Division Of Pediatric Surgery Research Articles

Does thyroglossal duct arborization play a role in the post-surgical outcome of Sistrunk procedure in children?

The purpose of the present study is to analyze thyroglossal duct cyst (TGDC) histopathological features, with focus on "arborization", in a cohort of pediatric patients who underwent surgical removal, and evaluate a possible correlation with clinical recurrences. A retrospective analysis of all patients who underwent surgical resection for TGDC at the division of Pediatric Surgery of the University of Pisa from 2015 to 2020 was performed; for each patient, the following data were recorded: age, sex, clinical presentation, localization, size of the lesion, diagnostic tools, histopathological features, perioperative complications, recurrence and follow-up. With respect to arborization, following histopathological analysis 25/30 patients (83.3%) presented thyroglossal duct branching. After a median follow-up of 3.5years, only 2 out of 30 patients (6.7%), one male and one female, respectively aged 4 y.o. and 6 y.o., presented recurrence within one year from first surgery. Surgery for TGDC remains a challenge for pediatric surgeons, while arborization was present in most of our cases which underwent surgery. With respect to the role of arborization, our study did not highlight sufficient conclusive data regarding their role in recurrence: instead, it showed wide resection as satisfactory, being the arborization present in most of the cases at histopathology.

Outcome of Snodgraft (G-TIP) Urethroplasty for the Treatment of Primary Distal Hypospadias

Background: One of the most prevalent congenital abnormalities of the external genitalia in boys is hypospadias. One common method of treating distal penile hypospadias is tubularized incised plate urethroplasty. However, there are a few side effects of this procedure, such as neourethral stenosis, meatal stenosis, and uretho-cutaneous fistula. In distal hypospadias, snodgraft modification has been suggested as a way to lower the risk of meatal and/or neourethral stenosis. Objective: To find out the outcome of Snodgraft urethroplasty technique in distal penile hypospadias. Materials and Methods: This prospective observational study was carried out in the Division of Pediatric Surgery, Bangladesh Shishu Hospital & Institute from January 2020 to March 2022. Total 40 patients having distal variety of primary hypospadias were included by selection criteria. All patients with single stage urethroplasty using inner prepucial skin graft has been done. Statistical analysis was carried out using the Statistical Package for Social Sciences version 26.0 for Windows. Results: Majority of the patients had subcoronal variety 27(67.50%) followed by coronal 10(25.0%) and glanular hypospadias 3(7.50%). More than three fourth (77.5%) patients had urethral plate width 4-8 mm. Wound infection was developed in two patients out of 40, one coronal and one subcoronal. Four patients had developed urethro-cutaneous fistula among them one was coronal three was subcoronal. No meatal stenosis and urethral stricture was found in follow up period. Conclusion: The patient with Snodgraft (G-TIP) modification in repair of primary distal hypospadias leads to reduce the complication.

LinkedIn Usage Trends Among Surgeons at a Large Academic Institute

IntroductionSocial networking platforms have evolved into a self-promotional space. The LinkedIn platform allows users to share knowledge, research accomplishments, and network in an academic setting. Our objective was to determine LinkedIn usage trends among surgeons at a large academic institution. MethodsA list of surgeons within the department of surgery at a large academic institute was compiled. All publicly available profiles were analyzed for their LinkedIn activity and followership. Active accounts were defined as users who have posted or interacted with any posts within the last year. Comparisons of LinkedIn usage grouped by gender, surgery division, and rank were analyzed. ResultsA total of 133 surgeons were included. Among these surgeons, 88 had a LinkedIn profile (66.2%); however, only 43 surgeons had active usage on this platform (32.3%). The median number of followers among surgeons with a profile was 110 (IQR [24–427]). Male surgeons had a higher median of followers (167 IQR [38–502]) compared to female (54 IQR [21–209]). A greater percentage of male surgeons had a profile compared to female surgeons (68.5% M versus 61.0% F, P = 0.12). The transplant surgery division had the highest percentage of LinkedIn accounts (90.9%) followed by surgical oncology (87.5%). However, active usage was led by the pediatric surgery division (80.0%), followed by the plastic surgery division (71.4%). Instructors, assistant professors, associate professors, and professors all had LinkedIn accounts; however, instructors were the least active users with 33.3% being active on their LinkedIn. The lowest percentage of those with LinkedIn accounts were instructors (50%). Professors were found to be the most active users at 57.1%. ConclusionsSocial media use is on the rise in academic surgery. Within a department of surgery at a large academic institution, only 32.3% were active users of LinkedIn, suggesting that there is room for improvement in utilizing this resource as a tool for mentorship, professional development, and networking.

