Department Of Pediatric Surgery Research Articles

Epidemiology, clinical features, and outcomes of intussusception in young children: A tertiary center experience

Abstract Background: Intussusception in young and old children is different. A study of clinical features, associations, and outcomes of these cases would enhance understanding to guide proper management. Objectives: Analysis of the epidemiology, associations, clinical features, and management outcomes of intussusception in children younger than 2 years. Patients and Methods: A retrospective descriptive study on intussusception patients younger than 2 years was conducted from January 2018 to December 2022 in the department of pediatric surgery at a tertiary center. Demographic details, clinical features, and management outcomes data were collected and analyzed. Results: A total of patients were 133 with mean, median, and modal age of 9.5, 7, and 6 months, respectively; the maximum incidence was in March. 81.95% of cases were idiopathic; important lead points were Meckel diverticulum, inflamed appendix, roundworm, cecal duplication, and intraluminal polyps. Two postoperative cases occurred in Wilms’ tumor and congenital diaphragmatic hernia patients, whereas two postrotavirus vaccination cases were seen. Ten (7.5%) had associated malrotation which necessitated Ladd’s procedure. Only 15 cases presenting early responded to nonoperative treatment (9/15 hydrostatic reduction and 6/15 conservative management); among late presenters, 12.71% had manual reduction, 68.64% had resection and anastomosis while in 16.95%, temporary stoma was needed. Wound infection, burst abdomen, subacute intestinal obstruction, recurrent intussusception, peristomal excoriation, and stomal prolapse were a few complications along with one death. Conclusion: Intussusception in children younger than 2 years is a heterogeneous group. Although mostly idiopathic, several associations and well-defined lead points require additional intervention. Early diagnosis and prompt intervention ensure a favorable outcome with fewer complications.

Evaluating Pediatric Appendicitis Score and Alvarado Scoring System for Detecting Acute Appendicitis in Pediatric Population

Abstract Background Acute appendicitis is the most common surgical condition of children. About 1 to 10% of children presenting in surgical emergencies with acute abdomen fall within the domain of acute appendicitis. In few of these cases, clinical signs and symptoms at presentation are such that acute appendicitis is a clear diagnosis while more often it is challenging for a surgeon to make a clinical diagnosis of acute appendicitis. In these circumstances, explorations reveal negative appendectomies and an organ with potential functions can be lost. Objective To evaluate the Pediatric Appendicitis Score and Alvarado Scoring System in Detecting Acute Appendicitis in Pediatric Population in terms of applicability, safety, and specificity in the diagnosis of Acute Appendicitis among the study group and to suggest improvements and/or modifications to increase the predictive values of Pediatric Appendicitis Score and Alvarado Scoring System, decrease the rates of false diagnosis or reduce costs. Methods a prospective cohort study that was conducted on 50 patients aged under 14 years admitted to pediatric surgery department in Ain Shams University Hospital within a period of 6 months with an expected diagnosis of Acute appendicitis. Each patient was subjected to a detailed medical history taking (with emphasis on The age, gender, duration of pain, complaint complaints ofabdominal pain and duration, fever, nausea-vomiting, diarrhea or constipation), Clinical examination:(right lower quadrant sensitivity,defense, rebound tenderness, percussion/ cough/ right lower quadrant sensitivity with jumping). Laboratory investigations:(complete blood count, the total white blood cell (WBC) and total neutrophil counts c-reactive protein ) and Ultrasound examination. Alvarado score as well as PAS were calculated for each patient . the results were then compared to the intra operative findings confirming or excluding the diagnosis of acute appendicitis. Results in the study group that was 38% males and 62% females with ages ranging from 3 to 14 years .Pediatric appendicitis score (PAS) was found to significantly predict acute appendicitis in the studied patients at cutoff 5.0 with sensitivity, specificity, PPV and NPV was 60.5%, 100%, 100% and 71.9% respectively (p < 0.001). Alvarado score can significantly predict acute appendicitis in the studied patients at cutoff 4.0 with sensitivity, specificity, PPV and NPV was 79.1%, 85.7%, 84.7% and 80.4% respectively (p < 0.001). Conclusion The results of this study showed the higher sensitivity of Alvarado score and more specificity of the Pediatric Appendicitis score. However, the sensitivity, specificity, PPV, and NPV of these criteria were not considered enough to confirm the diagnosis of acute appendicitis alone. There is a need for new parameters in the scoring systems. Such as including ultrasonagraphic findings and additional laboratory investigations such as CRP.

Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients

PurposeAbdominal wall closure in patients with giant omphalocele (GOC) and complicated gastroschisis (GS) remains to be a surgical challenge. To facilitate an early complete abdominal wall closure, we investigated the combination of a staged closure technique with continuous traction to the abdominal wall using a newly designed vertical traction device for newborns.MethodsFour tertiary pediatric surgery departments participated in the study between 04/2022 and 11/2023. In case primary organ reduction and abdominal wall closure were not amenable, patients underwent a traction-assisted abdominal wall closure applying fasciotens®Pediatric. Outcome parameters were time to closure, surgical complications, infections, and hernia formation.ResultsTen patients with GOC and 6 patients with GS were included. Complete fascial closure was achieved after a median time of 7 days (range 4–22) in GOC and 5 days (range 4–11) in GS. There were two cases of tear-outs of traction sutures and one skin suture line dehiscence after fascial closure. No surgical site infection or signs of abdominal compartment syndrome were seen. No ventral or umbilical hernia occurred after a median follow-up of 12 months (range 4–22).ConclusionTraction-assisted staged closure using fasciotens®Pediatric enabled an early tension-less fascial closure in GOC and GS in the newborn period.

Lifestyle Practices of Adolescents in a Tertiary Care Centre in India

Introduction: Adolescents are individuals in the 10–19year age group; there are 253 million adolescents in India. Growth and development are predominant during adolescence, a relatively healthy time. Good diet, physical activity, sleep, and screen time are pillars of good health. Aims & Objectives: To identify lifestyle practices such as diet, physical activity, sleep, and screen time among adolescents in the outpatient and inpatient services, Departments of Paediatrics and Paediatric Surgery, Christian Medical College, Vellore. Methods: A descriptive study design employing a non-probability purposive sampling technique was used to recruit 1420 adolescents. Written consent and assent were obtained, demographic and clinical variables were collected using interviews, and the lifestyle practice was assessed using a modified YRBS questionnaire. Results: 70.8% of the adolescents were in the age group of 10-14 years; males and females were almost equal (46.2 and 53.8%), 73.6% lived in nuclear families, and 19.4% had a BMI of 23 adult equivalent. Regarding diet in the past 7 days, 41.3% did not consume green/vegetable salads, and 89.7% of the adolescents ate breakfast daily, but the meals of 81.4% did not contain 25% carbohydrates. 42.2% did not meet the recommended 60 minutes of daily physical activity, and 51% were not a part of any sports team in the past year. Most (33.8%) of the adolescents slept for about 8 hours during the school days, but 68% reported difficulty falling asleep. Most participants (58.7% and 59.2%) stopped screentime just before sleep on weekdays and weekends. Conclusion: Adolescence is when lifestyle behaviours that affect present and future health begin. Therefore, helping adolescents establish healthy lifestyles and avoid developing health risk behaviours is crucial and should be started before these behaviours are firmly established. Keywords: Adolescents, Lifestyle, Diet, Physical Activity, Sleep, Screen time.

Comparison of different preoperative fasting times for pediatric elective surgical procedures: A randomized controlled trial.

