Department Of Pediatric Surgery Research Articles

Practice of Pediatric Neurosurgery at the “Hôpital Spécialisé Mère-Enfant Blanche Gomes” in the Republic of the Congo

Introduction: Pediatric Neurosurgery is a growing specialty in its own right worldwide. Its practice in sub-Saharan Africa remains confronted with many challenges, notably the absence of a pediatric neurosurgeon, the lack of a dedicated service and the absence of multidisciplinary pediatric collaboration (neuroanesthesist, neurologist, oncologist and psychotherapist). The objective of this preliminary study is to describe the practice of pediatric neurosurgery at the HSMEBG and to present perspectives for its improvement. Methods: This is a retrospective, monocentric, descriptive study covering the period from March 2021 to March 2022 at the Pediatric Surgery Department of the HSMEBG. Résults: During the study period, 50 children were hospitalized for a neurosurgical condition. The sex ratio was 1.77. The average age was 6 years with extremes of 2 weeks and 16 years. Most children were from the emergency department (46%). Computed tomography (CT) was performed in 35 patients (70%), magnetic resonance imaging (MRI) in 4% and plain radiography in two patients (8%). Malformative, traumatic (cranial and spinal) and tumor pathology were the most frequent with 42%, 36% and 12% respectively. Twenty-six patients were operated (52%). We recorded one postoperative infection (2.5%). The overall mortality was 8% (N = 4). Conclusion: This preliminary study allowed us to identify the epidemiological and clinical profile of the patients treated in our context as well as the therapeutic approach. Malformative pathology remains the most frequent, followed by traumatic and tumor pathology. The development of the practice of this discipline remains a challenge in our working conditions and requires the training of pediatric neurosurgeons and dedicated paramedical staff.

A rare cause of intestinal obstruction in children trichobezoar: How to diagnose?

Trichobezoar is a rare clinical condition in children, which is caused by the accumulation of swallowed hair mass in the digestive tract. This condition is most common in young women with psychiatric histories who suffer from trichotillomania (TTM), where they have an irresistible urge to pull out their hair. Diagnosis and treatment of this pathology, which is already extremely rare, and its variable clinical presentations are challenging. The aim of this study was to increase awareness of trichobezoar in the differential diagnosis of signs of intestinal obstruction in children and to evaluate the diagnosis and management of this rare pathology. The clinical data of six patients who were treated for trichobezoars in the pediatric surgery department of our hospital between 2009 and 2022 were retrospectively analyzed. Six female patients were treated with the diagnosis of trichobezoar during this period. Patients were diagnosed with the help of anamnesis, physical examination, abdominal ultrasonography (USG), and finally, endoscopy. USG can predict the intestinal wall infiltration and the tail extended to the duodenum through pylorus in the series. All patients were evaluated with contrast-enhanced abdominal radiography. Five surgical interventions were performed in four of the cases. In a case who underwent surgery twice, the distal intestinal satellite bezoar was not noticed in the first operation. Two patients were diagnosed to have trichobezoar, but surgery was not required. These patients were younger and had early-onset TTM (before 10 years old). The patients were followed for an average of 10.8 years and no recurrence was detected. Trichobezoar is a rare cause of intestinal obstruction in children with fatal complications when diagnosed late. Failure to follow an algorithm for the management of the disease causes difficulties in the diagnosis and treatment. Especially in pa-tients with a known psychiatric history, whole abdominal USG and laparoscopy performed with awareness can prevent unnecessary examinations.

Pediatric Surgery in Rural Government Medical College: A Cross-sectional Study of Admission Pattern and Need of Super Speciality Services

Abstract Background: The aim of the study was the admission pattern of elective and emergency patients admitted in the paediatric surgery department to highlight the importance of paediatric surgery super speciality in the rural regions. Materials and Methods: The study was a retrospective cross-sectional study over a period of 1 year from 1st March 2021 to 28th February 2022. All the complete records of patients admitted in paediatric surgery (age ≤15 years) from 1st March 2021 to 28th February 2022 were included in the study. The collected data were analysed using the Statistical Package for the Social Sciences (IBM SPSS 26.0, Armonk, NY, USA: IBM Corp.). Descriptive and analytical methods were utilised. P < 0.05 was considered statistically significant with 95% confidence interval. Results: A total of 155 patients were admitted, the mean age was 6.5 (standard deviation ± 4.7) years and male-to-female ratio was 2.5:1. n = 96 were elective admissions while n = 59 were emergency admissions. Most common elective surgery performed was hernias (17%) while most common emergency surgery performed was appendicectomy (9%). Trauma represents 11% admissions. The most common cause of non-operative admission was non-specific abdominal pain abdomen (8.4%). Mean pre-operative stay and total hospital stay for elective surgeries compared to emergency surgeries were statistically significant (P < 0.05). No surgical site infection observed among emergency and elective cases. Conclusions: In our study, the most common causes of admissions were hernia, appendicitis, trauma and non-specific abdominal pain requiring super speciality services in the rural regions.

