Objective To summarize the experience of performing selective laparoscopic appendectomy in re-admission children who had been given conservative treatment for acute appendicitis complicated with peri-appendiceal abscess.Methods From September 2019 to July 2024,22 patients with acute appendicitis complicated with peri-appendiceal abscess underwent three port laparoscopic appendectomy after receiving conservative treatment for 6-14 weeks.Their age ranged 5-14 years old,with an average of 8.5 years old.A 5 mm trocar and a 30° laparoscope were inserted through a midline umbilical incision,and 5 mm trocars and forceps were placed at the suprapubic area,lateral to the left rectus abdominis,and 3-5 cm below the umbilicus.Adequate adhesiolysis was performed,including detaching the omentum from the pelvic sidewall,separating the ileocecal region from the omentum,and freeing the appendix from the lateral peritoneum and the mesenteric tissue of the terminal ileum to expose the affected appendix.The mesoappendix and the base of the appendix were then ligated and transected.Results The operations in all the 22 cases were successful.The surgical time ranged 50-150 min(mean,75.5±10.0 min).The patients were able to mobilize independently at 6-8 h postoperatively,resumed passing gas and consumed clear liquids within 1-1.5 d.The postoperative hospital stay was 3-6 d,with an average of 4 d.Pathological reports indicated chronic appendicitis with necrotizing perforation.Follow-ups lasted for 2-13 months(mean,6 months),with no reports of abdominal pain,fever,incision infection,adhesive intestinal obstruction,residual appendicitis,or pelvic abscess.Conclusions For children with acute appendicitis complicated with peri-appendiceal abscess who have received conservative treatment,effective adhesiolysis within the abdominal and pelvic cavities during selective laparoscopic appendectomy is crucial,which is also the primary reason for a relatively prolonged surgical time.Adhesions are primarily located between the omentum and pelvic sidewall,between the ileocecal region and omentum,and between the appendix and lateral peritoneum as well as the mesentery of the terminal ileum.Adequate adhesiolysis followed by appendectomy can effectively alleviate symptoms such as abdominal pain.

Objective To investigate the safety,feasibility,and surgical skills of laparoscopic high ligation of the hernia sac after laparoscopic appendectomy in children with gangrenous perforated appendicitis or peri-appendiceal abscess.Methods Between February 2015 and May 2024,laparoscopic high ligation of the hernia sac was conducted in 9 cases of gangrenous perforated appendicitis and 3 cases of peri-appendiceal abscess who had undergone laparoscopic appendectomy for 4 months to 3 years and 8 months(mean,1 year and 4 months).Clinical data of these patients was retrospectively reviewed and summarized.Results All the 12 patients were found to have adhesion of greater omentum to the patent tunica vaginalis with folded peritoneum around inner ring orifice.For 3 cases of adhesion to the inner ring orifice,the greater omentum adhesion was released followed by two-port laparoscopic inner ring closure assisted by extracorporeal suture traction,the operative time being 18 min,21 min,and 22 min,respectively.For 8 cases of adhesion to the wall of the tunica vaginalis and 1 case of adhesion to bottom of the tunica vaginalis,the greater omentum adhesion was released and disconnected by using an electric hook followed by three-port laparoscopic inner ring closure assisted by forceps pulling the thick peritoneum,the operative time being(45.5±5.7)min.No intraoperative complications were found and the patients were discharged within 6 h postoperatively.A total of 11 patients were followed up for 4-20 months(mean,7.5 months).One patient was found contralateral inguinal hernia at 1 year and 7 months postoperatively,and high ligation of the hernia sac was conducted after re-admission.No incision infection,hydrocele,iatrogenic cryptorchidism,or testicular atrophy.Conclusions After laparoscopic appendectomy,there is a possibility of the greater omentum adhesion to the inguinal canal during laparoscopic high ligation of the hernia sac.During the operation,it is advisable to add a trocar for assisting the detachment of the greater omentum and fully exposure of the inner ring orifice and retroperitoneum.While protecting the spermatic cord blood vessels,vas deferens,and testes,the greater omentum can be loosened and detached,and high ligation of the hernia sac can be performed.This operation is safe and feasible.