Do Unpaid Children's Hospital Account Balances Correlate with Family Income or Insurance Type?

Current understanding of medical debt among various income ranges and insurance carriers is limited. We analyzed median household incomes, insurance carriers, and medical debt of plastic surgery patients at a major metropolitan children's hospital. A retrospective chart review for zip codes, insurance carriers, and account balances was conducted for 2018-2021. All patients were seen by members of the Division of Pediatric Plastic Surgery at Ann and Robert H. Lurie Children's Hospital of Chicago. Blue Cross was reported separately among other commercial insurance carriers by the hospital's business analytics department. Median household income by zip code was obtained. IBM SPSS Statistics was used to perform chi-squared tests to study the distribution of unpaid account balances by income ranges and insurance carriers. Of the 6877 patients, 630 had unpaid account balances. Significant differences in unpaid account balances existed among twelve insurance classes (P < 0.001). There were significant differences among unpaid account balances when further examined by median household income ranges for Blue Cross (P < 0.001) and other commercial insurance carriers (P < 0.001). Although patients with insurance policies requiring higher out-of-pocket costs (ie, Blue Cross and other commercial insurance carriers) are generally characterized by higher household incomes, these patients were found to have higher unpaid account balances than patients with public insurance policies. This suggests that income alone is not predictive of unpaid medical debt and provides greater appreciation of lower income families who may make a more consistent effort in repaying their medical debt.

Invited Commentary on Abdullah F, et al: A Novel Pediatric Surgery Division Incentive Program Engaging Faculty, Advanced Practice Providers, and Staff Around a Single Financial Growth Target

Invited Commentary on Abdullah F, et al: A Novel Pediatric Surgery Division Incentive Program Engaging Faculty, Advanced Practice Providers, and Staff Around a Single Financial Growth Target

A Novel Pediatric Surgery Division Incentive Program Engaging Faculty, Advanced Practice Providers and Staff Around a Single Financial Growth Target

BackgroundProductivity-based financial incentive programs for faculty are common. We implemented a novel Division wide clinical productivity incentive sharing professional fee collections across faculty, nurses, and staff with half of bonuses reserved to be given out proportionally to achievement of the annual growth target. MethodsA novel bonus plan was formulated to incentivize collection of professional fees to achieve a 15% annual growth target. The 15% was divided equally between the clinical provider, the responsible provider's center(s) of excellence, and all Division members. 50% of the bonus pool was paid out monthly and the remaining 50% was held for an end of the year payout proportional to achievement of the Divisional professional fee collection annual growth target. Principal findingsDuring the initial year of the program, overall Division collections and charges grew 30% and 17%, respectively. Average monthly bonuses paid through the new incentive program for faculty, advanced practice providers, and staff were $1,700, $700, and $200, respectively. The program cost $525,000 in additional bonuses over the previous year while the Division saw an increase of 2 million dollars in collections over the previous year. ConclusionA clinical productivity incentive program based upon professional fee collections distributed across faculty, nurses, and staff was feasible and successful in its first year. Collections increased by a significantly higher percentage than charges, we believe collections incentive including support staff will be most useful in practices with lower rates of charge collection. Further study is needed to measure the effects of different components of the program. Level of EvidenceLevel IV. Study TypeCost Effectiveness Study.