Aetiological Profile and Outcomes of Acute Kidney Injury among Neonates Admitted in a Neonatal Intensive Care Unit at a Tertiary Care Hospital, Northeast India: A Prospective Cohort Study

Introduction: Acute Kidney Injury (AKI) affects approximately 8%-24% of critically ill neonates, with a mortality rate ranging from 10%-61%. Groups of newborns at higher risk for AKI include those with perinatal hypoxia, Respiratory Distress Syndrome (RDS), premature and very low birth weight infants, and newborns with sepsis. AKI is associated with poor short-term and long-term outcomes and has a multifactorial aetiology. Aim: To evaluate the aetiological profile and short-term outcomes of AKI in neonates admitted to the Neonatal Intensive Care Unit (NICU). Materials and Methods: A prospective cohort (descriptive) study was conducted in the NICU at Gauhati Medical College and Hospital, Guwahati, Assam, India, over a period of one year, from September 1, 2021, to August 31, 2022. A total of 100 neonates exhibiting signs and symptoms of AKI according to Acute Kidney Injury Network (AKIN) criteria. Detailed neonatal history, including neonatal resuscitation, history of perinatal asphyxia, signs and symptoms of sepsis, Respiratory Distress Syndrome (RDS), or any other symptoms, were recorded. The course and outcome of the neonates during their NICU stay were noted. Data were presented in terms of frequency (n) and percentages (%). Results: Among the 100 AKI neonates, 58 were males and 42 were females, with a male-to-female ratio of 1.38:1. Out of 100 neonates, birth asphyxia constituted 40 (40%) cases, of cases, followed by sepsis in 30 (30%), RDS 27 (27%), dehydration 2 (2%), and obstructive uropathy in 1 (1%) case. Among the 100 AKI neonates, 64 (64%) cases were discharged, 35 (35%) expired, and 1 (1%) were transferred to the paediatric surgery department. Conclusion: Neonatal AKI is an independent contributor to morbidity and mortality. Therefore, early identification and prompt management are crucial for improving outcomes and prognosis.

A Comparison of The Effects of Pre-Emptive and Intraoperative Intravenous Acetaminophen Administration on Pain Management After Circumcision

Aim: The aim of this study was to compare the efficacy of the pre-emptive and intraoperative use of intravenous acetaminophen in post-circumcision pain in children.
 Methods: The records of patients who had undergone circumcision were retrospectively evaluated using our database in the Samsun University, Samsun Training and Research Hospital, Department of Pediatric Surgery, Turkey, from May 2021 to May 2022. Patients were divided into two groups based on administration of pre-emptive (Group 1) and intraoperative (Group 2) acetaminophen. Baseline characteristics, vital signs, outcomes, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores were then compared between the groups.
 Results: Two hundred four patients, 95 (46.6%) in Group 1 and 109 (53.4%) in Group 2, were enrolled in the study. No significant difference was determined in terms of mean body mass index, age, length of stay in the recovery room, operative time, or length of hospital stay. Vital findings exhibited no difference in preoperative, induction, intraoperative, or postoperative recordings. Significant differences were observed between the groups’ mean pain scores 30 minutes after surgery (p = 0.024). However, no such significant differences were observed at one and three hours after surgery (p = 0.063 and p = 0.708, respectively). Rescue analgesia was performed in 13 (13.7%) cases in Group 1 and 17 (15.6%) in Group 2 (p = 0.7).
 Conclusions: Pre-emptive intravenous acetaminophen reduced pain 30 minutes after circumcision. Pre-emptive and intraoperative use of acetaminophen resulted in similar and acceptable efficacy in pain relief one and three hours after surgery.

