Pediatric Surgery Unit Research Articles

Acute appendicitis in children: A series of 75 cases in the pediatric surgery unit in the general surgery department at Ignace Deen National Hospital

Introduction: Acute appendicitis is an acute inflammation of the vermicular appendix. The objective of this study was to describe the clinical and therapeutic aspects of acute appendicitis in children in the pediatric surgery unit in the general surgery department. Material and methods: This was a descriptive prospective study lasting one year from January 1, 2022 to December 31, 2022 carried out in the pediatric surgery unit in the general surgery department at the hospital. National Ignatius Deen. Results: We collected 75 cases, i.e. a frequency of 37.5% compared to all the digestive surgical pathologies operated on. The most affected age group was 11-15 years or 46.66%. The female sex was predominant at 60% with a sex ratio of 0.78. Abdominal pain localized to the FID was observed in all patients, i.e. 100%. The treatment was essentially surgical under general anesthesia with the main approach: an incision at the Mac Burney point. The latero-caecal position was the most observed at 76%. The postoperative course was simple in 86.67% of patients and complicated in 13.33% of patients. Conclusion: Acute appendicitis is a frequent reason for consultation in the pediatric surgery unit.

Is cystourethroscopy a crucial preoperative step in severe and complex types of hypospadias?

Proximal hypospadias is considered the most severe subtype of the hypospadias spectrum and represents approximately one-fifth of the total cases. It is well-evidenced by many studies that the rate of postoperative complications following the repair of this complex subtype is significantly higher when compared to the distal variants. Few reports described the proximal hypospadias from the other perspective which is the preoperative one. Most pediatric surgeons notice an unexplained incidence of lower urinary tract infection and occasional difficulty of urinary catheterization in those children. This sometimes requires the use of additional measures such as the use of urethral sounds, filiforms and followers, and even catheterization under anesthesia. The aim of the work is to evaluate the role of preoperative cystourethroscopy in detecting associated anomalies in cases of proximal and severe hypospadias. This prospective study was conducted in the pediatric surgery unit at Alexandria Faculty of Medicine between July 2020 and December 2021 and included all children with severe grades of hypospadias. After thorough evaluation, all children underwent cystourethroscopy just before the procedure. Any abnormalities in the urethra, urinary bladder, or ureteric openings were recorded if present. Finally, the definitive operation was performed as per schedule. Fifty-two patients (41 fresh and 11 redo patients) with a median (range) age at presentation of 5 (1-16) years were enrolled in this study. The intraoperative cystourethroscopy was done in all of the patients. Significant abnormal findings were recorded in 32 patients (61.5%), while the other 20 patients (38.5%) were revealed to be normal. The most common abnormal findings were dilated prostatic utricle opening and hypertrophied verumontanum (in 23 and 16 cases, respectively). Although most of the associated anomalies with proximal hypospadias are asymptomatic, cystourethroscopy is better used owing to a high incidence of these anomalies. This can facilitate an early diagnosis as well as early detection and intervention at the time of repair.

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation.

Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years. The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test. Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.

Needlescopic Primary Paediatric Inguinal Hernia Repair By Hernia Sac Disconnection And Peritoneal Closure.

To evaluate the short-term outcome of the needlescopic hernia sac disconnection and peritoneal closure in the treatment of primary paediatric inguinal hernia. The prospective study was conducted from April 2019 to April 2021 at the Paediatric Surgery Unit of the General Surgery Department at Kafrelsheikh University Hospital, Egypt, and comprised patients aged 6-144 months having uncomplicated paediatric inguinal hernia. The patients were subjected to needlescopic hernia sac disconnection and peritoneal closure. The follow-up protocol included outpatient visits at 1 week and at 1, 3 and 6 months postoperatively to check for recurrence and other complications. Data was analysed using SPSS 24. Of the 50 patients with 65 hernias, 37(74%) were males and 13(26%) were females. The overall mean age was 50.78± 31.74 months (range: 9-120 months) and mean internal ring diameter was 11.90±3.518mm (range: 8-20mm). The mean operative time was 20.66±2.94 minutesfor unilateral cases and 30.60±5.15 minutesfor bilateral cases. There was no conversion to conventional laparoscopy or to open herniotomy. All cases were followed up for a mean of 11.56± 3.99 months. No recurrence was encountered in any case and the scars were invisible in 40(80%) cases 6 months postoperatively. Needlescopic hernia sac disconnection and peritoneal closure wasfound to be feasible,safe and effective in the treatment of primary paediatric inguinal hernia.