Objective To summarize the experience of emergency laparoscopic appendectomy for pediatric acute gangrenous perforated appendicitis complicated with periappendiceal abscess≤4 cm in diameter.Methods From January 2021 to August 2024,49 children with acute gangrenous perforated appendicitis complicated by periappendiceal abscess ≤ 4 cm in diameter underwent three-port laparoscopic appendectomy.A 5 mm trocar and a 30° laparoscope were inserted through a supraumbilical midline incision.Two 5 mm trocars with operating forceps were placed at 2-3 cm proximal of the bladder and 2-3 cm below the umbilicus at the lateral edge of the left rectus abdominis.Blunt dissection was performed to release the omentum and intestinal adhesion,exposing the abscess in the intestinal interspace.The pus cavity was aspirated,and the diseased appendix was identified.After freeing and exposing the appendix,the mesoappendix was ligated at its base.The mesoappendix was then divided with an electric hook,and the diseased appendix was removed.Results All the 49 cases were operated successfully.The operative time was 50-150 min,with an average of(85.5±10.5)min.All the patients were able to get out of bed at 6-8 h postoperatively,and resumed flatus and started a liquid diet within 1.5-2 d.Postoperative blood tests on the 6th day showed normal white blood cell count,neutrophil count,and neutrophil ratio,with C-reactive protein levels ranging 26-55 mg/L.Ultrasound showed a low-density shadow in the cecum with a maximum diameter≤2.0 cm and a pelvic fluid depth≤2.0 cm.The average postoperative hospital stay was 8.5 d(range,6-11 d).Pathological reports confirmed acute gangrenous perforated appendicitis with periappendiceal abscess.Follow-ups for 6-18 months(mean,12.5 months)showed no complications such as wound infection,adhesive bowel obstruction,residual appendiceal stump inflammation,or pelvic abscess.Conclusions Emergency laparoscopic appendectomy for pediatric acute gangrenous perforated appendicitis complicated by periappendiceal abscess≤4 cm in diameter is safe and feasible.Key steps in the procedure include identifying and exposing the appendix and releasing intestinal adhesions.

Objective To summarize the surgical experience of residual cavity reduction by using dermal-fascial suture in giant posterior cervical subcutaneous mass(maximum diameter≥7 cm)resection.Methods From September 2019 to June 2024,27 pediatric patients with posterior cervical subcutaneous masses with maximum diameter≥7 cm underwent mass resection.By using 4-0 polypropylene suture,the residual cavity was reduced through a novel suturing technique:sutures were passed through the dermal layer into the residual cavity,and then anchored to the cervical muscular fascia through the surgical incision.After exiting the skin at 0.5-1 cm adjacent to the entry point,a 1 cm × 1 cm gauze bolster was placed between entry and exit points,and tied and secured.A drainage tube was placed at the lowest point of the residual cavity.Results All the 27 procedures succeeded.The operation time was 70-160 min(mean,95.0±12.5 min),with dermal-fascial suturing requiring 10-20 min(mean,15 min).The drainage volume was measured 2-5 ml at postoperative day 3,with no detectable fluctuation or significant tenderness at the residual cavity and skin incision.Cervical ultrasound confirmed no obvious residual cavity or fluid accumulation,and the drainage tube was removed.The postoperative hospital stay was 4-8 d(mean,6 d).Postoperative pathological diagnosis included 16 cases of lipomas,7 cases of fibrolipomas,and 4 cases of lymphangiomas.At 10 d follow-up visit,no discomfort was reported.Upon dressing change,the cervical shape was found to be normal,with no protrusions or indentations,or incision infection.At one month after surgery,ultrasound showed no abnormalities in the subcutaneous space of the neck,and the skin incision had healed.At 6 months after surgery,no recurrence of tumor was found.Conclusion Dermal-fascial suture effectively reduces residual cavity following giant posterior cervical mass resection in children,promoting tissue regeneration and wound healing while preventing complications.

