Pediatric laparoscopy

Introduction: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are impalpable. In these cases, the laparoscopic technique is the method of choice for diagnosis and treatment. Materials and Methods: From 1 April 2009 to 31 October 2010, 37 testicles of 30 patients were submitted to diagnostic laparoscopy for impalpable testes. This was a prospective study seeking the diagnostic accuracy and therapeutic outcomes of use of laparoscopy in impalpable testes. Age, operative techniques, complications, the cosmetic aspect and outcomes were also recorded. Results: Mean age was 6.64 ± 3.96 years and 23% cases were bilateral. Twenty-one cases had primary orchiopexy, 9 had 1st stage Fowler-Stephens (FS) procedure, 3 had 2nd stage FS, 13 cases needed inguinal exploration and there was one vanishing testicles. Average operating time was 40 min for diagnostic laparoscopy, 90 min for unilateral and 120 min for the bilateral cases. Two of the patients had late postoperative complications e.g. one uretereral obstruction and one recurrence. Conclusions: In pediatric age group, the laparoscopic approach is safe and feasible. The purpose of study is to see whether the laparoscopic procedure presents excellent results in terms of diagnosis and therapy of the impalpable testis.

Introduction: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are impalpable. In these cases, the laparoscopic technique is the method of choice for diagnosis and treatment. Materials and Methods: From 1 April 2009 to 31 October 2010, 37 testicles of 30 patients were submitted to diagnostic laparoscopy for impalpable testes. This was a prospective study seeking the diagnostic accuracy and therapeutic outcomes of use of laparoscopy in impalpable testes. Age, operative techniques, complications, the cosmetic aspect and outcomes were also recorded. Results: Mean age was 6.64 ± 3.96 years and 23% cases were bilateral. Twenty-one cases had primary orchiopexy, 9 had 1st stage Fowler-Stephens (FS) procedure, 3 had 2nd stage FS, 13 cases needed inguinal exploration and there was one vanishing testicles. Average operating time was 40 min for diagnostic laparoscopy, 90 min for unilateral and 120 min for the bilateral cases. Two of the patients had late postoperative complications e.g. one uretereral obstruction and one recurrence. Conclusions: In pediatric age group, the laparoscopic approach is safe and feasible. The purpose of study is to see whether the laparoscopic procedure presents excellent results in terms of diagnosis and therapy of the impalpable testis.

Purpose Indications for laparoscopic inguinal hernia repair in infants and children remain controversial. The purpose of this study is to compare clinical features and outcome of laparoscopic inguinal hernia repair in infants with older children. Methods Retrospective single centre review of all patients \16 years of age (n = 380) undergoing laparoscopic inguinal hernia repair over a 5-year period (Jan 2005-Dec 2009). Outcomes were compared between infants (B12 months of age) with older children (1-15 years). Results There was a trend towards higher recurrence rate in older children than in infants (4 % vs. 1 %; p = 0.17). Total complications and complications requiring surgery were similar in both age groups. There was one testicular atrophy in an infant who had an incarcerated inguinal hernia. The incidence of bilateral inguinal hernia and contralateral patent processus vaginalis (PPV) were both significantly higher in infants (total 61 % compared with 35 % in older children). Conclusions Laparoscopic inguinal hernia repair in infants is safe and carries acceptable complication and recurrence rates. The laparoscopic approach may be particularly beneficial in infants since it allows simultaneous closure of a contralateral PPV and bilateral herniae. The outcome of laparoscopic inguinal hernia repair in older children requires further evaluation.

Objectives: To evaluate the results obtained with the technique of distal spermatic vessel ligation in children with upper or intra-abdominal undescended testis. Methods: Analysis of cryptorchid patients treated with Koff-Sethi technique for orquiopexy. Patient series: 15 children with uni-or bilateral cryptorchidism. Postoperative gonad viability was evaluated on the basis of clinical data, physical examination and testicular scintigraphy. Results: Mean age was 5.4 years. Cryptorchidism was unilateral in 10/15 (67%) patients and bilateral in 5/15 (33%). The total number of testicles operated was 25. Of these, 19/25 (76%) required ligation of the spermatic vessels performed according to the Koff-Sethi technique. Eighteen (98%) gonads remained well positioned in the scrotum and one remained in a high position. Late evaluation revealed that 14/19 (74%) testicles had normal consistency and volume upon palpation and 3/19 (16%) were atrophic. Two patients did not return for late reevaluation. Scintigraphy demonstrated good testicular perfusion in 14/17 (82%) gonads evaluated. The patient with bilateral ligation of the spermatic vessels had good perfusion in both gonads. Conclusions: Distal spermatic vessel ligation (Koff-Sethi technique) is safe and useful for the treatment of high cryptorchid testicles.

The objective of this study is to discuss the presentation, diagnosis, and surgical management of a young, healthy patient with a symptomatic mesenteric cyst. He had a 5-month history of abdominal pain from this disorder, and the case is presented to illustrate the clinical picture and operative management of this rare disorder.

Background/Purpose: Contralateral exploration (CLE) in children with unilateral inguinal hernias is still controversial. Various methods have been devised to assess the presence of contralateral patent processes vaginalis in order to rationalize the conralateral exploration. This study evaluates the selective use of the intraoperative pneumo-peritoneum technique in detecting the contralateral hernia in high-risk children. Patients and Methods: A retrospective analysis of two groups of children who underwent repair of unilateral inguinal hernias was done. Analysis included three subgroups at high-risk of developing contralateral hernia, namely, females, left side hernias, or children less than two years of age. In group I (n=126 patients), the intraoperative pneumo-peritoneum technique was not performed with the repair, in group II (n=14 patients), the test was performed using the Goldstein technique. Result: In group I, 28 children presented with left-side hernias, two of them (7%) ...

