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Fung ACH, Tsang JTW, Leung L, Chan IHY, Wong KKY. Comparative Outcomes of Single-Stage versus Two-Stage Laparoscopic Fowler-Stephens Orchidopexy: A Systematic Review snd Meta-Analysis. Eur J Pediatr Surg 2024. [PMID: 39079708 DOI: 10.1055/a-2375-9784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Intra-abdominal testis (IAT) remains a challenging and controversial subset within the management of cryptorchidism. While Fowler-Stephens orchidopexy (FSO) is still being advocated as the gold standard for the treatment of this entity, there is new and conflicting evidence on the comparative outcomes between single- or two-stage laparoscopic FSO (LFSO). The aim of the study is to investigate whether staging has benefits in children receiving LFSO. METHODS We searched the PubMed, Medline, Embase, and Cochrane Trials databases for studies comparing single- with two-stage LFSO in children from January 1, 1995 to December 31, 2023. We assessed the identified studies for quality and performed a systematic review and meta-analysis in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses. The main outcome measures examined were success rate (in terms of the scrotal position of the testis) and testicular atrophy, which were analyzed using fixed effect models. RESULTS We included 17 eligible studies that involved a total of 499 operated testes. The overall success rates of single- and two-stage LFSO were 79.4 and 90.3%, respectively. The overall testicular atrophy rates of single- and two-stage LFSO were 17.3 and 11%, respectively. Fixed effect model analysis showed that two-stage LFSO is significantly superior to single-stage LFSO in overall success rate (odds ratio [OR: 2.57]; 95% confidence interval [CI]: 1.50-4.39, p = 0.0006) and testicular atrophy rate (OR: 0.48; 95% CI: 0.28-0.79, p = 0.004). There is no heterogeneity in the reports, and the funnel plot showed no publication bias. CONCLUSIONS Two-stage LFSO remains the first choice of operation for children with a high IAT, with a significantly higher success rate and a lower testicular atrophy rate.
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Affiliation(s)
- Adrian Chi Heng Fung
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jaime Tze Wing Tsang
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ling Leung
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ivy Hau Yee Chan
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kenneth Kak Yuen Wong
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Bašković M, Zaninović L, Sansović I, Meašić AM, Katušić Bojanac A, Ježek D. Trends in the treatment of undescended testes: a pediatric tertiary care center experience from Croatia. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000461. [PMID: 36474738 PMCID: PMC9716856 DOI: 10.1136/wjps-2022-000461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/13/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Undescended testes (UDT) is the most common anomaly of the male genitourinary tract. The guidelines suggest that orchidopexy in congenitally UDT should be performed between 6 months and 18 months of age, while in acquired UDT, orchidopexy should be performed before puberty. Delay in treatment increases the risk of cancer and infertility. The main aim of this study was to determine whether we meet international standards in the treatment of UDT. Methods The present study included all boys who underwent orchidopexy either due to congenital or acquired UDT in 2019 (from January 1 to December 31). For each group, laterality, location, associated anomalies, premature birth and in how many cases ultrasound was applied were determined. Additionally, for each group, the types of surgery, the number of necessary reoperations, and in how many cases atrophy occurred were determined. Finally, ages of referral, of clinical examination, and of orchidopexy were determined. Results During this period, 198 patients with 263 UDT underwent orchidopexy. The median time of orchidopexy for the congenital group was 30 months, while that for the acquired group was 99 months. In the congenital group up to 18 months of age, orchidopexy was performed in 16 (16%) boys, while in the acquired group up to 13 years of age, orchidopexy was performed in 95 (96.94%) boys. Conclusion Given the well-known risks of late treatment of UDT, orchidopexy needs to be performed much earlier, especially in the congenital group.
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Affiliation(s)
- Marko Bašković
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Luca Zaninović
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ivona Sansović
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Department of Medical Genetics and Reproductive Health, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ana Maria Meašić
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Department of Medical Genetics and Reproductive Health, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ana Katušić Bojanac
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Department of Medical Biology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Davor Ježek
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Department of Histology and Embryology, University of Zagreb, School of Medicine, Zagreb, Croatia
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
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Zhou G, Chen J, Yin J, Liu X, Su J, Li S. Open Versus Laparoscopic Gubernaculum-Sparing Second-Stage Fowler-Stephens Orchiopexy for Intra-Abdominal Testis: A Long-Term Study. J Laparoendosc Adv Surg Tech A 2022; 32:920-924. [PMID: 35442805 PMCID: PMC9416541 DOI: 10.1089/lap.2021.0843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The benefits of performing open versus laparoscopic gubernaculum-sparing second-stage Fowler–Stephens orchiopexy (FSO) remain unclear. We compared the two techniques to answer this question. Methods: We retrospectively studied a cohort of patients who underwent laparoscopic first-stage FSO and open versus laparoscopic gubernaculum-sparing second-stage FSO at our institution between September 2004 and June 2020 (all patients underwent surgery by a single surgeon). We evaluated both procedures based on the incidence of testicular atrophy, testicular ascent, and other complications. Results: The age at initial surgery was 45.7 ± 28.2 months (median, 39). One hundred nine cases were treated with open second-stage gubernaculum-sparing FSO (OFSO), and 96 cases were treated with laparoscopic second-stage gubernaculum-sparing FSO (LFSO). The mean follow-up period was 59.8 months (median, 54; standard deviation, +35). The overall testicular atrophy rate was 1.5%. Atrophy was observed in 2 and 1 patient in the OFSO and LFSO groups, respectively (1.8% versus 1.0%, P > .05). There was no significant difference in the incidence of testicular ascent between both groups (2.8% versus 3.1%). Five and four complications were noted in the OFSO and LFSO groups, respectively (P > .05). Conclusions: Second-stage gubernaculum-sparing FSO achieved high testicular survival rates and satisfactory testicular positions. Neither the open nor laparoscopic approach appeared superior, because the overall testicular survival rates and incidence of testicular ascent and other complications were equivalent between both groups.
