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Complete excision of the thyroglossal cyst consists of removal of the cyst, the entire tract and the midportion of the hyoid bone through which the tract passes. If this principle is followed, recurrence is extremely unlikely. While the procedure is easily performed in native tissue, dissection is much more difficult in a previously infected cyst. Therefore, postponement of the surgical procedure is not to be recommended once the diagnosis has been made.

Recurrences are most likely due to proliferation of residual epithelium from cysts or sinuses. The surgical procedure should thus be performed electively soon after diagnosis. Infected cysts and sinuses are treated with antibiotics until the inflammatory signs subside, unless abscess formation mandates incision and drainage. Repeated infections render identification of the tissue layers much more difficult. Surgery after infections of remnants of the first branchial pouch carries an increased risk of facial nerve injury. In order to avoid damage to vital vascular and nerve structures it is important to confine dissection close to the sinus tract.

Tracheostomy is a simple technical procedure to perform, but it can be one of the more difficult procedures in paediatrics. The cannula should be selected carefully to make certain that it is not too long after the roll (used to extend the neck) is removed and the patient is repositioned. Occasionally, it is necessary to order a special tracheostomy cannula. Such is the case for a short, wide trachea.

The most common problems occur post-operatively when the cannula becomes occluded or, worse yet, dislodged. This is why we secure the sutures to the chest wall, to make certain that if the cannula becomes dislodged it will be as easy to re-insert it or a new cannula into the tracheal lumen.

We change the cannula 10 days after the surgery, before the patient is discharged from the hospital, to make certain that the cannula can be changed easily and to minimize the risk of cannula-related problems after discharge.

These patients need to be followed closely as they grow to assure the optimal cannula size and to determine whether the tracheostomy still is necessary.

Decannulation, when possible, is done in the hospital, usually after flexible or rigid bronchoscopy to assess the adequacy of the tracheal lumen and the presence of obstructing granulation tissue or malacia.

The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

Duplication of the renal pelvis and ureters is the commonest anomaly of the upper urinary tract. It occurs in approximately 0.8% of the population and in 1.8–4.2% of pyelograms. Commonly these are asymptomatic. However, they can challenge the diagnostic acumen with a wide variety of manifestations.

We share the view of many authors, that an isoperistaltic left colon segment based on the left colic vessels is the best method of oesophageal replacement for benign caustic oesophageal strictures in children. A sufficient length is available to replace the whole oesophagus and even the lower pharynx if needed. The blood supply from the left colic vessels is robust and rarely prone to anatomic variation. The close relationship between the marginal vessels and the border of the viscus results in a straight conduit with little redundancy or tendency to kinking. The left colon seems to transmit solid food more easily than the right colon and fewer problems are associated with its removal. The colon has proved to be relatively acid-resistant, and significant ulceration in the interposed segment is unusual.

In a survey of the last 475 cases, we had five deaths related to respiratory problems. No instance of graft necrosis occurred in this series; however, three patients developed late graft stenosis, two of which were at the distal part. Both patients required surgical revision, and the third patient developed an unusual proximal stenosis that was corrected by gastric pull-up.

Mortality of this procedure is in the region of 5% while the morbidity is significant and includes:

Most of the children prefer to take small frequent meals, although in the older children a normal eating pattern is generally established. Many of the patients grow at a slower rate than normal and are in the lower half of the growth charts for both weight and height. This applies particularly to children who are born with oesophageal atresia.

VATS has revolutionized surgery not only in adults but also in infants and children. Almost all operations were classically performed through a thoracotomy can now be performed using VATS. VATS gives a perfect view of the anatomy and dissection is not particularly difficult. The difficulty is suturing.