Posterior urethral valve is one of the major common
congenital obstructive urethral lesions in male children.
Endoscopic fulguration with observation is the
treatment of choice for posterior urethral valves (PUV).
This prospective study was carried out to assess the
outcome of endoscopic fulguration of posterior urethral
valves based upon the clinical, radiological and
laboratory findings.
The study started in Bangabandhu Sheikh Mujib
Medical University Hospital and Sir Salimullah
Medical college Mitford hospital, Dhaka in October 2004
on 50 male children with posterior urethral valves who
were treated with endoscopic fulguration and came for
routine follow up. Diagnosis was established by voiding
cystourethrogram (VCUG) and confirmed by
urethrocystoscopic findings. The patients came for
follow up after valve ablation at three months interval
up to 1 year, and at six months interval onward.
Mean age of the patients was 2 years ranging from 1 to
12 years old. At diagnosis mean serum creatinine level
± SD was 90.4±44.8 µmol /litre and it decreased to
58.3±11.4µmol/litre at the end of 18 years follow up.
Hydronephrotic changes decreased from decreased
from 84% to 2%. Proteinuria decreased from 38% to
4%.Urinary tract infections decreased from 58% to 8%
at the end of last follow up.
In this study patients improved dramatically following
fulguration of posterior urethral valves. But these
patients need regular follow up because some of these
patients may develop ESRD in the long run.
Key words: Posterior urethral valves, Fulguration,
Follow up.

This study aims to determine the actual incidence of bilateral inguinal hernia in
pediatric surgery patients who initially presented with unilateral symptoms in Region 1
Medical Center. A retrospective study was conducted in pediatric surgery outpatient and
operating room between June 2021- June 2024. All pediatric patients aged 18 years

and below who underwent elective or emergency laparoscopic herniotomy with a pre-
operative diagnosis of unilateral indirect inguinal hernia were included in this study. All

data are gathered from operating room records and minimally invasive surgery

logbooks. Descriptive statistics was used to summarize the collected data. From eighty-
three cases of unilateral inguinal hernia diagnosed pre-operatively as unilateral, 25.35%

(n=21) were discovered to be actually bilateral inguinal hernias intraoperatively via
laparoscopic approach. Also, it can be deduced that both unilateral and bilateral hernias
have a higher incidence in males than in females. The p-value of 0.750 implies no
significant difference between the incidence of unilateral and bilateral hernia across the
sexes. In addition, the results found that there is a higher incidence of inguinal hernia
cases in ages < 5 years old (55, 66.3%), than in > 5 years of age (28, 33.7%). There

3
is a higher incidence of inguinal hernia cases in male pediatric patients than in females;
with a percentage of 80.7 (n=67), and 19.3% (n=16) respectively. Most cases had right
laterality (53, 63.9%) than left (30, 36.1%).

A 31-year-old male patient was admitted with complaints of widespread abdominal pain, high temperature (T max 39.2°C), lack of appetite, weakness, weight loss. The patient underwent "Laparoscopic fundoplication in Toupet modification" for GERD 10 days ago. The early postoperative period passed without peculiarities. On the 5th postoperative day, the patient had abdominal pain, lack of appetite, weakness. The patient was treated with symptomatic therapy according to the doctor's recommendations, but without any effect. On the 10th day the patient with the above complaints came to the clinic. On examination "plank-shaped abdomen", peritoneal symptoms were positive, intestinal peristalsis was sluggish. In laboratory parameters the level of CRP-339 mg/ml, no changes in clinical blood analysis were detected. The patient underwent diagnostic laparoscopy, the revision revealed diffuse purulent peritonitis, no defects of the walls of the gastrointestinal tract organs were revealed, the place of fundoplication without features, the sutures were sound. The abdominal cavity was drained: right and left lateral canals, subhepatic space and small pelvis. Antibacterial therapy has been assigned: meropenem 1.0 x3 i/v, metronidazole 500 mg x2 i/v, massive infusion therapy and parenteral nutrition. Positive clinical and laboratory dynamics was observed in the postoperative period. On the 9th postoperative day, the level of CRP decreased to 43 mg/ml, the patient was discharged for outpatient treatment in satisfactory condition.

Bilateral ureteral triplication is a very rare form of congenital urinary tract anomaly; so far, less than 10 cases have been reported worldwide. We report an infant with bilateral complete duplex kidneys and a rare variant of Type II bilateral ureteral triplication. The diagnostic challenges and successful laparoscopic management are discussed. Key words: ureteral triplication, complete duplex, laparoscopy

Introduction. Acute appendicitis is the most common surgical emergency in the pediatric population. The peak incidence occurs in the first decade of life, while it is uncommon to face appendicitis in children younger than 5 years of age. Laparoscopy is now demonstrated to be the optimal approach also to treat complicated appendicitis, but in very young children this standardized operation is not always easy to perform. Material and Methods. From January 2009 to December 2015 we operated on 525 acute appendicitis, with 120 patients less than 5 years of age. Results. 90 children had a complicated appendicitis (localized or diffuse peritonitis): 43 (48%) were operated on by open approach and 47 (52%) by laparoscopy. The overall incidence of postoperative complications was greater in the open appendectomy group (63% versus 26%) and all severe complications requiring reintervention (6% of cases: 3 postoperative abscesses resolved with ultrasound guided percutaneous abscess drainage; 1 tubal surgery for salpingitis; 1 adhesion-related ileus requiring relaparotomy) were mostly associated with open surgery. Conclusions. Laparoscopic surgery resulted as the best approach for treating complicated appendicitis also in younger children, with minor and less severe postoperative complications compared to open surgery.

