High ligation orchidectomy in paediatric patients is performed for testicular tumours. This is carried out via open surgery at the inguinal or groin region. In these boys, elective insertion of testicular prostheses is carried out later to improve the external genitalia appearance. In most cases, insertion of testicular prosthesis or implant is carried out via the previous scar, to avoid prosthesis extrusion; however this is usually difficult due to scarring and may cause haematoma and possible infection. We report a novel technique of laparoscopic assisted orchidectomy in an adolescent boy with disorder of sexual development (DSD) whom was suspected of having bilateral gonadal (testicular) malignant change, he successfully underwent bilateral ligation of testicular vessels laparoscopically and removal of both testes via a midline scrotal raphe incision; hence avoiding bilateral groin incisions. With this method, future insertion of testicular prostheses can be carried out via virgin inguinal incisions.

Backgraound: Open appendectomy (OA) has been the treatment of choice for acute appendicitis since its introduction by Mc-burney in 1884. Laparoscopic appendectomy(LA) though widely practiced, has not gained universal approval. LA was first described in 1983. Some early studies showed equivocal results about benefit of LA. Recent studies showed overall benefit in favour of LA. So far no such a large study was done in any Bangladeshi hospital. So, we decided to do this study with a view to evaluate the therapeutic benefit of LA by comparing with conventional OA.Materials and methods: We collected data of 763 appendectomies done in Jahurul Islam medical college hospital from July 2007 to June 2012 for a period of 5 years. Out of them 448 had conventional OA and 315 had LA. We compared the mean operation time, time of first oral feeding, narcotic analgesic requirement, duration of post operative hospital stay.Results: We found that mean operation time was 33±5.8 minute and 37± 7.5 minute in LA and OA respectively. Duration of post operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. Laparoscpic appendectomy was safely performed in paediatric patient without any adverse effect. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy and endometriosis can be diagnosed and managed laparoscopically in the same sitting.Conclusion: Our study found that laparoscopic appendectomy is an effective and safe procedure irrespective of age and sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stay and less requirement of narcotic analgesic.

Retroperitoneal cysts (RCs) are rare. They are composed of both epithelial and mesothelial tissues, and those without an epithelial lining in the wall are called pseudocysts. Most retroperitoneal pseudocysts are pancreatic in origin, and nonpancreatic pseudocysts are very rarely reported.We report a case of large cystic lesion adjacent to the left kidney in a 25 years old man. He presented with 2 and half years history of gradual swelling of left upper abdomen. Abdominal ultrasonography and CT scan showed a large unilocular cystic mass in left side of the abdomen, which was attached with the lower pole of the left kidney. The cystic mass was excised laparoscopically. Histology showed a fibrous wall without epithelial lining thus confirming the diagnosis of a nonpancreatic pseudocyst.

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Aim: To evaluate the role of newly created transcanal endoscopic antrostomy hole as a passage in restoring the aeration of epitympanum and mastoid antrum.Materials & Methods: Study design: Retrospective case series study. Study duration: From January 2013 to January 2014. Study place: Private tertiary care hospital. Patients: 27 ears of 23 adult patients (age ranging from 15years to 54years) underwent transcanal endoscopic tympanoplasty for their chronic middle ear diseases in presence of inflamed middle ear mucosa along with radiological shadows of stagnant fluid in their epitympanum and mastoid antrum. Structured three months follow-up was ensured in every case. Intervention: A hole was created at a selected site of posterior meatal wall purely through transcanal endoscopic approach that established direct communication between mastoid antrum and external auditory canal. Thereafter this newly created passage was used for three purposes- assessment of the condition of mastoid antrum, performing the water test for checking epitympanic patency and in few cases placement of temporary tube for postoperative ventilation and drainage of middle ear. Main out come measures: The feasibility, performance and management of transcanal endoscopic antrostomy hole as passage for reestablishing the aeration of epitympanum and mastoid antrum.Results: The chosen site for antrostomy hole was found effective and safe in providing convenient entrance into the mastoid antrum in every case in this study with out facing technical complexity and failure. Postoperative healing of skin over antrostomy hole was found complete in all ears without any inward growth of skin in to mastoid antrum. Available post operative CT scan imaging of temporal bones showed improved aeration in their epitympanum and mastoid antrum.Conclusions: The role of transcanal antrostomy hole has been proved worthy in restoring ventilation pathway to epitympanum and mastoid antrum during tympanoplasty. This antrostomy hole has the potentiality to be considered in future for placement of long term mastoid ventilation tube in order to treat persistent atelectatic middle ear.