To compare the mean residual gastric volume and gastric pH with standard and liberal fasting in children undergoing general anesthesia for elective procedures. A randomized controlled trial (NCT05922072) was conducted at Department of Pediatric Surgery, Mayo Hospital Lahore from June 2021 to December 2021 and 120 patients undergoing elective daycare surgical procedures under general anesthesia were enrolled. Patients were divided into Group-A (Standard fasting) and Group-B (Liberal fasting). Group-A with 6-, 4- and 2-hours Nil per oral (NPO) for solids/ formula milk, breast milk and clear fluid, while Group-B with six, four and one hour NPO for solids/ formula milk, breast milk and clear fluid respectively. Residual gastric volume and pH were measured after anesthetizing the patient. Effect modifiers like age, gender, duration of anesthesia and procedure were controlled through stratification. Post-stratification, t-test was applied and p-value less than 0.05 was taken as statistically significant. In Group-A, mean age was 6.1±4.5 years and 6.4±4.6 years in Group-B. Mean residual gastric volume with standard fasting was 0.67±0.48 ml and liberal fasting 0.80±0.44 ml (p value 0.13). Mean gastric fluid pH with standard fasting was 1.72±0.78 as compared to liberal fasting 1.63±0.70 (p value 0.53). Free fluid fasting allows for significantly shorter fasting times, though statistically insignificant higher residual gastric volume was recorded in liberal fasting group with a lower pH.

A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children.

Surgery remains the mainstay in treating intussusception in developing nations. A correspondingly high bowel resection rate exists despite a shift to nonoperative reduction in high-income countries. We aimed to study the clinical profile of the patients with intussusception presenting to our hospital and to assess the clinical and radiological predictors of success or failure of nonoperative management of intussusception. This prospective study was conducted in the Department of Pediatric Surgery over a period of 3 years and included a total of 118 patients who presenting to our emergency division with features suggestive of intussusception and were managed accordingly either with hydrostatic reduction or by surgical intervention. We observed that the majority of the patients were males (65.5%). The mean age was 13.54 months. Intermittent pain was the most common symptom. Both pain and vomiting did not affect the outcome. Lab parameters like raised total leukocyte counts (TLC), C-reactive protein (CRP) and lactate levels were significantly associated with failure of hydrostatic reduction. Patients with air fluid levels on X-ray were more likely to end up in surgery. Ultrasound findings of bowel wall edema, aperistaltic gut loops and a pathological lead point was associated with failure of hydrostatic reduction as well. The overall success rate of hydrostatic reduction was 85.5%. Hydrostatic reduction of intussusception is a safe and effective method of management of intussusception whenever indicated. Factors that might reduce the chance of its success include continuous pain, irritability, tenderness, deranged lab parameters like TLC, CRP and lactate levels, air fluid levels on X-ray, bowel wall edema, aperistalsis and the presence of a lead point. Shah JY, Banday I, Hamdani HZ, et al. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepato-Gastroenterol 2024;14(1):81-85.

Pathology of the urachus in children

Introduction: Urachal malformations, arising from incomplete obliteration of the urachus during fetal development, are rare conditions predominantly seen in children. They present various clinical challenges due to their potential for infection and malignant transformation. Objective: This study aims to report on the epidemiological, diagnostic, and therapeutic aspects of urachal malformations in a pediatric population. Patients and methods: A retrospective study was conducted in the pediatric visceral surgery department of the Hassan II University Hospital of Fez over a period of 7 years (2014-2021), involving 10 cases of urachal pathology. Clinical presentations, radiological findings, treatment approaches, and outcomes were analyzed. Results: The patients ages ranged from 1 to 15 years, with an equal gender distribution. The most common clinical presentation was umbilical discharge. Abdominal ultrasound was the primary diagnostic tool, supplemented by CT scans in six cases. Surgical treatment, typically involving midline sub-umbilical or peri-umbilical approaches, was performed in all cases, revealing 7 cysts, 2 fistulas, and 1 sinus. Postoperative outcomes were generally favorable, with an average hospital stay of 12 days. However, there was one recurrence and one wound infection. The mean follow-up period was 2.5 years. Conclusion: Early diagnosis and appropriate surgical intervention are crucial for managing urachal malformations in children. Radiological imaging, particularly ultrasound, plays a vital role in diagnosis. While surgical excision of the urachus, including the bladder dome collar, is the preferred treatment to prevent recurrence and potential malignancy, careful follow-up is necessary to monitor for complications. Further studies are recommended to refine treatment protocols and improve patient outcomes.