Objective: To evaluate the effectiveness of needle assisted laparoscopic repair (NALR) of inguinal hernias inchildren. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pediatric surgery, Pak Emirates Military Hospital, Rawalpindi, from Aug 2017 to Apr 2018. Material and Methods: A total of 50 patients were included in the study. All the patients were diagnosed with inguinal hernias on the basis of history given by parents and clinical examination. All patients underwent NALR of inguinal hernias after preoperative workup and informed written consent. Pneumoperitoneum was created in all cases by open method. Transumblical 3mm port was used for telescope along with a single 3mm port in lower abdomen for grasping forceps. Internal inguinal ring was closed by transfixing it with a loop suture using 22 G spinal needle and 2/0 prolene suture. Operative time and presence of contralateral processus vaginalis was noted. Patients were followed up at fo...

The study aimed to assess the outcome and safety of PCCL in the pediatric population coming with bladder stones in developing countries. Methodology: Patients of pediatric age with vesical calculus were evaluated for PCCL. Department of Peads Urology Institute of Kidney Diseases Thirty participants were included in the single center study, with enrollment beginning in January 2000 and ending in August 2021. General anesthesia was used for the operation. Following a cystoscopy examination, a suprapubic puncture was performed, and the urethral tract was dilated to a maximum of 26 Fr. Pneumatic lithotripsy was used to break up the stone. A nephroscope was used to see where it was lodged so it could be removed. A percutaneous urethral catheter was inserted was taken out after 48 postoperative hours. Findings: The patients' median age was 4.1 (1-10). Patients tended to be men. The typical size of a gem was 10.1 millimeters. The average operational time to successfully remove the stones was just 30 minutes. Hematuria, infection, and mild mucosal damage were the only serious complications seen during or after surgery, and all were treated conservatively. Ammonium acid urate comprised the bulk of the stones and the nucleus in 26 cases (86%). Percutaneous suprapubic lithotripsy is a tested and reliable method with a high success rate for treating bladder stones in children. The procedure is short and has few adverse effects.

Purpose: The study aimed to assess the outcome and safety of PCCL in the pediatric population coming with bladder stones in developing countries. Methodology: Patients of pediatric age with vesical calculus were evaluated for PCCL. Department of Peads Urology Institute of Kidney Diseases Thirty participants were included in the single center study, with enrollment beginning in January 2000 and ending in August 2021. General anesthesia was used for the operation. Following a cystoscopy examination, a suprapubic puncture was performed, and the urethral tract was dilated to a maximum of 26 Fr. Pneumatic lithotripsy was used to break up the stone. A nephroscope was used to see where it was lodged so it could be removed. A percutaneous urethral catheter was inserted was taken out after 48 postoperative hours. Findings: The patients&#39; median age was 4.1 (1-10). Patients tended to be men. The typical size of a gem was 10.1 millimeters. The average operational time to successfully remove...

Background The role of laparoscopy in pediatric inguinal hernia (IH) is still controversial. The authors reported their twenty-year experience in laparoscopic IH repair in children. Methods In a twenty-year period (1995-2015), we operated 1300 infants and children (935 boys-365 girls) with IH using laparoscopy. The average age at surgery was 18 months (range 7 days-14 years). Body weight ranged between 1.9 and 50 kg (average 9.3). Preoperatively all patients presented a monolateral IH, right-sided in 781 cases (60.1 %) and left-sided in 519 (39.9 %). We excluded patients with bilateral IH and unstable patients in which laparoscopy was contraindicated. If the inguinal orifice diameter was C10 mm, we performed a modified purse string suture on peri-orificial peritoneum, in orifices B5 mm, we performed a N-shaped suture. Results No conversion to open surgery was reported. In 533 cases (41 %), we found a contralateral patency of internal inguinal ring that was always closed in laparoscopy. In 1273 cases (97.9 %), we found an oblique external hernia; in 21 cases (1.6 %), a direct hernia; and in 6 cases (0.5 %), a double hernia on the same side (hernia en pantaloon). We found an incarcerated hernia in 27 patients (2 %). Average operative time was 18 min (range 7-65). We recorded 5/1300 recurrences (0.3 %), but in the last 950 patients, we had no recurrence (0 %). We recorded 20 complications (1.5 %): 18 umbilical granulomas and two trocars scar infections, treated in outpatient setting. Conclusions On the basis of our twenty-year experience, we prefer to perform IH repair in children using laparoscopy rather than inguinal approach. Laparoscopy is as fast as inguinal approach, and it has the advantage to treat during the same anesthesia a contralateral patency occured in about 40 % of our cases and to treat also rare hernias in about 3 % of cases.