Objectives: To compare the efficiency and surgical morbidity associated with laparoscopic management of tubal ectopic pregnancy (EP) compared with that of open laparotomy. Materials and methods: During November 2008 to October 2012, there were 89 with a confirmed ectopic pregnancy These patients were admitted through emergency or outpatient department and managed by laparoscopy (number 70) and by laparotomy (number 19). The diagnosis of ectopic pregnancy was based on history, clinical symptoms, physical examination, a positive serum B-human chorionic gonadotropin (B-HCG), transvaginal ultrasonography. Patients were informed pre-operatively about the surgical procedures. The main outcome measured included operative time, blood loss, and complications.Results: Laparoscopic surgery gives an overall success rate of 98.9%. Linear salpingostomy was the main procedure performed in both groups. Estimated blood loss was significantly lower in the laparoscopy group compared with laparotomy group (p<0.001). Only 3 (3.81%) patients in the laparoscopy group required blood transfusion, whereas 16 (74.94%) in the laparotomy group needed transfusion (P<0.0001). The duration of operation in laparoscopy group was 53.2 ± 16.8 minutes and 84.5 ± 30.3 minutes in the laparotomy group. The duration of hospitalization was significantly shorter in the laparoscopy group 1.12±0.5 days compared to 5.25±0.1days in the laparotomy group (p<0.0001). ). In the laparoscopy group 57(72.4%) patients did not need analgesia after surgery compared with laparotomy group where all the patients needed analgesia.Conclusion: Laparoscopic treatment (Salpingostomy or Salpingectomy) of EPs offers major benefits superior to laparotomy in terms of less blood loss, less need for blood transfusion and postoperative analgesia, a shorter duration of hospital stay. Laparoscopic management of ectopic pregnancy might be the most beneficial procedure with maximal safety and efficacy.

Introduction: Posterior urethral valve (PUV) is the most frequent cause of urethral obstruction in male child. These lesions may result in lifelong disabilities with incontinence and decreased renal function despite optimal medical management. Primary fulguration without upper tract diversion is the preferred modality of treatment in most cases of PUV. Regular follow-up is needed to check completion of valve fulguration, renal function, status of hydronephrosis, vesicoureteric reflux (VUR), urinary tract infection (UTI), and bladder function. Materials and Methods: An interventional study among 30 purposively selected patients of PUV was conducted from December 2009 to July 2011. Most of the patients presented with weak urinary stream, dribbling of urine, straining at micturition, UTI, and palpable bladder. All children were subjected to ultrasonography (USG), blood urea, serum creatinine, routine urine examination, and culture studies. Structured questionnaire was used to collect information regarding improvement or disappearance of VUR and renal functional status before and after primary fulguration of PUV. Results: Ages ranged from 10 days to 14 years; 16 were between 1year and 14 years (53.3%), 11(36.7%) were infants, and the rest 03(10%) were neonates. Average serum creatinine levels were found gradually decreasing significantly (p < 0.01) in subsequent follow-ups. Average blood urea nitrogen (BUN) was also decreased significantly (p < 0.05). VUR was present in 63.3% cases. Non-VUR was found in 60% cases on right side and 50% cases on left side. On the third follow-up after 3 months it became 73.3% on right side and 63.3% on left side. Positive correlation found in Pearson correlation test about the changes of reflux grades before and after fulguration was significant (p < 0.001). It was significant on both left and right kidneys. Positive correlation found in Pearson correlation test about the changes of GFR before and after fulguration was also significant (p < 0.001). Collected data was cleaned, edited, and analyzed with the help of software SPSS window version 15.0. Conclusion: VUR disappeared in some cases and decreased in majority of the cases by 3 months after adequate restoration of urethral patency. Renal function came to normal range in two thirds of the cases. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0013 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 23-28