Cloacal malformations in the pediatric surgery department of Fez

Introduction: Cloacal malformations, which exclusively occur in females. These anomalies are rare. The immediate prognosis depends mainly on the severity of the associated malformations and relies on the quality of the surgical repair. Patients and methods: This is a retrospective descriptive study of 5 patients managed in the pediatric surgery department of the Hassan II University Hospital of Fez, during a 13-year period from January 2008 to January 2021. Results: The diagnosis is made postnatally following systematic clinical examination in the delivery room, with only one case presenting with intestinal obstruction. The malformative assessment revealed: One case with cardiopathy, abnormal renal ultrasound findings in 3 cases (predominantly uretero-pyelocaliceal dilation), and spinal anomaly found in 2 cases, and abnormal MRI findings in 3 cases, while not performed in 2 cases. Four contrast studies were performed after colostomy, revealing 2 rectovesical fistulas and 2 bilateral VUR (vesicoureteral reflux). Immediate postoperative course was uneventful, with no dehiscence, stenosis, or obstruction noted. One patient died due to cardiac decompensation at 3 months of age. Long-term evolution was characterized by the presence of anal incontinence. Conclusion: Cloacal malformation is a serious pathology, it can frequently lead to functional and vital prognosis without forgetting the psychological one. The prognosis depends mainly on the quality of management and the presence of associated malformations.

The Tuberculous Synovitis of the Elbow: A Misunderstood Entity

We present the case of a 7-year-old child with a history of tuberculosis exposure, admitted to the pediatric surgery department due to a chronic swelling of the right elbow persisting for 3 years. Despite being afebrile, the patient experienced unspecified weight loss. Clinical examination revealed a painful fluctuating swelling of the right elbow, limited flexion, and a 12-degree valgus deformity of the ulna. Laboratory tests showed an elevated CRP level indicative of an inflammatory process. Standard radiographs exhibited soft tissue hypertrophy without bone lesions. MRI demonstrated synovial hypertrophy of the right elbow joint with adjacent bone marrow infiltration and deformation of the distal humerus. Biopsy revealed nonspecific chronic synovitis. Surgical removal of the synovial mass was performed, and histopathological examination revealed features suggestive of tuberculosis. Extension studies for tuberculosis were negative. The patient was treated with antituberculous therapy and physiotherapy, leading to the regression of symptoms. This case highlights the diagnostic utility of MRI in detecting synovial hypertrophy and bone marrow infiltration in cases of chronic elbow swelling, especially in the context of tuberculosis exposure.

Primary Mesenteric Hydatid Cyst in Pediatric Patients: Case Report and Literature Review

Mesenteric hydatid cyst in children is not common, even in endemic areas. The primary or secondary origin of this site, especially in children, remains controversial. Secondary peritoneal hydatid cyst mainly results from spontaneous or traumatic rupture of concurrent liver cysts or leakage of cystic contents during surgery. The aim of our study is to present a mesenteric hydatid cyst in children. Our study focuses on a single case of a child with peritoneal hydatid cyst, who underwent surgery in 2021 in the pediatric surgery department of the Mohammed VI hospital in Marrakech. The diagnosis is based on abdominal ultrasound, computed tomography and hydatidosis serology. The treatment is surgical by open or laparoscopic excision, which can be associated with medical treatment.

Umbilical keratinous cyst in a 7-year-old girl: A case report

Keratinous cysts, the most common kind of epidermal cysts, are filled with keratin originating from the epidermis, most often from the hair follicle. Keratinous cyst is one of the most common skin lesions and occurs most commonly in the face, head, trunk, extremities, and genitals. A 7-year-old girl reported to the pediatric surgery department with a painless, small tumor arising from her umbilicus. There was no history of trauma, and it has been slowly growing for the past many years. Clinical examination revealed a 3-cm-long skin tag with three small interconnected tumors from the umbilicus. It was soft, and the parts of the tumors looked like they contained whitish material inside. Her general and other systems, including the abdominal examinations, were within the normal limits. The tumor was resected through a sub-umbilical skin incision. She made an uninterrupted recovery. The excised specimens subjected to histology were reported as superficial keratinous cysts. Keratinous cysts are one of the most common benign skin lesions, but not the most common, at the umbilicus. Clinicians need to be aware of such pathology during the evaluation of the umbilical swellings and tumors, especially in children.