Background The role of laparoscopy in pediatric inguinal hernia (IH) is still controversial. The authors reported their twenty-year experience in laparoscopic IH repair in children. Methods In a twenty-year period (1995-2015), we operated 1300 infants and children (935 boys-365 girls) with IH using laparoscopy. The average age at surgery was 18 months (range 7 days-14 years). Body weight ranged between 1.9 and 50 kg (average 9.3). Preoperatively all patients presented a monolateral IH, right-sided in 781 cases (60.1 %) and left-sided in 519 (39.9 %). We excluded patients with bilateral IH and unstable patients in which laparoscopy was contraindicated. If the inguinal orifice diameter was C10 mm, we performed a modified purse string suture on peri-orificial peritoneum, in orifices B5 mm, we performed a N-shaped suture. Results No conversion to open surgery was reported. In 533 cases (41 %), we found a contralateral patency of internal inguinal ring that was always closed in laparoscopy. In 1273 cases (97.9 %), we found an oblique external hernia; in 21 cases (1.6 %), a direct hernia; and in 6 cases (0.5 %), a double hernia on the same side (hernia en pantaloon). We found an incarcerated hernia in 27 patients (2 %). Average operative time was 18 min (range 7-65). We recorded 5/1300 recurrences (0.3 %), but in the last 950 patients, we had no recurrence (0 %). We recorded 20 complications (1.5 %): 18 umbilical granulomas and two trocars scar infections, treated in outpatient setting. Conclusions On the basis of our twenty-year experience, we prefer to perform IH repair in children using laparoscopy rather than inguinal approach. Laparoscopy is as fast as inguinal approach, and it has the advantage to treat during the same anesthesia a contralateral patency occured in about 40 % of our cases and to treat also rare hernias in about 3 % of cases.

Introduction: We evaluated a minimally invasive surgical technique involving a single percutaneous access with a laparoscopic trocar under videocystoscopic vision for managing large bladder stones. All patients were candidates for open surgery. Materials and Surgical Technique: Fourteen patients with bladder stones larger than 3 cm in diameter or multiple stones were treated with this technique. The procedure involved the percutaneous placement of a laparoscopic trocar under cystoscopic control and the introduction of a rigid nephroscope into the bladder. Stones were cleansed via fragmentation or direct removal. Discussion: The technique was successful in all cases, resulting in controlled, stone-free bladders; there were no surgical complications. The mean operation time was comparable to that of standard management. All patients discharged uneventfully. None reported urethral stricture during the 24-month follow-up period. Percutaneous cystolithotripsy under endoscopic control is easy to perform and should be considered as an alternative for large or multiple bladder stones as it decreases the risk of urethral stricture.

Purpose: We attempted to determine whether preoperative human chorionic gonadotropin (HCG) improves fertility in intra-abdominal rat testes subjected to orchiopexy. Materials and Methods: Newborn male Sprague-Dawley rats were made cryptorchid by bilateral gubernaculum excision at age 14 days. Select rats served as controls and underwent sham operations. Half of the animals were injected with 10 international units HCG daily from days 14 to 28. On day 28 the animals were divided into group 1-6 that underwent sham operation with or without HCG, group 2-6 with cryptorchidism with or without HCG, group 3-22 that underwent standard orchiopexy with or without HCG and group 4-22 that underwent Fowler-Stephens orchiopexy with or without HCG. Contralateral orchiectomy was performed simultaneously. On day 65 each male rat was mated with 2 female rats for 3 ovulatory cycles. Results: Mean testicular weight was markedly decreased in cryptorchid compared to sham operated testes (87.2 versus 344 mg./100 gm. body weight). Mean testicular weight was similar after standard and Fowler-Stephens orchiopexy. HCG enhanced mean testicular weight aRer sham operation, standard orchiopexy and Fowler-Stephens orchiopexy (403 versus 344, 193 versus 176 and 194 versus 175 mg./100 gm. body weight, respectively) but these differences were not statistically significant. Fertility was present in all 6 sham operated, 0 of the 6 cryptorchid, 1 of the 11 standard orchiopexy and 1 of the 8 Fowler-Stephens orchiopexy rats. Of the HCG treated animals 2 of the 8 that underwent Fowler-Stephens orchiopexy and 1 of the 8 that underwent standard orchiopexy were fertile. Mean weight of the testes associated with pregnancy was significantly greater than those not associated with pregnancy (p <0.001). Conclusions: The intra-abdominal rat testis has limited fertility potential after orchiopexy that is not improved with preoperative HCG. After orchiopexy fertility correlates closely with testicular weight.

Suprapubic endoscopic access to the urinary bladder is a major advance in the endoscopic management of intravesical pathology. In this report, we present our laparoscopy-assisted suprapupic approach to the urinary bladder and discuss the advantages of this method over the more conventional techniques.

Background: The incidence of primary bladder calculi in developed countries has been steadily and significantly declining since the 19th century because of improved diet, nutrition and infection control. In these countries, vesical calculi affect adults. However, bladder calculi remain common in developing and less developed countries. Despite the presence of several studies in countries with a high incidence of the disease, no complete uniformity in the reporting of data exists.Methods: The present study was carried out in 76% admitted patient of vesical calculus, investigated and treated by spcl. Some stones were subjected to bacteriological culture.Results: Incidence of vesical calculus was 1.01% of the total surgical admission and 14.87% out of total genito-urinary disease cases.Maximum number of patients were in the age group 0-10 years. Males predominated the females with a 12:1 ratio. E.coli was the commonest organism covering 22.3% of infection. All the cases were managed by...

Appendiceal pathology’s management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were n...

