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Prof. Dr. Zenon Pogorelić
Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia

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0 Laparoscopy
0 Pediatric Surgery
0 Pediatric Urology
0 Esophageal Atresia
0 neonatal surgery

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Appendicitis
Pediatric Surgery
Testis
Testicular torsion
Laparoscopy
Acute scrotum
Minimally invasive surgery
thoracoscopic surgery
Varicocele
Esophageal Atresia
Surgical infection

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Journal article
Published: 13 August 2021 in Children
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Background: The standard of treatment for infants with hypertrophic pyloric stenosis is still pyloromyotomy. Recently, in most of the pediatric surgery centers laparoscopic pyloromyotomy has become popular. The aim of the present study is to compare the outcomes of treatment in infants with hypertrophic pyloric stenosis between traditional open approach and laparoscopic pyloromyotomy using 3-mm electrocautery hook. Methods: A total of 125 infants, 104 (83.2%) males, with median age 33 (interquartile range, IQR 24, 40) days, who underwent pyloromyotomy because of hypertrophic pyloric stenosis, between 2005 and 2021, were included in the retrospective study. Of that number 61 (48.8%) infants were allocated to the open group and 64 (51.2%) to the laparoscopic group. The groups were compared in regards to time to oral intake, duration of surgery, the type and rate of complications, rate of reoperations, frequency of vomiting after surgery, and the length of hospital stay. Results: No differences were found with regards to baseline characteristics between two investigated groups. Laparoscopic approach was associated with significantly better outcomes compared to open approach: shorter duration of surgery (35 min (IQR 30, 45) vs. 45 min (40, 57.5); p = 0.00008), shorter time to oral intake (6 h (IQR 4, 8) vs. 22 h (13.5, 24); p< 0.00001), lower frequency of postoperative vomiting (n = 10 (15.6%) vs. n = 19 (31.1%)), and shorter length of postoperative hospital stay (3 days (IQR 2, 3) vs. 6 days (4.5, 8); p< 0.00001). In regards to complications and reoperation rates, both were lower in the laparoscopic pyloromyotomy group but the differences were not statistically significant (p = 0.157 and p = 0.113, respectively). The most common complication in both groups was mucosal perforation (open group, n = 3 (4.9%); laparoscopic group, n = 2 (3.1%)) followed by wound infection in open group, n = 3 (4.9%). No cases of wound infection were recorded in the laparoscopic group. Conclusion: Open and laparoscopic pyloromyotomy are equally safe and effective in treatment of hypertrophic pyloric stenosis. Laparoscopic technique is associated with faster recovery, shorter duration of surgery and shorter duration of hospital stay.

ACS Style

Zenon Pogorelić; Ana Zelić; Miro Jukić; Carlos Martin Llorente Muñoz. The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants. Children 2021, 8, 701 .

AMA Style

Zenon Pogorelić, Ana Zelić, Miro Jukić, Carlos Martin Llorente Muñoz. The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants. Children. 2021; 8 (8):701.

Chicago/Turabian Style

Zenon Pogorelić; Ana Zelić; Miro Jukić; Carlos Martin Llorente Muñoz. 2021. "The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants." Children 8, no. 8: 701.

Review
Published: 03 August 2021 in Children
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Background: Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a laparoscopic approach in the treatment of palpable cryptorchidism. The present systematic review and meta-analysis investigated the utility of laparoscopic orchiopexy for palpable cryptorchidism. Methods: Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant articles using the following terms: (palpable cryptorchidism or palpable undescended testes) AND (laparoscopic orchiopexy or laparoscopic orchiopexy). The inclusion criteria were all children with unilateral or bilateral palpable undescended testes who underwent laparoscopic orchiopexy (LO) compared to children who underwent conventional open orchiopexy (CO). The main outcomes were the proportion of children requiring redo-orchiopexy and the incidence of postoperative complications. Secondary outcomes were duration and the cost of surgery. Results: The final meta-analysis included five studies involving 705 children; LO, n = 369 (52.3%) and CO, n = 336 (47.7%). The majority of the included patients had unilateral palpable cryptorchidism. No significant differences were found in regard to average age at the time of surgery and follow-up periods between the investigated groups. No statistically significant differences were found in regard to redo-orchiopexy rates (RR = 0.22, 95% CI 0.03–1.88, p = 0.17), early complications (RR = 0.66, 95% CI 0.21–2.08, p = 0.48) and incidence of testicular atrophy (RR = 0.36, 95% CI 0.03–3.88, p = 0.40). No significant differences in the operative duration were observed among the groups. Laparoscopy was associated with higher costs in most of the studies. Conclusion: LO is safe and effective in children with palpable cryptorchidism. The rates of redo-orchiopexy as well as an incidence of early complications and testicular atrophy rates are comparable to CO.

ACS Style

Sachit Anand; Nellai Krishnan; Zenon Pogorelić. Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis. Children 2021, 8, 677 .

AMA Style

Sachit Anand, Nellai Krishnan, Zenon Pogorelić. Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis. Children. 2021; 8 (8):677.

Chicago/Turabian Style

Sachit Anand; Nellai Krishnan; Zenon Pogorelić. 2021. "Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis." Children 8, no. 8: 677.

