Objective:To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS) in the perioperative period of congenital choledochal cysts in children.Methods:This is a multicenter prospective randomized controlled study. The clinical data of 273 pediatric congenital choledochal cysts(CCC) patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform. Among them, 123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode, and 150 cases in conventional group were managed according to traditional mode. The length of hospital stay,time to first farting, time to complete feeding, the incidence of complications, cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results:Compared with the conventional group, median time to start farting (2.0 d vs. 3.0 d, P<0.001), median time to complete feeding (5.0 d vs. 7.0 d, P<0.001), median postoperative hospitalization time (6.0 d vs. 9.0 d, P<0.001),the median total length of stay(13.0 d vs. 15.0 d, P<0.001) were shorter,the median hospitalization cost (37,000 yuan vs.43,000 yuan P<0.001) was lower, and stress indexes recovered quickly. The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups. Conclusion:It is safe and feasible to implement ERAS for children with CCC in the perioperative period, which can reduce stress response, speed up recovery,and save medical costs.

Objective:To explore the optimal surgical time of laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.Methods:Clinical data of 86 children with appendiceal abscess diagnosed in the Department of General Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2016 to June 2020 were retrospectively analyzed.According to the delayed laparoscopic appendectomy interval after the appendiceal abscess was cured, 86 children were divided into group A, B and C. Briefly, patients in the 3 groups were treated with laparoscopic appendectomy 4 weeks, 8 weeks and over 12 weeks after the appendiceal abscess was cured, respectively.Children with recurrent appendicitis during delayed operation were not included.The incidence of appendicitis recurrence during delayed operation, the incidences of intraoperative complications, conversion to laparotomy, and postoperative complications, operation time, the time of postoperative intestinal function recovery, and postoperative hospital stay were compared among 3 groups.Results:There were 10, 31 and 45 cases in group A, B and C, respectively.Among them 10, 30 and 39 patients received laparoscopic appendectomy, and 0, 1 and 6 cases had appendicitis recurrence in group A, B and C, respectively.There were no significant differences in the age, gender, diameter of appendiceal abscess, inflammatory indexes at diagnosis of diagnosing appendiceal abscess, cure time of conservative treatment of abscess, and inflammatory indexes at laparoscopic appendectomy among the 3 groups (all P>0.05). The incidence of appendicitis recurrence in group C(13.33%) was significantly higher than that in group A (0) and group B (3.22%)( P<0.05). There was no significant difference in the incidence of appendicitis recurrence between group A and group B( P>0.05). The incidences of intraoperative(group A, B, C was 40.00%, 10.00%, 10.26%, respectively) and postoperative complications (group A, B, C was 40.00%, 6.70%, 5.10%, respectively), and conversion to laparotomy(group A, B, C was 20.00%, 0, 0), operation time [group A, B, C was (106.70±7.42) d, 41.40±10.44) d, (39.60±11.27) d, respectively], postoperative intestinal function recovery time [group A, B, C was(5.80±2.15) d, (0.93±0.17) d, (0.83±0.11) d], and postoperative hospital stay[group A, B, C was(12.40±4.15) d, (1.67±0.31) d, (1.58±0.44) d] in group A were significantly higher than those in group B and group C(all P<0.05), but no significant differences were found between group B and group C(all P>0.05). Conclusions:Eight weeks are the best time for laparoscopic appendectomy after conservative treatment of appendiceal abscess in children.

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.

Objective To study the use of laparoscopy in the diagnosis and treatment of obstructive infantile cholestasis.Methods The clinical data of 106 patients with obstructive infantile cholestasis from January 2012 to June 2017 were studied retrospectively.After two weeks of conservative treatments which failed to decrease the bilirubin levels significantly,these patients were subjected to laparoscopic diagnosis and treatment.Results A correct diagnosis was established in all these 106 patients by laparoscopic biliary tract exploration and cholangiography.Eighty-eight patients were diagnosed to have biliary atresia (83.0％),16 patients inspissated bile syndrome (15.1％) and 2 patients biliary hypoplasia (1.9％).Thirty-eight of the 88 biliary atresia patients gave up operative treatment after laparoscopic biliary tract exploration and cholangiography.The remaining 50 biliary atresia patients were treated with open Kasai portoenterostomy.The prognosis of the biliary atresia patients were different from the non-biliary atresia patients.On follow-up for 4 months to 5 years,all the 18 non-biliary atresia patients were in good condition and there was no recurrence of jaundice after laparoscopic cholecystostomy and biliary tract irrigation.Conclusions The laparoscopic minimally invasive technique helped to establish diagnosis and treatment in patients with obstructive infantile cholestasis.For patients with biliary atresia,this procedure gave a definitive diagnosis and offered an opportunity for surgery.For patients with inspissated bile syndrome and biliary hypoplasia patients,laparoscopic cholecystostomy and biliary tract irrigation established the correct diagnosis and reduced liver damage resulted by cholestasis.

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.

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 etiology,clinical characteristics,diagnosis and treatment of the bile duct perforation in children.Methods The clinical data of 7 children with the bile duct perforation were retrospectively summarized in Wuhan Children's Hospital from April of 2009 to April of 2014.Results There were 7 cases of the children with perforation of the bile duct,1 male and 6 female,the average age was 2.05 years.The most common presenting symptoms were abdominal distension in 7 cases(100.0％),nausea and vomiting in 6 cases(85.7％),abdominal pain in 5 cases(71.4％),jaundice in 1 case(14.3％) and diarrhea in 1 case(14.3％).Six cases experienced preoperative abdominal paracentesis,which all gained bilious ascites.Both abdominal ultrasound and computed tomography(CT) showed ascites in 5 cases.On exploration,sites of perforation were seen in 3 cases(42.8％) at the junction of the common hepatic duct and cystic duct,1 case(14.3％) at common hepatic duct,and 1 case(14.3％) at common bile duct,while sites of perforation in other 2 cases(28.6％) were not localized.In the cases(case 1,2,5 and 7) whose site of perforation was large,the T-tube drainage and peritoneal drainage through laparotomy or laparoscopic surgery was performed.In case 4 whose site of perforation was very small,and case 3 and 6 whose site of perforation was not localized,the cholysystostomy and peritoneal drainage was performed through laparotomy or laparoscopic surgery.Simple closure of the perforation was performed in case 4.Case 4 and 5 showed recurrent abdominal pain after operation and abdominal CT revealed biliary tract dilatation,and then biliary reconstruction was performed.Both of the patients recovered well postoperatively.The other 5 children recovered well and had an uneventful postoperative period from the 7 months to 5 years follow-up.Conclusions Early diagnosis of perforation of the bile duct can be made based on clinical manifestations,abdominal ultrasound and CT and abdominal paracentesis.Active surgical treatment should be performed once diagnosis was made.Depending on the size of perforation of the bile duct,appropriate surgical drainage scheme is made.The children with recurrent abdominal pain and biliary tract dilatation should receive biliary reconstruction.