Background Owing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatric patients is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness, and success. Objective The objective of this study is to compare postoperative patient comfort, length of hospital stay, and cost-effectiveness of pediatric laparoscopic appendectomies performed under spinal and general anesthesia with the usual standard-of-care procedures employed in the hospital. Methods This is a case series of 77 consecutive pediatric laparoscopic appendectomies (involving 5-8–year-old children) that took place in a hospital in Chittagong, Bangladesh, in 2019. A total of 40 patients underwent spinal anesthesia and 37 patients underwent general anesthesia. Variables such as surgery and operation theater times, pain score, incidence of postsurgery vomiting, analgesic usage, discharge times, and hospital costs were recorded. Statistical analysis ...

When widespread use of laparoscopy and thoracoscopy in adult patients occurred in the first part of the 1990s, it did not transfer into widespread application in the pediatric population for a number of reasons. One of the strong reasons was the fact that pediatric surgeons did not have a commonly performed procedure, such as cholecystectomy, in which to refine their endoscopic skills. The most common intra-abdominal procedure performed in infants and children is appendectomy and fundoplication and it is difficult initially to learn these skills. In addition, the small intra-abdominal working space in infants and young children makes the operations more difficult and time-consuming. Children seem to recover more rapidly than adults because of the fact that there is no underlying heart or lung disease (Fig. 1). In the early 1990s, it was unclear whether there would be further benefits to an already faster healing process and recovery time. The main advantage of laparoscopy is the fact that it enables a magnified view of the abdominal cavity and the treatment of more than one pathology, even

Background and Purpose: Percutaneous endoscopic management of bladder stones is not new. The ideal technique to establish suprapubic access, however, is still not justified. In this study, we used the 12-mm selfretaining laparoscopic trocar for access during management of large bladder stones. Patients and Methods: With the patient in the lithotomy position, a 12-mm self-retaining laparoscopic trocar was inserted in a full bladder under cystoscopic visual control. A 28F nephroscope was used to fragment the stone using ultrasound and pneumoclast lithotriptors. After stone treatment, the trocar was left in place, and transurethral resection of the prostate (TURP) was completed when indicated. Both urethral and suprapubic catheters were left at the end of the procedure. Clinical examination, urinalysis, and ultrasonographic examination were routinely performed during follow-up visits. Results: The mean stone size was 4.07 þ 0.20 cm (2.8-6 cm). The average time for stone fragmentation was 32.78 þ 2.16 minutes (range 8-53 min). A concomitant TURP was performed in 12 patients. The mean hospital stay was 2.56 þ 0.15 days (range 1-4 days). All patients were stone free, and a total of six complications occurred, including extravasation, one patient; hematuria, two patients; and fever, three patients. All were treated conservatively. The mean follow-up time was 15.65 þ 1.51 months (range 9-36 mos). Conclusions: Suprapubic percutaneous cystolithotripsy is a safe, minimally invasive alternative for management of large bladder stones. The use of a self-retaining trocar facilitates access and allows use of a large nephroscope for rapid fragmentation and extraction of the stone fragments. The presence of specific trocars for suprapubic access into the urinary bladder will encourage more transvesical end-laparoscopic procedures.

Aim This survey reviewed the practice of laparoscopic appendectomy in pediatric surgical centers across Europe. Methods An online survey questionnaire was created and data obtained analyzed. Results There were 58 responders (52 Consultants and 6 trainees), of them n = 24 performed > 100 laparoscopic procedures per year. Procedures were performed by trainee with scrubbed consultant supervision n = 30, trainee with unscrubbed consultant n = 14, independent trainees n = 8 and consultants n = 6. Optic port preferences were 10 mm (n = 29), 5 mm (n = 24) and 12 mm (n = 3). Working port placement preference was sectorization n = 32, triangulation n = 16 and n = 10 decided based on intraoperative findings. Mesoappendix was dissected by monopolar hook n = 26, bipolar forceps n = 20, harmonic devices n = 8, and bipolar scissors n = 4. Appendix ligation was done with 3 vicryl endoloops (n = 36), 2 vicryl endoloops (n = 13), 3 polydioxanone (PDS) endoloops (n = 7) and endostaplers (n = 2). Appendix was removed through optic 10-12 mm port (n = 27), exchanging 5 mm for 10-12 mm port (n = 9), endobag (n = 8), sterile glove digit endobag (n = 7), through 5 mm ports (n = 5) and along 5 mm port (n = 2). In complicated appendicitis, n = 48/58 would proceed with laparoscopy on prior confirmed perforation and n = 53/58 would continue with laparoscopy when intraoperative findings showed complicated appendicitis. In the presence of pus, n = 52/58 would perform peritoneal lavage and n = 4/58 would only suction pus. Complicated appendices were removed via endobag n = 30, through 10-12 mm port n = 10, sterile glove digit n = 10, exchange 5 mm for 10-12 mm port n = 7 and along with work port n = 1. Conclusion Opinions were divided with regards to approach in performing various steps of pediatric laparoscopic appendectomy in institutions throughout Europe.

Suprapubic endoscopic access to the urinary bladder is a major advance in the endoscopic management of intravesical pathology. In this report, we present our laparoscopy-assisted suprapupic approach to the urinary bladder and discuss the advantages of this method over the more conventional techniques.