Journal article
Published: 23 July 2021 in Healthcare
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(1) Background: The aim of the present study was to develop and validate the psychometric characteristics of a scale measuring nurses’ experiences working with COVID-19 patients. (2) Methods: The participants were 180 Croatian nurses who worked in departments with COVID-19 patients, with a mean age of 36.8 years (ranging from 20 to 48). Research was conducted from March to June 2020. For the purpose of constructing the scale, 10 statements were developed. Factor analysis was used to determine the factor structure and construct validity of the scale. (3) Results: The scale consisted of nine statements divided into a three-factor structure: factor I—stigmatization and mistrusting (four items), factor II—social distancing (four items), and factor III—fear of infection (two items). Cronbach α was calculated to confirm the reliability of the scale: factor I—α = 0.80, factor II—α = 0.76, and factor III—α = 0.70. (4) Conclusion: The nurses’ pandemic-related experiences scale showed good psychometric properties and can be applied in future research as a standardized tool for measuring health care workers’ experience during COVID-19 or other infectious crises.

ACS Style

Matea Dolić; Vesna Antičević; Krešimir Dolić; Zenon Pogorelić. Questionnaire for Assessing Social Contacts of Nurses Who Worked with Coronavirus Patients during the First Wave of the COVID-19 Pandemic. Healthcare 2021, 9, 930 .

AMA Style

Matea Dolić, Vesna Antičević, Krešimir Dolić, Zenon Pogorelić. Questionnaire for Assessing Social Contacts of Nurses Who Worked with Coronavirus Patients during the First Wave of the COVID-19 Pandemic. Healthcare. 2021; 9 (8):930.

Chicago/Turabian Style

Matea Dolić; Vesna Antičević; Krešimir Dolić; Zenon Pogorelić. 2021. "Questionnaire for Assessing Social Contacts of Nurses Who Worked with Coronavirus Patients during the First Wave of the COVID-19 Pandemic." Healthcare 9, no. 8: 930.

Journal article
Published: 19 July 2021 in Children
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Background: Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol on recovery after laparoscopic surgery in pediatric patients. Methods: Two hundred children with median age of 5 years who underwent laparoscopic surgery were randomized into two groups. Propofol 1% was used for induction and maintenance of anesthesia in group I, while ketamine-propofol combination (ketofol) was used in group II. Ketamine-propofol combination (ketofol) was prepared in the same applicator for group II. Ketofol ratios of 1:4 and 1:7 were used for induction and maintenance of anesthesia, respectively. A reduced McFarlan infusion dose was used in group I (1.2, 1.0, and 0.8 mL/kg/h for 15, 15, and 30 min, respectively), while a McFarlan infusion dose was used in group II (1.5, 1.3, and 1.1 mL/kg/h for 15, 15, and 30 min, respectively). Extubating time, duration of anesthesia, and length of stay in post-anesthesia care unit (PACU) were recorded. Results: Extubating time was significantly lower in the ketofol group than in the propofol group (240 s vs. 530 s; p< 0.00001). Significantly shorter duration of anesthesia (47 min vs. 60 min; p< 0.00001) as well as length of stay in the PACU (35 min vs. 100 min; p< 0.00001) were recorded in ketofol compared to the propofol group. Total fentanyl (100 µg (interquartile range, IQR 80, 125) vs. 50 µg (IQR 40, 60); p< 0.00001) and propofol (260 mg (IQR 200, 350) vs. 160 mg (IQR 120, 210); p< 0.00001) consumption per body weight were significantly lower in the ketofol group. Conclusions: TIVA with ketamine-propofol combination (ketofol) using a reduced McFarlan dose regimen shortened extubating time, duration of anesthesia, as well as length of stay in the PACU in pediatric anesthesia after laparoscopic surgery.

ACS Style

Ana Biliškov; Božena Ivančev; Zenon Pogorelić. Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures. Children 2021, 8, 610 .

AMA Style

Ana Biliškov, Božena Ivančev, Zenon Pogorelić. Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures. Children. 2021; 8 (7):610.

Chicago/Turabian Style

Ana Biliškov; Božena Ivančev; Zenon Pogorelić. 2021. "Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures." Children 8, no. 7: 610.

Journal article
Published: 27 May 2021 in Animals
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Background: The aim of this study was to compare consequences in single and triple testicular biopsy by biopty gun in pubertal rats using histological and immunohistochemical analysis. Methods: Thirty-two Sprague-Dawley male rats were used as the experimental model. The rats were randomly divided into three study groups. The rats from the first group (n = 12) received a single-biopsy of upper pole of the left testis, while the rats from the second group (n = 10) received triple-biopsy of upper and lower poles and lateral surface of left testis. The third group (n = 10) was a control group. On the eightieth day after the biopsy in all rats bilateral orchiectomy and funiculectomy were performed to obtain testicular tissue and sperm for analysis. The consequences of the puncture were observed by pathohistology, immunohistochemistry and semen analysis. Results: The results of the study showed lower percentage of sperm count (14.5 mill/mL vs. 16 mill/mL, p = 0.130), sperm motility (24.6% vs. 32.7%, p > 0.05), abnormal sperm (30% vs. 27%, p > 0.05), atrophic tubules (21% vs. 6%, p< 0.001), volume (1.7 mL vs. 2.28 mL, p< 0.01) and apoptotic index (1.56 vs. 1.19, p = 0.650) in the testes with a triple-biopsy compared to the testes with a single-biopsy. Semen analysis showed a borderline significant difference between the group with triple-biopsy where sperm count was lower than it in the control group (14.5 mill/mL vs. 17.5 mill/mL, p = 0.05). A single-biopsy has little effect on the testis, especially on overall fertility. A triple-biopsy showed higher degree of the testicular damage but without a significant impact on overall fertility. Semen analysis showed that single- and triple-biopsies did not have a significant effect on sperm count, motility and morphology. Conclusion: Biopty gun procedure is a cheap, simple and reliable method for testicular biopsy in rats without a significant effect on sperm count, motility and morphology.