Objective: To assess the efficacy and surgical morbidity associated with laparoscopic management of tubal ectopic pregnancy (EP) compared to that of open laparotomy. Study design: A randomized, prospective clinical trial was conducted at a private clinic setting, over a period between February 2007 and December 2012. Methods: A total of 166 women were admitted for suspected EP. Out of them 149 patients who had confirmed tubal EPs were subjected to different management options (conservative/medical/surgical). The diagnosis was based on the patient’s history, gynecological examination, ultrasound findings (transvaginal and or transabdominal), and serum [beta human chorionic gonadotrophin (β-hCG)] estimation. Based on inclusion criteria (only haemodynamically stable patients), a total of 85 patients were enrolled for the study. All the enrolled patients were managed surgically and randomly allocated to either laparoscopy group (n = 43) or laparotomy group (n = 42) by lottery method. Data regarding patient’s demographics, clinical presentation, diagnostic modalities, and treatment outcomes of two surgical techniques (laparoscopy or laparotomy) were recorded for every patient in a pre-designed data capture form. Statistical analysis was done by using SPSS version-15. Results: No significant differences were found between the two study groups regarding age, parity, gestational age, size & location of the ectopic gestation, the mean pre-operative β-hCG level, history of previous surgeries, pelvic inflammatory disease, or endometriosis. Total operation time (entry to peritoneal cavity up to exit) needed in the laparoscopic group was less compared to that of laparotomy group (73.2 ± 26.8 min vs. 84.5 ± 34.3 min), which was not statistically significant (p > 0.001). The laparoscopic approach was associated with a reduction in intra-operative blood loss (subjective), need for post-operative analgesia (odds ratio 0.08, 95% CI, 0.04–0.43) and other post-operative morbidity (odds ratio 0.29, 95% CI, 0.18–0.55). The length of hospital stay following laparoscopic management was significantly less (p < 0.001) than that of laparotomy group (2.7 ± 0.6 vs. 3.2 ± 1.1 days). Conclusion: Laparoscopic management of EP offers major benefits in terms of less operating time, fewer analgesics, early recovery, and significantly shorter hospital stay within maximum safety and efficacy. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0015 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 35-38

Purpose: There are numerous procedures of minimally invasive surgery for repair of inguinal hernia in children including percutaneous techniques. We describe here our technique of using 18G or 20G needle in a very simple and effective way for this purpose. Methods: Needle-assisted laparoscopic percutaneous repair internal ring was performed in 55 children between 1st November 2010 and 31st July 2011. An 18G or 20G needle and a 3/0 polyglycolic acid thread were used. A 5-mm supraumbilical port for 30? 5 mm telescope and a 3-mm port in iliac fossa opposite to the lesion to handle the thread intra-abdominally were used. Results: Age ranged from 3 months to 12 years and 40 were males. Seven cases were bilateral making total 62 lesions. Mean operating time was 30.54 ± 5.84 min (range 20–42) and there was no intraoperative complication. Postoperatively five cases had transient hydrocele which resolved spontaneously. One case recurred after 2 months. Conclusions: Needle-assisted laparoscopic inguinal hernia repair in children is a simple and effective technique that can be performed routinely in resource poor countries. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0011 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 7-10

Purpose: Inguinal hernia is one of the commonest conditions in paediatric surgical practice that requires surgical repair. Open repair is a conventional procedure. With the advance of minimally invasive surgery, laparoscopic repair of childhood inguinal hernia has been attempted. Now many centres practice it routinely. From different studies, reported advantages are excellent visual exposure, minimal dissection, and thus fewer trauma to the inguinal canal and its content, detection, and repair of contralateral hernia (if present) in same setting, less post-operative pain, early recovery, and better cosmesis. To date, despite increased interest in laparoscopic repair, there is no published study focusing on paediatric inguinal hernia in Bangladesh. So the present study is designed to assess the above mentioned clinical benefits of this method and to compare the laparoscopic repair and open repair of paediatric inguinal hernia. Materials and Methods: This prospective comparative interventional study was carried out in the Department of Paediatric Surgery, DMCH, Dhaka, during the period of May 2009 to June 2012. Total 60 patients were included in this study. Among them 30 patients in Group-L were repaired by laparoscopic procedure and another 30 patients in Group-O were repaired by open procedure. Both groups were followed-up for 3 months. The early post-operative complications were almost same and there was no recurrence in any groups. Results: It was found that laparoscopic repair is superior to open repair with regards to early pain relief and cosmesis. Moreover, on laparoscopy, detection of contralateral hernia or contralateral patent processus vaginalis and repair is possible in the same setting. Conclusions: Laparoscopic repair is superior with regard to early pain relief and cosmesis, but needs to be evaluated on wider group of patients and long period of follow-up. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0014 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 29-34