Predictive Accuracy of Paediatric Trauma Score, our experience at Children Hospital, Lahore

Aim: To find predictive accuracy of pediatric trauma score (PTS) in terms of mortality in the Children’s hospital and institute of child health Lahore. Study design: Cross sectional study. Setting: Paediatric Surgery department, CH & ICH, Lahore. Duration of study: 1st January 2019 to 30th June 2019. Methods: All patients presented with trauma, aged 1-15 years were included in study. All patients with major burn, associated cardiac injuries (e.g., stab heart), victims who required monitoring and hospitalization less than 24 hours, and those referred to other hospitals were excluded from the study. Initial assessment of all patients was done and paediatric trauma score was evaluated in the emergency room. Patients were managed and 24 hours follow-up was done to predict the mortality. Results: From 290 children, 207(71.38%) were males and 83 (28.6%) were females. Mean age of the children was 7.53 years. The most common mode of trauma was Car accident in children 67(23.1%), followed by Auto rickshaw vs. motorcycle n= 50 (17.24%), and auto rickshaw vs. pedestrian 40(13.79%). Mean Hospital Arrival Time in Minutes was 100.31 minutes. Mean paediatric trauma score amongst all children was 7.22. Overall mortality was reported in 27(9.3%) children. PTS < 8 turned out to be statistically significantly related to mortality (P value < 0.001). Patients with diagnostic test characteristics of PTS < 8 to predict mortality were having sensitivity 91.0%, specificity 56.1%, positive predictive value 38.4%, negative predictive value 95.4% and the diagnostic accuracy of 64.1%. Conclusion: By Paediatric trauma score we can predict about the necessity of critical interventions in patients and also, we can predict percentage of mortality in paediatric trauma patients. However, accuracy of paediatric trauma score seems to be moderate in detecting most severe paediatric trauma cases. Keywords: PTS, mortality, hospital arrival time, morbidity, major burn predictor.

Professor Roman Romanovich Vreden (1867–1934) (on the 155<sup>th</sup> anniversary of his birth)

An outstanding orthopedic traumatologist and military field surgeon, scientist and teacher, one of the founders of orthopedics in Russia, founder and long-term director of the St. Petersburg Orthopedic Institute (1906–1924), organizer of the first Department of Pediatric Surgery in Russia (1933) and creator of a large scientific school of orthopedic traumatologists, Professor Roman Romanovich Vreden was born on March 9 (21), 1867 in St. Petersburg in the family of a well-known otorhinolaryngologist, Professor Robert Robertovich Vreden. From childhood, Roman chose the profession of a doctor for himself, and after graduating with a gold medal from the First Classical Gymnasium in St. Petersburg in 1885, he entered the Imperial Military Medical Academy. After graduating from the academy in 1890, he passed the competition and left for further development of the specialty as an adjunct at the Department and Clinic of Hospital Surgery founded by N. I. Pirogov and led by Professor V. A. Ratimov. In 1893, R. R. Vreden successfully defended his dissertation for the degree of Doctor of Medicine on the topic: «On the etiology of cystitis», after which he was sent to Kiev, where from 1893 to 1896, he worked as a resident at the Kiev Military Hospital, headed the Surgical and Ear Departments there. In 1896, Roman Romanovich returned to the Military Medical Academy and received the position of senior assistant in the Hospital Surgical Clinic of V. A. Ratimov. In 1898, R. R. Vreden was awarded the academic title of Privatdozent. In 1902, in connection with the retirement due to illness of V. A. Ratimov, a competition was held to fill the position of the head of the Department of Hospital Surgery, but R. R. Vreden lost to S. P. Fedorov in it, after which he left the Department. In 1902–1904, he was a leading surgeon and director of the French Hospital in St. Petersburg and a surgical consultant at the Nikolaev Military Hospital. In 1903, R. R. Vreden was appointed an official for special assignments at the Main Military Medical Directorate. In February 1904, the Russo-Japanese War began and R. R. Vreden was sent to the Far East. In March 1905, Roman Romanovich returned to St. Petersburg, until 1906, served as head of the faculty surgical clinic of the Women’s Medical Institute. In July 1906, Roman Romanovich was appointed the first director of the first Russian Orthopedic Institute in St. Petersburg. R. R. Vreden can rightfully be considered the founder of operative orthopedics in our country. Such surgical interventions as arthrotomy, arthroplasty, arthrodesis, bone and joint resections, tendon and bone plasty, osteotomy, open reduction of dislocations and others were widely performed at the Institute. In 1911, Roman Romanovich was elected a professor at the Psychoneurological Institute and created the Department of Orthopedics on the basis of his Institute. In 1912, he organized training in orthopedics for doctors at the Clinical Institute of the Grand Duchess Elena Pavlovna, and in 1918, he created and headed the Department of Orthopedics at the First Petrograd Medical Institute. In 1925, the «Practical Guide to Orthopedics» was published, which summed up the 18-year activity of R. R. Vreden in this field of medicine. Roman Romanovich created one of the first and largest scientific schools of orthopedic surgeons in our country. Professor Roman Romanovich Vreden died in Leningrad on February 7, 1934 and was buried at the Smolensk Lutheran cemetery. In 1967, the Leningrad Research Institute of Traumatology and Orthopedics was named after R. R. Vreden.