ACS Style

Tomislav Šušnjar; Ivana Kuzmić Prusac; Ivan Švagelj; Anđela Jurišić; Tomislav Šušnjar; Antonija Jurišić; Miro Jukić; Zenon Pogorelić. The Effect of Single and Triple Testicular Biopsy Using Biopty Gun on Spermatogenesis in Pubertal Rats. Animals 2021, 11, 1569 .

AMA Style

Tomislav Šušnjar, Ivana Kuzmić Prusac, Ivan Švagelj, Anđela Jurišić, Tomislav Šušnjar, Antonija Jurišić, Miro Jukić, Zenon Pogorelić. The Effect of Single and Triple Testicular Biopsy Using Biopty Gun on Spermatogenesis in Pubertal Rats. Animals. 2021; 11 (6):1569.

Chicago/Turabian Style

Tomislav Šušnjar; Ivana Kuzmić Prusac; Ivan Švagelj; Anđela Jurišić; Tomislav Šušnjar; Antonija Jurišić; Miro Jukić; Zenon Pogorelić. 2021. "The Effect of Single and Triple Testicular Biopsy Using Biopty Gun on Spermatogenesis in Pubertal Rats." Animals 11, no. 6: 1569.

Original paper
Published: 13 May 2021 in Acta Chirurgica Belgica
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Evaluation and comparison 30-day readmission rate (ReAd) from discharge within three year period and to note could it be a quality-of-care indicator in pediatric surgery. The case records of the patients that were readmitted within 30 days of primary surgery from January 1st2017 to December 31st2019 were identified retrospectively, for each year separately. Demographic data, diagnosis and the treatment on primary admission, length of hospital stay, and diagnosis with treatment on readmission, were collected. For each year readmissions were identified and divided into two groups (emergency and elective) based on the nature of the primary surgery. Outcomes were compared between two groups. A total of 5392 admissions were identified among three years (2017, n = 1821; 2018, n = 1806; 2019, n = 1765). There was 1014(55.6%) elective admissions in 2017, 953(52.8%) in 2018 and 950(53.8%) in 2019. The overall ReAd rate was 0.82%, 0.99% and 0.57% for years 2017, 2018 and 2019, respectively (p = 0.348). The most common cause for readmission was appendicitis related followed by surgical site infection in different subfields. The share of the number of readmissions during the three-year period is 3.2 times higher for emergency admissions than for elective admissions (p < 0.001). The majority(>75%) of all readmission in all three years occurred in children above age of eight. Male gender was significantly more frequently associated with readmission(74.4%)(p < 0.001). ReAd is a reproducible and good quality-of-care indicator in pediatric surgery. An incidence of ReAd is significantly higher in emergency admissions and an appendectomy is the most common procedure associated with ReAd.

ACS Style

Miro Jukić; Jelena Antišić; Zenon Pogorelić. Incidence and causes of 30-day readmission rate from discharge as an indicator of quality care in pediatric surgery. Acta Chirurgica Belgica 2021, 1 -5.

AMA Style

Miro Jukić, Jelena Antišić, Zenon Pogorelić. Incidence and causes of 30-day readmission rate from discharge as an indicator of quality care in pediatric surgery. Acta Chirurgica Belgica. 2021; ():1-5.

Chicago/Turabian Style

Miro Jukić; Jelena Antišić; Zenon Pogorelić. 2021. "Incidence and causes of 30-day readmission rate from discharge as an indicator of quality care in pediatric surgery." Acta Chirurgica Belgica , no. : 1-5.

Full length article
Published: 30 April 2021 in Journal of Pediatric Urology
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Summary Introduction Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature. Objective The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period. Study design A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation. Results During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007). Conclusion During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required.Summary figureRates of orchidopexy/orchiectomy between pre-COVID-19 and COVID-19 periods.Summary figure

ACS Style

Zenon Pogorelić; Karla Milanović; Ana Bosak Veršić; Miram Pasini; Dalibor Divković; Oliver Pavlović; Josip Lučev; Vanja Žufić. Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic? - A retrospective multicenter study. Journal of Pediatric Urology 2021, 1 .

AMA Style

Zenon Pogorelić, Karla Milanović, Ana Bosak Veršić, Miram Pasini, Dalibor Divković, Oliver Pavlović, Josip Lučev, Vanja Žufić. Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic? - A retrospective multicenter study. Journal of Pediatric Urology. 2021; ():1.

Chicago/Turabian Style

Zenon Pogorelić; Karla Milanović; Ana Bosak Veršić; Miram Pasini; Dalibor Divković; Oliver Pavlović; Josip Lučev; Vanja Žufić. 2021. "Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic? - A retrospective multicenter study." Journal of Pediatric Urology , no. : 1.

Journal article
Published: 19 April 2021 in Children
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Background: This prospective observational study aimed to evaluate the validity of appendicitis inflammatory response (AIR) score in differentiating advanced (perforated) from simple (non-perforated) appendicitis in pediatric patients. Methods: A single-center prospective cross-sectional study was conducted between 1 January 2019 until 1 May 2020 including 184 pediatric patients who underwent appendectomy. Based on the intraoperative finding of advanced (n = 38) or simple (n = 146) appendicitis the patients were divided into two groups. Recipient-operator curve (ROC), with calculation of sensitivity and specificity of best cutoff and the area under the curve (AUC), were used to measure the diagnostic value and the potential for risk stratification of the AIR score, among the patients with simple or advanced acute appendicitis. Results: The median value of the AIR score in the perforated and non-perforated groups was 10 (interquartile range, IQR 9, 11), and was 7 (IQR 6, 9), respectively (p < 0.001). Based on the calculated value of AIR score, the patients were classified with a high precision into low, indeterminate and high risk groups for acute appendicitis (p < 0.001). A cutoff value of ≥9 was demonstrated to serve as a reliable indicator of perforated appendicitis with a sensitivity and a specificity of 89.5% and 71.9%, respectively (AUC = 0.80; 95% CI: 0.719–0.871; p < 0.001). Conclusions: Acute appendicitis can be detected with a high level of sensitivity and specificity using the AIR score. Also, the AIR score may differentiate perforated from non-perforated appendicitis in pediatric patients with a high level of accuracy.

