98 research outputs found
Minimally invasive pilonidal sinus disease (PSD) treatment in pediatric patients: A narrative review
No full textPilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative techniques are available options for the treatment of this pathology, but the ideal technique is still debatable. Analyzing the literature we found out that more recently minimally invasive approaches have been described. In particular, the mechanism of an endoscopic approach relies on the use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to daily activities. Published results of studies of newer approaches have demonstrated a lower short and long-term complication rate compared to open surgery. However, very poor reports are available in literature about pediatric population
Efficacy of indocyanine green (ICG) fluorescent cholangiography to improve intra-operative visualization during laparoscopic cholecystectomy in pediatric patients: a comparative study between ICG-guided fluorescence and standard technique
No full textIn the last few years, indocyanine green (ICG) fluorescent cholangiography (FC) has been adopted to perform intra-operative biliary mapping during laparoscopic cholecystectomy (LC). This study aimed to compare the results of LC with and without use of ICG-FC
Treatment of vesico-ureteral reflux in infants and children using endoscopic approaches
No full textAbstract
Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Endoscopic treatment of VUR dates back to 1981 when Matouschek first described injection of the ureteral orifice in an attempt to correct VUR. In addition, also Politano and colleagues and McDonald described successful correction of reflux using endoscopic techniques. After these reports subureteral Teflon injection (STING) came to be appreciated as a viable new way to less invasively correct one of the most common pediatric urologic problems. The technique is technically easy to perform and is usually performed as an outpatient procedure. It is performed in general anesthesia in children and may require repeat injections, particularly in patients with high-grade reflux. As for endoscopic technique, a main problem existed. The success in children with high grade reflux was less than reported for open or laparoscopic reimplant techniques. However, in the past 10 years, newer products have become available that are changing the indications for endoscopic correction. In these review, we analyzed the papers published in the literature on this topic to give to the readers an updated overview about the results of endoscopic treatment of VUR after 30-years of his first description
Frequency of Antibiotic-Associated Diarrhea and Related Complications in Pediatric Patients Who Underwent Hypospadias Repair: a Comparative Study Using Probiotics vs Placebo
No full textAbstract This study aimed to evaluate the effectiveness of
probiotics (Lactobacillus rhamnosus GG), as a preventive
measure of antibiotic-associated diarrhea (AAD) in children
who underwent hypospadias repair and its clinical consequences
on postoperative outcome, comparing the group treated
with probiotics + antibiotics with two control groups (only
antibiotics and antibiotics + placebo). We performed a prospective,
randomized, placebo-controlled study with three
groups of patients (30 boys for each group) who underwent
hypospadias repair in our unit from March 2016 to December
2016. G1 received antibiotics + probiotics (L. rhamnosus
GG), while G2 and G3 respectively received only antibiotics
or antibiotics + placebo (glucose solution at 5%) for the same
period. The patients were evaluated in regard to the number of
evacuations/day, stool consistency, and the number of dressings/
day. The overall incidence of postoperative AAD was
33.3% (30/90), and it was statistically lower in G1 patients
compared to G2 and G3 ones (p = 0.002). The duration of
AAD was significantly longer in G2 and G3 compared to G1
(p = 0.001). In G1, the frequency of dressing change was
significantly lower compared to G2 and G3 (p = 0.001).The
incidence of postoperative complications (fistula and dehiscence)
was significantly higher in G2 and G3 compared to
G1 (p = 0.001). Our study confirmed that the use of probiotic
L. rhamnosus GG associated with antibiotics significantly reduced
the incidence and the duration of postoperative AAD.
In addition, the use of probiotics LGG reduced the frequency
of dressing changes and the incidence of postoperative complications,
such as urethral fistula and foreskin dehiscenc
Gabriel Tarde
No full textThe article about Gabriel Tarde stands as an innovative sociological research that introduces the study of emotions through a detailed examination of the theory and concepts of the classical author of discipline
Gabriel Tarde
No full textThe article about Gabriel Tarde stands as an innovative sociological research that introduces the study of emotions through a detailed examination of the theory and concepts of the classical author of discipline
Standardization of Pre‐ and Postoperative Management Using Laser Epilation and Oxygen‐Enriched Oil‐Based Gel Dressing in Pediatric Patients Undergoing Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)
No full textUrethral duplication with bilateral megaureter and bladder outlet obstruction: unusual case managed by PADUA technique
No full textEvaluation and outcome of the distal ureteral stump after nephro-ureterectomy in children. A comparison between laparoscopy and retroperitoneoscopy
No full textIn children with a poorly functioning kidney due to vesicoureteral reflux (VUR) or ureteropelvic junction obstruction, management is by nephrectomy with total or proximal ureterectomy. The complete removal of all the ureter minimizes the risk of future morbidity associated with the distal ureteral stump (DUS), including febrile urinary tract infections (UTIs), lower quadrant pain and hematuria, the so-called ureteral stump syndrome.
