Department Of Pediatric Surgery Research Articles

Compare the Role of 5% Phenol in Almond Oil and Injection Sodium Tetradecyl Sulfate in the Treatment of Rectal Prolapse

Objective: To compare the role of 5% Phenol in Almond oil and Injection Sodium Tetradecyl Sulfate in the treatment of rectal prolapse. Methods and material: This study was conducted at Pediatric Surgery Department, Mayo Hospital Lahore. A total of 100 patients were included in the study and randomly divided into 2 groups. In Group-A patients were given 5% Phenol in Almond Oil and in Group-B patients were given Sodium Tetradecyl Sulfate. Patients were followed up at 1st post operative day and at 1st post operative month to see recurrence or any other complications (bleeding, perirectal inflammation, urinary retention, ischiorectal abscess, and necrosis of the rectal mucosa) in cases in both treatment groups. Results: In Group-A mean age was 5.63±3.34 years and in Group-B mean age of children was 7.16±2.80 years. In Group-A 46 and in Group-B 39 children were included.. There was significant association between treatment groups and outcome on 1st postoperative day reduction (P < 0.05). In Group-A 5 and in Group-B 1 child had bleeding PR after postoperative day. No statistically significant association was present between treatment groups and bleeding PR after POD (P > 0.05). In Group-A 49 and in Group-B 44 children had achieved reduction when observed at one month follow up time period. In Group-A reduction was achieved in greater number of patients as compared to that of Group-B patients (P < 0.05). Practical implication: Current study will bring a revolution in the awareness of community amoung rectal prolapse problem and treating it successfully with the knowledge provided with the current literature. The role of 5% Phenol in Almond oil and Injection Sodium Tetradecyl Sulfate is well shown which proven to be a good treatement in Rectal prolapse. Conclusion: We conclude that 5% Phenol almond oil is more effective than Sodium Tetradecyl Sulfate in treating rectal prolepses. i.e., after the one-month follow-up, the post-operative decrease was 98% vs. 88 percent. Keywords: Rectal submucosa, ischiorectal abscess, ulceration, polyps, inflammation, idiopathic rectal prolapse,Etiology.

Reliability of Single Perforator Based Free Anterolateral Thigh Flap Reconstruction among Children with Post Traumatic Limb Defects

Aim: To evaluate reliability of anterolateral thigh flap based on a single perforator in pediatric population for lower limb post traumatic defects. Study design: Retrospective cross sectional study Place and duration of study: Pediatric plastic surgery department of the children hospital & university of child health science, Lahore from January 2018 to January 2022. Methodology: After approval from ethical review board, 50 patients who underwent a free Alt flap reconstruction were included in this retrospective analysis. All flaps for lower limb post traumatic raised on a single perforator were included and reliability of flap was assessed for technical feasibility, outcomes and safety. Data was entered and analysed in SPSS ver: 21.0 and presented as frequency and percentages. Results: Mean age was 8.2±3.45 years 64% were males.96% had undergone road traffic accident (4% burn).Lower limb was affected in majority of patients 80% (upper limb 20%). 78% of patients were discharged at 10th post-operative day and 8% had partial flap loss. Conclusion: We concluded in this studyfree tissue transfer of anterolateral thigh flap based on a single perforator in children for covering large defects is a reliable method with good safety margin and minimal complication rate. Keywords: Anterolateral thigh flap, single perforator, pediatric population, free flap, free tissue transfer, perforator flap reliability

Outcome of Classical Tubularized Incised-Plate Urethroplasty (TIP) for Primary Anterior Hypospadias Repair: 5 Years’ Experience

Introduction: Classical Tubularized Incised-plate Urethroplasty (TIP) is a surgical procedure used to repair hypospadias, which is a birth defect in which the opening of the urethra located on the underside of the penis rather than at the tip. Aim of the Study: The aim of this study was to evaluate the surgical outcome of classical tubularized incised plate (TIP) urethroplasty. Methods: This retrospective study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital & Institute, Dhaka from July 2017 to June 2022. Total 53 patients were included in this study. Result: In the current study, the mean age of participants was 43.08±21.72 months where the minimum age was 12 months and maximum age was 103 months. The mean weight of participants was 19.25±7.78 kg. The mean penile length of participants was 35.9±8.05 mm. The mean operation time was 73.24±4.80 minutes. Mean operation cost was 277.50±40.46 US$. Mean hospital stay was 10.7±0.75 days. In our study, 15.09% had UC fistula, 5.66% had wound infection and 7.54% had meatal stenosis. Follow up period was 7.9±2.1 months. In this study, more than half (50.94%) had distal penile hypospadias, 28.30% had coronal hypospadias and 20.75% had sub-coronal hypospadias. Conclusion: According to the findings of our study, Tubularized Incised-plate (TIP) urethroplasty is found to be a safe and reliable technique for hypospadias repair. The rate of complications was found low in TIP urethroplasty.