ACS Style

Zenon Pogorelić; Jakov Mihanović; Stipe Ninčević; Bruna Lukšić; Sara Elezović Baloević; Ozren Polašek. Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children. Children 2021, 8, 309 .

AMA Style

Zenon Pogorelić, Jakov Mihanović, Stipe Ninčević, Bruna Lukšić, Sara Elezović Baloević, Ozren Polašek. Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children. Children. 2021; 8 (4):309.

Chicago/Turabian Style

Zenon Pogorelić; Jakov Mihanović; Stipe Ninčević; Bruna Lukšić; Sara Elezović Baloević; Ozren Polašek. 2021. "Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children." Children 8, no. 4: 309.

Journal article
Published: 11 April 2021 in Children
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Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia in children. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period October 2015–January 2021. Surgical times, intraoperative and postoperative complications, in addition to outcomes of treatment were compared among the pediatric surgeons. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (12 (interquartile range, IQR 10.5, 16.5) min vs. 21 (IQR 16.5, 28) min and 25 (IQR 21.5, 30) min; p = 0.002) and bilateral (19 (IQR 14, 21) min vs. 28 (IQR 25, 33) min and 31 (IQR 24, 36) min; p = 0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were higher at the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed a fewer number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (p = 0.190). Conclusions: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon had performed at least 30 cases. After that number of cases PIRS is a safe and effective approach for pediatric hernia repair. A surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve.

ACS Style

Zenon Pogorelić; Dario Huskić; Tin Čohadžić; Miro Jukić; Tomislav Šušnjar. Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing. Children 2021, 8, 294 .

AMA Style

Zenon Pogorelić, Dario Huskić, Tin Čohadžić, Miro Jukić, Tomislav Šušnjar. Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing. Children. 2021; 8 (4):294.

Chicago/Turabian Style

Zenon Pogorelić; Dario Huskić; Tin Čohadžić; Miro Jukić; Tomislav Šušnjar. 2021. "Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing." Children 8, no. 4: 294.

Journal article
Published: 02 March 2021 in Journal of Pediatric Urology
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Summary Introduction Endoscopic laser-puncture or electrosurgical incision are the most commonly used minimaly invasive approaches for the treatment of the ureterocele. Both techniques are mainly successful in decompressing of ureteroceles, but the consequence of such treatment may be formation of de novo vesicoureteral reflux and febrile urinary tract infection which could impact the final results. Objective To compare outcomes of treatment of two endoscopic techniques used in management of neonatal patients with intravesical ureterocele. Study design A case records of 64 neonates who underwent endoscopic procedures for intravesical ureterocele, performed at our institution from January 2005 to January 2021, were retrospectively reviewed. The patients were divided in two groups depending on used endoscopic procedure. The first group (n = 41) consisted of patients who underwent electrosurgical incision of the ureterocele, while the second group (n = 23) consisted of patients in whom 6 to 8 laser-punctures of the ureterocele were performed. The groups were compared in regards to outcomes of treatment, with special emphasis on de novo vesicoureteral reflux and the need for further treatment and surgery. Results Median follow-up was 7.5 (IQR 3, 11.5) and 3.5 (IQR 1.5, 5) years in the electroincision and laser-puncture groups, respectively (P = 0.017). No significant differences between the groups in regards to medians of duration of surgery (12 min vs. 11 min, P = 0.670), length of hospital stay (2 days in both groups, P = 0.988) or postoperative obstruction (n = 1 vs. n = 0, P > 0.999) were recorded. Ureterocele decompression was achieved after endoscopic treatment in 87.9% and 100% of the patients in electrosurgery and laser-puncture groups, respectively (P = 0.150). Five patients (12.1%) from electrosurgery group required endoscopic retreatment. The laser-puncture group had a significantly decreased rate of de novo vesicoureteral reflux (8.7% vs. 58.5%; P = 0.0001) and lower incidence of subsequent surgery due to de novo vesicoureteral reflux (50% vs. 62.5%; P = 0.727). Conclusion Both electrosurgical incision and laser-puncture endoscopic techniques are safe and effective in relieving the obstruction. Laser-puncture technique is associated with significantly lower incidence of de novo vesicoureteral reflux and accordingly fewer invasive procedures for neonatal patients.Summary Table 1Treatment outcomes between the investigated groups.Summary Table 1Group IGroup IIPElectroincision (n=41)Laser-puncture (n=23)Complications, n (%)3 (7.2)00.547aIntraoperative1 (2.4)0Postoperative2 (4.8)0Endoscopic retreatment, n (%)5 (12.1)00.150aDe novo VUR, n (%)24 (58.52 (8.7)Grade I000.0001aGrade II01Grade III311Grade IV150Grade V60aFisher exact test.

ACS Style

Zenon Pogorelić; Jakov Todorić; Dražen Budimir; Marijan Saraga. Laser-puncture of the ureterocele in neonatal patients significantly decreases an incidence of de novo vesico-ureteral reflux than electrosurgical incision. Journal of Pediatric Urology 2021, 1 .

AMA Style

Zenon Pogorelić, Jakov Todorić, Dražen Budimir, Marijan Saraga. Laser-puncture of the ureterocele in neonatal patients significantly decreases an incidence of de novo vesico-ureteral reflux than electrosurgical incision. Journal of Pediatric Urology. 2021; ():1.