Use of Ultrasound in Pediatric Caudal Anesthesia: A Randomized Comparative Study

Objective: The aim of this comparative study was to evaluate the efficacy and safety of ultrasound-guided caudal anesthesia compared to blind caudal anesthesia for subumbilical surgery in pediatric patients. Methods: This prospective study included pediatric patients undergoing subumbilical surgery in the Department of Pediatric Surgery. Patients were divided into two groups: the ultrasound-guided caudal anesthesia group and the blind caudal anesthesia group. Primary outcomes assessed included the success rate of block placement, onset and duration of sensory and motor blockade, analgesic requirements, and perioperative complications. Results: A total of 40 patients were included in the study, with 20 patients in the ultrasound-guided group and 20 patients in the blind group. The success rate of block placement was significantly higher in the ultrasound-guided group compared to the blind group (p < 0.001). The ultrasound-guided group also demonstrated faster onset of sensory and motor blockade (p < 0.05) and longer duration of analgesia (p < 0.05) compared to the blind group. Postoperative analgesic requirements were significantly lower in the ultrasound-guided group (p < 0.001). No significant differences in perioperative complications were observed between the two groups. Conclusion: Ultrasound-guided caudal anesthesia was found to be more effective and reliable than blind caudal anesthesia for subumbilical surgery in pediatric patients. It provided a higher success rate of block placement, faster onset and longer duration of sensory and motor blockade, reduced postoperative analgesic requirements, and comparable safety profile. Ultrasound guidance should be considered as the preferred technique for caudal anesthesia in this patient population.

Comparison of Outcome of SAC Ligation Versus No SAC Ligation in Pediatric Patients Undergoing Inguinal Orchidopexy for Incompletely Descended Palpable Testes: A Randomized Control Trial

Background and Objective: The case of undescended Testis (UDT) is one of the most common condition presented to a pediatric surgeon. The standard procedure to rectify UDT is known as Orchidopexy. The main objective of this study is to examine and compare the results of orchidopexy surgeries conducted with or without sac ligation in palpable undescended testis of pediatric patients.Methods: This randomized controlled trial was done over a period of 12 months (July 2018 to July 2019) atthe Department of Pediatric Surgery, Children's Hospital & Institute of Child Health, Lahore. The selection of cases was made dependent upon fulfillment of departmental criteria and approval by ethical review committee. Consequently, 280 cases divided into two equal groups i.e. Group-A and Group-B (140 cases in each group) were shortlisted for the study after detailed scrutiny. The allotment of patient to above mentioned groups was randomized by lottery method. The patients in Group-A underwent orchidopexy with ligation of sac while the patients of Group-B were operated without sac ligated. The surgeries were performed under general anesthesia by consultant surgeons of same caliber and competence. Moreover, in order to quantify and analyze the results of surgeries parameters such as Mean Operative Time, Postoperative Manifestations and recurrence of UDT were recorded on proforma. Subsequently, SPSS version 25 statistical software was utilized for calculating the mean and standard deviation of numerical variables such as age and operative time. Additionally, the frequency and percentage of variables such as recurrent UDT were also calculated. Chi-square test was applied to recurrent UDT and development of inguinal hernia. It is highlighted that P-value ≤0.05 was taken as significant.Results: Among 140 patients of sac ligation group, 40.7% were 1-4 years old and among 140 patients of nosac ligation group, 42.9% were 1-4 years old. In sac ligation group, 60.0% patients had right undescended testis while in no sac ligation group, 67.1% patients had right undescended testis. In sac ligation group, the mean operative time was 37.81 + 8.82 minutes while in non-sac ligation group; the mean operative time was24.34 + 4.12 minutes. In sac ligation group, no patient had post-operative hernia while in non-sac ligation group, 1.4% patients had post-operative hernia (p=0.15). In sac ligation group, 1.4% patients had recurrent UDT while in non-sac ligation group, 2.1% patients had recurrence. (p= 0.65)Conclusion: Study concluded that non-sac ligation technique is more effective than sac ligation technique interms of operative time and should be preferred for patients by surgeons.Keywords: Orchidopexy, undescended testes, testicular atrophy, inguinal hernia, recurrence

Responding to the need: An evaluation of the subspecialty units in a pediatric surgical department in a limited resource setting using selected optimal resources for children's surgery strategies.