Prevalence of Attention Deficit Hyperactivity Disorder and Sluggish Cognitive Tempo Symptoms in Children Presenting with Foreign Body Ingestion: A Case-Control Study

Foreign body ingestion (FBI) is one of the common causes of emergency admissions in infancy and childhood. Although the large majority of children who present with the FBI have no psychiatric diagnosis, present studies demonstrate that attention deficit hyperactivity disorder (ADHD) and related psychiatric problems might be a risk factor for FBI. This study aimed to compare the demographic variables and attention deficit hyperactivity disorder levels and sluggish cognitive tempo symptoms (ADHD-SCT) in children who ingested foreign bodies with healthy children. Also, we aimed to address the relationship between ADHD-SCT symptoms and the age of FBI. The FBI group comprised 44 children (age 2-8, median age: 5, 68.2% boys) admitted to the emergency, pediatric surgery, and pediatric gastroenterology department after FBI, and the healthy control group comprised 30 children (age 3-8, median age: 6, 56.7% boys). We administered the sociodemographic information form, SNAP-IV ADHD rating scale, and Barkley’s child SCT ratings scale to both groups of parents. Our results demonstrated that maternal education level was significantly lower in the FBI group, although other demographic characteristics of the samples were similar (p=0.023). In addition, ADHD-hyperactivity/impulsivity scores were significantly higher in the FBI group (p=0.01). Still, there were no significant differences in ADHD-inattention, SCT-daydreaming, and SCT-sluggishness scores (for all, p>0.05). We found positive-moderate relationships between SCT-daydreaming and sluggishness symptoms and FBI age (r=0.314, r=0.348, respectively). This means that higher SCT scores are related to an older FBI age. In conclusion, for the first time, we evaluated the ADHD and SCT symptoms in young children against FBI and found that ADHD-hyperactivity, but not ADHD-inattention symptoms, were significantly higher in the FBI group, and SCT symptoms increase the risk of FBI at an older age. In addition, we found that a lower maternal education level could be an additional risk factor for FBI. Despite the high hyperactivity in the FBI group, the low rate of child psychiatry evaluation should be considered when evaluating a child.

Pediatric penile biometry guides the surgical outcome following tubularised incised plate urethroplasty for hypospadias: a single centre study

Background: In hypospadias urethral meatus opens onto the ventral surface of the penis proximal to tip of glans and its surgery is challenging. Recent focus of hypospadias surgery is on reduction of postoperative complications and objective assessment of penile anthropometry which can affect outcome. Aim of study was to assess the surgical outcome of tubularised incised plate urethroplasty on penile biometric parameters among children with coronal, distal penile and mid penile hypospadias. Methods: Study was conducted in the department of pediatric surgery in IPGMER and SSKM Hospital in Kolkata during November 2019 to October 2021. Results: Among 42 boys mean urethral plate length is 4.286 (coronal), 7.643 (distal penile) and 8.846 (mid penile), mean urethral plate width is 3.321 (coronal), 5.786 (distal penile) and 5.923 (mid penile), mean diameter at mid glans level is 4 (coronal), 5.071 (distal penile) and 5.923 (mid penile), mean diameter at coronal level is 5.75 (coronal), 6.429 (distal penile) and 6.769 (mid penile), mean stretched penile length is 39.2143 (coronal), 41.857 (distal penile) and 40.308 (mid penile) hypospadias respectively. P value is less than 0.05 for all except urethral plate depth which has a non-significant p value. Conclusions: Urethral plate length, urethral plate width, mid glans diameter, glans diameter at coronal sulcus level and stretched penile length affect the outcome of the surgical process TIP urethroplasty in coronal, distal penile and mid penile type hypospadias but urethral plate depth does not.