Chicago/Turabian Style

Zenon Pogorelić; Jakov Todorić; Dražen Budimir; Marijan Saraga. 2021. "Laser-puncture of the ureterocele in neonatal patients significantly decreases an incidence of de novo vesico-ureteral reflux than electrosurgical incision." Journal of Pediatric Urology , no. : 1.

Journal article
Published: 31 December 2020 in Acta Orthopaedica et Traumatologica Turcica
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The aim of this study was to analyze the outcomes of treatment and the rate of complications in children treated with flexible intramedullary nailing (FIN) for radial neck fractures. The study included 26 children (11 males and 15 females) with a median age of 9.5 years, treated with FIN for the radial neck fractures between May 2011 and May 2018. Immobilization after the surgery was not used. The median follow-up was 41 months. According to the Judet classification, 15 fractures were classified as type III and 11 as Type IV. For each patient, clinical, radiological, and disability of the arm, shoulder, and hand (DASH) scores were calculated. All patients achieved complete radiographic healing at a median of 5 weeks. The nails were removed at a median of 4 months. The rate of complications was 11.5%, including 1 radial head necrosis, 1 angulation of 15°, and 1 displacement of the radial head. Twenty patients (76.9%) achieved a perfect clinical healing, while 23 patients (88.5%) achieved a perfect radiological healing. The median DASH score was 1.25. No cases of delayed healing were recorded. After removing of the nails, all patients returned to full function of the extremity and all complications were resolved. The use of FIN for treating fractures of the radial neck in children shows very good functional and cosmetic results. It allows mobilization with rapid pain reduction. It is a minimally invasive, simple, and reproducible technique with a low rate of complication. Owing to excellent results, surgical stabilization of radial head and neck fractures using FIN is recommended in children and adolescents. Level IV, Therapeutic study

ACS Style

Zenon Pogorelić; André Capitain; Miro Jukić; Vanja Žufić; Dubravko Furlan; General Hospital Zadar Clinic Of Pediatric Surgery. Flexible intramedullary nailing for radial neck fractures in children. Acta Orthopaedica et Traumatologica Turcica 2020, 54, 618 -622.

AMA Style

Zenon Pogorelić, André Capitain, Miro Jukić, Vanja Žufić, Dubravko Furlan, General Hospital Zadar Clinic Of Pediatric Surgery. Flexible intramedullary nailing for radial neck fractures in children. Acta Orthopaedica et Traumatologica Turcica. 2020; 54 (6):618-622.

Chicago/Turabian Style

Zenon Pogorelić; André Capitain; Miro Jukić; Vanja Žufić; Dubravko Furlan; General Hospital Zadar Clinic Of Pediatric Surgery. 2020. "Flexible intramedullary nailing for radial neck fractures in children." Acta Orthopaedica et Traumatologica Turcica 54, no. 6: 618-622.

Original article
Published: 25 November 2020 in Langenbeck's Archives of Surgery
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The aim of this study was to compare lateral thermal damage of the appendix and clinical outcomes after laparoscopic appendectomy using new versus reused Harmonic scalpels. A total of 100 consecutive patients with acute appendicitis who underwent laparoscopic appendectomy were enrolled in the two-center, randomized clinical trial. Using a computer random number generator, patients were allocated to new or reused group. Histopathological measurement of lateral thermal damage of the appendiceal base and mesoappendix, speed of transection of the appendiceal base, duration of surgery, subjective rating of device functionality, length of hospital stay, and complications were compared within groups. The median lateral thermal damage on the appendiceal base in the new group (N = 49) was 0.2 mm (IQR 0.1–0.2) and 0.1 mm (IQR 0.1–0.3) in the reused group (N = 51) (P = 0.644), while on the mesoappendix for both groups, thermal damage was 0.1 mm (IQR 0.1–0.2) (P = 0.418). The median time required for base transection in both groups was 8 s (IQR 7–9) (P = 0.776). The median duration of surgery was also comparable between the groups (22 min, IQR 20–30 vs 25 min, IQR 21–35; P = 0.233). Two postoperative complications in the new group and one in the reused group were recorded (4% vs 2%; P = 0.536). Surgeons’ subjective assessment of the instrument did not reveal significant difference between the groups in all of the investigated categories. The results of our study support the reuse of Harmonic scalpels especially in the settings where economic constraints might hamper access to minimally invasive surgery to a larger number of patients. The results obtained on laparoscopic appendectomy might not be reproducible to other more demanding surgical procedures. ClinicalTrials.gov registry under identifier NCT04226482

ACS Style

Jakov Mihanović; Nataša Lisica Šikić; Ivana Mrklić; Zvonimir Katušić; Robert Karlo; Miro Jukić; Ana Jerončić; Zenon Pogorelić. Comparison of new versus reused Harmonic scalpel performance in laparoscopic appendectomy in patients with acute appendicitis—a randomized clinical trial. Langenbeck's Archives of Surgery 2020, 406, 153 -162.

AMA Style

Jakov Mihanović, Nataša Lisica Šikić, Ivana Mrklić, Zvonimir Katušić, Robert Karlo, Miro Jukić, Ana Jerončić, Zenon Pogorelić. Comparison of new versus reused Harmonic scalpel performance in laparoscopic appendectomy in patients with acute appendicitis—a randomized clinical trial. Langenbeck's Archives of Surgery. 2020; 406 (1):153-162.

Chicago/Turabian Style

Jakov Mihanović; Nataša Lisica Šikić; Ivana Mrklić; Zvonimir Katušić; Robert Karlo; Miro Jukić; Ana Jerončić; Zenon Pogorelić. 2020. "Comparison of new versus reused Harmonic scalpel performance in laparoscopic appendectomy in patients with acute appendicitis—a randomized clinical trial." Langenbeck's Archives of Surgery 406, no. 1: 153-162.

