To compare transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) in cases of acute uncomplicated appendicitis. 58 TULAA and 65 OA in patients with a preoperative diagnosis of acute uncomplicated appendicitis are compared. Pneumoperitoneum was obtained with a transumbilical 10 mm trocar (telescope access) and a 5 mm operative channel introduced in the left iliac fossa. Appendectomy was performed outside the abdomen, after the exteriorisation of the appendix through the transumbilical incision. In the TULAA group, operative time and hospital stay were reduced. Conversion was necessary in one case (1.7 %), and in one case (1.7 %), an additional 5 mm operative channel was introduced. Neither intra- or postoperative complications were found in the TULAA group, with excellent cosmetic results. In the OA group we had a wound infection (1.5 %) and in 8 cases (12.3 %) an enlargement of the incision was necessary. TULAA is the best approach in uncomplicated appendicitis. It is less invasive and traumatic, permits a complete evaluation of the peritoneal cavity with superior cosmetic results, especially in obese patients and in cases of ectopic appendicitis. Comparer l'appendicectomie trans-ombilicale (TULAA) et l'appendicectomie conventionnelle (OA) dans les formes non-compliquées d'appendicite aiguë. 58 TULAA et 65 OA avec un diagnostic pré-opératoire d'appendicite aiguë non compliquée sont comparées. Le pneumopéritoine était obtenu avec un trocart trans-ombilical de 10 mm et un trocart de 5 mm était introduit dans la fosse iliaque gauche. L'appendicectomie était réalisée en dehors de l'abdomen après l'extériorisation de l'appendice à travers l'incision ombilicale. Dans le groupe TULAA, le temps opératoire et le séjour hospitalier étaient réduits. La conversion n'a été nécessaire que dans 1 cas (1,7 %) et dans 1 cas (1,7 %), un trocart supplémentaire de 5 mm a été introduit. Aucune complication per et post-opératoire n'est survenue dans le groupe TULAA avec un excellent résultat cosmétique. Dans le groupe OA, nous avons une infection pariétale (1,5 %) et dans 8 cas (12,3 %) un élargissement de l'incision était nécessaire. TULAA est la meilleure approche de l'appendicite non compliquée, est moins agressif et traumatique. Elle permet une évaluation complète de la cavité péritonéale avec des résultats cosmétiques supérieures, particulièrement chez les patients obèses et en cas d'appendice ectopique. Comparar la apendicectomía transumbilical asistida laparoscópicamente (TULAA) con la apendicectomía abierta (OA) en el tratamiento de las apendicitis agudas no complicadas. Comparamos 58 casos de TULAA y 65 de OA en pacientes con diagnóstico preoperatorio de apendicitis aguda no complicada. Se indujo neumoperitoneo con un trócar transumbilical de 10 mm que sirvió para introducir la óptica y se usó un canal operatorio de 5 mm introducido en la fosa iliaca izquierda. La apendicectomía se realizó fuera del abdomen tras la exteriorización del apéndice a través de la incisión transumbilical. El tiempo operatorio y la estancia hospitalaria se redujeron en el grupo TULAA. Fue necesaria la conversión en un caso (1.7 %) y en otro se requirió un acceso suplementario de 5 mm (1,7 %). No hubo complicaciones intra o postoperatorias en el grupo TULAA siendo los resultados cosméticos excelentes. En el grupo OA tuvimos una infección de la herida (1,5 %) y en 8 casos (12,3 %) fué necesaria una ampliación de la herida quirúrgica. La TULAA es el mejor abordaje para la apendicitis no complicada. Es menos invasivo y traumático, permite una evaluación completa de la cavidad peritoneal con resultados cosméticos superiores especialmente en pacientes obesos y en casos de apéndice ectópico. In der vorliegenden Arbeit werden die offene Appendektomie sowie die mittels transumbilikaler Laparoskopie unterstützte Appendektomie (TULAA) miteinander verglichen. Hierzu wurden 48 TULAA-Operationen sowie 65 offene Appendektomien bei Patienten mit unkomplizierter Appendizitis durchgeführt. Es wurde ein transumbilikaler 10 mm-Trokar eingeführt und das Pneumoperitoneum etabliert. Dann wurde ein 5 mm-Trokar im Bereich der linken Fossa iliaca eingeführt. Die Appendektomie wurde außerhalb des Abdomens durchgeführt, nachdem der Wurmfortsatz durch die transumbilikale Inzision vor die Bauchhöhle verlagert worden war. In der TULAA-Gruppe konnte die Operationszeit und der Krankenhausaufenthalt verringert werden. Nur in 1 Fall (1,7 %) war eine Umwandlung in eine Laparotomie erforderlich, bei einem weiteren Patienten (1,7 %) musste zusätzlich ein 5 mm-Trokar eingebracht werden. In der TULAA-Gruppe wurden keine intra- oder postoperativen Komplikationen beobachtet, die kosmetischen Ergebnisse waren ausgezeichnet. Hingegen fand sich bei der laparotomierten Gruppe von Patienten eine Wundinfektionsrate von 1,5 %. In 8 Fällen musste die Inzision erweitert werden (12,3 %), um die Appendix zu entwickeln. Die laparoskopisch assistierte, präabdominale Appendektomie ist die beste Zugangsmöglichkeit für die unkomplizierte Appendizitis. Sie ist weniger invasiv, weniger traumatisch, erlaubt die vollständige Beurteilung der Bauchhöhle und zeigt ausgezeichnete Ergebnisse. Insbesondere bei dicken Patienten und einer atypischen Lage der Appendix scheint das Verfahren vorteilhaft.