Complications of Tubularized Incised-Plate (TIP) Urethroplasty in Anterior Hypospadias Repair: Interrupted VS Continuous Suture

Introduction: Hypospadias is a congenital defect that affects the development of the urethra in males, causing the urethral opening to be located on the underside of the penis rather than at the tip. Repair of hypospadias is a surgical procedure that aims to create a normal-appearing and functional penis that allows for normal urination. The tubularized incised-plate (TIP) technique is a widely used surgical approach for correcting distal hypospadias. TIP urethroplasty can be performed using either continuous or interrupted suture techniques. The present study aims to compare the complications of these two techniques in TIP urethroplasty for the repair of hypospadias. Aim of the Study: The aim of the study was to compare the complication rate among continuous and interrupted suture in TIP urethroplasty for anterior hypospadias repair. Methods: This Prospective Randomized comparative study was conducted at the Department of Pediatric Surgery, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh. The study duration was 5 years, from July 2017 to June 2022. After some drop-out patients, a total of 68 patients had been left, with Group-1 having 35 continuous suture TIP urethroplasty, and Group-2 having 33 interrupted sutures TIP urethroplasty. Result: The mean age of participants was 41.15±24.46 months in Group-1 and 38.05±25.14 months in Group-2. The mean weight of participants was 17.79±6.37 kg and 19.14±9.19 kg in Group-1 and Group-2 respectively. Operation time in group 1 and group 2 was 66.86±3.51 minutes and 79.38±5.04 minutes respectively, with statistically significant difference. But none of the post-operative complications had significant difference between the groups. Conclusion: The study showed that although operative time was significantly lower among patients undergoing continuous suture for TIP urethroplasty instead of interrupted suture TIP urethroplasty, the overall complications rate had no significant difference between the groups.

Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members

BackgroundIn contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world.MethodsA web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021–03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis.ResultsA total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (> 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5 years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p < 0.01). With regard to hospital size (≤ 500 versus > 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p < 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children < 12 years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p < 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively).ConclusionsMulti-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management.

Evaluation and Management of Developmental Dysplasia of Hip (DDH) in Children - Our Experience

Introduction: DDH is the most common congenital anomaly of the musculoskeletal system in newborns. The disease ranges from a simple flattening of the acetabular cavity to the complete dislocation of the femoral head. Most developed countries report an incidence of 1.5 to 20 cases of DDH per 1000 births, depending in part on the methods of screening used. It includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. Aim of the Study: The aim of this study was to evaluate the management of the Developmental Dysplasia of Hip (DDH) in children. Methods: This retrospective study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital &amp; Institute, Dhaka, Bangladesh during the period from January2018 to December 2021. Result: In total 54 neonates completed the study. In our study we found majority (53.70%) of children were aged less than 4 months old. Followed by 25.93% &amp; 20.37% were aged 1-2 months &amp; 3-4 months respectively. Majority of neonates were girls (61.11%) compared to boys (38.89%). The highest risk factors of DDH was breech presentation (19%).We found that majority of neonates (70.37%) had dysplasia on left side and 7.41% had dysplasia on right side respectively. The prevalence of bilateral condition was 12(22.22%). Conclusion: DDH a common congenital anomaly that can be successfully treated non-operatively if detected early. For older individuals with dislocated or unstable hips, surgery is necessary. Surgery's function in treating acetabular dysplasia in children is changing and largely determined by symptoms. Expanding therapy choices for DDH and improved anatomical patient assessment skills among doctors will result in the proper intervention at the right time.

Curative effect and technical key points of laparoscopic surgery for choledochal cysts in children.

