Introduction: Esophageal atresia (EA) is a congenital defect that causes esophageal discontinuity, often with an associated tracheo-esophageal fistula (TEF) in 70%–90% of cases. When the distance between esophageal ends precludes primary anastomosis, it results in long gap esophageal atresia (LGEA), complicating the surgical management. This study retrospectively reviewed LGEA cases from the past decade, treated with the goal of preserving the native esophagus, comparing surgical techniques and outcomes with current literature.Materials and methods: The data of patients treated for LGEA between 2013 and 2024 were collected from medical charts, focusing on patients treated with the preservation of their native esophagus.Results: Ten patients were enrolled for this study. All of them had a gap between the esophageal ends equal to or greater than three vertebral bodies. Four patients (40%) underwent a delayed primary anastomosis (DPA) procedure, while the remaining six (60%) underwent a traction staged repair. All patients were treated with open surgery. The follow-up period extended from 3 months to 10 years.Conclusion: Preserving the native esophagus in patients with LGEA is a challenging but feasible goal, with delayed primary anastomosis and traction techniques playing key roles. We advocate for the preservation of the native esophagus as the preferred approach for ensuring a high quality of life for patients, as it helps to avoid severe long-term complications associated with esophageal substitution.

Penile curvature could represent a great challenge to the paediatric urologist. Surgeons have to choose among several surgical techniques. Degloving and chordee section techniques are able to correct the majority of congenital bent penis. More invasive surgeries should be considered for residual curvature or severe cases. We report 35 cases of paediatric patients suffering from anomalies of penile curvature treated with different surgical approaches. No major complications are disclosed. In the majority of patients, degloving and chordee section resulted to be sufficient to correct the curvature. Further studies on a bigger patients’ population are required to assess the most correct approach to each degree of curvature and associated anomalies. Besides every peculiar anatomic condition, to deal with difficult situation where the line of must-treat is not so marked, in our opinion it is crucial to be able to count on multi-disciplinary teamwork which can accomplish a 360-degrees evaluation of the patients’ health and mental status.

Background: Omphalocele is a congenital midline abdominal wall defect, rarely associated with a congenital stoma. This unusual presentation presents unique diagnostic and surgical challenges, with only a handful of cases reported in the literature. Case report: We report a male neonate born at 36 + 6 weeks of gestation with a small-to-moderate omphalocele (6 cm) containing an externalized ileal segment that functioned as a congenital stoma. Preoperative evaluation, including contrast study via the stoma, echocardiography, and genetic testing, revealed no associated malformations. During the first month of life, conservative management was adopted, and the stoma remained functional. Subsequently, the infant developed signs of bowel obstruction with persistent bilious vomiting and therefore underwent surgical intervention. Intraoperative findings warranted resection of the affected bowel segment, followed by primary end-to-end anastomosis and direct abdominal wall closure. Histopathologic analysis confirmed congenital spontaneous fistulization without evidence of vitelline duct remnants or heterotopia. The postoperative course was uneventful, with early return to full enteral feeding and normal growth documented at 12-month follow-up. Methods: A scoping review of PubMed and Scopus identified previously reported cases of omphalocele with congenital stoma. Among 1,428 studies screened, only one met the inclusion criteria. Discussion and conclusion: Unlike previously reported cases, our patient had no intestinal atresia, suggesting a distinct embryologic mechanism. Omphalocele associated with a congenital stoma is exceptionally rare but can be safely repaired through deferred single-stage intervention in selected cases. Reporting additional cases and fostering multicenter collaboration are essential to improve understanding and guide management.

Background: Transumbilical laparoscopic-assisted (TULA) surgery is a minimally invasive technique that combines laparoscopic exploration with extracorporeal surgical management, offering potential advantages in neonatal abdominal surgery. However, comparative data with conventional open surgery in neonates remain limited. This study reports our single-center experience with TULA and compares its outcomes with those of a matched cohort of neonates undergoing open surgery. Methods: We performed a retrospective study on neonatal patients (<28 days of life) treated at our Pediatric Surgery Unit between 2015 and 2023. Twenty-five neonates underwent TULA for various intra-abdominal malformations. Each TULA patient was matched in a 1:2 ratio with neonates treated with open surgery based on gestational age, birth weight, and underlying diagnosis, resulting in a matched cohort of 50 patients. Primary outcomes included operative and anesthesia times, conversion rate, postoperative complications, length of hospital stay, and mortality. Results: The TULA cohort included 11 males and 14 females, with a mean gestational age of 37.5 ± 1.9 weeks and a mean birth weight of 2989 ± 675 g. Indications comprised intestinal malrotation, ileal atresia, duodenal stenosis, meconium ileus, and other abdominal pathologies. Mean operative time was comparable between groups (116 ± 37 min in the TULA group vs. 137 ± 65.9 min in the open surgery group; p = 0.52). Conversion from TULA to open surgery occurred in 16% of cases. No significant differences were observed in major postoperative complications or length of hospital stay between groups (p > 0.05). No mortality was reported. Conclusions: TULA represents a safe and effective surgical option for selected neonatal abdominal pathologies, with outcomes comparable to conventional open surgery. When performed in specialized centers with appropriate patient selection and multidisciplinary expertise, TULA offers favorable safety and cosmetic results.

Restorative Proctocolectomy (RP) with Ileal Pouch-Anal Anastomosis (IPAA) represents the gold-standard surgical treatment for patients requiring total colonic and rectal removal due to ulcerative colitis, familial adenomatous polyposis, and other colonic pathologies. The laparoscopic approach (L-IPAA) has been increasingly utilized in pediatric and young adult populations to enhance recovery and reduce morbidity; however, its benefits over open surgery (O-IPAA) remain uncertain. This meta-analysis aimed to compare outcomes between L-IPAA and O-IPAA, focusing on complications, operative time, and length of hospital stay (LOS). A systematic review and meta-analysis were performed according to PRISMA guidelines, including comparative studies of patients <21 years undergoing IPAA. Databases searched included PubMed, Ovid, and Cochrane CENTRAL up to September 2025. Primary outcomes were major intra- and post-operative complications; secondary outcomes included minor complications, operative time, and LOS. Data were analyzed using random-effects models, with risk of bias assessed via ROBINS-I and evidence quality graded using the GRADE system. Eight studies encompassing 1094 patients met inclusion criteria: 412 underwent O-IPAA and 682 underwent L-IPAA. No significant differences were found in major intra-operative (OR = 0.871, p = 0.888) or major post-operative complications (OR = 0.798, p = 0.599). L-IPAA showed a trend toward fewer minor complications (OR = 0.514, p = 0.071) and demonstrated a significantly shorter hospital stay (OR = 0.480, p < 0.001). Operative time was significantly longer in the laparoscopic group (OR = 1.784, p < 0.001). Heterogeneity across studies was moderate to high, and the overall certainty of evidence ranged from very low to moderate. Both laparoscopic and open IPAA are safe and effective for pediatric and young adult patients requiring total proctocolectomy. While laparoscopic surgery entails a longer operative time, it offers a clear benefit in reducing hospital stay, with comparable complication rates. Further multicenter randomized studies are needed to validate these findings and define the optimal surgical approach.