CORR Insights®: Can a Deep Learning Algorithm Improve Detection of Occult Scaphoid Fractures in Plain Radiographs? A Clinical Validation Study.

1Assistant Professor of Surgery, Pediatrics, and Biomedical Engineering, Division of Pediatric Surgery, University of Rochester, Rochester, NY, USA N. A. Wilson, University of Rochester Medical Center, Golisano Children’s Hospital, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA, Email: [email protected] This CORR Insights® is a commentary on the article “Can a Deep Learning Algorithm Improve Detection of Occult Scaphoid Fractures in Plain Radiographs? A Clinical Validation Study” by Yoon and colleagues available at: DOI: 10.1097/CORR.0000000000002612. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Diagnosis and Management of Choledochal Cyst in One Year-Old Baby: A Case Report

Background: Choledochal cysts (CC) are rare congenital anomalies of the biliary tract. The classic triad of jaundice, abdominal pain, and right upper quadrant mass are rare symptoms, mainly in children and adolescents. This study aimed to present the diagnosis and management of choledochal cyst cases in a baby girl.&#x0D; Case presentation: A 1-year-old girl, domiciled outside the city of Padang, was brought to the hospital by her parents with complaints of repeated vomiting for 1 day before being admitted to the hospital. This complaint has been accompanied by yellowish eyes and body, pale bowel movements, and dark brown urine since 3 months ago. The patient was never brought to the doctor for treatment. Since 1 month ago, the patient often feels pain in the abdomen and has a lump in the upper right abdomen. On the abdomen area, there was no distention, hepar was ¼-1/4 sharp edge, tenderness at the epicondrium area, no rebound tenderness, turgor was decreased, and no palpable mass. Abdominal ultrasonography presented a choledochal duct cyst with biliary obstruction. Abdominal CT scan with contrast revealed intrahepatic and extrahepatic biliaryectasis et causa suggestive of the choledochal cyst (Todani IVA) and hepatomegaly. The patient was consulted by the pediatric surgery division for further management and was advised to undergo surgery with the Roux En-y procedure. Follow-up after the patient underwent surgery showed clinical improvement. Symptoms of jaundice in the eyes and skin begin to decrease, as brownish stools and light brown urine.&#x0D; Conclusion: Surgical treatment with the Roux-en-Y procedure is the definitive treatment for choledochal cysts in this patient.

Pediatric Firearm Injury: Defining the Full Spectrum.

Division of Pediatric Surgery, Department of Surgery, Children’s of Alabama, University of Alabama at Birmingham, Birmingham, AL Invited Editorial for Article Entitled: Defining the Full Spectrum of Pediatric Firearm Injury and Death in the United States: It’s Even Worse than We Think; ANNSURG-D-22-01776 There is no funding provided for this project. The authors have no conflicts of interest to report. [email protected]

The Elephant in the Residency Room.

*Department of Surgery, Mayo Clinic Health System, 1400 Bellinger St, Eau Claire, WI 54702 †Division of Pediatric Surgery, Phoenix Children’s Hospital, 1919 East Thomas Rd, Phoenix, AZ 85016 Ethical Compliance: Not applicable. This is not a human subjects research project. Data Access Statement: Not applicable. The Elephant in the Residency Room This is an editorial-style piece for the “Surgical Perspectives” section in the Annals of Surgery No financial support was received for this manuscript. There are no conflicts of interest. [email protected]

Editorial introductions.

Editorial introductions.

