Background:The presence of heterotopic tissue in Meckel's diverticulum (MD) increases the incidence of future complications. Based on this concept, this study aimed to detect clinical and morphological parameters able to predict the probability of heterotopy in incidentally discovered uncomplicated MD and to develop a risk-based classification tool. Methods: The clinical records of 146 patients who underwent MD resection were reviewed. MD complications (bleeding, inflammation, perforation or involvement in pathological processes such as intussusception) and MD dimensions (width, length and the product width × length) were evaluated in association with heterotopy. Regression analysis was used to explore the discrete effect of clinically relevant parameters, which were subsequently combined in a Classification and Regression Tree. Results: The probability of heterotopy was higher in complicated MDs. The width of the base of the MD and the product width × length were also significant predictors of heterotopy. A stepwise combination (Classification and Regression Tree model) of (i) uncomplicated macroscopic presentation, (ii) width <2.5 cm, (iii) age <10 years and (iv) product width × length <4 cm 2 resulted in a null probability of heterotopy in our study group. Conclusion: The combination of MD-related clinical and morphological parameters using advanced statistical tools may assist in estimating the probability of heterotopy. This may be applied in incidentally discovered uncomplicated MDs during abdominal surgery for other morbidities. Prospective studies are required to confirm our findings and test the practical usefulness of the classification tool developed here. © 2019 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E241-E245ANZJSurg.com

The commonest type of hernia in children is the inguinal one. Either scheduled or as an emergency, hernia surgery is performed daily in every pediatric surgical institution worldwide, regardless of age or gender. In this chapter we deal with the embryology of the inguinal canal and its pathophysiological association with hernia formation. We also discuss the most frequent clinical and diagnostic issues of the pediatric hernia. The management and treatment of the strangulated hernia, the differential diagnosis, and the particular uncommon hernia types are presented as well. We finally present the evolution of hernia surgery from the classical operative methods to the modern laparoscopic and robotic techniques.

Background: Oesophageal atresia lacks sufficiently documented treatment approach, as guidelines are based rather on the opinion of experts than on systematic data. We aimed to answer the question if treatment of patients without major cardiovascular anomalies could be justified at a peripheral paediatric surgical institution, by evaluating the outcome of surgical correction. Methods: Thirty-three neonates underwent surgery for correction of oesophageal atresia during a period of 20 years. They were categorised into two time-period groups, to follow-up the evolution of surgical intervention and complications through time. Evaluation of post-operative outcome and morbidity was performed. The results were related to those of our recent cross-sectional study on families having experienced oesophageal atresia performed years after repair, regarding the long-term quality of life. Results: A shift from staged to primary repair occurred throughout time in the patients with a marginal long gap between proximal and distal oesophagus ( P = 0.008). Anastomotic stenosis was the major short-term complication encountered, treated with postoperative dilation sessions. Dysphagia and reflux were the most common long-term complications. Conclusions: Oesophageal atresia without severe cardiovascular abnormalities could be treated at a peripheral paediatric surgical department with satisfactory outcomes. However, qualified paediatric surgeons, anaesthesiologists and neonatologists and the availability of neonatal intensive care unit should be definitively required.

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