Gastrointestinal bleeding is common in children. The causes of hemorrhage is numer-ous and varies with age. Most of them can be identified by conventional endoscopy and imaging examina-tion. For unexplained bleeding,especially repeated bleeding which failed to conservative therapy,a one-stop hybrid procedure of gastrduodenoscopy,colonoscopy and laparoscopy showed great clinical application value. Endoscopic hematischesis is widely used for minimally invasiveness,effectiveness,and recognition of biopsied lesions. With the progress of laparoscopic technology,single-port transumbilical laparoscopy is increasingly applied in pediatric gastrointestinal bleeding. While surgical exploration is still mandatory for massive hemorrhage in emergency circumstances.

Objective To explore the value of laparoscopy in the diagnosis and treatment of recurrent inguinal hernia in children.Methods The clinical data of 67 cases receiving laparoscopic treatment for recurrent inguinal hernia in children at the Department of General Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science & Technology were retrospectively analyzed,including the type of hernia recurrence,operation time,intraoperative and postoperative complications,such as short-term hydrocele formation and testicular atrophy and so on.Results In 67 cases,there were 65 males and 2 females.Open repair surgery and laparoscopic surgery were respectively performed in 48 cases and 19 cases for the first operation and the hernia defects were found after operation.Contralateral patent vaginal process deformities were found in 11 sides in the reoperation.Among 67 cases of recurrent inguinal hernia,incomplete ligation of hernia sac was found in 21 cases,low level ligation of hernia sac in 17 cases,no ligation of hernia sac in 14 cases,omissive direct inguinal hernia in 4 cases,loose ligation of hernia sac in 4 cases,overlarge inner ring in 4 cases,weak abdominal muscles in 2 cases,and increased abdominal pressure (long-term constipation,asthma) in 1 case.All the patients were treated by laparoscopic hernia repair and no serious complications occurred during the operation.The average time of unilateral operation was (15.0±2.2) minutes (13-25 minutes),and bilateral operation was (27.0±4.3) minutes (18-41 minutes).All patients were discharged on the second day.Two patients showed short-term postoperative hydrocele and were cured with conservative treatment.During the follow-up time of (23±2) months (9-39 months),no recurrence or testicular atrophy was found.Conclusions Laparoscopy can confirm the type of recurrent inguinal hernia and contribute to reduce postoperative recurrence.Laparoscopic management of recurrent inguinal hernia in children is safe and feasible,which is expected to replace open hernia repair.

Objective:To investigate the clinical characteristics of pancreatic cystic neoplasms in pediatric patients.Methods:The clinical data of 13 patients with pancreatic cystic neoplasm at Wuhan Children′s Hospital from July 2007 to November 2019 were collected.There were 5 males and 8 females, with a mean age of 133 months(range: 9 to 170 months). Eleven patients presented with abdominal pain, vomiting, and a palpable mass. Tumors were located in the pancreatic head( n=7), body( n=2) and tail( n=4), respectively. Results:The preoperative diagnosis was confirmed by imaging examination in 11 patients, CT and MRI was significantly superior to ultrasound in the exact diagnosis of the tumor types. In this group, surgical methods mainly included pancreaticoduodenectomy( n=3), pylorus-preserving pancreatoduodenectomy( n=1), duodenum-preserving pancreas head resection( n=3), spleen-preserving distal pancreatectomy ( n=3), distal pancreatectomy plus splenectomy( n=2), and tumor enucleation( n=1). Postoperative complications including biochemical leakage( n=1), delayed gastric emptying(grade A) ( n=1), adhesive intestinal obstruction( n=1), transient elevation of platelet count( n=2), all were cured by conservative treatment. In one patient biliary leakage occurred and later developed into biliary stricture, this patient underwent the second operation 6 weeks later and recovered smoothly. All patients were diagnosed by postoperative pathology, including solid pseudopapillary neoplasm( n=10), serous cystadenoma( n=1), mucinous cystadenoma( n=1) and cystic lymphangiom( n=1). Three cases were lost in this group, the rest of patients were all accepted outpatient or telephones follow-up. There was no evidence of recurrence or metastasis during 3 to 92 months follow-up. Conclusions:The incidence of pancreatic cystic neoplasm is low in the pediatric patients. Symptomatic patients should receive surgical treatment timely. It′s safe and effective to choose the organs and functions-preserving surgical method.

Objective:To investigate the clinical characteristics of pancreatic cystic neoplasms in pediatric patients.Methods:The clinical data of 13 patients with pancreatic cystic neoplasm at Wuhan Children′s Hospital from July 2007 to November 2019 were collected.There were 5 males and 8 females, with a mean age of 133 months(range: 9 to 170 months). Eleven patients presented with abdominal pain, vomiting, and a palpable mass. Tumors were located in the pancreatic head( n=7), body( n=2) and tail( n=4), respectively. Results:The preoperative diagnosis was confirmed by imaging examination in 11 patients, CT and MRI was significantly superior to ultrasound in the exact diagnosis of the tumor types. In this group, surgical methods mainly included pancreaticoduodenectomy( n=3), pylorus-preserving pancreatoduodenectomy( n=1), duodenum-preserving pancreas head resection( n=3), spleen-preserving distal pancreatectomy ( n=3), distal pancreatectomy plus splenectomy( n=2), and tumor enucleation( n=1). Postoperative complications including biochemical leakage( n=1), delayed gastric emptying(grade A) ( n=1), adhesive intestinal obstruction( n=1), transient elevation of platelet count( n=2), all were cured by conservative treatment. In one patient biliary leakage occurred and later developed into biliary stricture, this patient underwent the second operation 6 weeks later and recovered smoothly. All patients were diagnosed by postoperative pathology, including solid pseudopapillary neoplasm( n=10), serous cystadenoma( n=1), mucinous cystadenoma( n=1) and cystic lymphangiom( n=1). Three cases were lost in this group, the rest of patients were all accepted outpatient or telephones follow-up. There was no evidence of recurrence or metastasis during 3 to 92 months follow-up. Conclusions:The incidence of pancreatic cystic neoplasm is low in the pediatric patients. Symptomatic patients should receive surgical treatment timely. It′s safe and effective to choose the organs and functions-preserving surgical method.