Comparison of the Outcome of Interrupted Suture and Continuous Suture in Tubularized Incised-Plate (TIP) Urethroplasty Hypospadias Repair

Introduction: The tubularized incised plate (TIP) urethroplasty has obtained worldwide acceptance for distal hypospadias repair due to its low complication rate, good cosmetic result, and technical simplicity. Aim of the Study: The aim of this study was to compare the surgical outcome between Continuous suture &amp; interrupted suture in case of tabularized incised plate (TIP) urethroplasty. Methods: This prospective randomized comparative study was conducted in the Division of Pediatric Surgery, Bangladesh Institute of Child Health &amp; Dhaka Shishu (Children) Hospital, Dhaka from July 2017 to June 2019. Total 40 patients were included in this study and divided in two groups which are Group A and Group B. Result: In the current study, the mean age of participants was 41.15±24.46 months in group A and 38.05±25.14 months in group B. There was no significant difference between ages of two groups as the p = 0.695. The mean penile length of participants was 31.90±7.04 mm in group A and 27.95±5.04 mm in group B. There was significant statistical difference between penile lengths of two groups as the p value was 0.049. Operation time in group A and group B was 66.86±3.51 minutes and 79.38±5.04 minutes respectively. The result showed that there was strong statistical difference between operation time in two groups as the p=0.0001. Operation cost in group A and group B was 18810.00±818.79 TK and 18385±1962.08 TK respectively. The result showed that there was no statistical difference between operation cost in two groups as the p=0.377. Hospital stay in group A and group B was 8.1±0.45 day and 8.0±0.0 day respectively. The result showed that there was no statistical difference between hospital stay in two groups as the p=0.324. There is no wound infection occurred in group B patient. There was no significant statistical difference between wound infection of two groups as the p value was &gt;0.05. There was no significant statistical difference between occurrence of UC fistula .......

Oral Sildenafil in the Treatment of Cystic Hygroma in Infant

Introduction: Cystic hygroma is a type of cyst that occurs when lymphatic fluid collects in the lymph nodes which occurs in infants and can cause significant swelling in the neck or other parts of the body. Sildenafil is a possible medication that can be used to treat erectile dysfunction in infant. Aim of the study: The aim of this study was to assess the effectiveness of oral sildenafil in the treatment of cystic hygroma in infant. Methods: This retrospective study was conducted from January 2020 to June 2022 in The Division of Pediatric Surgery, Bangladesh Shishu Hospital &amp; Institute and three other private clinics at Dhaka. Total 55 patients (aged between 2 months to 1 year) with cystic hygroma were included in the study. Result: In the present study, the median (Range) age of 55 patients was 6.2 (2-12) months. The median (Range) weight of 55 patients was 6.5 (4-12) kg. In this study, majority (60%) of the patients were male. More than half (52.73%) patients had the lesion on neck. The median (Range) pretreatment size of lesion was 13.30 (9.88-16.93) cm2. The median pretreatment size of lesion was 13.30 cm2 and median post treatment size of lesion was 0.00 cm2. There was highly significant difference (p &lt;0.001) between pre-treatment and post-treatment size. In this study, excellent response was found in 69.09% patients, good response was found in 21.82% patients. In the current study, 3 patients (5.45%) had cough, 4 patients (7.27%) had fever, 2 patients (3.64%) had rhinorrhoea and 3 patients (5.45%) had vomiting. In the current study, 12 (21.82%) patients had adverse effects. Cost of sildenafil per tablet was 34 cents (100 cents =1 $). Conclusion: Oral sildenafil resulted excellent size regression and low adverse effects for the treatment of cystic hygroma. It was also very cost effective and convenient to administer.

Effects of Intralesional Doxycycline in the Treatment of Cystic Hygroma

Background: Cystic lymphangioma is a congenital lymphatic malformation.The present study was conducted to find out the effects of intralesional Doxycycline in the treatment of cystic hygroma.&#x0D; Materials and methods: This prospective study was conducted among 30 children with cystic hygroma in the Division of Pediatric Surgery, Dhaka Medical college Hospital, Dhaka, from July 2019 to June 2021. All patients were followed up for six months. In every follow up size of the lesion was determined and adverse effects were also noted.&#x0D; Results: More than half of the cystic hygroma (53.3%) were in neck while 5 (16.6%) in axilla. Before treatment, the median size of cystic hygroma was 12.00 cm2 which significantly decreased to 0.75cm2after treatment (p&lt;0.001). After treatment, 83.3% participants showed excellent response and 16.6% participants showed good response. Out of 30 patients, 33.3% had adverse effects which included pain (n=5), redness of skin (n=5), fever (n=5) and skin pigmentation (n=2).&#x0D; Conclusion: Doxycycline monotherapy resulted in a high rate of excellent clinical outcomes after a few treatments without increased need for subsequent operative resection. It was very cost effective also.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 40-43

