IntroductionPolytrauma is defined by the presence of multiple traumatic injuries and poses a significant global health concern due to its associated morbidity. Clear guidelines or recommendations for the medical or surgical management of pediatric polytrauma patients are currently lacking.AimsNational Survey of the Management of Paediatric Polytrauma was conducted to clarify and delineate the current national standards in the care paediatric polytrauma patients.Material and methodsWe conducted a survey among senior physicians from the Italian Society of Pediatric Surgery and the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care. The survey focused on the management of pediatric polytrauma and compared practices between pediatric and hybrid hospitals, as well as between high- and low-volume centers.ResultsA national survey of 52 institutions revealed that 33% were paediatric hospitals and 67% were hybrid institutions treating adult patients. We found that 89% of the institutions had a dedicated paediatric emergency department, and 44% had a senior paediatric surgeon on call. Most hospitals had a dedicated paediatric intensive care unit, 72% had a multidisciplinary trauma team, and 94% had an internal protocol for paediatric polytrauma management. We found no significant differences in the number of second-level paediatric emergency departments, availability of paediatric surgeons, multidisciplinary trauma teams, or imaging modalities. High-volume centres had a higher annual incidence of polytrauma than low-volume centres.ConclusionThe study provides important insights into the current state of paediatric polytrauma management in the Italian healthcare system. The study emphasised the crucial need for standardisation, specialised training, and the development of evidence-based guidelines. The proposed national trauma registry will be instrumental in facilitating this process and improving the quality of care for paediatric polytrauma patients in Italy. Further research examining the effect of volume, training, and guideline implementation on patient outcomes will significantly enhance this field.

IntroductionPenetrating trauma in children is relatively uncommon but is associated with significant morbidity and mortality, particularly when major vascular or visceral structures are involved. Owing to anatomical and physiological differences, as well as limited paediatric-specific evidence, surgical decision-making remains challenging and often relies on extrapolation from adult data. This study aimed to describe the surgical decision-making strategies for haemodynamically stable paediatric patients with penetrating injuries, highlighting the roles of clinical assessment, imaging, and multidisciplinary management.MethodsWe report a retrospective case series of three paediatric patients with penetrating trauma who were managed at two tertiary paediatric referral centres. The clinical presentation, diagnostic workup, surgical approach, and outcomes were analysed.Case descriptionAll patients were haemodynamically stable on admission but presented with penetrating injuries involving high-risk anatomical regions. Contrast-enhanced computed tomography played a key role in the preoperative assessment of extremity injuries, whereas surgical exploration was deemed mandatory in the presence of abdominal evisceration, despite stable vital signs. A tailored surgical approach based on clinical and radiological findings allowed safe foreign body removal or exploratory surgery without major complications. No vascular or visceral injuries requiring repair were observed. The postoperative course was uneventful, and no early or late complications occurred during follow-up.ConclusionPenetrating trauma in haemodynamically stable paediatric patients requires individualised decision-making, supported by careful clinical evaluation, appropriate imaging, and multidisciplinary collaboration. Selective surgical exploration guided by injury pattern and anatomical risk can result in favourable outcomes while avoiding unnecessary procedures.

Background and aimsPrimary Spontaneous Pneumothorax (PSP) in paediatric patients is often managed according to adult guidelines, which may be inappropriate due to anatomical and physiological differences between adults and children. No management score has ever been developed for paediatric PSP. The aim of the study was to present the Spontaneous Pneumothorax in Adolescents and Children Evaluation (SPACE) score, a clinical scoring system designed to enhance decision-making in the paediatric PSP management.MethodsThis bicentric retrospective study was conducted across two tertiary paediatric surgery centres, including 53 paediatric patients diagnosed with their first PSP episode (Period: January 2012-January 2025). This study evaluated clinical and radiological factors influencing treatment decisions and employed statistical analyses to develop and validate the SPACE Score. The exclusion criteria encompassed inadequate data, loss to follow-up, and age exceeding 18 at the time of diagnosis.ResultsSignificant differences in PSP dimensions and clinical outcomes were observed between conservative (n = 35) and drainage (n = 18) treatment groups. The SPACE score demonstrated excellent predictive accuracy in distinguishing treatment needs, with area under the receiver operating characteristic curve values for all models exceeding 0.90. The presence of mediastinal shift and pneumothorax dimensions were identified as critical predictors of the need for drainage.ConclusionsThe SPACE score is a potential tool for improving paediatric PSP management, providing a standardized approach to treatment decisions. However, further research is needed to improve its applicability across clinical settings.