Objective To investigate the safety and feasibility of two-port laparoscopic full layer circular closure of the hernia ring for direct inguinal hernia.Methods Between September 2019 and February 2024,9 cases of pediatric indirect inguinal hernia were found to be accompanied by an occult direct inguinal hernia on the right side during two-port laparoscopic inner ring closure.After completing the high ligation of the indirect hernia under laparoscopic monitoring,the bottom of the direct hernia sac was investigated.The needle was held and inserted sequentially from the 4 o'clock direction,crossing the abdominal wall muscle layer through the peritoneum to the subcutaneous layer,and exited at the 8 o'clock direction.The same method was conducted from the 8 o'clock direction in and at the 12 o'clock direction out,and afterwards from the 12 o'clock direction in and at the 16 o'clock direction out(near the previous 4 o'clock insertion point),followed by knotting and closure of the hernia ring.Results Postoperative diagnosis indicated 3 cases of Pantalon hernia(right indirect hernia+right direct hernia)and 6 cases of left indirect hernia+right direct hernia.No extraperitoneal lipoma was found outside the hernia sac.Two-port laparoscopic high ligation of the indirect hernia and laparoscopic circular closure through muscle layer to subcutaneous layer of abdominal wall around the hernia ring was carried out.The operation time was(32.5±3.5)min,and blood loss was less than 1 ml.No intraoperative complications were seen.All the patients were discharged within 6 h after surgery and followed up for 5-13 months(mean,8 months),with 3 cases followed up for more than 12 months.No complications such as incision infection,recurrent hernia,hydrocele,iatrogenic cryptorchidism or testicular atrophy was found.Ultrasound examination of the direct hernia triangular area showed uniform thickness of the abdominal wall and no localized defects observed.Conclusions Laparoscopic circular closure through muscle layer to subcutaneous layer of abdominal wall around the hernia ring is safe and feasible.This procedure supplements the pediatric direct inguinal hernia repair procedure by suturing and closing both peritoneum and abdominal wall muscle layer of direct hernia defect without changing the normal anatomical position of the umbilical fold.

Objective To explore the safety and feasibility of extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure in the treatment of pediatric ovarian sliding hernia.Methods From September 2019 to September 2024,57 children with ovarian sliding hernia underwent extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure.Under the guidance of single-port umbilical laparoscopic monitoring,a 2-0 suturing needle with thread was inserted through the opposite internal ring and used to suture the round ligament of the uterus at the affected side's internal ring.The needle was passed through and exited near the entry point,and the extracorporeal suture traction was used to pull the ovary(and part of the fallopian tube)back into the abdominal cavity from the inguinal canal,maintaining the suture tension to prevent the ovary and fallopian tube from re-entering the internal ring.The internal ring was fully exposed.A 2-0 suturing needle with thread was inserted at the affected side(2-3 cm from the internal ring)to perform a circular suture of the peritoneum at the internal ring.The internal ring was closed at the level of internal ring orifice.Results All the 57 cases of ovarian sliding hernia were confirmed to be unilateral,with 18 cases on the right side(including 12 cases of pure ovarian sliding hernia and 6 cases of ovarian and fallopian tube sliding hernia)and 39 cases on the left side(including 22 cases of pure ovarian sliding hernia and 17 cases of ovarian and fallopian tube sliding hernia).The average surgery time was(22.5±2.5)min.All the patients were discharged within 6 h postoperatively and no complications were noted.A total of 49 patients were followed up for6-20 months(mean 9.5 months),with 21 cases followed for more than 12 months.No complications such as incision infection,recurrence of hernia,or Nuck's cyst were observed.Ultrasonic examinations showed normal bilateral ovarian blood flow.Conclusion For pediatric ovarian sliding hernia,extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure can effectively retract the ovary(and part of the fallopian tube)from the inguinal canal back into the abdominal cavity,fully exposing the normal anatomical form of the internal ring,with the characteristics of safety and feasibility.

Objective To explore the safety and feasibility of 3-mm laparoscopic needle holder combined with 3-0 needle-thread nylon in external silk thread traction-assisted two-port laparoscopic internal ring suturing for the treatment of inguinal indirect hernia in children≤3 months old.Methods From January 2020 to September 2024,49 children ≤ 3 months old with indirect hernia underwent external silk thread traction-assisted two-port laparoscopic internal ring suturing.All the patients were found to complicated with redundant peritoneum around internal ring.Under transumbilical single-port laparoscopic monitoring,the 3-mm laparoscopic needle holder holing the 3-0 needle-thread nylon was inserted through the inferior edge of the internal ring,entering the peritoneum and traveling through the retroperitoneal space.The external nylon thread was advanced to drag the redundant peritoneum,allowing the suture needle cross the surface of the spermatic cord vessels,the Doom's triangle,and the vas deferens(boys)or the uterine round ligament(girls)in the retroperitoneal space,followed by circular suturing and closure of the internal ring.Results The surgery time was(13.5±2.5)min for the 35 cases of unilateral hernia and(24.5±3.5)min for the 14 cases of bilateral hernia.No intraoperative complications occurred,and all the patients were discharged within 6 h post-operation.Except for 3 children of lost to follow-up,46 children were followed up for 6-26 months(mean,9.5 months),with 19 cases followed for＞12 months.No complications such as recurrence,wound infection,hydrocele,iatrogenic undescended testicle,or testicular atrophy were observed during the follow-ups.Conclusion For children ≤ 3 months old with indirect hernia,the use of 3-mm laparoscopic needle holder combined with 3-0 needle-thread nylon in external silk thread traction-assisted two-port laparoscopic internal ring suturing enhances the flexibility and convenience of the procedure,being safety and feasibility.