Truncal Valve Repair: 3-Dimensional Imaging and Modeling to Enhance Preoperative Surgical Planning.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 12Truncal Valve Repair: 3-Dimensional Imaging and Modeling to Enhance Preoperative Surgical Planning No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsNo AccessCase ReportRequest AccessFull TextTruncal Valve Repair: 3-Dimensional Imaging and Modeling to Enhance Preoperative Surgical Planning Trevor R. Williams, MD, Alana R. Cianciulli, BS, Yan Wang, RDCS, Andras Lasso, PhD, Csaba Pinter, PhD, Alison M. Pouch, PhD, David M. Biko, MD, Muhammad Nuri, MD, Michael D. Quartermain, MD, Lindsay S. Rogers, MD, Jonathan M. Chen, MD and Matthew A. Jolley, MD Trevor R. WilliamsTrevor R. Williams Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. *T.R. Williams and A.R. Cianciulli contributed equally. Search for more papers by this author , Alana R. CianciulliAlana R. Cianciulli Department of Anesthesiology and Critical Care Medicine (A.R.C., M.A.J.), Children’s Hospital of Philadelphia, PA. *T.R. Williams and A.R. Cianciulli contributed equally. Search for more papers by this author , Yan WangYan Wang Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Andras LassoAndras Lasso https://orcid.org/0000-0002-4220-7064 Laboratory for Percutaneous Surgery, Queens University, Kingston, Ontario, Canada (A.L.). Search for more papers by this author , Csaba PinterCsaba Pinter https://orcid.org/0000-0001-9982-3194 Pixel Medical, Kingston, Ontario, Canada (C.P.). Search for more papers by this author , Alison M. PouchAlison M. Pouch Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia (A.M.P.). Search for more papers by this author , David M. BikoDavid M. Biko Department of Radiology (D.M.B.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Muhammad NuriMuhammad Nuri Division of Pediatric Cardiac Surgery (M.N., J.M.C.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Michael D. QuartermainMichael D. Quartermain Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Lindsay S. RogersLindsay S. Rogers Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Jonathan M. ChenJonathan M. Chen Division of Pediatric Cardiac Surgery (M.N., J.M.C.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author and Matthew A. JolleyMatthew A. Jolley Correspondence to: Matthew Jolley, MD, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Email E-mail Address: [email protected] https://orcid.org/0000-0002-5626-0130 Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Department of Anesthesiology and Critical Care Medicine (A.R.C., M.A.J.), Children’s Hospital of Philadelphia, PA. Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia (A.M.P.). Search for more papers by this author Originally published12 Sep 2022https://doi.org/10.1161/CIRCIMAGING.122.014424Circulation: Cardiovascular Imaging. 2022;15Footnotes*T.R. Williams and A.R. Cianciulli contributed equally.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.014424.Correspondence to: Matthew Jolley, MD, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Email [email protected]chop.edu

An Analysis of Academic Background and Research Activity Among Pediatric Orthopaedic Surgery Division Chiefs and Fellowship Program Directors