Femoral hernia (FH) is a rare and often misdiagnosed pathology in pediatric population. The aim of our study was to describe the experience of a Tertiary Center in children with FH, underlying diagnostic and surgical details that could improve its management. A retrospective study of pediatric patients who underwent FH repair from January 2010 to June 2023 at our Institution was performed. In the analyzed period, 31 patients underwent surgical procedure for FH at our institution, of whom 16 (51.6

IntroductionInternational research suggests that poor patient compliance is the main cause of tutor failures in the context of potential novel orthopedic bivalve braces for conservative treatment of pectus carinatum. Our entire experimental study is based on the hypothesis that a rigid bivalve brace that patients can accept could solve the main problem associated with the conservative approach—poor compliance. The hypothesis was to reduce the thickness and weight of the classic bivalve brace to ensure concealment and make it sustainable enough to be worn several hours a day without compromising its therapeutic efficacy.Materials and methodThe research was conducted from January 2020 to December 2022 to ensure follow-up of all participants for at least 6 months. In 36 months, 140 patients with pectus carinatum were assessed and conservatively treated with the studied guardian to analyze the therapeutic efficacy of the bivalve brace and patient compliance. From the initial visit, the parents and patient were informed that this is a 2-year therapeutic course during which the bivalve brace should be worn at least 23 h a day (with 1 h of abstinence per day for routine personal hygiene practices). Compliance is the key to therapy success, and the duration of treatment depends on patient adherence.ResultsThe exceptional effectiveness of the experimental brace was confirmed by both the questionnaire from the patients (with an average satisfaction rate of 8.9/10) and an assessment of the therapy's results by a properly selected medical committee (with a VAS scale satisfaction of 7.2/10 for symmetric forms and 7.1/10 for asymmetric ones).ConclusionIn conclusion, the analyzed data confirmed the research hypotheses. First, none of the 140 patients had cardiovascular diseases directly related to their condition, confirming that pectus carinatum is a pathology of a purely aesthetic nature. Second, a cheap, lightweight, and easily obscured brace significantly improved patient compliance. Along with this, the social relevance of the aesthetic aspect today may be an important factor in motivating the study cohort to adhere to therapy. In the past, esthetics and appearance were less relevant at the social level, which may have contributed to the high abandonment and reduced compliance rates of the many studies in the literature.

BACKGROUND:Current pectus excavatum management includes a computed tomography scan to evaluate the correction index, whose superiority to the Haller Index in terms of specificity and sensibility is still under debate. Furthermore, several studies report interchangeability between the Haller Index as measured by computed tomography and as measured by X-radiograph; however, it is not clear whether this correlation also exists for the correction index. The aim of our study was to evaluate the correlation between measurements of the Haller Index and the correction index obtained by Computed Tomography and by X-radiograph. METHODS:This prospective study included 31 patients with pectus excavatum (who underwent preoperative chest computed tomography and X-radiograph) and a control group of 31 patients (who presented no chest deformity and underwent the same exams for other unrelated causes). We measured Haller Index and correction index on both exams for both groups. To demonstrate any correlation between computed tomography scans and X-radiographs for the two indexes, the Pearson R correlation test, Bland-Altman analysis, and ANOVA nested test were performed. RESULTS:Pearson's coefficient (0.829 with P<0.0001) and ANOVA nested test showed a significant correlation and similar results between the Haller Index and the correction index on computed tomography and on X-radiograph. CONCLUSIONS:Significant correlation and similar results are shown in our study in the measurement of CI and HI on computed tomography and X-radiograph. Further studies including a larger number of patients may be warranted.