Adnex Torsion Complicating A Dermoid Cyst of the Ovarian Girl: Apropos of 2 Cases in the Pediatric Surgery Unit of the Hospital in Mali

Adnexal torsion is a spontaneous rotation of the ovary and sometimes the fallopian tube around its axis which can interfere with arterial supply and lead to ischemia It is a rare complication of an ovarian cyst, which can occur at any age, from the fetal period to adulthood. The mature cystic teratoma accounts for 20% of all ovarian tumors and is seen especially in young girls and therefore is most often benign. It's a surgical emergency. We report here two cases of adnexal torsion operated at the level of the pediatric surgery unit of the Hospital of Mali The two girls are 14 and 13 years old, nulligest and normoregulated with recurrent abdominal pain admitted for acute pelvic pain. On palpation, an abdomino-pelvic mass of a firm and painful consistency is noted. An abdominopelvic ultrasound was performed in both cases and revealed torsion of the left adnexa on the left ovarian cyst in the first and on the right in the second. The surgical procedure performed was manual detorsion and cystectomy in both cases. The anatomopathological examination concluded with a dermoid cyst In the two girls and their postoperative course was simple.

Does Testosterone Advance the Meatus in Children with Proximal Hypospadias?

Background: Pre-operative preparation of the children with hypospadias may involve the administration of testosterone to argument penile dimensions. However, the effect of testosterone on the urethral meatus is not established. The aim of this study was to prospectively evaluate the effect of testosterone on the location of the hypospadiac meatus. Materials and Methods: This was a prospective observational study of children, aged 15 years and younger, who are being prepared for hypospadias repair at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were analyzed: age of the patients at presentation, type of hypospadias, proximal and distal penile measurements at onset and at 4 weeks after testosterone injection. Results: A total of 24 cases of proximal hypospadias were recruited into the study. The ages of the patients at presentation ranged from 1 month to 18 months with a median age of 3 months. Majority of the patients had mid-penile hypospadias. Regarding response to testosterone, proximal part of the penile shaft responded more than the distal part. However, statistical analysis showed no advancement in the location of the meatus. Conclusion: This is study has shown that a single dose of testosterone has no effect on the location of meatus in children with hypospadias.

Posterior Urethral Valves in the Pediatric Surgery Unit of the Mali Hospital

Posterior urethral valves (UPVs) are congenital obstructive membranous folds that represent the main cause of bilateral renal obstruction and dysuria in children and infants. The seriousness of this malformative uropathy lies in the importance of its impact on the upper urinary tract with a significant risk of end-stage renal failure. The objective of this work is to report our experience on the management of this pathology, for this we carried out a retrospective and descriptive study over a period of 5 years, from January 2018 to December 2022, including all hospitalized patients or seen in consultation at the pediatric surgery unit of Hôpital du Mal. The parameters studied were demographic, clinical, radiological and therapeutic variables. We collected 10 patients, an average of 2 patients per year and a frequency of 0.38%. The infant age group was the most represented, i.e. 80% of cases. The average age of our patients was 9.1 months with extremes of 2 days and 48 months. The most common reason for consultation was dysuria with 60% of cases. Overflow urination was the most frequent functional sign. Fever was present in 90% of cases. Abdominal distension was present in nearly half of our patients and acute urinary retention in 30% of cases. All our patients underwent cytobacteriological examination of urine. It was positive in 4 patients, i.e. 40% of cases. THE. Coli was the majority germ. All our patients performed retrograde urethrocystography (UCR) and objectified a dilation of the posterior urethra in all patients. Surgical treatment concerned all our patients. The FOGARTHY technique was used in 9 patients and a vesicostomy was performed in one patient. In the immediate therapeutic follow-up, 1 patient died in intensive care, 3 patients presented with sepsis, one of whom subsequently died. After an 8-month follow-up, the consequences are simple in all our patients.