Background: Pediatric orthopedics has seen a large increase in the number of practicing surgeons. As a field that is concentrated at tertiary referral centers, research productivity can be a critical component of academic advancement for pediatric orthopedics. Little has been published on the academic profiles of pediatric orthopedic leaders, and therefore, this study sought to highlight the demographics of these individuals. Methods: Pediatric orthopedic division chiefs and fellowship program directors (PD) were identified for all Pediatric Orthopedic Society of North America (POSNA) accredited fellowship programs in the 2020-21 application cycle. A combination of organizational and public websites was used to compile the academic profiles of these leaders, including demographic variables and research productivity. Division chiefs and PDs were then compared, as were leaders when stratified by fellowship size. Results: A total of 46 POSNA-accredited fellowships were identified. As 12 surgeons held dual roles as division chief and PD, 46 division leaders and 34 PDs formed the groups for comparison. Division chiefs had greater median years-in-practice (24.0 vs 13.0, p&lt;0.001), PubMed publications (56.0 vs 27.0, p=0.037), and more frequently were appointed as “Professor” (54.3% vs 23.5%, p=0.013) compared to fellowship PDs. Leaders working at programs with &gt;1 spot/year were more likely to have completed fellowship at their home program (40.0% vs 8.0%, p=0.001) and had higher research productivity across all metrics (all p&lt;0.002) than leaders at programs with 1 position/year. Female representation among division chiefs and fellowship PDs was 10.9% and 14.7%, respectively. Conclusions: When compared to fellowship PDs, pediatric division chiefs had higher research productivity and academic appointments. Division leaders at larger programs additionally had higher research output and more commonly trained at their current institution. Female representation among pediatric orthopedic leaders was higher than the field of orthopedics at large, but lagged behind reported POSNA membership.

Management of Pediatric Facial Burns with Zinc-Hyaluronan Gel

Zinc-hyaluronan-containing burn dressings have been associated with enhanced reepithelialization and low infection rates, although their effectiveness has not yet been investigated in pediatric facial thermal injuries. This single-arm, retrospective cohort study assessed the characteristics of 23 children (≤17-year-old) with facial superficial partial-thickness burns and the wound closure capabilities of the applied zinc-hyaluronan gel. Patients were admitted consecutively to the Pediatric Surgery Division in Pécs, Hungary, between 1 January 2016 and 15 October 2021. The mean age of the children was 6.2 years; 30.4% of them were younger than 1 year. An average of 3% total body surface was injured in the facial region and 47.8% of the patients had other areas damaged as well, most frequently the left upper limb (30.4%). The mean time until complete reepithelialization was 7.9 days and the children spent 2 days in the hospital. Wound cultures revealed normal bacterial growth in all cases and follow-up examinations found no hypertrophic scarring. In conclusion, pediatric facial superficial partial-thickness burns are prevalent during infancy and coincide with left upper limb injuries. Rapid wound closure and low complication rates are accountable for the moderate amount of hospitalization. These benefits, along with the gel’s ease of applicability and spontaneous separation, are linked to child-friendly burn care.

The outcome of hypospadias surgery and it’s advanced treatment in Arifin Achmad General Hospital in January 2019 – December 2020

Introduction: Hypospadias, the most common congenital genital anomaly, is defined as the abnormal ventral opening of the urethral meatus extent from the proximal tip of the glans penis, penis rod, scrotum until perineum. The incidence of Hypospadias continued to increase from time to time. Urethroplasty and orthoplasty is the only possible treatment for Hypospadias until this time. Surgical reconstruction cannot always be done in one step, many cases need more than one reconstruction even though an experienced surgeon did it. This study aims to describe patients’ characteristics in Arifin Achmad General Hospital. Methods: This is a descriptive retrospective study using a total sampling method and carried out 28 hypospadias patients at Pediatric Surgery of Arifin Achmad General Hospital from January 2019 until December 2020. Data were analyzed descriptively to describe the patient’s characteristics including age, hypospadias type, frequency of surgery based on Hypospadias type, day of hospitalization based on surgical procedure, complication after surgery based on Hypospadias type, and advanced treatment for the complication. Results: From 28 patients with hypospadias, it could be concluded that the highest number of hypospadias patients found in the 0-5 years age group (50%) with the most common type was penoscrotal as many as 12 cases (43%). One stage procedure was predominant and attributed to 75% more than multistage procedure (25%). Chordectomy procedure got hospitalized for 3 days and multi procedure (cordectomy + urethroplasty + scrotoplasty) got hospitalized for 7 days. Fistula urethrocutaneous majority found in shaft penile type as a complication after surgery (78%) and had cutaneous fistula closure as an advanced treatment for the complication. From the 28 cases, 23 cases were successful without complication (82%) and 5 cases had fistula as a complication after surgery (18%). Conclusion: Hypospadias treatment in Pediatric Surgery division at Arifin Achmad General Hospital such as Characteristics of hypospadias patient and surgical outcome majority had satisfied outcome and advanced treatment for complication after surgery is fistula urethrocutaneous closure.