Journal article
Published: 23 November 2020 in Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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Percutaneous internal ring suturing (PIRS) is a minimally invasive surgical technique of laparoscopic hernia repair in children under the control of a laparoscope placed in the umbilicus. The aim of this study was to evaluate the management and postoperative outcomes of PIRS for inguinal hernia repair in children. All children who underwent PIRS for an inguinal hernia, between February 2015 and February 2020, were included in the prospective cohort study. The following parameters were recorded: age, gender, body mass index, lateralization of hernia, surgical and anesthesia times, level of pneumoperitoneum, additional trocar introduction, length of hospital stay, and intraoperative or postoperative complications and recurrences were recorded. A total number of 228 PIRS procedures were performed in 188 children [126 (67%) male individuals and 62 (33%) female individuals] with a median age of 4 [interquartile range (IQR), 2 to 6] years and a median follow-up of 46 (IQR, 38 to 52) months. From the total number of hernia repairs there were 99 (52.7%) right, 49 (26.1%) left, and 40 (21.2%) bilateral hernia repairs. Median surgical time was 10 (IQR, 8 to 12) minutes for unilateral and 16 (IQR, 14 to 20) minutes for a bilateral repair. The median hospital stay was 24 (IQR, 8 to 24) hours. Regarding intraoperative complications, only 3 (1.3%) inferior epigastric veins injuries were recorded, without any consequences. During the follow-up period in 3 male children, hydrocele was recorded; in 2 cases, hydrocele resolved spontaneously and 1 required surgical treatment. No cases of other complications including testicular atrophy or recurrence were recorded. In a hands of an experienced pediatric laparoscopic surgeon, PIRS is a simple, safe, and effective technique for inguinal hernia repair in children with excellent outcomes, cosmetic results, and a low incidence of complications and recurrence.

ACS Style

Zenon Pogorelić; Tin Čohadžić; Miro Jukić; Ana Nevešćanin Biliškov. Percutaneous Internal Ring Suturing for the Minimal Invasive Treatment of Pediatric Inguinal Hernia: A 5-Year Single Surgeon Experience. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2020, 31, 150 -154.

AMA Style

Zenon Pogorelić, Tin Čohadžić, Miro Jukić, Ana Nevešćanin Biliškov. Percutaneous Internal Ring Suturing for the Minimal Invasive Treatment of Pediatric Inguinal Hernia: A 5-Year Single Surgeon Experience. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2020; 31 (2):150-154.

Chicago/Turabian Style

Zenon Pogorelić; Tin Čohadžić; Miro Jukić; Ana Nevešćanin Biliškov. 2020. "Percutaneous Internal Ring Suturing for the Minimal Invasive Treatment of Pediatric Inguinal Hernia: A 5-Year Single Surgeon Experience." Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 31, no. 2: 150-154.

Journal article
Published: 07 October 2020 in Journal of Pediatric Surgery
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Background The aim of this study was to investigate hyponatremia as a new biochemical marker associated with complicated appendicitis in the pediatric population. Methods Pediatric patients (n=184) with acute appendicitis confirmed by histopathology were enrolled in a prospective cohort study from January 2019 to May 2020. Medical history, demographic and clinical data were recorded in the study protocol. Blood samples for biochemical analysis, electrolytes and acute inflammatory markers were taken before surgery. Patients were further divided in two groups, those with non-perforated (n=148; 79%) and perforated appendicitis (n=38; 21%). Results The mean serum sodium level in patients with complicated appendicitis was significantly lower compared to patients with non-complicated appendicitis (132.2 mmol/L vs. 139.2 mmol/L, P <0.001). The receiver operating characteristic curve of plasma sodium concentration in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.983 (95% CI, 0.963–1.00). A cut-off-value of plasma sodium concentration of ≤135 mmol/L was shown to give the best possible sensitivity and specificity, 94.7% (95% CI: 82.2–99.3) and 88.5% (95% CI: 88.2–93.2) respectively (P <0.001). Patients with complicated appendicitis were more likely to be younger than five years of age (10.5% vs. 1.4%, P=0.005), have a duration of symptoms for >24 h (97.4% vs. 59.6%, P <0.001), sodium serum concentration ≤135 mmol/L (89.5% vs. 5.5%, P 38.5 ˚C (47.4% vs. 11.0%, P 62 mg/L (26% vs. 2%, P <0.001). Conclusion Hyponatremia is a novel and very discriminative marker of complicated appendicitis in the pediatric population, and is therefore recommended in appendicitis diagnostic and treatment planning. Type of study Prospective comparative study Level of evidence II

ACS Style

Zenon Pogorelić; Bruna Lukšić; Stipe Ninčević; Ozren Polašek. Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study. Journal of Pediatric Surgery 2020, 1 .

AMA Style

Zenon Pogorelić, Bruna Lukšić, Stipe Ninčević, Ozren Polašek. Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study. Journal of Pediatric Surgery. 2020; ():1.

Chicago/Turabian Style

Zenon Pogorelić; Bruna Lukšić; Stipe Ninčević; Ozren Polašek. 2020. "Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study." Journal of Pediatric Surgery , no. : 1.

Journal article
Published: 13 August 2020 in Acta Orthopaedica et Traumatologica Turcica
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Titanium nails Forearm Fracture Children Elastic stable intramedullary nailing

ACS Style

Zenon Pogorelić; Marko Gulin; Miro Jukić; Ana Nevešćanin Biliškov; Dubravko Furlan. Elastic stable intramedullary nailing for treatment of pediatric forearm fractures: A 15-year single centre retrospective study of 173 cases. Acta Orthopaedica et Traumatologica Turcica 2020, 54, 378 -384.