The purpose of this study was to investigate the curative effect of and experience with laparoscopic surgery for congenital choledochal cysts in children. This is a retrospective analysis of 33 children diagnosed with congenital choledochal cyst in the pediatric surgery department of the Affiliated Hospital of Southwest Medical University between January 2019 and December 2021. The cohort included 8 males and 25 females aged 0.25-13.7 years (median age, 3.2 years), including 21 cases of type I and 12 cases of type IV choledochal cyst (Todani classification). Laparoscopic choledochal cyst resection and hepaticojejunostomy with Roux-en-Y anastomosis were performed in all the patients. Laparoscopy without transit opening was successfully performed in the 33 cases. The duration of the procedure was 235-460 min (mean ± SD, 316 ± 61 min), and intraoperative blood loss volume was 15-40 ml (23 ± 7.6 ml). Postoperative hospital stay was 7-14 days (9 ± 1.8 days). Postoperative biliary fistula and pancreatitis occurred in two cases each, and all four patients were successfully treated with conservative treatment. No anastomotic stenosis, delayed bleeding, cholangitis, intestinal obstruction, or other complications occurred. All the children were followed up for 2-36 months (median period, 17.2 months). The clinical symptoms disappeared, and no obvious hepatic dysfunction was found on abdominal color ultrasound and liver function examination. Laparoscopic surgery for congenital choledochal cyst in children is safe and effective, as it is a minimally invasive surgery that is associated with a low degree of trauma and bleeding, rapid postoperative recovery, and satisfactory aesthetic appearance.

Applicability of the Broselow Pediatric Emergency Tape to Predict the Size of Endotracheal Tube and Laryngeal Mask Airway in Pediatric Patients Undergoing Surgery: A Retrospective Analysis.

Background This study aims to elucidate the applicability of the Broselow pediatric emergency tape in predicting the size of the endotracheal tube (ET) and laryngeal mask airway (LMA) in children of central India. Methods A retrospective review was conducted in the Department of Pediatric Surgery during the period of four years (January 2018 to December 2021), and all children between 1 month and 12 years of age who were admitted for routine surgery and were operated on were included. The goal was to assess the accuracy of Broselow pediatric emergency tape in predicting the size of ET and LMA in children and assess the applicability of this tape in an Indian setting based on observation and comparison with the predicted ET tube and LMA size based on the tape. The correlation was done between the predicted ET tube and LMA size and used ET tube and LMA size (the difference and mean). The Chi-square test was applied to test the difference between those matching and those not matching with their respective color zones with respect to weight, tracheal tube (LMA/ET) tube, and for both weight and tracheal tube, and then the p-value was calculated. A p-value of less than 0.05 was considered to be significant. Results A total of 296 patients were included in the study. There were 230 males and 66 females. A maximum number of patients were in the white zone (56 patients). A total of 112 patients (37.8%) matched the zone with their weight; 192 patients (64.8%) matched their LMA/ET tube with their respective zones; 81 patients (27.36%) matched both their weights and tracheal tube (LMA/ET) size with the predicted values as per their respective zones. Pearson's Chi-square test was applied to assess the significance of the difference between the number of patients matching and not matching their weight, LMA/ET tube, and both weight and LMA/ET tube with their corresponding color zones as per the Broselow tape. For all the above parameters, the differences were found to be not significant for p-value <0.05. Conclusions Broselow tape (BT) is applicable in acute trauma settings where it can be used for estimating weight and ET/LMA sizes in an emergency situation where weight measurement is not feasible.

Evaluation of the outcome of right subumbilical transverse incision approach for the management of complicated appendicitis in paediatric age group - A multi-institutional retrospective study.

The aim is to evaluate the outcome of right subumbilical transverse incision approach for the management of complicated appendicitis in paediatric age group. This is a retrospective multi-institutional study which was conducted in the Department of Paediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India and the Department of Paediatric Surgery, Rajiv Gandhi Super Speciality Hospital/Raichur Institute of Medical Sciences, Raichur, Karnataka, India. In this study, a review of 77 paediatric patients operated for complicated appendicitis using a right subumbilical transverse incision approach was done for a period of 3 years (from December 2017 to December 2020). All patients had proven complicated appendicular pathology like appendicular perforation, appendicular abscess or complicated appendicular lumps on ultrasonography or computed tomography scan, which mandated exploration. There was no mortality. Average operative time was 1 h 48 min (ranging from 58 min to 3 h 12 min). Average length of hospital stay was 9 days (ranging from 5 days to 13 days). There was no incidence of fecal fistula. Seventeen (22%) patients developed superficial surgical site infection which subsided with regular dressings. There was no incidence of wound dehiscence or burst abdomen. Five (6.5%) patients required the incision to be extended beyond the midline to the left side to deal with the pathology and to access the entire peritoneal cavity. Nine (11.6%) patients required loop ileostomies, which was fashioned on the lateral aspect of the transverse incision. Only one patient had a doubtful caecal injury which was repaired and loop ileostomy was done. Six patients (7.7%) had adhesive intestinal obstruction postoperatively, of which three required re-exploration. There was no incidence of incisional hernia or any stoma-related complications. Complicated appendicitis is a condition which lacks standardisation of approach for management, and is inherently associated with complications. However, with a more logical incision and intra-operative approach we can keep the complications to minimum and improve outcomes to great extent in those patients requiring surgical intervention. We have been using the subumbilical transverse incision in all sizes of patients ranging from small children to adolescents with excellent results, and we believe that the same approach can be applied even in adult patients in similar clinical scenarios.