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Affiliation(s)
- Guanglun Zhou
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Jinjun Chen
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Jianchun Yin
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Xiaodong Liu
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Jiahong Su
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Shoulin Li
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
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Shehata S, Hadziselimovic F, Khater D, Kotb M. The Management of Intraabdominal Testis: A Survey of the World Federation of Associations of Pediatric Surgeons (WOFAPS) Practices. Front Pediatr 2022; 10:928069. [PMID: 35844765 PMCID: PMC9277101 DOI: 10.3389/fped.2022.928069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/07/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The optimal treatment protocol of intraabdominal testis is still a matter of debate and until now there are a lot of areas of controversy as regards this challenging subtype. The aim of this report is to document current practice patterns among surgeons from different continents through an online Redcap survey supervised the World Federation of the Association of Pediatric Surgeons (WOFAPS). METHODS A 16-question-survey related to the management of intraabdominal testis was created and administered via RedCap. The WOFAPS headquarters sent an email to all members inviting voluntary survey participation. Data were entered using Microsoft EXCEL spreadsheet and analyzed. Descriptive statistics were performed for each survey item. RESULTS There were 436 WOFAPS members who participated in this study with a response rate of 29%, and the vast majority were pediatric surgeons. Only 13% tried to use hormone therapy aiming to induce testicular descent or to improve future fertility. The choices of various surgical techniques were noted. During laparoscopy, if vessels and cord structure were seen entering the ipsilateral internal inguinal ring, most respondents chose to explore the groin. On the other hand, should there was an absent or atrophic testis, the respondents were split on whether to perform a contralateral orchiopexy. CONCLUSION This survey describes the current practices of a sample of pediatric surgeons and urologists in the management of intraabdominal testis. The use of hormonal treatment, timing of fixation and management in case of passing through vas and vessels through DIR were undisputable. However, management of low-lying and peeing testis together with the management of contralateral testis were still debatable.
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Affiliation(s)
- Sameh Shehata
- Department of Pediatric Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Faruk Hadziselimovic
- Department of Pediatrics, Children's Day Care Center Liestal, Cryptorchidism Research Institute, Liestal, Switzerland
| | - Doaa Khater
- Department of Pediatric Endocrinology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mostafa Kotb
- Department of Pediatric Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt
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He TQ, Tong FY, Wang Z, Liu Y, Hu JJ, Chen YF, Tu L, He J, Zhao YW. Clinical Efficacy of Laparoscopic Orchiopexy With the Modified Prentiss Maneuver for Non-palpable Testis Near the Internal Ring. Front Pediatr 2022; 10:906739. [PMID: 35769212 PMCID: PMC9235851 DOI: 10.3389/fped.2022.906739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the clinical efficacy and safety of laparoscopic orchiopexy with the modified Prentiss maneuver (LOMPM) and laparoscopic trans-inguinal orchiopexy (LTIO) for the treatment of non-palpable testis (NPT) <1 cm from the internal ring. METHODS Children with unilateral NPT who underwent laparoscopic orchiopexy at our center between February 2018 and January 2021 were retrospectively analyzed. According to the surgical method, they were divided into LOMPM and LTIO groups. The operation time, postoperative pain degree, postoperative complications and follow-up results were compared between the two groups. RESULTS A total of 98 patients were included in this study, including 41 cases in the LOMPM group and 57 cases in the LTIO group. All patients underwent successful surgery. The LOMPM group was superior to the LTIO group in terms of postoperative testicular position (lower scrotm: 90.2 vs. 71.9%, P = 0.026). There were no significant differences in operation time, postoperative pain score, and complications between the two groups. Preoperative testicular volume, postoperative testicular volume, and testicular growth rate in the LOMPM group were comparable to those in the LTIO group. There were no testicular atrophy, inguinal hernia and hydrocele in both groups after operation. CONCLUSIONS LOMPM was comparable in safety to LTIO, but LOMPM had a good post-operative testicular position, and was suitable for the treatment of NPT near the internal ring.