Інвагінація кишечника в дітей: навчання та практика

Intestinal invagination is a mixed form of intestinal obstruction that occurs when one section of the intestine is telescopically immersed in the lumen of another and occurs mainly at the age of 3 months to 1 year, which is 90%, and mortality, according to the literature, ranges from 6 to 14.5%. Despite a sufficient number of scientific and clinical publications on the pages of medical journals regarding the diagnosis and treatment of intestinal intussusception, there are no fake simulators in the training of students and interns, which determines the relevance of this publication. Purpose - to improve the results of diagnosis and treatment of children with intestinal intussusception by analyzing domestic developments and visually studying the mechanism of its development with the help of a simulator both for the purpose of diagnosis and treatment - conservative disinvagination. Results. In today’s conditions, general practitioners and pediatricians are not trained to diagnose intussusception in children, that is, they do not have simple methods of examination. Hospitals usually do not have the equipment to examine and diagnose acute intussusception. In order to eliminate the gaps at the Department of Pediatric Surgery of the Bukovinian State Medical University, a dummy-simulator of intestinal intussusception «Garant» was developed and introduced into the educational process. Training on a simulator allows you to master the practical skills of diagnostics in the conditions of an X-ray room and conservative disinvagination followed by X-ray control. In turn, the development of skills by primary care physicians and pediatric surgeons in diagnosis and treatment will primarily improve the understanding of the onset of the disease and treatment methods. Conclusions. With certain and significant developments regarding the diagnosis and treatment of intestinal intussusception in children, the problem has not been solved, since some children seek help at the wrong time, and as a result of complications - necrosis, peritonitis with organ and multiple organ failure. The use of a scoring system for assessing the stage of invagination makes it possible to systematize the main prognostic indicators of sonographic and dopplerographic studies in order to determine an adequate method of treatment. Practicing the skills of diagnosis and treatment on the self-developed dummy «Garant» allows you to clearly understand the essence and purpose of the measures taken to establish and confirm the diagnosis of intestinal intussusception, evaluate the possibilities of various methods of conservative and surgical treatment and indications for them. No conflict of interests was declared by the authors.

Psychosocial Impact of Electrical Burn in Children: A Follow-Up Study Conducted at a Tertiary Care Hospital.

Introduction Electrical burn injuries are very common in the pediatric population and are usually accidental and sometimes occupational. The objective of our study was to evaluate the epidemiology of electrical burn injuries and prospectively evaluate the long-term psychosocial impact of electrical burn injuries in children. Materials and methods A qualitative interview study was conducted prospectively among sixty patients presented to Holy Family Hospital, Rawalpindi, Pakistan. Demographic details, mode of presentation, detail of injury, total body surface area, initial condition, and surgical interventions were noted during their stay at the hospital. Their physical and psychological outcomes were evaluated by administering the Strength and Difficulties Questionnaire (SDQ) and Body Dysmorphic Disorder Questionnaire (BDDQ) via telephonic interviews after six weeks of discharge from the hospital. The study was conducted over a span of 1 year from January 2021 to January 2022. Results There were 60 patients who presented to the department of pediatric surgery during the span of the study. The mean age was 9.9 years ± 3.133 years (SD) and 80% of the patients were above 8 years of age with a male-to-female percentage of 86.67% to 13.33%, respectively. Forty-two (70%) patients incurred high-voltage electrical burns while 18 (30%) suffered low-voltage electrical burns. Mortality was 13.33% (n=8). Out of 52 patients who survived, 35 (67.30%) were labeled as having Body Dysmorphic Disorder upon administration of BDDQ through a six-week follow-up. The majority of the patients had abnormal or borderline results in different scales of SDQ. Conclusion The long-term psychological stress and the varied spectrum of psychiatric disorders in electrical burn patients are profound. The prevention of burn injuries can be effectively achieved by educating parents about safety measures and improving health infrastructure. Implementation of a dedicated national program for psychological support of burn patients should be made accessible to all patients.

