RezumatBackground: Obezitatea la copil este o problemă cu care ne confruntăm din ce în ce mai des. Deşi chirurgia metabolică aplicată copiilor a fost iniţial privită cu scepticism, numărul articolelor ştiinţifice care abordează această problemă şi susţin intervenţia cât mai rapidă este deja coniderabil. Cu toate acestea există, încă multe controverse legate de indicaţia de intervenţie chirurgicală şi rezultatele pe termen lung la aceşti pacienţi. Scop: Analizarea rezultatelor chirurgiei bariatrice la un grup de adolescenţi cu obezitate operaţi în spitalul nostru. Metoda: Am analizat retrospectiv datele tuturor pacienţilor adolescenţi cu obezitate care au fost operaţi -gastrectomie longitudinală laparoscopică sau gastric by pass în perioada 2013noiembrie 2019 într-un Centru de Excelenţă în Chirurgia Bariatrică, urmărind prezenţa preoperator a comorbidităţilor legate de obezitate, evoluţia BMI şi a comorbidităţilor la 12 şi 36 luni postoparator. Rezultate: Şaizeci şi patru de pacienţi au fost incluşi în studiu, 62 cu gastrectomie longitudinală (SG) şi doi cu bypass gastric (GBP). Vârsta medie la momentul operator a fost de 15 ani şi 5 luni (SD 18 luni). Indexul BMI mediu înainte de operaţie a fost 39.45 kg/m 2 (SD 6.9) şi a scăzut la 24.92 kg/m 2 şi 22.7kg/m 2 la 12 respectiv 36 de luni de la intervenţie. Nu s-au înregistrat complicaţii majore perioperatorii, consemnând doar un caz de disfagie prelungită, tranzitorie postoperator. Durata medie de spitalizare a fost de 3.2 zile. În primul an de monitorizare postoperatorie s-au înregistrat doar complicaţii minore, ce au putut fi controlate medical: anemie (6/61), deficit de folaţi (5/61), constipaţie (22/61), căderea părului (12/61). Concluzii: Chirurgia bariatrică şi metabolică este sigură şi eficientă în tratamentul obezităţii la adolescent, atunci când este efectuată în centre cu experienţă. AbstractBackground: Childhood obesity is becoming more frequent and the age of diagnosis has decreased. Although initially sceptic about bariatric surgery in children and adolescents the number of papers to advocate earlier bariatric interventions in this age group is now considerable. However, there are still a lot of controversies about bariatric surgery's indications and long-term results in these patients. Aim/Objective: To analyze the outcomes of bariatric surgery in a group of adolescents with obesity operated in our hospital. Methods: We analyzed retrospectively all the consecutive adolescent patients who underwent laparoscopic gastric sleeve or gastric bypass between 2013 and November 2019 in a Bariatric Center of Excellence, tracking the perioperative morbidity, the changes of BMI and comorbidities at 12 and 36 PO months. Results: Sixty-four adolescent patients were included in the study, 62 with sleeve gastrectomy (SG) and two with gastric bypass (GBP). Mean age at operation was 15 years and 5 months (SD 18 months). Mean BMI before operation was 39.45 kg/m 2 (SD 6.9) and decreased to 24.92 kg/m 2 and 22.7kg/m 2 by 12 and 36 months respectively. There were no major pe...