OBJECTIVE:
To assess the outcome of the DUS after nephroureterectomy, we analyzed our recent experience of nephrectomy performed via retroperitoneoscopy and via laparoscopy.
METHODS:
The records of 21 consecutive patients (median age 3.5 years, range 1-10 years) who underwent nephroureterectomy via laparoscopy or via retroperitoneoscopy were retrospectively reviewed for symptoms caused by DUS and their management. Nephrectomy was undertaken for a poorly functioning dysplastic (4), scarred from VUR (10) or hydronephrotic (7) kidney. In the laparoscopic group (11 pts), 6 cases required nephrectomy for reflux while 5 patients were operated for hydronephrotic or dysplastic non-functioning kidney. In the retroperitoneoscopic group (10 pts), nephrectomy was performed for reflux in 4 cases versus 6 patients affected by hydronephrotic or dysplastic non-functioning kidney. The patients were evaluated using ultrasound (US) to check DUS length and clinically to evaluate symptoms due to a symptomatic DUS.
RESULTS:
The average length of surgery was 50 min for laparoscopy and 80 min for retroperitoneoscopy. The average of follow-up was 5 years. The length of DUS after laparoscopic nephrectomy was shorter (range 3-7 mm, statistically significant) than the DUS after retroperitoneoscopy (range 2-5 cm) (p < 0.001). Laparoscopic patients were all asymptomatic. Two patients, after retroperitoneoscopic nephrectomy, presented with recurrent UTIs; a voiding cystography revealed a VUR on the residual DUS and a redo surgery was performed in both the patients to remove the DUS (Figure).
DISCUSSION:
Several authors have stated that, in case of subtotal ureterectomy, the incidence of symptomatic DUS after nephrectomy for high-grade vesicoureteric reflux is low. However, in our series, the incidence of symptomatic DUS after nephroureterectomy was not insignificant (2/21, 9.5%). Symptoms related to a refluxing DUS occurred only in patients undergoing retroperitoneoscopic nephroureterectomy, where the DUS was longer than the DUS detected in laparoscopic patients.
CONCLUSIONS:
Considering that laparoscopy permits removal of all the ureter near the bladder dome, in children with non-functioning kidney due to VUR, it is advisable to always perform a laparoscopic rather than a retroperitoneoscopic nephrectomy to prevent problems related to a symptomatic DUS
Correlation between FLACC scale score and analgesic requirement in children undergoing Minimally Invasive Surgery
No full textPostoperative pain presents several challenges in pediatric Minimally Invasive Surgery. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale is a valid scale for pediatric postoperative pain. The aim of our study was to assess postoperative pain using FLACC scale and to analyze the correlation between FLACC scale score and analgesic requirement in children underwent Minimally Invasive Surgery. We retrospectively analyzed data of 153 children aged 2 months-3 years who underwent Minimally Invasive Surgery in our unit from January 2019 and December 2019. Postoperative pain assessment was established using FLACC scale. In each patient were analyzed the correlation between FLACC score and analgesic requirement. Pain evaluation was assigned immediately after surgery and at 15 and 60 minutes. 36.6% of patients (56 children) were asleep so considered pain free; 21.6% of patients (33 children) had a FLACC score more than 7 so they required analgesics and the pain assessment 15 and 60 minutes after was significantly lower. 41.8% of patients (64 children) had a postoperative FLACC score less than 3, so they didn’t require any analgesic treatment. On the basis of our results, we recommend FLACC scale for postoperative pain assessment in children underwent MIS aged 2 months-3 years. FLACC scale is an effective and precise scale in detection of postoperative analgesic requirement in children and it could be extended in different age groups with further research
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