AIM:Foreign body ingestion, particularly that of magnets, is a significant issue for children aged 6 months to 3 years due to their prevalence in toys and household items. Most ingested foreign bodies pass naturally, but 10%-20% of such cases require endoscopic removal, and <1% require surgery. CASE PRESENTATION:A 2-year-old girl presented with abdominal pain, nausea, and vomiting. Abdominal ultrasonography revealed numerous non-specific mesenteric lymph nodes. Plain abdominal radiography identified multiple high-radiopacity foreign bodies, 4.5 mm in diameter. RESULTS:We performed an emergency laparotomy and removed 24 spherical magnets through an intestinal breach. CONCLUSIONS:Over the past decade, the incidence of magnet ingestion in children has increased notably, largely owing to the presence of small high-strength neodymium magnets in toys. Legislative actions, including recalls and bans, have effectively reduced ingestion cases; however, challenges, such as the resale of banned products and insufficient public awareness, persist. This case report addresses the concerns of this ongoing trend and suggests easy preventive measures to improve the safety of children.

Purpose: Our aim was to explore the applicability of the definition of "large" primary spontaneous pneumothorax (PSP) of adult guidelines to pediatric patients. Methods: We performed a retrospective monocentric analysis of first-episodes of PSP (Period: January 2010-January 2023). We defined large PSP according to French SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines. Inclusion criteria: age 1-18 years-old, follow-up >= 1 year. We performed a comparative analysis between large and nonlarge PSP. We reported the categorical variables as frequencies, and continuous as median and range. We compared categorical variables using Chi-Square or Fisher test, and continuous using U Mann-Whitney test. p < 0.05 was considered significant. Results: The population consisted of 49 patients, 15 (30%) with large PSP. We found no significant differences at presentation between large and nonlarge PSP regarding age, sex, side, BMI, oxygen saturation, respiratory rate and hearth rate. Conservative first-line management was used significantly less for large PSP (26% vs. 82%, p = 0.0003), while drain more (46% vs. 8%, p = 0.005). The groups were similar regarding surgery. Large PSP had a significantly longer hospitalization (7 days vs. 4 days, p = 0.003). The incidence of first-line management failure was similar between the groups. During the follow-up, we found no significant differences regarding ipsilateral recurrence (33% vs. 17%, p = 0.275), and contralateral occurrence (0% vs. 5%, p = 1.000), need for drain (6% vs. 5%, p = 1.000), or surgery (33% vs. 14%, p = 0.246). Conclusions: In the first-line, large PSP were treated significantly less conservatively and more drained. Radiographic size of the pneumothorax does not seem to have an impact on first-line treatment failure and follow-up outcomes.

IntroductionOne of the most prevalent congenital wall abnormalities in children, umbilical hernias are often linked to premature or small-for-gestational-age babies. In cases of intestinal malrotation or if the cecum is very movable, generalized peritonitis may facilitate the imprisonment of these hernias.Case reportWe described a case of a 4-month-old baby who had a prior reducible umbilical hernia with a history of fever, vomiting, poor appetite, and constipation for around 48 h. The patient experienced significant intestinal bloating, vomiting, irreducibility of the umbilical hernia, skin pigmentation, and erythema at the umbilical site within 2 days after hospitalization. When there was no free abdominal air, a direct abdominal x-ray revealed evidence of hydro-gas stasis and various hydro-aerial levels that were pertinent to the ileum. In order to reduce the hernia, the patient had an emergency surgical treatment where the hernia sac was isolated and released from the ileal loop, which was securely attached to a fibrin plate. When the herniary sac was opened, a gangrenous and perforated appendix was found inside. On the seventh postoperative day, the patient was released from the hospital after an uncomplicated postoperative stay.ConclusionOur patient's clinical presentation is similar to that of only one other case report involving a 25-day-old male patient. Our case presented with a variant of the clinical symptoms of the previously described umbilical hernia, which became unfixable and strangulated as a result of appendix inflammation. The appendix was discovered inside the hernia sac during surgery.

IntroductionAbout 95% of congenital chest wall deformities are pectus abnormalities, with pectus excavatum (PE) being the most common. The purpose of this work is to offer a modified Taulinoplasty Technique based on 35 consecutive PE patients' 1-year single-center experience in 2022.TechniqueOne minimally invasive procedure for PE is taulinoplasty. In order to prevent invasion of the mediastinum or pleural cavity, it is considered that external traction can be used to raise the sternum. Our experience indicates that the most common surgical consequences of this procedure—which involves creating a submuscular and subcutaneous tunnel to install the metal device—are post-operative seroma and wound dehiscence. We modified the conventional method to achieve more aesthetically pleasing results.DiscussionTaulinoplasty seems to be a safe technique, easier and more feasible than standard Taulinoplasty, with better outcomes in terms of surgical complications, although further experience is necessary to confirm our preliminary data.

