Since the first description in 1998, the minimally invasive repair of pectus excavatum has gained increasing acceptance. The aim of this survey is to report on the experiences of eight European centres with this technique. 172 patients with a mean age of 15.1 (± 4.6) years were treated and evaluated, 35.5 % were symptomatic. 45.3 % of the patients had an asymmetric configuration of the chest, 74.3 % had a CT index above 3.25. Mean duration of the operative procedure was 76 minutes. Major complications, including dislocation of the bar or stabiliser, pneumonia, atelectasis, local infection, pleural and pericardial effusion and liver injury occurred in 11.1 % of the patients. Minor complications, such as self-resolving pneumothorax, atelectasis and subcutaneous emphysema were reported in another 8.1 %. Early cosmetic results were excellent or good in 81.5 %. Although the surgical procedure is simple, blood-sparing and short, consideration of some important technical details, proper patient selection and knowledge of the limitations is of vital importance. Long-term results are still lacking. Depuis la première description en 1998, la réparation mini-invasive du pectus excavatum s'est largement répandue. Le but de ce travail est de rapporter les expériences de 8 centres européens. 172 patients avec un âge moyen de 15.1 ans (± 4.6) ont été traités et évalués. 35,5 % étaient symptomatiques. 45,3 % des patients avaient une asymétrie thoracique. 74,3 % avaient un CT index en dessous de 3.25. La durée moyenne de l'opération était de 76 minutes. Les complications majeures incluant la mobilisation de la barre ou des stabilisateurs, pneumonie, atélectasie, infection locale, épanchement pleural et péricarique et traumatisme du foie, sont survenues chez 11,1 % des patients. Les complications mineures, telles que pneumothorax spontanément résolutif, atélectasie et emphysème sous-cutané étaient rapportées chez 8,1 % des patients. Les résultats cosmétiques précoces étaient excellents ou bons dans 81,5 % des cas. Quoique le procédé chirurgical soit simple, sans perte sanguine et court, la considération de quelques détails techniques importants, la sélection précise des patients et la connaissance des limites de l'indication est d'importance vitale. Les résultats à long terme manquent encore. Desde su primera descripción en 1998, la reparación mínimamente invasiva del pectus excavatum ha ganado progresiva aceptación. El objetivo de esta revisión es presentar la experiencia de 8 centros europeos con esta técnica. Se trataron 172 pacientes con una edad media de 15.1 ± 4.6 años. 35.5 % eran sintomáticos, 45.3 % tenían configuración asimétrica del pecho y 74.3 % tenían un índice CT por encima de 3.25. La duración media de la operación fue de 76 minutos. Se observaron complicaciones mayores como dislocación de la barra o del estabilizador, pulmonia, atelectasia, infección local, derrames pleurales o pericárdicos o lesión hepática en el 11.1 % de los pacientes. Hubo complicaciones menores como neumotórax de resolución espontánea, atelectasia o enfisema subcutáneo en el 8.1 %. Los resultados cosméticos en el periodo inmediato fueron excelentes o buenos en el 81.5 %. Aunque el procedimiento quirúrgico es simple, no sangrante y breve, es de importancia vital tener en cuenta algunos detalles técnicos importantes, una selección adecuada de los pacientes y el conocimiento de las limitaciones. Todavía no se conocen los resultados a largo plazo. Seit der Erstbeschreibung der minimal invasiven Korrektur der Trichterbrust 1998 hat sich diese Technik zunehmend durchgesetzt. Ziel dieser Untersuchung ist es, über die Erfahrungen von 8 europäischen Zentren zu berichten. 172 Patienten mit einem Durchschnittsalter von 15,1 (± 4,6) Jahren sind behandelt und ausgewertet worden, 35,5 % waren symptomatisch. 45,3 % der Patienten hatten eine asymmetrische Brustwand, 74,3 % hatten einen CT-Index über 3,25. Im Schnitt betrug die Operationszeit 76 Minuten. Relevante Komplikationen, wie Dislokation der Schiene oder des Stabilisators, Pneumonie, Atelektasen, Wundinfektion, Pleura- oder Perikarderguss, traten in 11,1 % der Patienten auf. Nicht behandlungsbedürftige Komplikationen, wie spontan regredierender Pneumothorax, Atelektase oder Weichteilemphysem, traten in weiteren 8,1 % auf. Das kosmetische Frühergebnis war in 81,5 % der Patienten sehr gut bis gut. Obwohl der Eingriff auf einfachen Prinzipien beruht, blutsparend und kurz ist, sind wichtige technische Details, Patientenselektion und Kenntnis von Limitationen der Technik von herausragender Bedeutung. Bislang verfügen wir über keine Langzeitergebnisse.