AMA Style

Zenon Pogorelić, Marko Gulin, Miro Jukić, Ana Nevešćanin Biliškov, Dubravko Furlan. Elastic stable intramedullary nailing for treatment of pediatric forearm fractures: A 15-year single centre retrospective study of 173 cases. Acta Orthopaedica et Traumatologica Turcica. 2020; 54 (4):378-384.

Chicago/Turabian Style

Zenon Pogorelić; Marko Gulin; Miro Jukić; Ana Nevešćanin Biliškov; Dubravko Furlan. 2020. "Elastic stable intramedullary nailing for treatment of pediatric forearm fractures: A 15-year single centre retrospective study of 173 cases." Acta Orthopaedica et Traumatologica Turcica 54, no. 4: 378-384.

Journal article
Published: 15 June 2020 in Indian Pediatrics
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ACS Style

Zenon Pogorelic; Doroteja Jukic; Miro Jukic; Ivana Mrklic. Factors Associated With Ovarian Preservation in Children and Adolescents With Primary Tumors of Ovary. Indian Pediatrics 2020, 57, 515 -518.

AMA Style

Zenon Pogorelic, Doroteja Jukic, Miro Jukic, Ivana Mrklic. Factors Associated With Ovarian Preservation in Children and Adolescents With Primary Tumors of Ovary. Indian Pediatrics. 2020; 57 (6):515-518.

Chicago/Turabian Style

Zenon Pogorelic; Doroteja Jukic; Miro Jukic; Ivana Mrklic. 2020. "Factors Associated With Ovarian Preservation in Children and Adolescents With Primary Tumors of Ovary." Indian Pediatrics 57, no. 6: 515-518.

Research paper
Published: 01 June 2020 in Indian Pediatrics
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To determine management of pediatric ovarian masses and identify the factors associated with ovarian preservation. From January, 2002 to January, 2019 the case records of 72 patients (median age 14 y), who underwent surgery for ovarian tumors were retrospectively reviewed. Tumors were most common in the age group 14’17 yrs (58.3%) and most (91.7%) were benign. The most common presenting symptom was abdominal pain (80.5%) followed by vomiting, elevated body temperature, nausea and palpable abdominal mass. 25 (34.7%) patients had an ovarian torsion. Six out of 72 (8.3%) patients had malignant tumors. Of the patients with malignant tumors, 75% had abnormal alpha-fetoprotein and 50% had abnormal β-human chorionic gonadotropin levels (P<0.001). Ovarian-preserving surgery was successfully performed in 74.3% of the benign lesions and two patients (25%) with malignant tumors (P=0.004). Factors associated with ovarian-preserving surgery are benign tumor, normal tumor markers levels, and smaller size of tumor.

ACS Style

Zenon Pogorelic; Doroteja Jukic; Miro Jukic; Ivana Mrklic. Factors Associated With Ovarian Preservation in Children and Adolescents With Primary Tumors of Ovary. Indian Pediatrics 2020, 57, 515 -518.

AMA Style

Zenon Pogorelic, Doroteja Jukic, Miro Jukic, Ivana Mrklic. Factors Associated With Ovarian Preservation in Children and Adolescents With Primary Tumors of Ovary. Indian Pediatrics. 2020; 57 (6):515-518.

Chicago/Turabian Style

Zenon Pogorelic; Doroteja Jukic; Miro Jukic; Ivana Mrklic. 2020. "Factors Associated With Ovarian Preservation in Children and Adolescents With Primary Tumors of Ovary." Indian Pediatrics 57, no. 6: 515-518.

Journal article
Published: 01 May 2020 in Journal of Laparoendoscopic & Advanced Surgical Techniques
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Purpose: Treatment of pneumothorax involves conservative treatment and surgery. The aim of this study was to assess the best approach of initial treatment and long-term outcomes of video-assisted thoracic surgery (VATS) for primary spontaneous pneumothorax in pediatric patients. Patients and Methods: From January 2009 until June 2019, 36 patients younger than the age of 18 who were treated for spontaneous pneumothorax were included into retrospective study. Patients were divided into 2 groups, non-VATS and VATS, depending on the way they were treated. The groups were compared regarding demographic and clinical data and outcomes of treatment (the length of hospitalization, the frequency of postoperative complications, and reoperations). Results: Out of 36 patients, there were 24 boys and 12 girls with median age of 16.5 years. Median duration of hospitalization was 8 days. Eight patients were treated by observation and 28 by chest tube insertion. In 14 patients with spontaneous pneumothorax, VATS was performed [indications were persistent air leak in 8 (57%) and recurrent pneumothorax in 6 (43%) children]. Patients who underwent surgery had significantly higher length of hospitalization (P < .001) and lower rate of recurrences (P = .003) than those who did not. In 12 (86%) patients, blebs were found intraoperative, and in all of them, pleurodesis was performed. Duration of chest tube insertion was significantly longer in patients who experienced recurrent pneumothorax (P < .001). Conclusions: VATS is successful, efficient, and safe method of treatment for spontaneous pneumothorax, due to its significantly lower rate of recurrence in comparison with chest tube insertion.

ACS Style

Zenon Pogorelić; Ružica Gudelj; Dora Bjelanović; Miro Jukić; Sara Elezović Baloević; Sandro Glumac; Dubravko Furlan. Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery. Journal of Laparoendoscopic & Advanced Surgical Techniques 2020, 30, 569 -575.

