Journal of pediatric surgery
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The minimally invasive Nuss procedure is emerging as the preferred technique for repair of pectus excavatum. Original methods of pectus bar placement have been modified to improve safety and efficacy and avoid cardiothoracic complications. The currently reported modifications to facilitate retrosternal pectus bar placement include routine use of right thoracoscopy or a subxiphoid incision. The purpose of this article is to describe additional modifications of the Nuss procedure to improve safety and efficacy. ⋯ By using left chest thoracoscopy and Endo-kittner dissectors, the risk of cardiothoracic injury can be eliminated. Moreover, other methods to ensure safe substernal dissection are unnecessary.
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Road traffic accidents continue to be a major cause of morbidity and mortality among children. Domestic animal-related injuries in general, camel-related in particular, have not been given much attention, and very little is written about them. ⋯ Camels are a potential cause of serious injuries and a major public health problem for children in this part of the world. This is especially so for camel jockeys. Every effort should be made to prevent such injuries, including limiting camel racing to older children as well as providing adequate protective measures and public education about the proper and compassionate handling of domestic animals.
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The aim of this study was to present the current experience and evidence relating to surgical evaluation and management of nonrenal genitourinary presentation in children with Henoch-Schönlein purpura (HSP). Henoch-Schönlein purpura is the most common systemic vasculitis in childhood. Presenting symptoms include a rash, arthralgia, abdominal pain, and, frequently, renal involvement. Genitourinary symptoms are infrequently reported; however, surgical evaluation is often required. ⋯ A wide variety of nonrenal genitourinary pathology may be expected by surgical evaluation of patients with HSP. Most cases are self-limited in nature. Scrotal symptoms are frequent, but testicular torsion is highly unlikely when the diagnosis of HSP is established. Clinical vigilance should be paid to patients with possible obstructive ureteritis, for whom prompt surgical intervention may be indicated.
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Comparative Study
Comparison of surgical stress between laparoscopic and open appendectomy in children.
The present study aimed to evaluate laparoscopic appendectomy (LA) in comparison with conventional open appendectomy (OA) in children, with special emphasis on the extent of surgical trauma after LA and OA, and to assess whether LA had any clear advantages compared with conventional OA. ⋯ LA for children was as safe and effective as the open procedure and had significant advantages over OA because of less operating time, less postoperative complications, less surgical trauma, and more rapid postoperative recovery.
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The aim of this study was to review the presenting features of pediatric patients found to have omental infarction with a normal appendix at surgery. ⋯ Omental infarction often mimics acute appendicitis preoperatively, although CT may be diagnostic. Surgical resection of the affected omentum expedites clinical recovery.