Perforated Meckel's diverticulum in neonates: a report of six cases and systematic review of the literature.

Background: Perforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms "Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum.

Laparoscopic Appendectomy for Chronic Right Iliac Fossa Pain: Correlating Histology with Outcome.

Background: Chronic right iliac fossa (CRIF) pain in children is associated with repeated hospital attendance, inconclusive investigations, and missed school days. There is increasing evidence for the role of laparoscopic appendectomy for the management of CRIF pain. However, currently there is no substantial evidence to correlate histological changes identified in the appendixes removed with resolution of pain.

Pediatric ovarian torsion: an uncommon clinical entity.

Pediatric ovarian torsion is an infrequent diagnosis and it often mimics acute appendicitis. Most cases are due to underlying ovarian pathology and if left untreated, ovarian torsion may eventually cause peritonitis. Emergency exploratory laparoscopy represents a valuable diagnostic and therapeutic tool in suspected ovarian torsion.

Laparoscopic watson fundoplication is effective and durable in children with gastrooesophageal reflux.

Gastroesophageal reflux (GOR) affects 2-8% of children over 3 years of age and is associated with significant morbidity. The disorder is particularly critical in neurologically impaired children, who have a high risk of aspiration. Traditionally, the surgical antireflux procedure of choice has been Nissen's operation.

In children undergoing umbilical hernia repair is rectus sheath block effective at reducing post-operative pain? Best evidence topic (bet).

A best evidence topic was constructed according to a structured protocol. The question addressed was: In children undergoing umbilical hernia repair is a rectus sheath block (RSB) better than local anaesthetic infiltration of the surgical site, at reducing post-operative pain? From a total of 34 papers, three studies provided the best available evidence on this topic. One randomised clinical trial showed RSB had a better analgesic effect in the immediate post-operative period.

Caeco-peritoneal band as a potential cause of right iliac fossa pain in children.

Background: A caeco-peritoneal band (CPB) has been observed during diagnostic laparoscopy for chronic right iliac fossa (RIF) pain. This has a veil-like configuration and arises along a broad base from the caecum and ascending colon and attaches to the anterior abdominal wall.

Methods: Retrospective analysis of a prospectively collected database of 31 patients, aged 11-16, who underwent diagnostic laparoscopy for ongoing RIF pain over a 10-year period was analysed for intra-operative presence of the CPB.

Mapping testicular blood supply in gubernaculum-sparing second-stage Fowler-Stephens procedure.

Background: Testicular survival following second-stage Fowler-Stephens (FS) procedure depends upon adequate arterial supply. There is evidence that testicular survival rates are greater following gubernaculum-sparing second-stage FS procedure. The importance of collateral vessels in preservation of the testis has been hypothesised, but never shown in the literature.

Chronically symptomatic patients with undetectable gall bladder on ultrasonography could benefit from early cholecystectomy.

90 percent of symptomatic patients undergoing cholecystectomy have cholelithiasis with 10% categorized as asymptomatic cholecystitis. In both instances, the gallbladder is evident on ultrasonography. In children with symptomatic biliary dyspepsia, the decision to proceed to cholecystectomy is made difficult if choleliths are not seen on ultrasonography.

SILS: Is It Cost- and Time-Effective Compared to Standard Pediatric Laparoscopic Surgery?

The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008-2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis.

Risk of hernia occurrence where division of an indirect inguinal sac without ligation is undertaken.

We sought to ascertain the risk of inguinal hernia occurrence when division of the processus vaginalis is undertaken without ligation, in the context of laparoscopic Fowler-Stephens orchidopexy. A cohort of patients with intra-abdominal testes subjected to a two-stage Fowler-Stephens procedure was reviewed. Analysis of a 68-month period between November 2005 and August 2011 was performed.

Initial success with gubernacular-sparing laparoscopic-assisted Fowler-Stephens orchidopexy for intra-abdominal testes.

A single surgeon's 5-year experience of preserving the gubernaculum in laparoscopic-assisted Fowler-Stephens orchidopexy is reported. Thirty-six cases of impalpable testes are considered. Sixteen patients were confirmed as having intra-abdominal testes, with 20 testes considered to be absent/vanished.

Systematic review for paediatric metachronous contralateral inguinal hernia: a decreasing concern.

Purpose: Controversy still surrounds the treatment of the asymptomatic inguinal region in paediatric patients with a unilateral inguinal hernia. The concern is the development of a future metachronous contralateral inguinal hernia (MCIH) and therefore the need for a second operation. Our aim was to provide a current systematic review of the evidence for routine contralateral exploration, and identify potential at-risk groups.

Video demonstration of the technique of laparoscopic gastrophrenopexy for the treatment of symptomatic primary organoaxial gastric volvulus.

Aim: The aim of this work was to demonstrate the technique of laparoscopic gastrophrenopexy performed for intermittent partial organoaxial volvulus.

Methods: Two pediatric patients, with an initial presentation of postprandial epigastric discomfort, were investigated by upper gastrointestinal contrast meal. These investigations revealed the presence of a rare variant of primary organoaxial gastric volvulus.

Outcome of lymphatic- and artery-sparing surgery for pediatric varicocoele.

Background: In recent years, laparoscopic equipment, and experience with its use, has improved. We are now able to appreciate microanatomy, and dissection of individual lymphatic channels is possible. Previously, the results of laparoscopic lymphatic-sparing procedures has been reported.

Improving outcome from Plastibell circumcisions in infants.

Circumcisions are among the most frequently performed operations in children and numerous techniques are employed often with varying results. Use of the Plastibell (Hollister Incorporated, Illinois, USA), under local anesthetic, is popular for cultural and religious circumcisions but is not without its problems. Complications of Plastibell (slippage, migration, bleeding and serious infection) have been reported.

Technique of laparoscopic transperitoneal lower pole heminephroureterectomy.

Background: Laparoscopic transperitoneal nephrectomy is technically feasible in most cases of benign renal disease. To date, there have been isolated reports of laparoscopic transperitoneal heminephroureterectomy of principally the upper moiety of a duplex system. Rarely reported are lower moiety nephroureterectomies.

A radiological chronicle of the presentation and management of a long gap oesophageal atresia.

Long gap oesophageal atresia is a clinically and technically challenging condition to manage. Documentation of the gap between the upper and lower pouches is critical to deciding the timing and feasibility of a primary anastamosis. Integral to this process is the role of radiology.