Introduction: Intestinal intussusception is the most common form of acquired intestinal obstruction in childhood. Diagnostic errors reach 50%, and complications occur in up to 53.7% of cases. Pneumoirrigoscopy under fluoroscopic control (PIS) has been the standard conservative technique, but its radiation burden and single-attempt limitation prompted the development of ultrasound-guided hydroechocolonographic disinvagination (HEC). This study aimed to compare the clinical outcomes of HEC and PIS in paediatric intestinal intussusception. Methods: A retrospective comparative study of 132 children aged 2 months to 10 years treated at the Specialized Paediatric Surgical Clinic of Samarkand State Medical University between 2000 and 2023. The control group (CG, n=59; January 2000–December 2013) received conventional PIS; the study group (SG, n=73; January 2014–December 2023) underwent ultrasound-guided HEC, a radiation-free technique developed at our institution. Primary outcomes were the rate of successful conservative reduction (assessed per patient), length of hospital stay, and mortality. Chi-squared and Student’s t-tests were used; p<0.05 was considered significant. Results: The predominant age group was 6 months to 1 year (51.5%); males predominated (70.5%, p<0.001). The ileocaecal variant was found in 90.1% of patients. Successful conservative reduction was achieved in 53.4% (39/73) of the study group versus 39.0% (23/59) in the control group. Mean hospital stay was significantly shorter in the study group (2.5±0.66 vs 4.6±0.51 days, p<0.05). Group-specific mortality was 2.7% (2/73) in the SG versus 8.5% (5/59) in the CG. Conclusion: Ultrasound-guided HEC is a safe, effective, and radiation-free alternative to PIS, achieving a higher rate of conservative reduction, a significantly shorter hospital stay, and enabling multiple reduction attempts. Disease duration alone should not determine treatment modality; clinical condition and the absence of peritoneal signs must be considered jointly.

Background: Laparoscopic appendectomy is the treatment of choice for acute appendicitis. The optimal technique of appendiceal stump closure is still under discussion because it is assumed to affect the occurrence of complications. The three-port combined technique with laparoscopically assisted extracorporeal base ligation (mesoappendix hemostasis performed intra-abdominally and the appendix ligated extra-abdominally) represents a novel technique with which to ligate the appendiceal stump following laparoscopic appendectomy. We compared this combined technique with the appendix stump treatment technique using an endoscopic loop, for complicated and uncomplicated appendicitis. Material and methods: In the period from January 1, 2020 to December 31, 2024, 628 patients under the age of 18 were operated on for appendicitis at the Clinic for Pediatric Surgery of the Clinical Center of the University of Sarajevo, 430(68.5%) with open appendectomy and 198(31,5%) with laparoscopic appendectomy We divided all the patients intotwo groups, group A with 102 patients who underwent surgery with a combined laparoscopic method, and group B where the base of the appendix was closed with an endoscopic loop (95 patients).Results: 198 patients underwent laparoscopic surgery, of which 123 (62%) were boys and 75 (38%) girls. Of these 198 patients who underwent laparoscopic surgery, 102 (52%) were treated using laparoscopically assisted extracorporeal ligation of the base of the appendix, 80 (40%) patients with one endoloop, 15 (8%) with 2 endoloops and only one patient with 1(0.5%) hem-o-lok and an endoloop. Of the 198 patients who were operated laparoscopically, 108 (54%) had complicated appendicitis, 59 (30%) uncomplicated appendicitis and 31 (16%) chronic appendicitis. The average duration of surgery for patients treated with the combined method was 58.61 minutes and with endoscopic loops 69.41 minutes. The average length of hospitalization for patients treated with the combined method was 3.96 days and with endoscopic loops 4.59 days.Conclusions: The three-port combined technique for laparoscopically assisted extracorporeal base ligation of the appendix is a safe, useful, and cost-effective alternative to endoscopic loops, with the advantages of less manipulation, fewer complications involving the appendix, and shorter operative times. This technique is particularly acceptable in resource-limited countries.

Objectives: This study aimed to evaluate the frequency, severity, and risk factors associated with Hickman catheterrelated complications in pediatric patients with acute leukemia at a tertiary pediatric care center in Bosnia and Herzegovina. Patients and methods: This retrospective study was conducted with 88 pediatric patients (54 males, 34 females; mean age: 5.9±4.6 years; range, 0 to 18 years) diagnosed with acute leukemia who had Hickman catheters inserted between January 2019 and July 2024. Data on complication rates, types, and outcomes were collected. Results: A total of 91 Hickman central venous catheters were inserted in 88 children. The cohort included 60 (68%) children with acute lymphoblastic leukemia (ALL) and 28 (32%) children with acute myeloid leukemia 14 (AML). The median follow-up was 190 days (95% confidence interval, 160-212), spanning 12,644 catheter days. Complications occurred in 24 (27.3%) patients. Twelve (13.1%) of these were mechanical, seven (7.7%) were infectious, and five (5.5%) were thrombotic; the incidence rates were 0.8, 0.48, and 0.08 per 1,000 catheter days, respectively. Notably, AML patients had a higher complication rate (1.59 per 1,000 catheter days) compared to ALL patients (1.22 per 1,000 catheter days). Conclusion: Hickman catheter-related complications in pediatric leukemia patients are relatively common, with AML patients facing a higher risk. Understanding these complications can help improve patient management and outcomes.