AMA Style

Zenon Pogorelić, Ružica Gudelj, Dora Bjelanović, Miro Jukić, Sara Elezović Baloević, Sandro Glumac, Dubravko Furlan. Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2020; 30 (5):569-575.

Chicago/Turabian Style

Zenon Pogorelić; Ružica Gudelj; Dora Bjelanović; Miro Jukić; Sara Elezović Baloević; Sandro Glumac; Dubravko Furlan. 2020. "Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery." Journal of Laparoendoscopic & Advanced Surgical Techniques 30, no. 5: 569-575.

Original thoracic
Published: 08 April 2020 in The Thoracic and Cardiovascular Surgeon
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Objectives The aim of this study was to observe outcomes of early decortication in a treatment of pleural empyema using video-assisted thoracoscopic surgery (VATS). Methods The case records of 21 pediatric patients who underwent VATS for empyema between 2009 and 2019 were retrospectively reviewed. Patients were observed based on demographic, laboratory, and clinical data, as well as treatment outcomes. Results Out of a total of 59 patients treated for pleural empyema, 21 (10 male and 11 female) children with a median age of 5 years (interquartile range [IQR] 2.8; 6.0) received VATS. The empyema was classified as stage I in 2 patients (9.5%), stage II in 4 patients (19%), and stage III in 15 patients (71.5%). Median surgical time was 60 minutes (IQR 50; 90). There were 2 (9.5%) postoperative complications and 1 recurrence (4.8%). Children treated in stages I and II showed significantly better postoperative results compared with the children treated in stage III. Length of hospital stay (8 vs. 10 days; p = 0.01), length of intensive care unit stay (1 vs. 5 days; p < 0.001), duration of chest tube drainage (4 vs. 6 days; p = 0.043), duration of postoperative fever (1.5 vs. 4 days; p = 0.001), and surgical time (40 vs. 70 minutes; p < 0.001) were significantly shorter in children operated in stages I and II than in stage III. Conclusion Early decortication using a VATS is a successful, effective, and easily performed surgical method in the treatment of pediatric pleural empyema, as well as a method that significantly improves recovery time and shortens the hospital stay.

ACS Style

Zenon Pogorelić; Dora Bjelanović; Ružica Gudelj; Miro Jukić; Jasna Petrić; Dubravko Furlan. Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome. The Thoracic and Cardiovascular Surgeon 2020, 69, 475 -480.

AMA Style

Zenon Pogorelić, Dora Bjelanović, Ružica Gudelj, Miro Jukić, Jasna Petrić, Dubravko Furlan. Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome. The Thoracic and Cardiovascular Surgeon. 2020; 69 (05):475-480.

Chicago/Turabian Style

Zenon Pogorelić; Dora Bjelanović; Ružica Gudelj; Miro Jukić; Jasna Petrić; Dubravko Furlan. 2020. "Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome." The Thoracic and Cardiovascular Surgeon 69, no. 05: 475-480.

Journal article
Published: 01 April 2020 in Surgical Infections
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Background: The aim of this study is the evaluation of clinical signs and outcomes of treatment in children under five years of age who underwent appendectomy because of acute appendicitis.Patients and Methods: From January 2009 until December 2018, 90 patients (54 boys and 36 girls) younger than five years of age, treated with appendectomy because of acute appendicitis, were included in this study. Patients were divided into two groups, depending on the intra-operative finding of non-perforated (Group I; n = 32) or perforated (Group II; n = 58) appendicitis. The groups were compared regarding demographic, clinical, and laboratory data and outcomes of treatment.Results: Of 1687 appendectomies in this period, 90 (5.3%) of them were performed in patients aged five years or younger. There were 58 (64.4%) patients with perforated appendix. Positive correlation between the rate of perforation and the age of patients was found. Perforation rates were significantly higher in younger patients (100%, <1 year; 100%, 1–2 y; 83.3%, 2–3 y; 71.4%, 3–4 y; 78.6%, 4–5 y, and 47.3%, 5 y) (p = 0.037). Vomiting and diarrhea were found more commonly in the group of perforated appendix (p < 0.002, p < 0.001), while constipation was found more often in the patients whose appendix was not perforated (p < 0.001). The median duration of symptoms (48 h vs. 16 h; p < 0.001) and median duration of hospitalization (7.5 d vs. 5 d; p < 0.001) were notably longer for the group of patients with perforated than the group of patients with non-perforated appendix. All complications occurred in the group of perforated appendix with total incidence of 4.4%.Conclusion: The clinical presentation of acute appendicitis for children aged five years or younger is often unusual, and establishing the proper diagnosis is often delayed. Patient age is tied closely to the stage of acute appendicitis, so the youngest patients present with more advanced stages of disease and are at greater risk of perforation. Acute appendicitis should be considered in all cases where a child is having abdominal pain, fever, and diarrhea, which has been shown to be present significantly more often in children with perforated appendix.

ACS Style

Zenon Pogorelić; Josipa Domjanović; Miro Jukić; Tina Poklepović Peričić. Acute Appendicitis in Children Younger than Five Years of Age: Diagnostic Challenge for Pediatric Surgeons. Surgical Infections 2020, 21, 239 -245.

AMA Style

Zenon Pogorelić, Josipa Domjanović, Miro Jukić, Tina Poklepović Peričić. Acute Appendicitis in Children Younger than Five Years of Age: Diagnostic Challenge for Pediatric Surgeons. Surgical Infections. 2020; 21 (3):239-245.

Chicago/Turabian Style

Zenon Pogorelić; Josipa Domjanović; Miro Jukić; Tina Poklepović Peričić. 2020. "Acute Appendicitis in Children Younger than Five Years of Age: Diagnostic Challenge for Pediatric Surgeons." Surgical Infections 21, no. 3: 239-245.