Quality of defecation in patients with anorectal malformation following posterior sagittal anorectoplasty (PSARP) in Arifin Achmad General Hospital of Riau Province, Indonesia

Background: Anorectal malformation is a congenital abnormality that shows imperfect anus or absence of anus. The most common complication in patients with anorectal malformations after posterior sagittal anorectoplasty (PSARP) are disorders in defecation, especially constipation. Method: The purpose of this study was to determine the correlation of quality of defecation measured with the presence of constipation with the type of PSARP surgery in Arifin Achmad Hospital of Riau Province. This study used an analytical retrospective method from November 2018 to March 2019. Total sampling was the sampling method used in this study, which accounted for a total of 28 subjects. The population of this study was all patients with anorectal malformation and fistula in the Pediatric Surgery Division of Arifin Achmad General Hospital. Result: This study showed that among 28 cases found, there were 19 female patients (68%) and 9 male patients (32%). Based on the lesion level, there were 17 cases (60,7%) of intermediate lesions and 11 cases (39,3%) of high lesions. In this study, rectovestibular fistula had the highest incidence among other types of fistula (53,6%). Constipation were found in 53.6% patients with p-value of 0.025 (OR 6.40, 95% CI 1.183-34.613). Conclusion: There was a significant correlation between the PSARP method and constipation in patients who underwent anorectal malformation surgery, which constipation was a sign of the quality of defecation.

Retrospective Analysis of Congenital Neonatal Intestinal Obstruction in a Tertiary Care Hospital in Bangladesh

Introduction: Patients with congenital neonatal intestinal obstruction are the main bulk of neonatal surgical departments. The incidence is approximately 1 in 1500-2000 live birth. Commonly caused by anorectal malformation (ARM), intestinal atresia, hirschsprungs disease (HD), meconium ileus, malrotation of gut, volvulus neonatorum, necrotizing enterocolitis (NEC) and rarely bands adhesion. These patients presented with vomiting, gradual abdominal distension and delayed or no passes of meconium. Usually, an abdominal radiograph is all that is necessary to make the diagnosis, since the gas pattern is distinctive and often will be a clue to the site of obstruction. The aim of the study is to detect the type of congenital neonatal intestinal obstruction, initial surgical approaches, and their outcome in our hospital. Materials and methods: This is a retrospective study conducted at the division of pediatric surgery in Bangladesh Shishu hospital &amp; institute, Dhaka, Bangladesh. The study period was 2 years from January 18 to December 19. All the neonates who underwent surgery for congenital neonatal intestinal obstruction were included. In this study only initial diagnosis, surgical procedure and outcome were included. Results: Our surgical department operated on a total of 246 neonates with congenital neonatal intestinal obstruction during this study period. Out of them, 139(56.50%) patients were male and 107 (43.50%) were female. The male-female ratio is 1.3:1. Gestational age was varied from 31 weeks to 40 weeks (Mean 36.2 weeks). Birth weight was from 1300 gm to 3800 gm (mean 2100gm). The most common cause of intestinal obstruction was ARM 72(29.27%), followed by hirschsprungs disease 53(21.54%), atresia 41(16.67%), meconium ileus 37(15.04%), malrotation of gut 28(11.38%) and other like bands adhesion, etc 15(6.09%). In case of atresia ileal atresia was common 16(39.02%) then jejunal 13(31.70%) and duodenal 9(21.95%). Only 3(7.31%) colonic atresia was found. ........