The Global Initiative for Children's Surgery group published the Optimal Resources for Children's Surgery (OReCS) document outlining the essential criteria and strategies for children's surgical care in low-resource settings. Limited data exist on subspecialties in pediatric surgery and their contribution to global surgery efforts. The study aimed to evaluate the development of subspecialty units within Chris Hani Baragwanath Academic Hospital (CHBAH) Department of Pediatric Surgery (DPS) from January 1, 2018 to December 31, 2021 using selected OReCS strategies for the improvement of pediatric surgery. A retrospective descriptive research design was followed. The study population consisted of CHBAH PSD records. The following data were collected: number of patients managed in PSD subspecialty unit (the units) clinics and surgeries performed, number of trainees, available structures, processes and outcome data, and research output. Of the 17,249 patients seen in the units' outpatient clinics, 8275 (47.9%) burns, 6443 (37.3%) colorectal, and 2531 (14.6%) urology. The number of surgeries performed were 3205, of which 1306 (40.7%) were burns, 644 (20.1%) colorectal, 483 (15.1%) urology, 341 (10.6%) hepatobiliary, and 431 (12.8%) oncology. Of the 16 selected strategies evaluated across the 5 units, 94% were available, of which 16.4% was partly provided by Surgeons for Little Lives. Outcome data in the form of morbidity and mortality reviews for all the units is available, but there is no data for timeliness of care with waiting lists. There were 77 publications and 41 congress presentations. The subspecialty units respond to the global surgical need by meeting most selected OReCS resources in the clinical service provided.

Safety and Feasibility of Enhanced Recovery after Surgery in Pediatric Colostomy Closure.

To study the safety and feasibility of enhanced recovery after surgery (ERAS) protocol in pediatric colostomy closure. Retrospective observational study of children who underwent colostomy closure. Data were collected from the electronic medical records and telephonic follow-up calls of patients from October 2013 to October 2023, in the Department of Pediatric Surgery of a Tertiary level Medical College. The parameters obtained were age, gender, type of stoma, primary diagnosis, discrepancy in luminal diameters, time to reach full feeds, postoperative hospital stay, and complications. The protocol followed for colostomy closure included the following-no bowel preparation or nasogastric tube, no overnight fasting, single dose of antibiotic prophylaxis, avoiding opioids, packing proximal stoma till mobilization and starting early oral feeds postoperatively. The continuous parameters were expressed as mean ± standard deviation or median (range) while the descriptive parameters were expressed as number and percentage. A total of 90 patients were included in the study. Most of the patients had colostomy for anorectal malformation. Five of them had significant luminal discrepancy of 4 or more times. Full feeds were reached within 2 days in 79 patients. Postoperative hospital stay was 2-3 days in 62 patients. Six patients stayed for more than 5 days, due to complications requiring further management. We noted surgical site infection in 6 patients all of whom were managed with regular wound dressings and fecal fistula in 4 cases, two of which resolved spontaneously. ERAS protocol in colostomy closure reduces the hospital stay and is cost effective, with early recovery and no added complications.

Tamarind Seeds in Tracheobronchial Tree: Challenges during Rigid Bronchoscopy.

