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Objective. Duodenal atresia (DA) routinely has been corrected by laparotomy and duodenoduodenostomy with excellent long-term results. We revisited the patients with DA treated in the last 12 years (2004–2016) comparing the open and the minimally invasive surgical (MIS) approach. Methods. We divided our cohort of patients into two groups. Group 1 included 10 patients with CDO (2004–09) treated with open procedure: 5, DA; 3, duodenal web; 2, extrinsic obstruction. Three presented with Down's syndrome while 3 presented with concomitant malformations. Group 2 included 8 patients (2009–16): 1, web; 5, DA; 2, extrinsic obstruction. Seven were treated by MIS; 1 was treated by Endoscopy. Three presented with Down's syndrome; 3 presented with concomitant malformations. Results. Average operating time was 120 minutes in Group 1 and 190 minutes in Group 2. In MIS Group the visualization was excellent. We recorded no intraoperative complications, conversions, or anastomotic leakage. Feedings started on 3–7 postoperative days. Follow-up showed no evidence of stricture or obstruction. In Group 1 feedings started within 10–22 days and we have 1 postoperative obstruction. Conclusions. Laparoscopic repair of DA is one of the most challenging procedures among pediatric laparoscopic procedures. These patients had a shorter length of hospitalization and more rapid advancement to full feeding compared to patients undergoing the open approach. Laparoscopic repair of DA could be the preferred technique, safe, and efficacious, in the hands of experienced surgeons.

Epididymal cysts (ECs) are relatively common in adults, rare in children. Normally their treatment is conservative. They may be situated anywhere in the organ, frequently in the region of the head. Torsion of these cysts is extremely rare in both children and adults, causing acute scrotal swelling. The diagnosis is intraoperative. A 16-year-old boy was referred to our Divisional Clinic by the treating physician for scrotal swelling appeared 4 months earlier.Absence of a history of minor scrotal trauma. Ultrasonography showed a 40×50 mm fluid-filled right para-testicular mass. We performed surgery finding a large black cyst connected to the head of the epididymis with 720°-degrees rotation. Histology revealed an acquired EC. The particularity of our case is due to the absence of symptoms in association with a big EC twisted of 720° degrees. This is the only case reported in literature. All patients with EC torsion reported presented symptoms related to acute scrotum. IntroductionEpididymal cysts (ECs) is a benign mass that usually develop in adult men, but it is rare in children, with a prevalence of 5-20% according to varying series reported in the literature. 1 They present as single or multiple, uni-or bi-lateral spherical cysts localized most frequently in the head of the epididymis. Although the cause of EC and spermatocele is often unknown, it may be caused by epididymal ducts obstruction. They are usually of lymphatic origin. When small, ECs remain undetected and can be found in approximately 30% of asymptomatic patients having scrotal ultrasound for other reasons. On the contrary to adolescent in adults most of these cysts are spermatocele. 2 With a certain diagnosis (ultrasound), their treatment is conservative under elective condition. Rarely, as result of trauma or torsion of these cysts, exploration of the scrotum is required to rule out other pathologies such as testicular torsion. An EC torsion is extremely rare especially in young boys and to the best of our knowledge only 6 cases have been reported in literature. 3 Case ReportThe treating physician has referred a 16-year-old boy to our Service for right scrotal swelling appeared 4 months before. The patient reported the absence of a history of minor scrotal trauma. He had no fever or urinary symptoms. Physical examination demonstrated left scrotal region and left testis normal. On the right side, tenderness and swelling of the right hemiscrotum; the testis was appreciated of regular consistency, with vague margins, located on the inferior-posterior area. Superiorly was appreciated an elastic area as loculated hydrocele. No pain on palpation. At the lower pole of the testis was appreciable a hard consistency area, 1 cm in length, painless. Abdominal examination was unremarkable. The inguinal canal was not engaged. Routine hematology, serum biochemistry, and urine analysis were normal. Color-Doppler-Ultrasonography showed both testes with normal parenchymal architecture and echogenicity with no perfusion defect as the left epididymis. On the...

The management of congenital primary obstructive megaureter (POM) is usually conservative, especially during the first year of life. Endoscopic high-pressure balloon dilatation (EHPBD) is indicated when symptoms, increasing dilatation and progressive renal damage are recorded, particularly in children younger than one year of age. We identified and described endoscopic prognostic factors predicting the success or failure of endoscopic dilatation. Thirty-eight patients (33 M;5 F) with POM from 2005-2018 were included. Diagnosis was based on US distal ureter dilatation (>7 mm), obstructive MAG-3 diuretic renogram and absence of vesicoureteral reflux (cystography). 24 patients were under 1 year of age. All patients underwent cystoscopy and high-pressure balloon dilatation with 3,5 Fr dilating balloon, after ascending pyelography. Median follow-up was of 6.5 years. We identified characteristics with poor prognosis: stenotic punctiform ureteral ostium and/or ostium located in a bladder diverticulum (9 pts) and stenotic tract longer than 1 cm (5 pts). The patients with a stenotic tract shorter than 1 cm (18 pts) were divided into two groups: <5 mm (5 pts) and between 5 and 10 mm (13 pts) showed a good response to dilatation. Endoscopic evaluation of ureteral ostium with pneumatic dilatation when possible is a useful diagnostic and therapeutic solution for POM treatment, especially under one year of age. EHPBD is effective in short stenotic tracts (<5 mm). It may also be repeated with good results in intermediate stenotic sections (5 mm-1 cm). According to our preliminary results, the procedure is more effective if performed earlier (3-7 months of life). Greater cohort and longer follow-up are needed to verify the stability of these results.

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