Appendiceal foreign body in a two-year-old child: a case report.

Pediatrics InternationalAccepted Articles e15533 CLINICAL NOTE Appendiceal foreign body in a two-year-old child: a case report Yohei Sanmoto, Corresponding Author Yohei Sanmoto [email protected] orcid.org/0000-0001-5006-2507 Department of Pediatric Surgery, Takeda General Hospital, Fukushima, Japan Correspondence Yohei Sanmoto Department of Pediatric Surgery, Takeda General Hospital 3-27Yamagachou, Aizuwakamatsu-shi, Fukushima, 965-8585, Japan. E-mail address: Email: [email protected]Search for more papers by this author Yohei Sanmoto, Corresponding Author Yohei Sanmoto [email protected] orcid.org/0000-0001-5006-2507 Department of Pediatric Surgery, Takeda General Hospital, Fukushima, Japan Correspondence Yohei Sanmoto Department of Pediatric Surgery, Takeda General Hospital 3-27Yamagachou, Aizuwakamatsu-shi, Fukushima, 965-8585, Japan. E-mail address: Email: [email protected]Search for more papers by this author First published: 21 March 2023 https://doi.org/10.1111/ped.15533 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ped.15533. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future.e15533 RelatedInformation

Paediatric Appendicitis: Has SARS-COV-2 Influenced the Clinical Profile and Management during the Pandemic Period?

Introduction: The Coronavirus Disease-2019 (COVID-19) had profound repercussions on routine medical practices all over the globe. There are fewer studies on the impact of the pandemic on childhood surgical conditions like Acute Appendicitis (AA), which is the most common paediatric surgical emergency. Aim: To analyse whether COVID-19 has influenced the clinical profile and management of paediatric appendicitis during the pandemic period. Materials and Methods: A retrospective study was carried out in the Department of Paediatric Surgery, SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India, comparing AA cases during the pandemic period (group A=from February 2020 to January 2022) with AA cases during the prepandemic period (group B=from February 2018 to January 2020). Analysis of data regarding patient demographics (age, sex), duration of symptoms and hospital stay, type of appendicitis, total and differential leucocyte count, ultrasonographic findings, treatment modality and complications was done. Subgroup analysis of children in group A was done by comparing AA cases with active/recent COVID-19 infection (Subgroup A1) with the rest of AA in the group (Subgroup A2). Pearson’s Chi-square test was used for the analysis of categorical variables and independent t-test was used for numerical data. p-value&lt;0.05 was considered significant. Results: There were 826 AA cases, with 375 children in group A and 451 in group B. A significant reduction in the number of AA cases was noted during the first year of the pandemic (n=167 vs n=242, p-value=0.009) and a significantly higher number of cases were managed conservatively during the pandemic period (n=48 vs n=10, p-value &lt;0.0001). Children with active/ recent COVID-19 infection presented late (p-value=0.03), had a significantly higher incidence of complicated appendicitis (p-value=0.02), decreased total leucocyte count (p-value=0.01), decreased polymorph count (p-value=0.02) and higher incidence of the conservative modality of treatment (p-value&lt;0.005). Conclusion: Overall, there were no significant differences in the clinical profile of AA during the pandemic period. But, children with AA who had active/recent COVID-19 infection had a longer duration of symptoms and a higher incidence of complicated appendicitis. The pandemic influenced the management protocols with an increase in the number of AA cases being managed conservatively when compared to the prepandemic period.

Evaluation and Management of Achalasia Cardia in Children: A Retrospective Observational Study.