A Descriptive Study to Assess Level of Stress, Anxiety, and Pain Among Hospitalized Children Admitted in the Pediatric Surgery Unit of APC, PGIMER, Chandigarh 2020−2022

Background Hospitalization is stressful for children. Hospitalized children suffer from stress due to the negative change in their life. Children facing medical procedures often experience pain and anxiety. Physical, psychological, social, cultural, and environmental factors all influence child behavior, which is especially challenging for children as compared to adults. Both pharmacological and non-pharmacological approaches can be used to manage distress among children. There are several ways to reduce stress, anxiety, and pain among hospitalized children. Puzzles, books, comics, crossword, video games, televisions, toys, phone, and so on. all are effective ways through which child can be engaged. Aim To assess the level of stress, anxiety, and pain among hospitalized children admitted in the Pediatric Surgery Unit, APC, PGIMER, Chandigarh, India. Methods A descriptive study was conducted on 60 hospitalized children. Purposive sampling was used to recruit the sample. The data were collected through interview schedule consisting of socio-demographic profile, clinical profile, and questionnaire on stress, anxiety and pain. Results The findings of the study revealed that all the children were having moderate stress, whereas majority of the children (91.7%) were having moderate anxiety, and only 8.3% of the children were having severe anxiety. During the assessment it was also found that almost 55% were having pain score 4, that is, Hurts little bit as assessed by Wong baker face pain scale. Conclusion Children who were being hospitalized were having varied degrees of stress, anxiety, and pain. Therefore, some diversional therapy should be planned to reduce their distress.

Resolution of Free Air in the Peritoneal cavity after Laparotomy for Bowel Perforation in Children: How Long Does It Take?

Background: Preoperatively, the presence of free air in the peritoneal cavity (pneumoperitoneum) is indicative of a gastrointestinal perforation and laparotomy exposes the peritoneal cavity and bowel to atmospheric air. The aim of this study was to evaluate how long (in days) it takes for free air in the peritoneal cavity to disappear following laparotomy in children. Materials and Methods: This was a prospective study of children aged 15 years and younger who had laparotomy for bowel perforation at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The patients were followed up postoperatively to evaluate which day post op the free air in the peritoneal cavity resolves. Results: A total of 112 cases of perforated bowel had laparotomy during the study period. Amongst this number, 37 (33%) patients showed pneumoperitoneum on their preoperative radiographs and form the basis of this report. There was male predominance. Abdominal pain is a consistent symptom in all the patients. Majority of the patients had typhoid intestinal perforation with single ileal perforation and primary intestinal repair was the most performed procedure. Wound infection was the most common post-operative complication and the general outcome was fair. Overall, the mean time for the pneumoperitoneum to disappear was 5.5 days postoperatively. Conclusion: Bowel perforation results mostly from infective/inflammatory processes such as typhoid intestinal perforation. Laparotomy is required for the repair of these perforations and its takes an average of 5.5 days for the free peritoneal air to resolve.

Factors associated with clinically apparent congenital urethra anomalies among pediatric patients attending Muhimbili National Hospital, Dar Es Salaam, Tanzania

BackgroundDespite the clinically apparent congenital urethra anomalies being one of the common causes of admission in pediatric urology, yet little is known about its associated factors, especially in third world countries. Understanding associated factors of clinically apparent congenital urethra anomalies is important in prevention and in genetic counseling that may help in reducing the incidence of their occurrence.MethodsHospital-based cross-sectional prospective study conducted among pediatric patients admitted to pediatric surgery unit at Muhimbili National Hospital from July 2021 to March 2022. Socio-demographic and clinical characteristics were collected from participant’s parent or guardian. Patients were examined thoroughly for clinically apparent congenital urethra anomalies and associated genital-urinary tract anomalies. Analysis was done using SPPS version 23 with descriptive statistics for categorical variables and univariate and multivariate logistic regression for association between presence of clinically apparent urethra anomaly and associated factors at 95% CI. A p-value of < 5 was considered statistically significant.ResultsOverall proportion of clinically apparent urethra anomaly was 24.4% (94 out of 386) with hypospadias being the commonest anomaly (23.6%); others were epispadias in 2 patients (0.5%) and bladder exstrophy in one patient (0.3%). Among hypospadias cases, sub-coronal (37.4%) and mid-shaft (29.6%) were the most prevalent. About 9.6% had associated anomalies cryptorchidism being the commonest in 8 (8.5%) patients. There was no any factor that was independently associated with development of clinically apparent congenital urethra anomalies. However, folic acid supplementation, maternal hypertension, environmental exposure to pesticides and familial history of congenital urethra anomalies were related to higher proportion of the anomalies despite no any significant relationship detected.ConclusionHypospadias is the commonest clinically apparent congenital urethra anomalies with cryptorchidism being the most prevalent associated genital-urinary tract anomaly. No associated factor has shown significant relationship with clinically apparent congenital urethra anomalies; however, attention is called to maternal hypertension, environmental exposure, especially pesticides and familial history of congenital urethra anomalies for detailed study. Proper examination of newborns is encouraged for early detection of such anomalies and hence planning for early intervention.

