Purpose: The necessity of orchiopexy for retractile testes was studied. Methods: From April 2000 to June 2006, 60 patients with retractile testes and 37 with cryptorchid testes visited our out patient clinic. The yearly changes of new patients and operation performed as well as the age at orchiopexy and the outcome were investigated. Results: The number of new patients (operations) with retractile testes were 0 (0) in 2000,4(0) in 2001, 5(2) in 2002, 10(6) in 2003, 15(6) in 2004, 11(5) in 2005, and 15(6) in 2006, respectively. The age at the initial visit ranged from 2 months to 9.9 years old (average 2.8 years old). The average age at orchiopexy for retractile testes was 3.0 ± 2.2 years. On the other hand, the numbers of new patients (operations) with cryptorchid testes were 1 (0) in 2000, 6(4) in 2001, 6 (7) in 2002,8(7) in 2003, 6(1) in 2004, 8(7) in 2005, and 2(1) in 2006, respectively. The age at initial visit ranged from 17 days to 13.4 years old (average 2.9 years old). The average age at orchiopexy for cryptorchid testes was 2.4 ±3.1 years. A patient with retractile testes who developed laterality of the testicle size was operated on immediately. An 8-year-old with retractile testes underwent simultaneous testicle biopsy, which showed mild interstitial fibrosis and degeneration of seminiferous tubules. Conclusions: The number of new patients with retractile testes has been increasing in our hospital. Some of them have potential for testicle hypotrophy, and early orchiopexy is recommended.

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Purpose: The precise connection between hydrocele and peritoneal cavity is still being disputed. Surgical anatomy was investigated to evaluate the efficiency of simple closure of processus vaginalis without incision of hydrocele for hydrocele in childhood. Methods: The connections between peritoneum and hydrocele were investigated in 332 hydroceles in 314 cases. Hydroceles were classified according to the extent of hydrocele and the existence of two components of remnant of processus vaginalis: peritoneal protrusion and cord-like connection. Length of each component was measured. Serial sections of the cord-like connections were studied microscopically in 13 cases. Hydroceles were operated by high closure of the connections with incision of the hydrocele in 63 cases, and without incision of the hydrocele in 269 cases. Results: Hydroceles were clinically communicating in 10 cases and non-communicating in 322 cases. In 289 cases, we observed three continuous structures: short peritoneal protrusion, cord-like connection and hydrocele. Peritoneal protrusions were short and thick structures at the level of internal inguinal ring. Cord-like connections were thin membranous structures tightly adhered to surrounding tissues. Microscopic study of serial sections of cord-like connections showed continuous lumens in all of 13 hydroceles examined. Operative results were excellent in 330 cases. Recurrence was observed in 2 cases. Conclusions: Hydrocele consists of three continuous components: short peritoneal protrusion, fine membranous cord-like connection and hydrocele. Cord-like connection is the site of incomplete closure of processus vaginalis, and has a microscopic communication. High closure of the processus vaginalis with no incision of hydrocele is enough for hydrocele in childhood.

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Purpose: We performed a retrospective statistical analysis of the pediatric patients who visited the Niigata Municipal Emergency Center late at night and were examined by the pediatric surgeons. Methods: We evaluated seven items including grade of emergency in 1,338 patients who visited the pedi- atrics of the Niigata Municipal Emergency Medical Center in the time zone from 0 : 00 AM to 7 : 00 AM from February 2005 to October 2006. Results: Fever was the most frequent complaint, and accounted for 547 cases. As for the diagnosis, 554 cases and 308 cases of upper respiratory infection and gastroenteritis, respectively, accounted for more than 60% of the patients. According to the necessity of the consultation with the doctors, 11% were considered as necessary, and 63% were as appropriate, while 24% or 2% of the patients were deemed for the self-satisfaction of the parents or unnecessary. Thirty-one percent of parents judged as needing self-satisfaction were fully equipped with medication Conclusions: The present study revealed the current status of the pediatric emergency in Niigata City, which needs further improvement on the doctor side as well as the patient side.

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Purpose: We experienced 6 cases of spontaneous pneumothorax (SpPn) after the Nuss procedure and it seemed to be a comparatively high incidence. We assessed characteristics of these patients with SpPn and discussed the possibility of a relationship between the Nuss procedure and the occurrence of SpPn. Methods: Six out of 382 patients who developed SpPn after the Nuss procedure were retrospectively reviewed. Results: Five were teenage males and one was a female in her 20s. All patients were tall with slender figures and one male had Marfan syndrome. Mean CT index was 7.2 ± 3.1, which was larger than that of all 382 cases (5.2 ± 2.8). Their mean preoperative Vertebral index and Frontosagittal index which were the parameters of sternal depression showed significant differences compared to the patients with similar age without SpPn. These postoperative parameters in the two groups improved to the same level. Three cases developed right SpPn and three bilateral. In the bilateral cases, SpPn occurred synchronously in two and separately in one. Five patients underwent bulla excision under thoracoscopy. All SpPn might result in rupture of bulla; however, a CT scan before the Nuss procedure did not show any cystic findings. Conclusion: SpPn developed in 1.6% during the bar placement after the Nuss procedure. The cause of SpPn was a pulmonary bulla. It could be speculated that the Nuss procedure enlarged the thoracic cavity and the lung volume leading to bulla formation. We should be reminded that SpPn may develop after the Nuss procedure.

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Femoral hernia in children is very rare and difficult to correctly diagnose preoperatively. We report a case of a laparoscopic femoral hernia repair in a 5-year-old boy. He showed a left groin bulge and had a diagnosis of a left indirect inguinal hernia. He underwent Potts repair at 4 years old. Four days after the surgery a left groin bulge appeared again. He had a diagnosis of a recurrence of a left inguinal hernia and underwent a re-operation one month after the surgery. Intraoperatively we made a diagnosis of a left direct inguinal hernia and performed a McVay repair. Sixteen days after surgery the recurrence of the left groin bulge appeared again. Ultrasonography and magnetic resonance imaging demonstrated a recurrence of a left inguinal hernia and the possibility of a femoral hernia. We performed the laparoscopic surgery at 5 years old which revealed that the diagnosis was a left femoral hernia. We performed a laparoscopic tension-free femoral hernia repair. The postoperative course for three years was uneventful and had no complication. The laparoscopic surgery is very useful in the case of a recurrent inguinal hernia because we can easily distinguish the type of hernia. This is the first report of a laparoscopic femoral hernia repair in children in Japan.

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Prevention of peritoneal adhesion is one of the critical factors for survival of children with bilateral Wilms tumors, who would possibly undergo peritoneal dialysis. In a 6-month-old girl who needed open biopsy and resections of the right kidney and multiple Wilms tumors of left kidney, Seprafilm^[○!R], hyaluronate carboxymethylcellulose-based bioresorbable membrane adhesion barrier was used intraperitoneally 4 times. Direct visual evaluation of the severity and extent of adhesions was performed at 2nd-, 3rd- and 4th-stage laparotomy for removal of tumors. Little adhesion was observed and peritoneal adhesion was prevented every time. Our experience suggests that the repeated use of Seprafilm^[○!R] in laparotomy might be safe and effective to prevent peritoneal adhesion for peritoneal dialysis in children with bilateral Wilms tumors. This girl became 5 years old without recurrence, peritoneal dialysis or failure to thrive.

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