Introduction. Flail chest can become life-threatening when accompanied by other complications of thoracic trauma. Current hospital flail chest management includes mechanical ventilation and pain control. Although mechanical ventilation management is constantly improving, prolonged intubation and intensive care lead to increased morbidity. Surgical fixation is gaining more ground against non-operative care and authors have reported better outcome and fewer complications in restricted retrospective studies, but a consensus still has to be reached regarding the guidelines for surgical fixation. In this article, we wish to present our perspective on the surgical fixation of flail chest. Materials and Method. A 39-year-old patient, known with chest trauma after a car accident for which he had undergone surgical treatment at another department, was admitted to our unit for chest instability and chronic pain. During the clinical examination of the left hemithorax, we noticed chest wall instability at the posterior arches of the 8th, 9th and 10th left ribs. CT scans of the thorax showed approximation of the ribs on the anterior fracture line and multiple displaced rib fractures, without callus formation, on the posterior fracture line. Results. The 5th to 10th left ribs were cleared of fibrotic tissue, re-approximated and repositioned using matrix RIB titanium plates and screws. After surgery, the patient was kept in the intensive care unit for two days and was discharged after another seven days. Postoperative pain was managed with opioid therapy. Conclusions. The debate regarding the operative management vs. the non-operative management of flail chest is ongoing given the relatively small number of patients included in the existing randomizedcontrolled trials. Osteosynthesis with plates and screws is easy to manage and we recommend the use of operative treatment of flail chest in patients who can withstand thoracic procedures.

Renal malformations represent a large part of the pathology referred to the pediatric surgeon. Most of them are diagnosed during pregnancy. We present one case of complete ureteral duplex with upper pole obstructive megaureter managed in a private hospital using minimally invasive methods for both diagnosis and treatment due to good teamwork. We do not want to demonstrate that other investigations are not leading to the same diagnose, we want to highlight an alternative to the classic approach. We hope that our experience is a starting point for further research and that in future radiation and general anesthesia in children will be avoided as much as possible for renal investigations.

Introduction. Acute appendicitis is the most frequent cause of surgical abdominal pain in children. There are multiple variants of surgical treatment of acute appendicitis, including laparoscopic stapler appendectomy. Aim. We proposed to present our experience regarding laparoscopic stapler appendectomy as an alternative treatment method in children diagnosed with appendicitis. Material and method. In this retrospective descriptive, observational study we analyzed the data of children admitted with appendicitis to Ponderas Academic Hospital between January 2018 and October 2020. Results. 78 laparoscopic appendectomies were performed in children with ages of 3 to 16 years old. Of these, 70 were performed using mechanical suturing devices. Time of surgery was 77 minutes in 2018, 76 minutes in 2019 and 91 minutes in 2020. In 2020 the number of complicated appendicitis was double than in 2019 and six times higher than in 2018 but time of surgery was smaller in these cases in 2020 with longer hospital stay. Conclusions. In 2020 we observed that was a smaller number of patients operated, with higher time of surgery, length of hospital stay, more complicated appendicitis (regarding drainage usage) but with smaller time of surgery in these complicated cases which indicates the effectiveness of using the stapler.

Introduction. Chronic constipation is a common reason for a pediatric patient to visit a doctor and we think that the number of cases is increasing but only a few patients are diagnosed with Hirschsprung disease. Aim. This study aims to clarify the difference between the two most common causes of chronic constipation in pediatric patients: habitual constipation and Hirschsprung’s disease regarding symptoms, clinical findings, investigations and treatment and to identify what is more important for the patients with chronic constipation: to go further with investigations after the clinical examination or to start the medical treatment as soon as possible in orther to establish a conduit in the management of these patients. Material and method. We present an observational, descriptive and retrospective 4 years study on children diagnosed with chronic constipation. Results. 122 patients were included in this study, in 3 cases Hirschsprung’s disease was diagnosed. As a complication of chronic constipation 58% of the patients had rectorrhagia and at local examination were found 34 patients with fecaloma, 32 with anal fissure and 5 with hemorrhoids, but none of these findings were associated with Hirschsprung disease. Only in 36% of the cases further investigations were needed. The average age at the first examination was 4 years and 3 months and the average age for the patients with rectorrhagia was 5 years and 3 months. Conclusions. The number of children with chronic constipation is increasing. Rectorhhagia, fecalomas, anal fissures and hemorrhoids are associated with habitual constipation but not with Hirschsprung disease. Because of the small number of cases diagnosed with Hirschsprung disease, the fact that the mean age of the children with rectal bleeding is 1 year higher than the one of the group and the small percentage of further investigation needed, we consider that in order to early prevent complications personalized medical treatment is needed and further investigations should not delay the begining of nursing.