Faculty of Medicine
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Item type:Publication, LAPAROSCOPIC AND OPEN APPENDECTOMY IN PEDIATRIC PATIENTS –OPERATIVE AND POSTOPERATIVE EXPERIENCE(2022-09); ; Risto SimeonovObjective: Acute appendicitis is very frequently encountered in children. Despite many scientific controversies in supporting classical or laparoscopic appendectomy, there is still no official consensus on this issue. This study aimed to present our experience from the comparison of operative and postoperative effects of laparoscopic and open appendectomy in pediatric patients with acute appendicitis. Materials and methods: The analytical cross-sectional study was conducted at the University Clinic for Pediatric Surgery, Ss. Cyril and Methodius University in Skopje, the Republic of N.Macedonia during the period 2015/2022. The study sample covered 184 hospitalized pediatric patients aged 4-14 years treated with laparoscopic (LA) or open appendectomy (OA). The data of interest included demographic characteristics, and selective operative and postoperative parameters. Results: The average age of the children in LA vs. OA group was 9.63±2.70 with min/max of 4/14 vs. 9.16±2.91 with min/max 2/14 respectively. Postoperative complications were detected in 1 (0.90%) of LA patients and 3 (4.11%) of OA patients with no significant association. Analgesics’ treatment received 57 (51.35%) of the children from LA group and all of the children from OA group. Conversion from LA to OA happen only in 1 (0.54%) child. The evaluation of parents/guardians related to the satisfaction from the cosmetic appearance of the scar the significantly higher level of satisfaction from the scare after LA compared to OA intervention. Conclusions: Laparoscopic appendectomy was found to be feasible and comparable to open approach in terms of operative time and offers advantages over the latter in terms of postoperative pain, length of hospital stay and earlier return of bowel function to normal. It is a safe approach in all types of appendicitis, with an overall better complication profile than OA. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FIRST EXPERIENCES WITH LAPAROSCOPIC HERNIOPLASTY IN THE TREATMENT OF INDIRECT INGUINAL HERNIAS IN FEMALE CHILDREN(2018); ; Introduction: Inguinal hernia is one of the most performed operations in pediatric surgery, and it is the most common reason for consulting a pediatric surgeon. The incidence of indirect inguinal hernia in children is 0.8-4.4%. There are more operative methods of open surgical and minimally invasive laparoscopic techniques. Aim: The aim of this study is to identify the descriptive characteristics of the initial cases of applying a laparoscopic hernia repair technique for the treatment of female children diagnosed with congenital indirect inguinal hernia. Materials and method: This is a descriptive study with collected clinical data from the University Clinic of Pediatric Surgery in Skopje. The sample, collected in the period 2015-16, covers a total of ten girls aged 0-14 years, who were clinically diagnosed with indirect inguinal hernia.The patients underwent PIRS(percutaneous internal ring suturing) techique.Results: The average age of the patients was 68,3 ± 34,2 months with a minimum of 24 and maximum of 168 months. According to the location of the inguinal hernia, in 7 (70%) patients it was right-sided, in 2 (20%) it was left-sided, and in 1 (10%) it was bilateral. During the laparoscopic exploration of the inguinal hernia repair there was an incidental finding of two contralateral occult inguinal hernias that were sutured with the same technique in a single act. In 50% of the patients the intervention lasted less than 25 (23-31) minutes. The length of the hospital stay was 10,8 ± 3,1 hours. The shortest hospital stay was 8 hours and the longest 16 hours. Fifty percent of the children took up a sitting position in bed in less than 4 hours. The average time for taking up a sitting position was 4,1 ± 0,9 hours with a minimum of 3 and maximum of 6 hours. Post-operative analgesia single dose was given to only 2 (20%) of the children. The length of the surgical scar in 50% of the children is less than 2mm. During the 6 month post-operative follow-up period, there were no recurrent findings of hernia in any of the cases. Conclusion:The laparoscopic technique of percutaneous closure of the internal inguinal ring in the treatment of inguinal hernia in female children is a minimally invasive procedure with preferable advantages in terms of reduced post-operative pain, reduced hospital stay, rapid return to normal activities as well as an excellent cosmetic effect.