Achalasia cardia is a neuromuscular disorder of unknown etiology characterized by aperistalsis of the body of the esophagus and failure of relaxation of the lower esophageal sphincter. The diagnosis of achalasia cardia is delayed due to the rarity and the ability to mimic other common conditions in children. Hence, a study was conducted to evaluate the clinical presentation and the management of achalasia cardia in children. A retrospective observational study was conducted in the department of pediatric surgery at a tertiary center. The children with achalasia cardia who presented between January 2014 and December 2021 were included. A total of 12 patients were treated for achalasia cardia during the study period. All children presented with recurrent episodes of vomiting, whereas dysphagia was seen in six (50%) children. Eighty-three percent of the children presented with a history of weight loss, whereas failure to thrive was seen in nine (75%) children. Five (42%) children were managed as gastroesophageal reflux disease (GERD) for more than a year before presenting to us. Three (25%) children underwent open cardiomyotomy with Thal fundoplication and the rest nine (75%) underwent laparoscopic cardiomyotomy. All are thriving well. Achalasia is an important differential diagnosis in children with suspected GERD. The most common symptom of achalasia cardia is vomiting followed by dysphagia. Weight loss and failure to thrive are important presenting features in children with achalasia which are uncommon in adults. Cardiomyotomy without fundoplication is safe and effective to treat achalasia cardia in children without having any extra complications.

Outcome of Dismembered Pyeloplasty in Children with Unilateral Pelviureteric Junction Obstruction: A Retrospective Observational Study

Introduction: Anderson-Hynes (AH) dismembered pyeloplasty is the standard procedure performed for the management of Pelviureteric Junction Obstruction (PUJO). Ultrasonography (USG) and diuretic renography are of great importance for the diagnosis and follow-up of PUJO. Aim: To evaluate the morphological and functional outcomes of open dismembered pyeloplasty in children with unilateral PUJO and to find the correlation between functional and morphological outcomes. Materials and Methods: A retrospective observational study was conducted, assessing the clinical charts of 200 children under 10 years of age with congenital PUJO who underwent open AH dismembered pyeloplasty in the Department of Paediatric Surgery at a teritary teaching Institute, Government medical college, Thiruvananthapuram, Kerala, India from from June 2015 to June 2020. The preoperative radiological assessment included renal USG and diuretic renography for all patients. Morphological and functional surgical outcomes were measured one year after surgery. The morphologic parameters analysed were the Anteroposterior Diameter (APD) of the pelvis and Parenchymal Thickness (PT). The functional outcome was assessed by improvements in Glomerular Filtration Rate (GFR), Split Renal Function (SRF), and drainage curve. Success was defined as improvement in function and morphology in followup USG and renogram after one year of surgery. Paired t-test was applied for statistical analysis using Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: Among the total 200 patients,180 (90%) cases demonstrated improved renal function after pyeloplasty. Among the total 200 cases, males were 120 (60%) and females were 80 (40%). Morphologic outcome improved in 188 out of 200 (94%) cases. The overall outcome was good in 168 out of 200 (84%) patients. The results showed a moderate negative correlation for APD with respect to SRF (r=-0.677, p-value=0.01) and GFR (r=- 0.430, p-value=0.01), whereas a moderate positive correlation was observed between SRF and GFR (r=0.423, p-value=0.01). Conclusion: AH dismembered pyeloplasty is an effective treatment for PUJO in children, not only relieving obstruction but also improving renal function. The present study recommends considering both morphologic and functional parameters to assess the success of the surgery.

Glans augmentation by pedicled inner preputial flap in distal penile hypospadias: A prospective interventional study

Abstract Aims and Objective: The aim of the study was to describe a modification in the tubularized incised plate (TIP) procedure that incorporates glans augmentation with the inner preputial flap in cases of distal penile hypospadias with small glans and shallow groove. Materials and Methods: This was a prospective interventional study conducted over a period of 1 year from July 1, 2021, to June 31, 2022, at the Department of Pediatric Surgery, SMS Medical College and attached SPINCH, Jaipur. All distal penile hypospadias patients with small glans and shallow groove were included in the study. Patients with failed repairs and having associated congenital conditions were excluded. All the included patients underwent hypospadias repair by the standard TIP technique, and a modification was added to augment the glans by inner preputial flap. The incidence of glans dehiscence and fistula formation along with cosmetic appearance was recorded. Results: A total of 25 patients were included, which comprised subcoronal (n = 14; 56%), distal penile (n = 7; 28%), and coronal (n = 4; 16%) hypospadias. There were no immediate or late postoperative complications. Follow-up periods were ranging from 4 months to 12 months. There was no meatal stenosis or urethra cutaneous fistula formation after 6 months of follow-up period. The cosmetic appearance and color of the glans were satisfactory after 6–12 months of follow-up. Conclusions: With this modification of the TIP procedure in patients with distal penile hypospadias having small glans and shallow groove, a good glans width with normally placed meatus without stenosis and fistula can be achieved.