BACKGROUND:In patients undergoing appendectomy, postoperative complications are more likely to occur with complicated appendicitis. Abdominal drainage may occasionally be used to prevent such scenarios. It is unclear, though, how abdominal drains help to reduce problems after surgery. METHODS:Pediatric patients who underwent appendectomy for complicated appendicitis at a tertiary center between October 2021 and September 2022 were reviewed retrospectively. Following appendectomy, patients with and without peritoneal drains were contrasted in terms of preoperative characteristics and postoperative outcomes. RESULTS:Thirty-seven of 83 patients (44.58%) undergoing emergency laparoscopic appendectomy for complicated appendicitis received abdominal drainage. The drain group had longer hospital stay (9 days [IQR 6-11] vs. 6 days [IQR 4-8], P=0.0002) and longer time to CRP normalization (6 days [IQR 4-9.5] vs. 8 days [7-12], P=0.0222) compared to the no-drain group. The drain group also had a higher complication rate (30.56% vs. 23.81%, P=0.6107), although such finding was not statistically significant. CONCLUSIONS:The use of abdominal drains after laparoscopic appendectomy did not significantly prevent postoperative complications in complicated appendicitis. Instead, it was associated with longer hospitalization, although patients in the drain group are likely to have experienced more severe conditions.

IntroductionMidgut volvulus and intussusception are prevalent paediatric abdominal emergencies. To the best of our knowledge, this is the first reported case of a connection between intestinal volvulus and a massive intussusception.Case reportAn 8-month-old male infant was brought to the emergency room with a history of abdominal pain and vomiting for <24 h. On physical examination, the child appeared restless and was found to have a circumferential hard mass of approximately 4 cm in diameter in the epigastric region. Upon admission, laboratory results showed a C-reactive protein level of 0.4 mg/dl, LDH level of 351 U/L, mild leukocytosis with a white blood cell count of 12 × 103 /µl, and 67% neutrophils. A physical exam was significant for abdominal distention, hyperresonance in percussion, and a palpable, painful epigastric mass. The findings of the operation included a dilated and ischemic intestinal loop, approximately 25 cm from the ileocecal valve, twisted upon itself for three turns. After de-rotation, an extensive occluding ileo-ileal invagination with an ischemic intestinal loop was identified, and a length of approximately 55–60 cm of the distal ileum, including the ischemic segment, was resected.DiscussionThis is the first reported case of a connection between intestinal volvulus and a massive intussusception. Currently, only two reported cases describe the connection between volvulus and intussusception, which are insufficient to establish a direct link between the two clinical conditions.

IntroductionPectus excavatum, also known as “sunken chest” or “funnel chest,” is a congenital condition where the sternum caves inward, creating a noticeable depression in the chest. This deformity can range from mild to severe cases, and can affect appearance and lung and heart function. Treatment options vary depending on the severity of the condition and associated symptoms. A case study was conducted on three patients suffering from severe forms of pectus excavatum using modified taulinoplasty with two Pectus Up bars.Case descriptionThe patients were males, with an age of 15 years. Preoperatively, they underwent spirometry, an echocardiogram, and allergy tests. The procedure involved inserting two Pectus Up bars into the chest wall at the major sternal defect, allowing the implant to remain completely invisible. The procedure involved placing the sternal plate at the deepest point and anchored to the sternum with five self-tapping screws. The chest plate was then fixed to the bar using two screws.DiscussionThe use of Pectus Up was first reported in 2016 and has been a subject of scientific discussion and research. The double Pectus Up technique offers improved correction, increased stability, and reduced complications. However, it also presents challenges such as increased technical complexity and potential for prolonged operative times. Patient outcomes showed promising results in terms of short-term correction and long-term stability. The use of a double bar technique in the modified Taulinoplasty procedure is a key area of ongoing clinical research and innovation in pectus excavatum repair. Further studies will be needed, including more institutions that use this technique to validate our initial experience.