Objective To investigate the safety and feasibility of emergency transumbilical single-site laparoscopy for persistent intestinal intussusception in children.Methods From September 2019 to January 2025,32 children with persistent intestinal intussusception caused by small intestinal polyps underwent emergency transumbilical single-site laparoscopic exploration,intestinal intussusception reduction,and polypectomy.A 5-mm longitudinal incision was respectively made at the umbilical midline and the inferior edge of the umbilical ring for trocar placement.Under laparoscopic guidance,grasping forceps were used to explore the intestine from the ileocecal region to locate the intussuscepted bowel,followed by trying the laparoscopic instrumental reduction.The incision was further extended between the umbilical midline and the inferior edge of the umbilical ring to 3-4 cm length,and the intussuscepted bowel was externalized through the incision.Manual reduction was performed if the laparoscopic reduction failed.The intestinal segment containing the polyp was identified,and a longitudinal incision was made at the polyp site by using an electrocautery knife.The polyp was resected near the mucosal margin followed by closure of intestinal wall.Results Laparoscopic reduction was successful in 5 cases,while 27 cases required external manual reduction.Complete small bowel polyp screening was performed in all the cases.Polyp identification,localization,and resection were completed extracorporeally.Isolated polyps were found in 31 patients,and two polyps were identified in one patient.The mean operative time for all the 32 patients was(72.5±12.5)min,with no intraoperative complications.Pathological examination confirmed juvenile polyps in all the cases.All the 27 cases were followed up for 3-18 months(mean,6.5 months),of which 13 cases were followed up for more than 12 months.Ultrasound follow-up revealed no abnormalities,including intestinal leakage,wound infection,recurrence of intussusception,or polyp reoccurrence.Conclusion Emergency transumbilical single-site laparoscopy is a safe and feasible approach for persistent intestinal intussusception in children.

Objective To study the objective changes and effects of speech characteristics in patients with nasal endoscopic surgery,and to analyze the relationship between surgery and changes in vocal tract structure.Methods A prospective study was conducted on 45 patients who underwent nasal endoscopic surgery from June 2023 to December 2023.Among them,13 patients underwent nasal septum deviation correction surgery and/or nasal polypectomy and/or turbinate shaping surgery group(G1 group),11 patients underwent simple sinus opening surgery group(G2 group),and 21 patients underwent nasal sinus opening+nasal septum deviation correction surgery and/or nasal polypectomy and/or nasal turbinate shaping surgery group(G3 group).Spectrogram detection was completed before and 1 month after surgery.Nasal resistance(Refft value),acoustic indicators resonance peak frequency(F1-F4),bandwidth(B1-B4),difference between F1 amplitude and nasal murmur resonance peak amplitude(A1-P0),and difference between F1 and nasal murmur resonance peak amplitude(A1-P1)under different sound tasks(oral vowels,nasal vowels,and phrases and short sentences containing nasal vowels)were analyzed.Results After surgery,there was no significant change in the acoustic indicators in any of the groups,and the Refft value significantly decreased.The change in the resonance peak of oral vowels was not significant,but the bandwidth significantly decreased.A1-P1 in each group showed an upward trend after surgery,while A1-P0 showed a downward trend after surgery.Among them,A1-P1 in G1 group showed a significant increase compared to preoperative levels in/ma/,/na/,/mi/,and/ni/,and A1-P0 showed a significant decrease in/ma/and/na/compared to preoperative levels.There were statisti-cally significant differences in A1-P0 between G2 group and preoperative group in both/ma/and/na/.The A1-P1 levels in G3 group showed significant differences compared to preoperative levels in/mi/and/ni/,and A1-P0 showed significant differences compared to preoperative levels in/ma/and/na/.Conclusion Nasal endoscopic surgery may have a measurable impact on the patient's speech.The spectrogram can be used to evaluate the postoperative pronuncia-tion characteristics of nasal endoscopy,with A1-P1 being a better measurement indicator for high vowels/i/and A1-P0 being a better measurement indicator for non high vowels/a/.