Purpose
The aim of this study was to compare the clinical features and examine the safety and feasibility of laparoscopic surgery versus open surgery in children with solid pseudopapillary tumors (SPTs).
Methods
Patients under age 18 diagnosed with SPT who underwent surgery for the condition at our single institution from January 2005 to December 2019 were retrospectively analyzed. The demographics and postoperative outcomes in the two groups were compared according to the surgical method and tumor locations.
Results
The 25 patients consisted of 23 females and two males with a mean age at surgery of 13.2 years (range, 6 to 18 years). The lesions were located in the pancreatic head (n=7, 28.0%), and body or tail (n=18, 72.0%). Fifteen patients (60.0%) were treated with laparoscopic surgery. In all patients, there was no difference in intraoperative and postoperative outcomes between the two groups. When analyzed according to tumor location, complications including postoperative pancreatic fistula did not show significant differences with the surgical method in both the head group and body or tail group.
Conclusion
Compared to open surgery, the clinical outcomes and complication rate of the laparoscopic approach in pediatric SPT patients was not significantly different. Therefore, laparoscopic surgery for SPTs in pediatric patients may be a feasible option.

Purpose
Temporary stoma formation is a common procedure in pediatric surgery. Surgical site infection after stoma reversal surgery is a common complication, and the cosmetic effect after skin suturing is reduced. Purse-string closure has been suggested for stoma reversal, preventing surgical site infections and providing better cosmesis. Positive results have been reported abroad for the purse-string closure technique for stoma reversal in pediatric patients; however, no cases have been reported in Korea. Therefore, we aimed to investigate the outcomes of purse-string closure for stoma reversal in pediatric patients.
Methods
From October 2018 to September 2022, all pediatric patients who underwent stoma reversal at the Department of Pediatric Surgery were included. The electronic medical records of the patients were retrospectively reviewed. The following variables were analyzed: perinatal data including gestational age, sex, birth weight, Apgar score, and types of delivery; preoperative conditions including total parental nutrition, steroid use, and tracheal intubation; operational data such as diagnosis, types of stoma, age, body weight, skin closure methods and operation time; and postoperative data such as surgical site infection, transfusion, days until extubation, and start of enteral feeding. The serial wound healing process after purse-string closure was documented using photographs.
Results
Thirty-seven patients underwent stoma reversal surgery, 14 underwent purse-string closure, and 23 underwent conventional lineal closure. No surgical site infection occurred in the purse-string group and four cases of surgical site infection occurred in the conventional liner group. However, there were no statistically significant differences between both groups (p=0.276).
Conclusion
No surgical wound infection was found in pediatric patients who underwent purse-string closure for stoma reversal, and the cosmetic effect was promising. However, no statistically significant difference was found between the purse-string closure and conventional linear closure groups. Further multicenter studies involving a larger sample size are needed to determine statistical significance.

Purpose
Enterostomies in premature infants are associated with a high incidence of complications. This study analyzed the factors associated with complications in very low birth weight (VLBW) infants who underwent enterostomy.
Methods
VLBW infants with preoperative weights below 1,500 g who underwent enterostomy between January 2003 and May 2018 were analyzed. The gestational age, corrected age, birth weight, weight at the time of surgery, surgery location, causative disease, laboratory findings, and complications were also analyzed.
Results
A total of 61 cases were included, consisting of 16 cases with stomal complications (26.2%); 12 prolapses (19.7%), 3 cases of parastomal hernias (4.9%), and 1 case of prestomal obstruction (1.6%). Premature infants born before 28 weeks gestation had approximately a three-fold increase in complications, albeit without statistical significance (p=0.11). These infants also had high incidences of bedside operations (p=0.003). Differences in surgical sites did not significantly impact the complication rate. Seven patients (11.5%) underwent reoperation for their complications. Twelve patients had prolapses, and six of these patients (50%) underwent reoperative surgeries. The mortality rate among the included patients was 24.6% (15 patients). These deaths were not associated with enterostomy, and seven deaths (46.7%) were attributed to neonatal sepsis and necrotizing enterocolitis.
Conclusion
VLBW infants, particularly those born before 28 weeks of gestation, typically have stomal complications. Therefore, surgical techniques should be aimed at minimizing stomal complications when operating on VLBW patients.

