study. METHODS A total of 494 pediatric surgical patients (median age 59 months, 75.8% males) were included in this prospective study conducted over 3 months. SD-scores <-2 for Body Mass Index (BMI) for age or weight-for-height (WFH) and height-for-age (HFA) were considered to indicate acute and chronic malnutrition, respectively. The STRONGkids NRS tool was used to determine risk for malnutrition. RESULTS Malnutrition was detected in 13.4% in this group of pediatric surgical patients. Acute malnutrition was identified in 10.1% of patients and more commonly in patients aged ≤60 months than aged >60 months (13.4 vs. 6.6%, p=0.012). Chronic malnutrition was identified in 23 (4.6%) of patients with no significant difference between age groups. There were 7 (1.4%) children with coexistent acute and chronic malnutrition. The STRONGkids tool revealed that 35.7% of patients were either in the moderate or high risk group for malnutrition. Malnutrition, as revealed by anthropometric measurements, was more likely in the presence of gastrointestinal (26.9%, p=0.004) and inguinoscrotal/penile surgery (4.0%, p=0.031), co-morbidities affecting nutritional status (p<0.001) and inpatient admissions (p=0.014). Among patients categorized as low risk for malnutrition, there were more outpatients than inpatients (89.3 vs. 10.7%, p<0.001) and more elective surgery cases than emergency surgery cases (93.4 vs. 6.6%, p<0.001). CONCLUSION Providing data on the prevalence of malnutrition and risk of malnutrition in a prospectively recruited group of hospitalised pediatric surgical patients, the data acquired in the present study emphasise the need to raise clinician's awareness about the importance of nutritional status assessment among hospitalised pediatric patients and the benefits of identifying patients at the risk of nutritional depletion before malnutrition occurs. Our findings support the use of the STRONGkids tool among pediatric surgical patients to identify patients at risk for malnutrition and to increase the physician's awareness of nutritional assessment among hospitalised patients upon admission.