IntroductionHemoptysis is an alarming clinical presentation caused by a vast number of primitive conditions (infectious, malignancies, malformations, vasculitis). However, at the root of hemoptysis, there is always a “noxa patogena” altering vessel structure, usually bronchial arteries, which are characterized by high pressure. Bronchial artery embolization (BAE) is the first-line treatment for hemoptysis for its technical and clinical success, although the long-term overall outcome is not equally adequate.Case reportA 12-year-old boy was referred to our hospital for massive hemoptysis after a history of recurrent episodes since the age of 3. The patient had been diagnosed with bilateral and widespread bronchial artery hypertrophy at another hospital and treated with several BAE procedures. We performed BAE to stabilize the child as well as an angio-CT scan, which confirmed the presence of the recently placed coil to embolize a hypertrophic bronchial arteriosus branch originating from the left thyrocervical trunk and directed to the right lower lobe. Results of previous embolization (metal coils) were found at the origin of the right inferior thyroid artery and the right costo-cervical trunk. After 21 months since his first admission to our hospital, the patient was transferred by air ambulance for a massive hemoptysis recurrence. Further BAE of the previously coiled vessel coming from the right succlavia (and right inferior thyroid artery) was impossible to perform due to the presence of the coils positioned in the past. A thoracoscopic approach was chosen: the previously identified anomalous vessel was isolated and ligated using double metal clips, two on both the proximal and distal sides. Accurate exploration of the thoracic cavity was accomplished, verifying the absence of collateral vessels coming from the diaphragmatic side. The patient was discharged in four days in good clinical.DiscussionAlthough bare-minimum invasive embolism (BAE) is still the gold standard for treatment, there are situations when it may not produce the desired clinical outcome and increase the risk of rebleeding. In these situations, minimally invasive surgical procedures using a videothoracoscopic approach can be beneficial if there is a suspicion of an aberrant vessel on a DSA or CT scan.

Background: Laparoscopic appendectomy followed by postoperative intravenous (IV) antibiotics is the standard of care for acute appendicitis and postoperative prevention of intra-abdominal abscesses. The aim of or study was to determine if intraperitoneal irrigation with antibiotics could help prevent intra-abdominal abscess formation after laparoscopic appendectomy for complicated appendicitis in pediatric patients. Methods: A retrospective study was conducted on consecutive pediatric patients with acute appendicitis who had appendectomy in our Pediatric Surgery Department between August 2020 and February 2022. We compared two groups with similar age and symptoms. The first group (A) was treated with the normal standard of care, i.e., laparoscopic appendectomy and postoperative IV antibiotic therapy. For the second group (B) intraperitoneal cefazoline irrigation was added at the end of the laparoscopic procedure. Postoperative intraabdominal abscess was diagnosed with ultrasound examination, performed after clinical suspicion/abnormal blood test results. Results: One hundred sixty patients (males:females 109:51; median age 10.5 years [range 3-17 years]) who had laparosopic appendectomy for complicated appendicitis were included, 82 in group A and 78 in group B. In the first 7 days after surgery, 18 patients in group and 5 in group B developed an intra-abdominal abscess ( p < 0.005). Drains were positioned in 38 patients in group A vs. 9 in group B. One patient in group A had a different complication which was infection of the surgical incision. Conclusions: Intraperitoneal cefazoline irrigation at the end of the laparoscopic appendectomy in pediatric patients significantly reduces the formation of intra-abdominal abscesses

BackgroundDescribed for the first time in 1954, Jeune syndrome (JS), often called asphyxiating thoracic dystrophy, is a congenital musculoskeletal disease characterized by short ribs, a narrow thorax, and small limbs. In this study, we analyzed and presented our preliminary experience with a device for progressive internal distraction of the sternum (PIDS) in patients with symptomatic JS. In addition, we reviewed the contemporary English literature on existing surgical techniques for treating children with congenital JS.Material and methodsA retrospective analysis of pediatric patients (<18 years old) treated for symptomatic JS at our tertiary center between 2017 and 2023 was performed.ResultsWe presented two patients with JS who underwent surgery using an internal sternal distractor, a Zurich II Micro Zurich Modular Distractor, placed at the corpus of the sternum among the divided halves.ConclusionsWe obtained promising results regarding the safety and effectiveness of this less-invasive device for PIDS in patients with symptomatic JS. Further studies on long-term outcomes are needed to validate these findings.