Objective. We aim to evaluate the effect of peritoneal closure on postoperative pain and life quality associated with open appendectomy operations. Methods. This is a single-center, prospective, randomized, and double-blinded study. Here, 18–65-year-old patients who underwent open appendectomy for acute appendicitis were included. Demographic data of the patients, operation time, length of hospital stay, pain scores using a 10 cm visual analogue scale (VAS) on the first postoperative day, quality of life assessment using the EuroQol-5D-5L questionnaire on postoperative 10th day, deep wound dehiscence, bowel obstruction, and mortality data were recorded. Results. In total, 112 patients were included in the study. The demographic data showed no significant difference between the groups. The median VAS score was lower in the group with open peritoneum, but this difference was not statistically significant (3 vs. 4, p=0.134). The duration of surgery was significantly shorter in the peri...

A 48 year old female self presented accompanied by her husband to our Urology service on Valentine's day with a history of accidental insertion of foreign body in the urethra instead of vagina as part of consensual sexual act. She complained of dysuria and suprapubic fullness. There was accompanying single episode of haematuria. Her past medical history included overactive bladder for which she was on antimuscarinics. On initial examination vital signs were within normal range. Examination of the cardiovascular and respiratory systems was unremarkable. Examination of the abdomen revealed suprapubic tenderness. Pelvic examination was unremarkable. Baseline blood investigations included a full blood count, renal profile, coagulation screen, urine analysis and Xray pelvis. All bloods were with in normal range. Her urine analysis showed microscopic haematuria without any evidence of active infection. Xray pelvis revealed a large foreign body in the bladder Fig. 1.

A 2-year-old female guinea pig was referred for management of a urethral stone. The stone was diagnosed on radiographs following a 10-day history of stranguria, dysuria and hematuria. Attempts to remove the stone by urethral catheterization and flushing were unsuccessful. The stone was successfully fragmented and removed by cystoscopic-guided transurethral laser lithotripsy, performed under general anesthesia. The postoperative recovery was uneventful, and hematuria and stranguria resolved 24 hours after the procedure. The animal presented a good urine stream immediately following the procedure and continued to urinate well at recheck a month later. This is the first report of transurethral laser lithotripsy for the treatment of a partially obstructive urethral stone in a guinea pig. This minimally invasive approach provided excellent visualization of the urethra and bladder and allowed complete evaluation of the lower urinary tract in a retrograde manner in this female guinea pig. This novel approach holds great promise for the future treatment of lower urinary tract stones in this species.

Laparoscopic appendectomy has become favored over open surgical methods for its association with decreased postoperative pain, more rapid return to daily activities, and improved cosmetic results. Mini-incision appendectomy was being performed in our clinic for a long time especially in patients with noncomplicated appendicitis and in patients with appropriate body mass index. Although laparoscopy presents obvious advantages especially for obese patients and young women, with respect to the results of our study, mini-incision appendectomy seems to be an alternative for selected patient groups.

Aims and Objectives: The study was conducted to evaluate the efficacy, safety, complications and the results of  Litholopaxy for bladder stones Study Type; Case Study Place and Duration of study; Obaid Noor Hospital Mianwali from july 01, 2010 to june 30,2013. Material & Methods: This was a prospective case study conducted at Obaid Noor Hospital Mianwali in Urology Department. The patients were selected by simple random means. The procedure was based on the principles of endoscopic removal of bladder stones using mauremayer stone punch. The patients were evaluated by detailed history, clinical examination, ultrasonography, radiography, routine urine examination and urine cultur and sensitivity test. We studied the results of 70 patients with bladder stones treated by cystolitholapaxy. The other concomitant pathologies were BPH, Strictur Urethra, and Bladder diverticuli which were treated by TURP and Optical Urethrotomy along with cystolitholapaxy..We also studied the comlications an...

Background and Purpose: Percutaneous endoscopic management of bladder stones is not new. The ideal technique to establish suprapubic access, however, is still not justified. In this study, we used the 12-mm selfretaining laparoscopic trocar for access during management of large bladder stones. Patients and Methods: With the patient in the lithotomy position, a 12-mm self-retaining laparoscopic trocar was inserted in a full bladder under cystoscopic visual control. A 28F nephroscope was used to fragment the stone using ultrasound and pneumoclast lithotriptors. After stone treatment, the trocar was left in place, and transurethral resection of the prostate (TURP) was completed when indicated. Both urethral and suprapubic catheters were left at the end of the procedure. Clinical examination, urinalysis, and ultrasonographic examination were routinely performed during follow-up visits. Results: The mean stone size was 4.07 þ 0.20 cm (2.8-6 cm). The average time for stone fragmentation was 32.78 þ 2.16 minutes (range 8-53 min). A concomitant TURP was performed in 12 patients. The mean hospital stay was 2.56 þ 0.15 days (range 1-4 days). All patients were stone free, and a total of six complications occurred, including extravasation, one patient; hematuria, two patients; and fever, three patients. All were treated conservatively. The mean follow-up time was 15.65 þ 1.51 months (range 9-36 mos). Conclusions: Suprapubic percutaneous cystolithotripsy is a safe, minimally invasive alternative for management of large bladder stones. The use of a self-retaining trocar facilitates access and allows use of a large nephroscope for rapid fragmentation and extraction of the stone fragments. The presence of specific trocars for suprapubic access into the urinary bladder will encourage more transvesical end-laparoscopic procedures.

Vesical calculus is a common entity in children of developing countries. Foreign body ingestion is a common occurrence in the pediatric population. An ingested foreign body eroding into the urinary bladder and leading to the formation of a vesical calculus is an extremely rare condition. We encountered a 14-year-old girl who presented with a vesical calculus and a history of ingestion of a nut bolt 7 years earlier. After cystolithotomy and retrieval of the calculus, we noticed that the nut bolt formed its core. As it is an extremely uncommon presentation, it is being reported here, with a brief review of the literature.