Tamarind seed aspiration is not frequent in children and is usually observed in kids from rural backgrounds, with easy access to tamarind fruits and their by-products. We report a retrospective review of five patients managed in the pediatric surgery department for tamarind seed aspiration into the tracheobronchial tree. The data were analyzed based on age, clinical presentation, bronchoscopic observations, and the challenges faced during the rigid bronchoscopic retrieval and postoperative course. There were four boys and one girl with a median age of 10 years. High-resolution computed tomography thorax was done in all patients. The foreign body was identified in the right main bronchus in one and the left main bronchus in four patients. All five patients underwent rigid bronchoscopy and retrieval of the seed. Two patients had an early presentation (within a week) - they needed temporary tracheotomy as the swollen seed could not be negotiated through the narrow glottis. Two patients had a late presentation (around 15 days) - they required removal in piecemeal using crushing forceps and multiple insertions of bronchoscope prolonging surgical time. One patient presented at 22 days posttamarind aspiration. It was soft enough for easy disintegration with crocodile forceps and expeditiously removed in three to four pieces. All patients recovered uneventfully. Removal of tamarind seed foreign body from the tracheobronchial tree is challenging. Anticipating the difficulties and being prepared well, helps to reduce the intraoperative difficulty, and allow successful removal with favorable patient outcomes.

Management of paediatric surgical patients during the COVID-19 pandemic: Our challenges

Purpose: Here we describe the challenges and procedures adopted to ensure safe paediatric surgery services during the COVID-19 pandemic at the paediatric surgery department in non-Covid-19 wing of Dhaka Medical College Hospital-1. Materials and Methods: Design: Retrospective study. Setting: Department of paediatric surgery in non-Covid- 19 wing of Dhaka Medical CollegeHospital-1, a tertiary care academic medical center in Dhaka, Bangladesh. Participants and duration: All patients who were admitted in the department of paediatric surgery in Dhaka Medical College Hospital-1 from March 1 through June 30, 2020. Methods: We identified patients with or without a rRTSARS- CoV-2 PCR receiving care at the department of paediatric surgery. The healthcare professionals were trained to clean, disinfect, use of PPEs, and other wastes were disposed of as per waste management protocols. Data collection & analysis: Patient data were manually abstracted from the medical record for evaluation. Responses were analysed using Microsoft Excels & SPSS, and presented as categorical data and percentages. Main outcome measures: We describe patient characteristics including demographics, presenting symptoms, type of treatment (Surgery vs Non Surgery), outcomes (morbidity & mortality), hospital stay, and distance travelled for treatment. Results: A total of 320 paediatric surgical patients were included in this study, among all patients about 66.87% patients were male child and 79.06% patients required surgeries. There were 5 patients with confirmed COVID- 19, who were transferred to the Covid-Surgical unit. During this period, there were 4 (1.25%) children who died due to non-COVID related causes. In surgical group only 24(7.5%) patients developed postoperative complications. Length of hospital stay of 44 (13.75%) of non-surgical patients were less than 72 hours, whereas 141 (40.06%) of surgical patients were more than 72 hours. Majority of patients of both groups travelled more than 100 km distance for treatment. Conclusions: This corona crisis has provided an opening for rational health care and formulating global policies. So that in future such pandemics can be tackled more carefully and consistently with advancing knowledge and better preparation. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 15-21

Histopathological study of the fertility components of undescended testes in boys of different age group

Background: Undescended testes presents the most common male developmental abnormalities, with infertility frequently observed in unilateral as well as bilateral forms. In that study, we evaluated the histological parameters of Undescended testes based on patient’s age and we recommended for the optimal timing for orchiopexy. Objective: To evaluate the histological parameters of undescended testis and determine the optimal timing for orchiopexy. Methods and Materials: This cross-sectional study included 30 patients with undescended testis(es) in the department of paediatric surgery, BSMMU. After taking relevant history, examination findings and investigation reports of all the study subjects were recorded in the pretested data collection sheet. Then biopsy specimens were collected from the selected testes during orchiopexy and analyzed the parameters including mean tubular diameter (MTD), mean tubular fertility index (MTFI) germ cell count (GCC), Sertoli cell index (SCI) and interstitial fibrosis index (IFI) Results: The MTFI and GCC in children <1 years of age were significantly higher than those of other older age group. (P= 0.011 & P= 0.003) The MTFI, GCC and IFI were significantly better in patients <2 years of age when compared to those of > 2years. IFI in the > 5-years group was significantly higher than those of any of the other younger age groups (P < 0.05). Other parameters such as testicular volume, MTD and SCI showed no statistically significant difference between the age groups studied. Conclusions: This study revealed that higher number of germ cells exists in the tubules between 6 months and 1 year. After first year of life, the major germ cell parameters deteriorate continuously, thus we recommended that orchipexy should be performed, between 6 months and 1 year but no later than 2 years for preserving future fertility. Journal of Paediatric Surgeons of Bangladesh (2019) Vol.10 (1 & 2): 26-31