Gastrointestinal Duplications: A Decade's Experience.

Gastrointestinal (GI) duplications are rare congenital malformations with diverse presentations. They usually present in the pediatric age, especially in the first 2 years of life. To present our experience with GI duplication (cysts) at a pediatric surgery tertiary care teaching institute. It is a retrospective observational study undertaken in the department of pediatric surgery at our center between 2012 and 2022 for GI duplications. All children were analyzed for their age, sex, presentation, radiological evaluation, operative management, and outcomes. Thirty-two patients were diagnosed with GI duplication. Slight male predominance was present in the series (M: F ≈ 4:3). Fifteen (46.88%) patients presented in the neonatal age group; 26 (81.25%) patients were under 2 years. In the majority of cases (n = 23, 71.88%), the presentation was acute onset. Double duplication cysts on opposite sides of the diaphragm were present in one case. The most common location was ileum (n = 17), followed by gallbladder (n = 6), appendix (n = 3), gastric (n = 1), jejunum (n = 1), esophagus (n = 1), ileocecal junction (n = 1), duodenum (n = 1), sigmoid (n = 1), and anal canal (n = 1). Multiple associations (malformations/surgical pathologies) were present. Intussusception (n = 6) was the most common, followed by intestinal atresia (n = 5), anorectal malformation (n = 3), abdominal wall defect (n = 3), hemorrhagic cyst (n = 1), Meckel's diverticulum (n = 1), and sacrococcygeal teratoma (n = 1). Four cases were associated with intestinal volvulus, three cases with intestinal adhesions, and two with intestinal perforation. Favorable outcomes were present in 75% of cases. GI duplications have varied presentations depending on site, size, type, local mass effect, mucosal pattern, and associated complications. The importance of clinical suspicion and radiology cannot be underrated. Early diagnosis is required to prevent postoperative complications. Management is individualized as per the type of duplication anomaly and its relation with the involved GI tract.

Pattern of Preoperative Uroflowmetry in Hypospadias Patients and Age-matched Control Patients.

Patients with hypospadias often present with voiding difficulties after successful repairs. We sought to analyze the degree of uroflowmetric anomalies that may be present in children with hypospadias before a surgical repair. We, thus, undertook this study to compare the pattern of preoperative uroflowmetry study in hypospadias patients and a comparable age-matched control group. A total of 90 children underwent preoperative uroflowmetry in the Department of Pediatric Surgery at All India Institute of Medical Sciences (AIIMS), Jodhpur, India, between January 2019 and December 2020. Thirty patients with hypospadias and sixty age-matched controls who presented to the outpatient department without any associated urological or neurological anomalies were included in the study. Uroflowmetry parameters such as maximum urine flow rate (Qmax), average urine flow rate (Qavg), voided volume (VV), urination duration, duration of reaching maximum speed, and urine flow curves of the cases and the control group were measured and compared. The median age of patients at the time of uroflowmetry in the hypospadias group was 7 years, while the same for the control group was 7.5 years. Median maximum urinary flow rates (Qmax) (10.7 vs. 14.45 mL/s, P = 0.01278), average urinary flow rates (Qavg) (6.5 vs. 8.5 mL/s, P = 0.0124), the ratio of maximum urinary flow rates with VV (Qmax/VV) (0.043 vs. 0.053, P = 0.0264) was found to be significant (P < 0.05). These values were significantly lower in the hypospadias group (P < 0.05). The voiding time (43.5 vs. 30 s, P = 0.0285) was significantly higher in the hypospadias group. However, there was no difference in the VV per micturition (219.5 vs. 270.0 mL, P = 0.40) and time to maximum flow rate (10 vs. 10, P = 0.43). Flow curve pattern analysis revealed plateau-shaped curves in 60% of the hypospadias group compared to 27% in the control group, while bell-shaped curve was seen in 37% of the hypospadias group as compared to 65% in the control group which were statistically significant (P = 0.003415). No statistically significant association was found between meatal localization and the uroflowmetry parameters. Children with hypospadias have abnormal uroflowmetry even before surgical correction and have a significantly low maximum urine flow rate. These uroflow anomalies may be due to meatal stenosis or hypoplastic proximal urethra. We postulate that these preoperative abnormal uroflow patterns in patients with hypospadias may contribute to voiding difficulties in repaired hypospadias cases. A greater understanding of the factors behind these uroflowmetric anomalies may allow surgeons to proactively tackle these intraoperatively, leading to better outcomes for patients with hypospadias.