The field of pediatric surgery has undergone numerous changes throughout the past few years. First of all the laparoscopic surgery, introduced with reluctance because many of the instruments were not appropriate for their tiny patients. Finally, the often quoted benefits of smaller scars, less pain, and shorter hospital stays had not been shown to be true in the pediatric patient. However, in the mid 1990s, surgeons began to publish their laparoscopic pediatric cases, showing laparoscopy to be a potential alternative for these patients. When pediatric surgeons began to perform laparoscopic procedures on small children and neonates, they were often forced to use instruments designed for adult patients. In the mid 1990s, 2- and 3-mm instruments were developed, which allowed surgeons to work with greater ease in confined spaces. Around the same time, a neonatal insufflator was also developed. In contrast to adult insufflators, neonatal insufflators deliver CO2 in small, controlled puff...

Background: The aim of this article is to standardize the laparoscopic technique to treat direct inguinal hernia in pediatric patients. Patients and Methods: In the last 3 years we treated laparoscopically 163 patients with a diagnosis of inguinal hernia. In 7 patients we discovered laparoscopically a direct inguinal hernia. This study is focused on the management of these 7 cases (4 girls and 3 boys; median age 4.6 years). They presented a right defect in 4 cases and a left defect in 3 cases. Six of 7 patients had been already operated for an inguinal hernia and presented a recurrence of the hernia. We used three trocars, 5-mm 0 degree optic, and two 3-mm instruments. In each case, after the resection of the lipoma using the hook cautery, the defect was closed by means of separated stitches. In every case we used the vesical ligament as an autologous patch to reinforce the closure of the defect. Results: The average operative time was 35 minutes. All the procedures were performed in a day-hospital setting. We had neither conversions nor complications in our series. With a minimum follow-up of 1 year, we had no recurrence. Conclusions: Laparoscopic identification and repair of direct inguinal hernia in children is a safe and effective procedure to adopt. The key points of the technique are the resection of the lipoma, the closure of the defect using separated, nonabsorbable sutures, and the use of the vesical ligament to reinforce the suture. We believe that in case of recurrence of inguinal hernias after inguinal approach, laparoscopy is the gold standard technique to identify and treat the cause of the recurrence itself.

Repair of inguinal hernia is one of the most commonly performed pediatric surgical procedures. The standard of treatment has been open herniotomy (OH). Recent trends have shown promising results with use of laparoscopy (LH) for the same. The aim of this study was to compare laparoscopic herniotomy with the standard of care at the time of the study, which has become an increasingly common procedure at our center. This was a prospective follow-up study conducted at the Department of Surgery at Nepal Medical College and Teaching Hospital. A total of sixtyfour patients who underwent herniotomy were included in the study and followed up for a total duration of two years post-operatively. Immediate post-op pain was assessed with the use of visual analogue scales. Complications, recurrence, and metachronous herniation were noted in the follow up visits. Use of laparoscopy resulted in a longer operative time (36.68 min vs 22.5 min for OH, P &lt;0.001). Pain scores were similar at immediate ...

To assess the outcome of laparoscopic orchiopexy and the two-stage Fowler Stephens technique for managing patients with impalpable testis in terms of safety, feasibility and efficacy. Patients and methods: This study included 78 patients who presented with 88 non-palpable testes to the outpatient clinic of Sohag university hospital in 2005e2009, and underwent laparoscopy by the same surgeon. Intra-abdominal testes were managed by laparoscopic orchiopexy if low, two-stage FowlereStephens technique if high, and orchiectomy if atrophic. Children were evaluated postoperatively to check the location and size of the testicle and to exclude any other complication. Results: Median age at presentation was 16 months (range 11e42 months). Four testes were absent while inguinal exploration was necessary for six testes with the vas entering the internal ring. Of the 78 intra-abdominal testes, 45 were identified as high (FowlereStephens in 43; orchiectomy in two atrophic testes) and 33 as low (orchiopexy). Follow up was 3e55 months (mean 34 months). Twelve patients (12 testes) were lost to follow up (7 FowlereStephens; 5 orchiopexy). On follow up, the testes were normal sized and well positioned in the scrotum in 28/28 and 32/36 testes in the orchiopexy and FowlereStephens groups with an overall success rate of 100% and 88.8%, respectively. Two testes showed testicular displacement and two showed testicular atrophy in patients of the Fowlere-Stephens group. Conclusion: Laparoscopy provides a safe and accurate modality for diagnosing and managing patients with non-palpable testes, with excellent outcomes.