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Affiliation(s)
- Tian-Qu He
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Fang-Yun Tong
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Zhi Wang
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yu Liu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Jian-Jun Hu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yi-Fu Chen
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Lei Tu
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Jun He
- Department of Urology, Hunan Children's Hospital, Changsha, China
| | - Yao-Wang Zhao
- Department of Urology, Hunan Children's Hospital, Changsha, China
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Benzi TC, Logsdon NT, Sampaio FJB, Favorito LA. Testicular arteries anatomy applied to fowler-sthephens surgery in high undescended testis - a narrative review. Int Braz J Urol 2021; 48:8-17. [PMID: 34003614 PMCID: PMC8691233 DOI: 10.1590/s1677-5538.ibju.2021.99.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/10/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. Material and Methods: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. Results: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. Conclusions: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.
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Affiliation(s)
- Tatiana C Benzi
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Natasha T Logsdon
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Francisco J B Sampaio
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano Alves Favorito
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Chen G, Wang X, Zhao Y, Zhu L, Tang D. Splenogonadal fusion: a case report and review of the literature. BMC Urol 2021; 21:16. [PMID: 33536002 PMCID: PMC7860507 DOI: 10.1186/s12894-021-00781-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Splenogondal fusion (SGF) is a rare congenital anomaly characterized by abnormal association between the splenic tissue and the gonads or mesonephric remnants. SGF that requires separate two-stage laparoscopic staged Fowler-Stephen orchiopexy on both the left and right sides is extremely rare. SGF could be misdiagnosed as testicular malignancy and leads to unnecessary orchiectomy. Case presentation This is a case of an 8-month old male infant presented with bilateral cryptorchidism, B-mode ultrasound visualized the left and right testes in the lower abdominal cavity and the upper margin of the left testicle as a hypoechoic mass extending to the spleen, indicating an undescended right testis and possible SGF on the left side. Single-site laparoscopic examination confirmed the diagnosis of SGF on the left side and an undescended right testis. As both testes were high and the right spermatic vessel was poorly developed and short, a routine single stage orchiopexy would be difficult and risky, therefore, separate two-stage laparoscopic staged Fowler-Stephen orchiopexies for both sides were implemented. Stage 1 of the staged Fowler-Stephen orchiopexy for the right side was performed first without treating the left side, Stage 2 for the right side, separation of the left testis from the spleen as well as Stage 1 for the left side were performed 7 months later, and Stage 2 for the left side was performed 7 months after that. Follow-up ultrasound 1 year after the surgery revealed no obvious abnormalities in the shapes of the testes or their blood supply. This treatment strategy prevented unnecessary orchiectomy. Conclusions We reported a rare case of SGF that needed separate two-stage laparoscopic staged Fowler-Stephen orchiopexies for both sides, and a review of the recent literature. SGF is a rare congenital anomaly often diagnosed incidentally during exploration/surgery for scrotal swelling/mass, cryptorchidism or inguinal hernia in young patients. Surgeons, especially pediatric surgeons should be aware of this rare condition to avoid unnecessary, life-altering radical orchiectomy. When routine single stage orchiopexy is not feasible or risky for either side, separate two-stage laparoscopic staged Fowler-Stephen orchiopexies could be performed on both the left and right sides to avoid unnecessary orchiectomy.
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Affiliation(s)
- Guangjie Chen
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Xiaohao Wang
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Yijun Zhao
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Linfeng Zhu
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Daxing Tang
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China.
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Liu J, Tang R, Wang X, Sui B, Jin Z, Xu X, Zhu Q, Chen J, Ma H, Duan G. Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: A Retrospective Study From a Single Center. Front Pediatr 2021; 9:677955. [PMID: 34222147 PMCID: PMC8247650 DOI: 10.3389/fped.2021.677955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To evaluate the efficacy and safety of 2nd-stage laparoscopic traction orchiopexy (Shehata technique) compared to Fowler-Stephens (F-S technique) for high intra-abdominal testes (IATs) in children. Patients and Methods: We performed a retrospective review of all children (<14 years old) who underwent laparoscopic treatment of high IAT in the pediatric surgery center of Yijishan Hospital of Wannan Medical College from April 2016 to April 2020. Participants were divided into the Fowler-Stephens (F-S) group and Shehata group according to the surgical method. We collected the medical records of all children and analyzed them statistically. Results: In this study, 43 patients in our center received 2nd-stage laparoscopic surgical treatment. The results showed that there were 23 high IATs in 22 patients in the F-S group and 22 IATs in 21 patients in the Shehata group. All patients completed the operation successfully. No significant difference in operation time was noted between the two groups. There was no significant difference in the testicular atrophy rate between the two groups (P = 0.323). The testicular retraction rate of the F-S group was greater than that of the Shehata group (P = 0.04). Conclusion:The results of this study indicate that the application of assisted laparoscopic testicular traction technology can effectively retain the main blood supply of the testis and vas deferens with a high survival rate and clear advantages. The preliminary results show that the Shehata technique is safe, reliable and effective in the treatment of high IAT in children.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Rui Tang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xiao Wang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bangzhi Sui
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Zhiyuan Jin
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xudong Xu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Qinghua Zhu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Jin Chen
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Honglong Ma
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
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