Persistent Bowel Loop in the Left Upper Quadrant: An Indication for Relaparotomy in Paediatric Adhesive Intestinal Obstruction: A Retrospective Cohort Study

Introduction: Abdominal surgery in children is known to contribute to Adhesive Small Bowel Obstruction (ASBO). No X-ray findings have been validated for predicting management in ASBO. Various imaging modalities often cannot predict complications or if a conservative line of management would be successful. Aim: To determine if a persistent prominently dilated small bowel loop in the Left Upper Quadrant (LUQ) on plain X-rays (Omega loop) would suggest early operative intervention. Materials and Methods: A retrospective cohort study was conducted in the Department of Paediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India from January 2016 to December 2018. Diagnosis was based on history, clinical features, and radiologic findings. Demographic, clinical, radiologic, and operative data were collected. After exclusions, the study population was divided into two groups: Group A - ASBO patients with the characteristic Omega loop, and Group B - patients without the Omega loop. Appropriate statistical methods were used to compare the groups, with significance defined as p&lt;0.05. Results: Among the 72 cases of ASBO that met the inclusion criteria, 40 (55%) were successfully managed conservatively, and 32 (45%) required non urgent relaparotomy. The median age was 6.9 years (range: 2-12 years), and 55% were male. Group A comprised 16 patients (22.2%), and the remaining patients were in Group B 56 (77.8%). Group A showed higher rates of failure of conservative management (n=14, p=0.0002), with higher rates of single-band obstruction, bowel loss, perforation, matting of bowel loops, and difficult dissection. The Omega loop had a low sensitivity (43.7%) but high specificity (95%) and positive predictive value (87.5%) for the need for relaparotomy. Conclusion: The Omega loop suggests the possibility of more complications, and therefore, earlier operative intervention should be considered.

Factors contributing to mortality in neonates with congenital diaphragmatic hernia and eventration.

Despite all the advances, the mortality rate of congenital diaphragmatic hernia (CDH) ranges from 30% to 60% for isolated CDH and as high as 89% when they are associated with additional structural or chromosomal anomalies. Hence, a study was conducted to evaluate the factors contributing to the mortality of neonates treated for CDH or the eventration of diaphragm. A retrospective study was conducted in the department of paediatric surgery at a tertiary centre. The neonates admitted with a diagnosis of CDH or eventration requiring surgery, between March 2013 and March 2021, were included in the study. A total of 123 neonates were included in the study. The variables, earlier median age at presentation (1 [1-23] vs. 3 [1-28]; P < 0.001; Mann-Whitney U-test), preterm birth (10/79 vs. 0/44; P = 0.01; Fischer's exact test), inborn (68/79 vs. 27/44; P = 0.002; Chi-square test), weight ≤2 kg (18/79 vs. 1/44; P = 0.003; Chi-square test), central cyanosis at presentation (21/79 vs. 1/44; P < 0.001; Chi-square test), antenatal detection (47/79 vs. 14/44; P = 0.003; Chi-square test) and earlier mean age at surgery (3.66 ± 1.47 vs. 7.66 ± 6.88; P < 0.001; Independent sample t-test) were associated with increased mortality. On multinominal logistic regression analysis, the factors preterm (odd's Ratio [OR] =4.735; P = 0.03), weight ≤2 kg (OR = 5.081; P = 0.02), central cyanosis at presentation (OR = 6.969; P = 0.008) and antenatal detection (OR = 7.471; P = 0.006) were found to be independently associated with increased mortality in CDH/eventration. The factors: prematurity, weight <2 kg, cyanosis at presentation and antenatal diagnosis were independently associated with increased mortality in neonates with CDH/eventration requiring surgery.