Objective: Cryptorchidism affects 1% of male births. The majority of patients with undescended testis are identified and treated in childhood, but a significant proportion of them especially in third-world countries are neglected and present late. Herein, we present our initial experience of managing impalpable testis in older children and adults with laparoscopic assistance. Patients and Methods: This study was conducted from 2003 through 2008 at LUMHS Jamshoro. Thirty-two patients with 40 impalpable testes were included in this study. Diagnostic laparoscopy was performed in 32 anesthetized patients. Laparoscopic-assisted orchiopexy or orchiectomy was performed in patients with intraabdominal testis. Testicular vessels and vas deferens were mobilized and after obtaining sufficient length were brought through the posterior wall of the inguinal canal by creating a neo-inguinal ring medial to the epigastric vessels after a small inguinal incision. Results: Of 40 impalpable testis, ultrasound localized 16 (40%) of them, and on laparoscopy, 36 (90%) were localized, 30 (75%) as intraabdominal and in 6 (15%) cases vas and vessels were entering into the internal inguinal ring (intracanalicular). The remaining 4 patients were diagnosed as having vanishing testis (anorchia). Laparoscopic orchiectomy was performed in 14 (35%) of these testes, while single-stage laparoscopic-assisted orchiopexy using Prentiss' maneuver was performed in 16 (40%) testis. No major complications occurred. Seven testes were associated with ipsilateral hernias and were simultaneously repaired laparoscopically. Conclusion: Laparoscopic-assisted single-stage orchio-pexy is a safe and successful procedure for intraabdominal testis in adolescents and older patients. The additional benefit of shortening the usual course of spermatic cord was beneficial to fix the testis in the scrotum without tension.

The aim of this study is to describe a new technique using laparoscopic instruments for percutaneous bladder stone management and determine the efficacy of this procedure. The technique is based on percutaneous removal of the bladder stone(s) by using laparoscopic instruments under video-cystoscopic visualization. Laparoscopic large grasper or butterfly net like sac were used to extract bladder stones in six patients who were candidates of open cystolithotomy. Satisfactory results have been obtained in patients with solitary bladder stones that have diameters up to 3 cm or multiple stones. In selected cases, operation time, urethral and mucosal damage, hospital stay, and cost can be decreased to a minimum with this simple technique. It may be an alternative method to previously reported percutaneous bladder calculi management modality, in which percutaneous nephrolithotomy devices have been utilized.

INTRODUCTION We sought to evaluate the safety and efficacy of percutaneous cystolithotripsy in children. MATERIALS AND METHODS Thirty children (27 boys and 3 girls; mean age, 6.06 +/- 2.64 years; range, 1.5 to 12 years) with bladder calculi underwent percutaneous stone removal. The mean size of the largest diameters of the calculi was 24.8 +/- 8.47 mm (range, 13 mm to 50 mm). Under general anesthesia, a 1-cm incision was made 1 to 2 cm above the pubic symphysis. A 26-F nephroscope was introduced into the bladder following tract dilation, and the calculi were removed. If the calculi were larger than 1 cm, fragmentation was performed. The procedure was done without fluoroscopy. Finally, a urethral catheter was placed for 48 hours. RESULTS All patients became stone free. The mean operative time was 23.13 +/- 8.38 minutes (range, 12 to 40 minutes). All patients were discharged 24 hours after operation, except 1, who was hospitalized 2 more days for suprapubic pain and severe irritating ...

Bilateral ureteral triplication is a very rare form of congenital urinary tract anomaly; so far, less than 10 cases have been reported worldwide. We report an infant with bilateral complete duplex kidneys and a rare variant of Type II bilateral ureteral triplication. The diagnostic challenges and successful laparoscopic management are discussed. Key words: ureteral triplication, complete duplex, laparoscopy

Objective: To evaluate the effectiveness of povidine-iodine swab versus electrocautery to disinfect appendicular stump. Methods: A randomized controlled trial was conducted in Services Institute of Medical Sciences, Lahore, with a sample size of 40 patients from 1st Dec 2012 to 31th August 2013. Random allocation was done into two equal groups. After cutting appendix, a culture swab was taken from the appendix stump. Electrocautery was used to disinfect appendicular stump in group A while, 10% povidone-iodine was used in group B. A second culture swab was taken from stump after five minutes. Absence of growth on the second culture was considered as effective therapy. Results: Out of total 40 patients, 27 (67%) were males and 13 (33%) were females. Mean age of the patients was 25.6 years. Electrocautery was effective in 100% while Povidone-Iodine was effective in 60% cases (p&lt;0.05). Wound infections were reported in 15% of the cases in electrocautery group and 20% in povidone-iodi...

Introduction: Cryptorchidism or undescended testis is one of the most common genital disorders of boy. Now a day's laparoscopy has been widely used for the diagnosis and treatment of non-palpable testis. This study was done to evaluate the last five years' experience of laparoscopic management of non palpable testis at Dhaka Shishu (Children) Hospital. Methods: This retrospective study was done from July 2012 to June 2017. The patients between the ages of 9 months to 16 years who had diagnostic laparoscopy for non palpable testes were included in the study. Physical examination results, preoperative diagnosis, a geat surgery, laparoscopic and inguinal exploration findings, surgical procedures, results and follow up findings were evaluated. Results: Total 135 preoperatively diagnosed non pal pablete testes in 113 patients were managed laparoscopicaly. Mean age was 2.8±2.3 years. In 66 (48.8%) cases, laparoscopic examination followed by inguinal exploration was performed. Sixty nine (51%) testes were found within the abdomen. Of those staged Fowler-Stephens procedure performed in 16 and in 49 cases (36.3%) laparoscopic assisted single stage orchidopexy was done. A mean follow up period was 21 months. 52(80%) of 54 testes of laparoscopic orchidopexy, had symmetrical testicular growth. Conclusion: Laparoscopic approach is a reliable, useful and safe method for management of non palpabletestes. Its diagnostic uses obviate the unnecessary preoperative imaging studies, in guino-scrotal explorations to locate the accurate position of testes and help to decide the treatment options. The rapeuticroles of laparoscopy on mobilization of vas and testicular vessels and staged Fowler-Stephens procedures also very effective