Minimally invasive repair of duodenal atresia has gained widespread popularity since its introduction in 2001. While the diamond-shaped (DS) anastomosis is considered the gold standard in open surgery and superior to the side-to-side (SS) anastomosis, the SS anastomosis has regained popularity in minimally invasive repairs of duodenal atresia. To date, no comprehensive review has assessed the impact of anastomotic technique on outcomes in minimally invasive duodenal atresia repair. This systematic review evaluates the impact of DS versus SS anastomosis on complications and outcomes in laparoscopic duodenal atresia repair. A comprehensive literature search was conducted from January 2001 to December 2024 across PubMed, EMBASE, and Web of Science to identify studies reporting on minimally invasive duodenal atresia repair with hand-sewn anastomosis. Thirteen studies, including 288 patients (159 DS, 129 SS), were included. Primary outcomes analyzed included operative time, conversion rate, time to feeding, and length of hospital stay. Secondary outcomes focused on postoperative complications, including anastomotic leaks and strictures. Statistical analyses were performed using Mann-Whitney U tests and Fisher's exact tests. No significant differences were found between DS and SS with regard to operative time, time to initial or full feeding, or hospital stay. The DS group had a higher conversion rate (11 % vs. 3 %, p = 0.01), but no significant difference was observed in overall complications, stricture rates, or time to feeding. Notably, the DS group had a significantly higher incidence of anastomotic leakage (p = 0.03), primarily driven by a single study. The leakage rate was lower in studies using a continuous running suture for the DS anastomosis. In laparoscopic duodenal atresia repair, the SS anastomosis is not inferior to the DS technique in terms of operative time, hospital stay, or feeding outcomes. The DS technique carries a higher risk of anastomotic leakage, which can be mitigated with the use of a continuous suture technique. Both techniques are equally safe for minimally invasive duodenal atresia repair, suggesting that SS offers a viable alternative to DS. IV.

Radiation exposure early in life is associated with greater incidences of malignancy. Our goal was to quantify radiation exposure in shunt-treated hydrocephalus patients and study changes in the diagnostic modalities used. A single-center, retrospective analysis was performed, and 41 children treated for hydrocephalus using an adjustable ventriculoperitoneal shunt were identified. Diagnostics associated with hydrocephalus and other comorbidities were analyzed and radiation exposure was calculated. During 330.09 total shunt years, patients were exposed to a mean hydrocephalus-associated radiation dose of 3.93 mSv (range: 0–24.38 mSv), which amounted to a mean rate of 0.49 mSv per shunt year, respectively. Radiation exposure was greatest after shunt insertion in the first year of life. A continuous change from CT scans to MRIs could be seen over the study period, such that patients who underwent shunt insertion after 2017 were not exposed to additional hydrocephalus-associated radiation during their first year of life. Nevertheless, our patients, and a few individuals especially, seemed to be at higher risk for radiation sequelae. Our results suggest that CT scans should be substituted with MRIs, which decrease overall radiation exposure and can lead to zero additional radiation exposure during the first year of life after shunt insertion.

Megacalycosis is a rare non-obstructive congenital anomaly of the kidneys. The underlying pathogenesis has not yet been understood. Theories include the coexistence of distinct calyceal developmental stages, malformation of the calyceal structure, and transient, self-limiting obstruction. The management of this condition consists of close sonographic and functional follow-up. It is of the utmost importance to differentiate between an obstructive cause of hydronephrosis, although this can be challenging. Avoiding unnecessary surgical intervention is a crucial objective in this regard. The number of case series is limited, and the follow-up periods are often brief. The study included pediatric patients with megacalycosis who had been treated at the institution between 2009 and 2024. The extracted data comprised demographics, prior treatments, and follow-up data concerning sonographic and functional tests. The two-sample Student's t-test or the Mann-Whitney-U test were employed, depending on the normality of the distribution of the variables. The statistical analysis was conducted using Microsoft Excel 365. A total of 19 affected kidneys in 18 patients were identified. The median follow-up period was 5 years (range 1.2-13). All patients exhibited stable renal function at Tc-99m MAG3 scintigraphy. While a plateau phase was evident in the majority of patients following furosemide injection, delayed tracer clearance 40-60 min later was adequate. In cases where the diagnosis was uncertain or where prior surgery had been performed, retrograde pyelography was a valuable additional tool for ruling out obstruction. This is the largest series with the longest follow-up period of patients affected by megacalycosis to date. The diagnostic process can be challenging. The only appropriate management is non-operative, which preserves renal function. Retrograde pyelography can be a useful additional tool in cases where the diagnosis is uncertain.