Congenital Hereditary Spherocytosis (CHS) is an inherited dysfunction or a deficiency in one of the erythrocyte membrane proteins. It is an inherited form of haemolytic anaemia which is noted by the presence of spherical erythrocytes. This leads to increased fragility and haemolysis. This case report is based on an 8-year old girl with CHS. She presented with acute abdominal symptoms and was subsequently managed with a combined cholecystectomy and splenectomy. This strategy seeks to address both the frequent haemolytic crises and the presence of gallstones, ultimately providing an extensive management strategy for paediatric patients with CHS.

We present a new approach to high intraabdominal testis (IAT) for elongation of the testicular vessels without division. The technique entails fixation of the testis to a point one inch above and medial to the contralateral anterior superior iliac spine for 12 weeks. Subdartos orchiopexy is then done as the second stage. Both stages are laparoscopically assisted. The a new approach to high intraabdominal testis, two-stage laparoscopic traction-orchiopexy, is useful and resulted in significant elongation of the testicular vessels without atrophy. It is a safe and valid alternative to the two-stage laparoscopic Fowler–Stephens technique, which entails division of the main testicular vessels.

Introduction: Cholelithiasis is occurance of one or several gallstones in the gallbladder. It can be complicated with choledocholithiasis, acute or chronic cholecystitis, cholangitis, biliary pancreatitis, biliary ileus, etc. Causes for this disorder in pediatric population can be hemolytic (hereditary spherocytosis, thalassemia, sickle cell anemia) or non hemolytic - other hereditary disorders as cystic fybrosis, Wilson's disease or ileum disordes, total parenteral nutrition, usage of certain medicaments, choledochal cysts, organ transplantation and, in adolescency, those similar to adult patients (obesity). Mostly gallstones found in children are cholesterol ones or pigmented gallstones. There are many diagnostic imaging methods for objectifying gallstones and its complications (as choledocholithiasis that requires ERCP). There is also some differential dyagnoses that should be taken in consideration before the tretment (billary dyskinesion, Odii sphincter dysfunction, neonatal jaundice, cholestasis, pediatric cholecystitis, pediatric pancreatitis and pancreatic pseudocysts as well as pediatric pyelonephritis). First line of treatment of cholelithiasis is with diet, saline infusions and medicaments and if cholelithiasis is symptomatic and/or complicated then cholecystectomy is recomended. Having in mind operative approach it can be open procedure of laparascopic one. Some study show that injuries of bile ducts are more common in laparascopic tretment of pediatric cholelithiasis but nevertheless it is shown that with experienced team and good preparation this is the golden standard in the treatment of pediatric cholelithiasis. Objectives. Hereby we present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis in pediatric population. Methods: Between 2010. and 2022, retrospectively, we explored data points of children who underwent laparoscopic cholecystectomy reviewed with included demographics properties, indication for cholecystectomy, used surgical technique, operative time, complications, and length of hospital stay. We performed 37 laparoscopic cholecystectomies (due to cholelithiasis and one case of cholecystitis without calculi) with 2 conversions to open procedures and via open approach we treated 3 cholecystes in this period. Male to female distribution was: 12 male patients and 25 female patients Results: Thirty-seven children (12 male patients and 25 female patients with ages ranging from 7 to 18 years, mean: 11,9 years) underwent laparoscopic cholecystectomy. The indication for surgery was associated to symptomatic cholelithiasis in almost all patients. The surgery was performed under general anesthesia and classical 4-port approach was done in twenty-two patients, and 2-port approach in combination with 2 portless 2.3-mm percutaneous graspers was used in two patients. The operating time ranged between 45 and 120 minutes (mean: 77 minutes). Two patients were treated by open surgery. Only one patient had leakage due to choledocholithiasis, and open surgery and ERCP had to be performed. Median of hospital stay for all patients was 3-4 days. Conclusion: Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adult series.

Introduction: Ganglioneuromas are rare, slowly growing, benign tumors originating from sympathetic ganglions with a benign histology. Although ganglioneuromas are benign, the treatment is surgical as they can cause pain or compression symptoms, can be locally aggressive and can lead to cord compression. Case Report: A 7 years old-boy was referred to our Oncologic Pediatric Departement due to a giant retroperitoneal and mediastinal mass detected in computed tomography (CT) scans. The initial symptoms were presence of a nonproductive cough a few months early. Presurgical biopsy revealed a benign ganglioneuroma. Total tumor resection of 125x115x165mm tumor was obtained successfully via thoracotomy. Histopathological analysis confirmed the diagnosis. Surgically challenging aspects were the tumor invasion into the mediastinum through the aortic hiatus. Postoperative functioning was excellent without any sign of neurologic deficit. Conclusions: Ganlioneuromas of the mediastinum are slow-growing, large tumors, mostly asymptomatic, and the first symptoms are a consequence of the compressive effect of the tumor. The gold standard in the diagnosis of ganglioneurinoma is CT and needle biopsy. Complete surgical removal is recommended for symptom control or prevention of potential malignant degeneration Subsequent long-term follow-up including imaging controls is mandatory to prevent potential relapse.

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together.

A 16-year-old girl with an asymptomatic large splenic cyst. The disease was discovered by an accidental ultrasound of the abdomen due to a urinary infection. The patient was followed up conservatively for 3 years, and after the gradual enlargement of the cyst, laparoscopic surgery was indicated. The operation and postoperative follow-up for a period of 6 months is satisfactory.