Management of Pyeloureteral Junction Syndrome in the Pediatric Surgery Department of the Mali Hospital in Bamako

Introduction: The pyelo-ureteral junction syndrome is defined by a dilation of the renal pelvis and the calyxes with a downstream ureter of normal caliber. It is a fairly frequent pathology often of congenital cause whose diagnosis can be ante-natal or post-natal thanks to ultrasound. The treatment is surgical especially if there are clinical manifestations. The objective of this work is to study in general the pyelo-ureteral junction syndrome in the pediatric surgery department of the Mali hospital. Material and Methods: This was a prospective study which took place at the Mali hospital from May 2018 to April 2021. This study included all patients aged 0 to 15 who were operated on for pyelo-ureteral junction. Results: During the 3-year study period, we collected 12 cases of pyelo-ureteral junction syndrome. The average age was 3 years with extremes of 20 days and 14 years. All patients had an abdominal mass accompanied by abdominal pain in 83.3% of cases. Dehydration was present in 66.66% of patients. The attack of the left kidney was predominant is 66.66% of the patients, in only one patient the expectation was bilateral. Serum creatinine was normal in all patients. Cytobacteriological examination of urine found 2 cases of Echerichia coli infections. 10 pyeloplasties and 2 nephrectomies were performed with simple postoperative course. Conclusion: The pyeloureteral junction syndrome is a frequent pathology in the literature but not very frequent in our daily practice. Most of our diagnoses are made post natally. It is not very symptomatic, mainly affecting male infants. Ultrasound and Uro scanner have a very important role in the exploration of this pathology. Open-air surgery is the technique of choice in our context.

Surgically proven small bowel intussusception in children: Analysis of 36 cases

Background: Intussusception is one of the most common abdominal emergencies in children. While the majority of childhood intussusceptions are ilecolic and idiopathic, small bowel intussusceptions are rare and a pathological trigger is often blamed for the etiology. Ultrasonography is the most commonly used diagnostic tool in the diagnosis of intussusception.
 Objectives: To determine auxiliary diagnostic criteria for ultrasonography in the differentiation of small bowel intussusceptions based on ultrasonography, reduction and surgical findings of surgically confirmed small bowel intussusceptions and to contribute to the diagnosis and treatment algorithm of small bowel intussusceptions based on our clinical experience.
 Methods: The records of patients who underwent surgery for small bowel intussusception at the Faculty of Medicine, Department of Pediatric Surgery between January 2008 and December 2020 were retrospectively reviewed. Demographic characteristics, ultrasonographic findings, onset and duration of symptoms, treatment method, intraoperative findings and histopathological results of the patients were recorded.
 Results: Thirty-six pediatric patients with small bowel intussusception were operated. The average age of these patients was 59 ± 49.7 months and %78 was male. The location of the small bowel intussusception detected by ultrasound scan was the paraumbilical area and left quadrant in 19 (53%) patients and the right quadrant in 15 (42%) patients. In ultrasonography, the mean diameter of the invaginated segment was 3 (1.2-6.5) cm and the mean length was 6.7 (3-15) cm. Pathological lead points were detected in the etiology of nineteen (53%) patients. Thirteen (36%) patients underwent segmental resection and anastomosis due to necrosis.
 Conclusions: Small bowel intussusceptions are often localized in the paraumbilical and left upper quadrant. However, it should be kept in mind that it may be localized in the right lower quadrant like ileocolic invaginations. Enema reduction can be used as an adjunctive diagnostic method to exclude ileocolic invaginations rather than treatment in these patients. The diameter and length of the invaginated segment may be decisive in the surgical decision of the small bowel intussusception.

Using Machine Learning Technique to Predict the Most Reliable Diagnostic Finding for Foreign Body Aspiration in Children: Symptoms, Chest X-ray, or Auscultation?

Foreign body aspiration (FBA) is one of the most critical and life-threatening pediatric emergency situations. Prompt diagnosis in these cases is very important as they are associated with high mortality among children. When diagnosing FBA, symptoms of the patient, auscultation findings, and chest X-ray findings are usually evaluated. In this study, we conducted a retrospective analysis of all the cases involvingsuspicion of FBA in children under the age of 18 years who were hospitalized in theDepartment of Pediatric Surgery at Denizli Pamukkale University Hospital, Turkeyfrom January 2005 to September 2020. Instead of traditional statistical methods, we used machine learning techniques such as random forest and logistic regression to determine whichfinding was diagnostically the most reliable. The variables included in the analysis that were considered to be significant were as follows: symptoms, auscultation findings, chest X-ray findings, patient gender, age, location of the foreign body, and the time of admission. For the purpose of this study, we developed four different models. Model 1 included gender, age, time of admission, location, and symptoms as variables; the correct classification rate of the model was found to be 82.3%. Model 2 included auscultation findings in addition to Model 1, and the correct classification rate of the model was 84.8%. Model 3 included chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.4%. Model 4, on the other hand, included both auscultation findings and chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.6%. Based on our findings, a definitive diagnosis of FBA using only symptoms, auscultation findings, or chest X-ray findings in isolation does not seem possible. Additionally, using only symptoms and chest X-ray findings is also insufficient to make a diagnosis.