Result of simple versus layered repair of urethro-cutaneous fistula developing after hypospadias surgery

Background: Urethro-cutaneous fistula (UCF) after hypospadias surgery occurs regardless of the location of the meatus, procedure performed or experience of the surgeon. Hypospadias repair continues to be a singularly demanding form of surgical expression with considerable artistic latitude. The commonest complication of hypospadias surgery is fistula formation, which almost always requires repeat and similarly demanding surgery. Aims and Objectives: The aim of our study was to compare the result between simple and layered repair of UCF developing after hypospadias surgery. Materials and Methods: This comparative type of study was carried out in the Department of Paediatric Surgery, BSMMU, Dhaka from June 2015 to August 2016 for a period of 15 (fifteen) months. Forty (40) diagnosed cases of UCF were included in the study. All the participants were randomized into two groups named Group A & Group B. Group A was assigned to the simple repair technique & Group B was assigned to the layered repair technique. Relevant data were collected in a predesigned questionnaire. Results: The recurrent fistula formation rate was much higher in Group A (30%) than in Group B (05%), which was statistically significant in between the two groups. The majority of the fistulae recurred within a few days of the removal of the stent (from 7th to 10th POD). 6, out of 7 recurrent UCF were observed in this period. No recurrent fistula was observed beyond 4 weeks after operation. Conclusions: This study revealed that, the layered repair technique, with the addition of vascularized dorsal dartos fascia reduces the recurrent fistula formation rate in a significant number. Though more time consuming and technically difficult, we recommend wide application of layered repair technique in the management of post hypospadias UCF. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 37-42

Safety and advantages of early oral feeding after intestinal anastomosis in children: Our experience

Background: Restoration of enteral feeding is believed to enhance recovery after surgery, but intestinal anastomosis is a matter of apprehension for surgeons to start enteral feeding early. Before 2022, our standard practice was to wait three to four days to begin oral feeding after intestinal anastomosis. Since 2022, we have allowed oral feeding to start within 24 hours of intestinal anastomosis. This study compares the safety and benefits of early oral feeding after intestinal anastomosis in children. Methods: This retrospective study was done in the neonatal and paediatric surgery department, BSH&I, from January 2021 to December 2022. Children who received early oral feeding in 2022 compared with children who received oral feeding after three days in 2021. Children with duodenal anastomosis and anastomosis with a covering stoma were excluded. Demographic and clinical data were extracted from hospital records using a predefined questionnaire. Data were analyzed in SPSS 26, and a p-value <0.05 was considered significant. Results: One hundred thirty-three children (90 in 2022 and 43 in 2021) underwent intestinal anastomosis. Fiftynine (44.4%) children had small gut anastomosis, 62 (46.6%) children had large gut anastomosis, and 12 (9%) children had ileocolic anastomosis. There was no difference in gender and mean age at the surgery between the two groups. The mean time to start oral feeding was 19.9±0.59 hours in the case group and 79.1±13.9 hours in the control group (p<0.001). The mean time to full oral feeding was 61.05±4.5 hours in the case group and 125.67±25.51 hours in the control group (p<0.001). The mean hospital stay was 4.16±1.18 days in the case group and 7.06±1.96 days in the control group (p<0.001). The two groups had no significant differences in anastomotic and wound complications. Conclusion: Early oral feeding after intestinal anastomosis is safe in children and reduces postoperative hospital stay without any added risk. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 22-25