Purpose: Jejunoileal atresia (JIA) is a rare disease. We aimed to determine the overall incidence of this malformation and associated malformations in a national cohort. Furthermore, we compared the treatment results of this cohort with the current literature.Methods: Data from the major health insurance company, which covers ~30% of the German population, were analyzed. All patients with ICD-10-Code Q41.1-9 (atresia of jejunum, ileum, other parts and not designated parts of the small bowel) who underwent any surgical procedure for small bowel were analyzed in a 10-year period between 2007 and 2016.Results: A total of 435 patients were included in the study. The incidence was 2.1 per 10,000 live births. The male:female ratio was 1:2. Sixty-four percent were premature, 21% had associated cardiac anomalies, 16% had abdominal wall defects, 7% had urogenital malformations, and 7% had cystic fibrosis. Sixty percent of all patients with jejunoileal atresia, 57% of patients with accompanying abdominal wall defects and 72% of patients with associated cystic fibrosis required ostomy as the initial procedure. In 25% of all patients, only one intestinal operation was coded. In 39% of patients, two operations were coded. Twelve percent of all patients required feeding gastrostomy or jejunostomy. Sixteen percent of all patients presented with liver-related complications, i.e., cholestasis or liver insufficiency. Six patients underwent an intestinal lengthening procedure (2 Bianchi, 4 STEP). In five patients, initial lengthening was performed within 1 year after the first intestinal operation. Mortality until 1 year after initial surgery was 5%. Of those who died, 88% were premature, 34% had cardiac anomalies and 16% had abdominal wall defects. None had cystic fibrosis. Patients with ostomy significantly more often needed operative central venous line or operative feeding tube. Short bowel was coded significantly more often in these patients.Conclusion: Patients with JIA present with low mortality. The rate of ostomies is higher than in literature. To give clinical recommendations for the initial surgical approach, further clinical research is needed.

Introduction Pediatric surgery has emerged from general surgery to take better care of the needs of surgically ill children. The development of pediatric surgery in Germany started in the early 19th century and is still ongoing. This study was performed to investigate how pediatric surgery is organized in Germany. Materials and Methods Data were obtained from the following sources: German Society, Information System of the Federal Health Monitoring, German Medical Association, Joined Federal Committee, Federal Bureau of Statistics, and Perinatal Centers. Results Pediatric surgery in Germany was started in the beginning of the 19th century. In 1962, there were approximately 20 units. The number increased to 98 in 2005 and to 129 in 2017. Presently, there are 769 pediatric surgeons registered in Germany. The current growth of pediatric surgery is attributed to a political decision of implementing centers for the care of preterm babies who need pediatric surgeons. Most work performed by pediatric surgeons in Germany can be categorized as low-risk, high-volume surgery. Currently, there is a trend of spontaneous centralization for some high-risk, low-volume pediatric surgical procedures. Conclusion Pediatric surgery in Germany shows a development toward a nearly complete coverage of the country, thus providing increasing number of children with specialist care. Rare diseases, such as in oncology or newborn surgery, are generally not centralized and rarely performed by small units. New approaches for better quality measurements may lead to centralization even without political action in the future.

The aim of this study was to evaluate the outcome of esophageal atresia in Germany in a retrospective observational study of a large cohort. Data from the major health insurance company in Germany, which covers approximately 30% of German patients, were analyzed. All patients born and registered between 2009 and 2013 with a diagnosis of esophageal atresia at first admission to the hospital were included. Mortality was analyzed during the first year of life. We identified 287 patients with esophageal atresia, including 253 with and 34 without tracheoesophageal fistula. Associated anomalies were found in 53.7% of the patients; the most frequent were cardiac anomalies (41.8%), anomalies of the urinary tract (17.4%), and atresia of the colon, rectum, and anus (9.4%). Forty-one patients (14.3%) had a birth weight <1500 g. Seventeen patients (5.9%) died before surgery. Gastrostomy was performed during the index admission in 70 patients (25.9%). The reconstruction of the esophageal passage was performed in 247 patients (93.9%). Forty-eight percent of the patients who underwent an operation required dilatation. The mortality rate in the patients who underwent an operation was 10.4%. These results from Germany correspond to the international results that have been reported. The number of dilatations was in the middle of the range of those reported in the literature; the overall mortality rate was in the upper portion of the range of the international rates. Efforts should be made to establish a clinical registry to measure and improve the quality of care for this and other rare conditions.