Application of the Locking Compression Pediatric Hip Plate™ in children with proximal femoral tumors

BackgroundPediatric proximal femoral tumors often present with accumulative and severe bone destruction and are often complicated by pathological fractures and malunion. Such tumors are treated clinically by lesion scraping and graft reconstruction with autologous iliac bone alone or in combination with artificial bone. This study aimed to determine the efficacy of the Locking Compression Pediatric Hip Plate™ in treating pediatric proximal femoral tumors.MethodsFrom 2012–2017, the Locking Compression Pediatric Hip Plate™ was applied for internal fixation in 28 children in the Department of Pediatric Surgery. The complications were pathological fractures in 19 patients and multiple lesions in 5 patients. Tumors were removed by tumor curettage and reconstruction with autogenous iliac bone or artificial bone graft. The Locking Compression Pediatric Hip Plate™ was then applied. Postoperative pathological examination confirmed the diagnosis.ResultsThe cohort comprised 20 males and 8 females (mean age 7.8 ± 2.9 years). The mean follow-up duration was 26.1 ± 8.1 months (range 18–48 months). Post-treatment radiography showed that the lesions and local pathological fractures were healed in 3.2 ± 0.4 months (range 3–4 months), with no complications. Four patients continued to receive antineoplastic therapy postoperatively. Four patients experienced recurrence in situ, while another four developed distant metastases. The radiographic and joint function findings indicated that the affected limbs had excellent function. The mean Enneking score was 28.7 ± 1.0 points (range 27–30 points).ConclusionsInternal fixation with the Locking Compression Pediatric Hip Plate™ in children achieves good therapeutic effects. Moreover, the Locking Compression Pediatric Hip Plate™ resolves the shortcomings of external fixation by traditional plaster casts and internal fixation by Kirschner wires and elastic intramedullary screws.

Adaptation to the Resource Available in Construction of Stoma in Pediatric Stoma Care in Bangladesh: A Descriptive Analytical Study

Background: Stoma construction is a routine operation in the field of pediatric surgery. Commercially accessible resources, such as ostomy bags (either disposable or with extended lifespans), are often employed to care for these stomas. These may be rather pricey, especially in places like Bangladesh, and it might be difficult to get ones in the right size. Objective: In this study our main objective is to evaluate the efficacy of resource available in construction of stoma in Pediatric stoma care in Bangladesh. Method: From January 2014 through December 2015, a total of 60 patients were included in a prospective research done by the pediatric surgery department at Dhaka Medical College and Hospital. The research group consisted of patients less than 12 years old who had temporary loop colostomy or ileostomy in the pediatric surgical units at Dhaka Medical College & Hospital throughout the study period. Zinc oxide paste was first administered to the Peristomal skin after stoma formation. The stoma was covered with a betel leaf, which had a glossy, smooth outside surface and a rough inner surface. The size of the hole in the betel leaf was adjusted to accommodate the stoma. The stoma is protected by an additional leaf that is still fully intact. When nature calls, one must remove the undamaged leaf above it and wipe away the feces before moving on. The cleaned leaves were put to further use. Ostomy bags (like those made by Convatec) and adhesive paste (Stomahesive) are used to seal the bag to the Peristomal skin. Results: During the study, both the stoma bag and betel leaf groups had a wide range of ages, from one day to 4,320 days. In addition, both group anorectal malformations found as common indication 70% vs 73.33% (stoma bag vs betel leaf) followed by in stoma bag group 23.33% had Hirschsprung’s disease and 6.67% had Colonic atresia. Where as in betel leaf group 20% had Hirschsprung’s disease and 6.67% had Colonic atresia? In stoma bag group majority had ......

Weekly anal Dilatation after Anoplasty in Low Variety Anorectal Malformations - A Cross Sectional Study