Introduction Management of primary spontaneous pneumothorax (PSP) is mainly based on adults. Data are controversial with regards to its management in children. We aimed to assess: (1) the length of hospital stay (LOS) between conservative management (i.e., observation with O₂ administration), aspiration/chest drain, and surgical management; (2) the risk of recurrence after nonsurgical treatment versus surgery; (3) the risk of recurrence in the presence of bullae. Materials and Methods Using a defined search strategy, three independent investigators identified all the studies on the management of PSP in children. Case reports, opinion articles, and gray literature publications were excluded. The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was performed using RevMan 5.3. Data are expressed as mean ± SD. Results Of 3,089 abstracts screened, 95 full-text were analyzed, 23 were included in the quantitative analysis, and 16 were included in the meta-analysis (1,633 patients). LOS was similar between conservative and surgical management (6.2 ± 0.8 days vs. 5.9 ± 1.4 days; p = ns). Recurrence of PSP was significantly higher among children with a nonsurgical management (32%) versus those surgically treated (18%; p = 0.002). The incidence of recurrence was slightly higher in patients managed by aspiration/chest drain (34%) compared with those with a conservative management (27%; p = 0.05). Risk of recurrence in patients with or without documented bullae was not significantly different (26 vs. 38%, respectively; p = ns). Conclusion Given the lack of a standardized management of pediatric PSP, the present study seems to demonstrate a better outcome in children treated with surgery as first-line of management. Level of Evidence This is a Level III study.

Chest and abdominal X-rays after the insertion of an epicutaneo-caval catheter in infants are the standard method of checking the tip location in many neonatal intensive care units. The role of ultrasound in the tip location of the epicutaneo-caval catheter in neonates has been the subject of many recent studies. This systematic review investigates the accuracy of epicutaneo-caval catheter tip location by comparing ultrasound and conventional radiology. We performed a systematic literature search in multiple databases. The selection of studies yielded nineteen articles. The systematic review and meta-analysis were performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis). The analyses showed that ultrasound is a better imaging technique for epicutaneo-caval catheter tip location in the neonatal intensive care unit than conventional radiology. By improving operator training and selecting a standardized echography protocol, ultrasound could become the gold standard for visualizing the epicutaneo-caval catheter tip in the neonatal intensive care unit. This would have some important benefits: (1) increased accuracy in tip location (2); a more rapid use of the central venous access (3); and a significant reduction in radiation exposure.

Recent epidemiological studies showed an increase in ulcerative colitis among children, especially in its aggressive form, requiring surgical treatment. Although medical therapeutic strategies are standardized, there is still no consensus regarding indications, timing and kind of surgery. This study aimed to define the surgical management of paediatric ulcerative colitis and describe attitudes to it among paediatric surgeons. This was a retrospective cohort study. All national gastroenterology units were invited to participate. From January 2009 to December 2013, data on paediatric patients diagnosed with ulcerative colitis that required surgery were collected. Seven units participated in the study. Seventy-one colectomies were performed (77.3% laparoscopically). Main surgical indications were a severe ulcerative colitis attack (33.8%) and no response to medical therapies (56.3%). A three-stage strategy was chosen in 71% of cases. Straight anastomosis was performed in 14% and J-pouch anastomosis in 86% of cases. A reconstructive laparoscopic approach was used in 58% of patients. Ileo-anal anastomosis was performed by the Knight–Griffen technique in 85.4% and by the pull-through technique in 9.1% of patients. Complications after colectomy, after reconstruction and after stoma closure were reported in 12.7, 19.3 and 35% of cases, respectively. This study shows that there is general consensus regarding indications for surgery. The ideal surgical technique remains under debate. Laparoscopy is a procedure widely adopted for colectomy but its use in reconstructive surgery remains limited. Longer follow-up must be planned to define the quality of life of these patients.