IntroductionThe prevalence of life-threatening complications (LTCs) related to the minimally invasive repair of pectus excavatum (MIRPE) is unknown and underreported. The aim of this study is to contribute to the real prevalence of these rare but dramatic complications and show what went wrong in order to prevent it in the future.Case presentationA 15-year-old boy affected by pectus excavatum with severe asymmetric deformity of the chest wall was evaluated for elective corrective surgery. Preoperative computed tomography showed a Haller index of 5.7 and a correction index of 0.40. MIRPE was performed under right video-assisted thoracoscopy. Cardiac arrhythmias occurred after placement of the bar introducer. The introducer was removed, and massive bleeding was noted. Emergency Clamshell thoracotomy was performed, and cardiac surgeon was alerted immediately. A first pulmonary wound was found and controlled. Two cardiac lacerations were found: on the interventricular wall and on the right atrium. Under cardiopulmonary bypass, cardiac lacerations were sutured and other three pulmonary wounds were repaired. An urgent fasciotomy was performed for compartmental syndrome of the right lower art after femoral cannulation. Pulmonary distress occurred; the patient was admitted on ECMO (ExtraCorporeal Membrane Oxygenation) in intensive care unit. Right lower lobectomy was carried out on the fifth postoperative day due to massive pulmonary bleeding requiring temporary tracheostomy. The patient was discharged to rehabilitation after 3 months with no brain injuries, minor hearing loss, and tracheostomy.ConclusionWe want to maintain the high alertness required for this procedure. Reporting these scaring complications contributes to the real prevalence of LTCs. We suggest the use of bilateral thoracoscopy and crane elevator in severe sternal defects. We also suggest to have a cardiac surgeon available in the hospital owing to cardiac perforation.

AIM: Intestinal duplication is a rare congenital malformation characterized by the presence of a duplicity of the alimentary canal. The intestinal duplication may contain pancreatic tissue in 3% of cases, as reported in the literature, andin rare cases - it can be completely isolated from the gastrointestinal tract itself with an independent vascular axis. CASE EXPERIENCE: Here the first case, as far as we know, is reported, of isolated intestinal duplication of the mesentery, with pancreatic tissue and gastric cells inside, found in a 2 -year -old child who presented clinical and ultrasound symptoms that simulated a perforated Meckel's diverticulum. CONCLUSIONS: Intestinal cystic duplications are a rare disease with a clinical spectrum ranging from asymptomatic peritonitis to perforation. It is important to underline that intestinal cystic duplication should be considered as a differential diagnosis in those patients who present a common symptomatology attributable to intestinal obstruction, peritonitis or appendicitis. In cases of accidental finding, these lesions must - in any case - be removed due to the risk of complications such as intestinal invagination on the "leading point", peritonitis or subsequent neoplastic degeneration.

Background and objectivesMarfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients.MethodsRetrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10–June 22), with special emphasis on diagnosis, treatment, and follow-up (FU).ResultsSixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up.ConclusionsTreatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population.

BackgroundNo age-specific pediatric guidelines exist for the management of spontaneous pneumothorax (SP) in children and adolescents. Treatment remains heterogeneous and center dependent. The role of computed tomography (CT) has yet to be defined.AimsReview the management of SP in children and adolescents, with emphasis on conservative management and role of CT.MethodsRetrospective analysis of 61 consecutive patients with SP at single tertiary center. Clinical, radiological, surgical data, follow-up, and outcomes were revised.ResultsFirst-line management was conservative for 32 (53%) patients and operative for 29 (47%). Asymptomatic/paucisymptomatic patients managed conservatively experienced less first-line treatment failure. Furthermore, the patients needing at least a chest drain or surgery during the follow-up were significantly lower in the conservative group. Conservative and operative patients showed no significant differences regarding ipsilateral recurrences or contralateral occurrences. Of the 61 overall CTs performed, 14 (23%) had an impact on management. Forty-three (70%) patients had at least a CT, in 22 (51%) the CT was positive for blebs. For 10 of these patients (45%) the presence of blebs had an impact on management. Patients with and without blebs showed no differences regarding ipsilateral recurrence, contralateral occurrences, or the need for at least a chest drain or surgery during the follow-up.ConclusionsFirst-line conservative management had a significantly shorter hospitalization and better outcome, with a similar incidence of recurrences. The presence of blebs at CT does not predict the risk of recurrence. The CT scan should be reserved for a small number of selected patients who have post-VATS refractory or recurrent pneumothorax.