Introduction: Low variety anorectal malformations (ARM) include almost one half of all anorectal malformations. Most of them undergo single stage anoplasty in neonatal age as an emergency procedure. Anal Dilatation is started after 10-14 days of surgery as a general protocol. Aim of our study was to measure the outcome of weekly dilatation instead of daily dilatation plan in low variety ARM patients undergoing anoplasty in terms of complications. Materials and Methods: After Ethical considerations, a prospective cross sectional study was carried out from April 2020 to March 2022 in the Department of Pediatric Surgery, The Children Hospital and the Institute of Child Health, Multan. 34 patients of low variety of ARM were included in the study. Anoplasty was done on Hager dilator no. 10. After two weeks of surgery, the patients were called for weekly follow up and dilatation. The dilatation was performed as an outpatient procedure for three months and then monthly for three months. After data collection on a pre-designed performa, statistical analysis was done using SPSS version 20. Results: Constipation was seen in 10 (29.4%) patients, followed by anal stenosis in 6 (17.6%) and wound dehiscence in 3 (8.8%) patients. Most of the patients responded to oral laxatives and intravenous antibiotics. 3 (8.8%) patients needed redo anoplasty. Overall, 26 patients (76.5%) did well on weekly dilatation program, while in 8 (23.5%) weekly dilatation program had to be converted to daily dilatation program. Conclusion: Weekly calibration by surgeons has acceptable outcomes. It is kinder and gentle to patients and lessens excessive physical and psychological trauma and morbidity to patients. The weekly dilatation plan will benefit patients not only financially but it will also lessen the psychological and physical trauma to the patients and their caregivers. Key words: anorectal malformations, low variety, anal dilatation.

Buck’s Fascia in Addition to Dartos Fascia is an Effective Intermediate Layer in Repair of Hypospadias

Background: Being a common congenital urogenital disorder, hypospadias is mostly treated by Snodgrass urethroplasty; urethrocutaneous fistula is the most frequent complication. Objective: To assess the outcomes of Snodgrass Urethroplasty when Buck’s (external spermatic) fascia was used with Dartos fascia to interpose between the neourethra and skin and to compare the results when only Dartos fascia was applied. Study Design: Prospective comparative study Place and Duration of Study: Department of Pediatric Surgery, Children’s Hospital & Institute of Child Health, Lahore Pakistan from 1st September 2018 to 31st August 2019 Methodology: Seventy four patients who were randomly divided into two groups. Group 1 who underwent Snodgrass urethroplasty with dartos fascia as intermediate layer; while both dartos & buck’s fascia was used in Group 2. Post-operative results were compared in terms of urethrocutaneous fistula, meatal stenosis and wound dehiscence. Results: Eleven patients with urethrocutaneous fistula, the rate of urethrocutaneous fistula was significantly less in the Buck’s and Dartos group [2(5.4%) versus 9(4.3%) in the dartos only group; p=0.022]. 4 patients presented with meatal stenosis; 3 (8.1%) from dartos group and 1 (2.7%) from dartos and buck’s group. 5 patients presented with Wound dehiscence; 4 (10.8%) from control group and 1 (2.7%) from experimental group, both of which were not statistically significant (p-value 0.304 and 0.165 respectively). Conclusion: The use of Buck’s Fascia in addition to Dartos Fascia as an interpositional layer in hypospadias repair bears immense role in the prevention of the most common complication i.e. urethrocutaneous fistula. Keywords: Buck’s fascia, Dartos fascia, Hypospadias, Urethrocutaneous fistula

Disorders of sex development: Challenges in a low-resource country

AimWe aimed to identify the challenges in the management of sexual development abnormalities in a low-resource country. MethodsThe study was retrospective from January 2000 to December 2017 based on patient records from two pediatric surgery departments. Epidemiological, clinical, paraclinical, treatment, and outcome data were studied. ResultsWe collected data on 13 patients (average age = 7.95 years). The sex of rearing was as follows: three females (23%), 10 males (77%). Atypical genitalia other than hypospadias represented the reason for consultation in 92% of the cases. We could not find complete hormonal analyses; testosterone levels were studied in 69.23% of cases. We found the following disorders of sexual development (DSD): four patients with 46,XX karyotype (30.77%), eight patients with 46,XY karyotype (61.53%), and one patient with 46,XX/XY karyotype. Four patients had medical treatment only, four had surgical treatment only, and one patient had medical and surgical treatment. The medical treatment comprised topical administration of androgen. The surgical treatment consisted of feminizing genitoplasty for one patient and masculinizing genital surgeries for two patients. Six of the 13 patients were lost to follow-up. ConclusionThe socioeconomic difficulties of the population and the lack of access to basic diagnostic and paraclinical methods, coupled with the negative cultural representations of the pathology, constitute the challenges in the management of DSD in our practice.