Purpose
Increases in intestinal length (IL) in patients with short bowel syndrome (SBS) may differ by age and underlying diseases. This study analyzed the elongation rate of the remnant IL according to underlying disease to establish a therapeutic plan for intestinal rehabilitation.
Methods
The charts of SBS patients who underwent surgery at our center from 2000 to 2018 were retrospectively reviewed. The enrolled patients included those with a remaining IL less than 25% of the average and those with a remaining IL of approximately 50% who had been administered parenteral nutrition for more than one year. Patients were excluded if they underwent only one operation or two operations with the first being a serial transverse enteroplasty procedure, meaning that base length was not known.
Results
Ten patients were enrolled. Causes of SBS included total colonic aganglionosis (TCA) in seven patients (70.0%), necrotizing enteritis in two (20.0%), and malrotation/volvulus in one (10.0%). The IL growth rate in the three non-TCA patients was 9-fold higher than the estimated proportion, whereas the growth rate of the IL according to age was significantly lower in the TCA than in the non-TCA group (p=0.01).
Conclusion
The IL growth rate may differ between TCA and non-TCA patients in SBS. Rehabilitation protocols might consider the underlying disease. Additional larger trials are required to confirm these findings.

Purpose
During the coronavirus disease 2019 pandemic, with an aim to reduce the burden on the strained health care resources, operating on suspected perforated appendicitis while managing simple appendicitis conservatively was followed in our institution. The aim of this study was to determine the predictive value of clinical features and investigations for discriminating between perforated and non-perforated appendicitis in children and devise a scoring system.
Methods
A retrospective study of all consecutive children who underwent appendectomy for acute appendicitis at our institution, a tertiary care pediatric center in South India, between 1st June 2020 to 31st May 2021 (period, one year) was carried out. In line with our standard operative procedure suspected perforated appendicitis were operated while simple appendicitis were managed conservatively in our institution. Patient demographics details, clinical features and investigations data were collected, and univariate and multivariate analysis carried out.
Results
Total of 58 patients were included in the study. Longer duration of symptoms, leukocytosis, serum sodium <135 mEq/L, appendicolith and free fluid and abscess on ultrasonography are good predictors of perforated appendicitis. We have evolved a reliable scoring system to identify perforated appendicitis.
Conclusion
Accurate identification perforated appendicitis with our scoring system is possible and results in effective usage of health care resources.

Jejuno-ileal atresia is often associated with various other gut pathologies. A 5-day male presented with bilious vomiting, abdominal distension and non-passage of stools. Exploratory Laparotomy showed a type IIIA ileal atresia with midgut volvulus and atypical malrotation for which Ladd’s Procedure and anastomosis of atretic bowel was done. A fleshy tubular structure extracted from distal bowel showed ileal duplication. In JIA, the vascular theory of pathogenesis is widely accepted with multiple studies to suggest the same. The mechanism being mesenteric ischemia leading to intestinal necrosis, resorption, and atresia. It has been found that abdominal duplication cyst often occurs simultaneously with short bowel, intestinal atresia, stenosis and enteric duplication for which a common vascular pathogenetic mechanism has been suggested. Our case serves as an in vivo description of the proposed theory where the findings may be described elegantly. We describe and discuss the mesenteric ischemia theory in bowel atresia and hope to further our understanding about the same.

Caecal duplication cysts (DCs) are rare anomalies and presentation varies according to size, site, the mucosal lining of the cyst, and age of the patient. The rarity of the condition and varied clinical presentation makes it difficult to diagnose preoperatively. A high index of suspicion and intraoperative examination of the whole bowel is essential to localize intraluminal DC. We herein describe a case of an intraluminal caecal DC in an infant along with its presentation, management, and review of pertinent literature.