Ultrasound Guided Hydrostatic Versus Open Reduction in Intussusception

The surgical and nonsurgical technique has been utilized to manage intussusception. Surgical management of intussusceptions involves open laparotomy along with manual reduction. The non-surgical technique, Ultrasound-guided hydrostatic reduction (USGHR) is a renowned alternative technique for intussusception reduction. Objective: To compare the ultrasound-guided hydrostatic reduction versus open reduction for the management of intussusception in terms of successful reduction, recurrence, and hospital stay. Methods: It was a randomized controlled trial in which 158 cases were admitted through the Emergency Department of Pediatric Surgery of The Children’s Hospital Lahore, from August 2018 to August 2019. These patients were divided into 2 groups (79 in each group), Group A (ultrasound-guided hydrostatic reduction) and group B (open reduction). Data were collected through a questionnaire, which was entered into the computer using SPSS version 24.0. Results: Among 79 patients treated in-group A, 54.4% were up to 12 months old, and 67.1% males, in this group the hospital stay for 74.7% was 1-2 days and 74.7% had a successful reduction. In group B; patients treated in group B, 77.2% were up to 12 months old, and 72.2% were males. The hospital stay for 59.5% of patients was 5-7 days, and 83.5% had a successful reduction of intussusceptions. The recurrence was only in group B (3.8%) after the reduction of intussusceptions. Conclusion: The study concluded that ultrasound-guided hydrostatic is effective in terms of successful reduction, recurrence and hospital stay and should be preferred among children due to its safety and effectiveness.

Open Versus Laparoscopic Appendicectomy in Pediatric Patients; A Comparative Study in A Single Center

Appendicitis is the commonest surgical emergency in paeadtric patients. Appendicectomy is still being performed by both open and laparoscopic methods. The first laparoscopic appendicectomy was performed in 1983. Objective: To compare the outcome of open appendectomies with laparoscopic appendectomies in pediatric patients was the objective of this study. Methods: Two hundred pediatric patients of both genders with acute appendicitis were enrolled from emergency department of Pediatric Surgery, Qazi Hussain Ahmad medical complex, Nowshehra, from March 2020- December 2020. In this convenient study patients were dividing into two groups. Group A patients received open appendectomy and Group B received laparoscopic appendectomy. Outcome of both procedures were noted and compared between groups by chi square test. Results: Mean ages of patients were 10.11±2.67 and 10.01±2.31 years (p=0.796) in group A and B, respectively. There were 63.0% and 69.0% males 1) in group A and B, respectively. Mean operative time, mean hospital stay and mean VAS were26.19±8.14 vs. 36.79±11.41 min.,2.01±0.61 vs. 1.03±0.01 days and 3.67±1.41 and 6.07±2.01 (p=0.000) in group A and B, respectively. Complications were hemorrhage (0.0% vs. 0.0%; p=1.0), Iatrogenic injury (0.0% vs. 0.0%; p=1.0) and Pelvic collection (3.0% vs. 0.05; p=1.0), SSI (6.0% vs. 0.0%; p=0.00) in group A and B, respectively. None of the pediatric patients after laparoscopic appendectomy required another exploration to deal with complications however, 3.0% patients needed exploration in open appendectomy. No mortality (0.0%) was observed in any group. Conclusions: laparoscopic appendectomies in pediatric patients is safe and feasible as compared to open appendectomy

Professor Girey Alievich Bairov (1922–1999) (to the 100th anniversary of the birth)

An outstanding Soviet and Russian pediatrician and pediatric surgeon, one of the founders of pediatric surgery in the USSR and the founder of the Leningrad Scientific School of Pediatric Surgeons, Doctor of Medical Sciences (1960), Corresponding Member of the USSR Academy of Medical Sciences (1963) and RAMS (1992), laureate of the USSR State Prize (1979), Honored Doctor and Honored Scientist of the RSFSR (1994), Professor (1962) Girey Alievich Bairov was born on May 2, 1922 in Alushta. In 1955, G. A. Bairov was the first in the Soviet Union to successfully operate on a newborn boy with esophageal atresia and tracheoesophageal fistula. In 1959, he was elected head of the Department of Pediatric Surgery with Orthopedics and Anesthesiology at the Leningrad Pediatric Medical Institute. In 1960, he defended his doctoral dissertation on the topic: «Fractures in the elbow joint in children». G. A. Bairov was a very versatile surgeon: he perfectly operated on newborns, children of different ages with various diseases of the chest and abdomen, performed urological, traumatological and orthopedic interventions, operated on the spine. In 1963, for outstanding achievements in the development of pediatric surgery, he was elected a corresponding member of the USSR Academy of Medical Sciences. For the development of methods of surgical treatment of congenital and acquired diseases of young children, he was awarded the State Prize of the USSR in 1979. G. A.Bairov was the author and co-author of about 400 scientific papers, including 20 monographs and textbooks, more than 40 inventions, rationalization proposals, new methods of surgical interventions. Under his direct supervision, 31 doctoral and 120 master’s theses were defended. Professor G. A. Bairov passed away on July 6, 1999 and was buried at the Smolensky cemetery in St. Petersburg.