Pediatric Stomas: A Study in a Teaching Hospital, Our Experience

Background: A stoma is a purposeful surgical connection of a segment of a hollow viscus (intestine, ureter) to the anterior abdominal wall and can be a life-saving procedure. The aim of this study was to evaluate our experience in respect of stomas (ileostomies, colostomies, ureterostomies) performed in children. Materials and Methods: This was a retrospective study of children who had stoma created at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Children who had intestinal or urinary tract stomas were included in the study and covered a 10-year period. The information analyzed included the patients’ age, gender, diagnosis, indications for the stoma creation, type of stoma (colostomy, ileostomy and ureterostomy), post-operative complications and treatment outcome. Results: A total of 112 stomas were created in children during the 10-year study period. There were 80 (71.4%) males and 32 (28.6%) females. Hirschsprung’s disease and typhoid intestinal perforation were the first and second most common indications for stoma creation. Colostomy creation and peristomal skin excoriations were the most performed stoma and most common post-operative complication respectively. Eleven (9.8%) patients expired due to respiratory failure and uncontrollable sepsis. Conclusion: Stoma creation may form an essential component for the treatment of surgical conditions in children and it can be life-saving. Stomas can be created for disorders of the intestinal and urinary tracts. There may be stoma complications accounting for morbidity experienced in these patients.

EFFECT OF CHLORHEXIDINE SCRUB ON SURGICAL SITE INFECTION - A HOSPITAL BASED RANDOMIZED STUDY

Background: In this study, we wanted to evaluate theeffect of chlorhexidine scrub on surgical site infection, compare it with povidone iodine,and evaluate the microbiological organisms found in surgical site infectionsalong with other risk factors contributing to the surgical site infections. This was a hospital Materials And Methods: based randomized control study conducted among 300 patients who presented with elective surgeries to the Department of General Surgery, Paediatric Surgery, and Cardiothoracic and Vascular Surgery units of PSG Institute of Medical Science and Research Centre, over a period of 9 months after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Surgical site infections were isolated from 14 Results: patients out of 300 (4.66%). 50% of isolated organisms (7 out of 14) were found in surgical site. The commonest organism isolated in one study was Escherichia coli followed byKlebsiella and Staphylococcus spp., by univariate analysis. Patient's age, co-morbid conditions, socioeconomic status, length of hospital stay, ASA scoring, duration of surgery, skin closure type and obesity were associated with signicance in those with MDRO infected foot ulcers. Analysis by logistic regression indicated that about 3 factors signicantly increased the risk of acquiring SSI infections: Skin closure type= suture, staples, Duration of surgery, Length of post op stay. Chlorhexidine scrub as a Conclusion: preoperative skin preparation had less number of surgical site infections when compared to povidone iodine.Factors like duration of surgery, type of surgery and length of post-operative stay had a signicant impact in development of surgical site infections.Escherichia coli is the commonest isolate from the surgical site infected patients.Surgical site infections are still a real risk for surgery and represent a substantial burden of disease for both patients and health care services in terms of morbidity, mortality and economically.Surveillance of surgical site infections with feedback of appropriate data to surgeons would be desirable to reduce the surgical site infection rates.Chlorhexidine is commercially available in aqueous or alcohol formulations and has broad activity against gram positive and negative bacteria, anaerobes, yeast and some lipid enveloped viruses.Research has shown that surgical techniques, skin preparation and the timing, method of wound closure and length of hospital stay are signicant factors that can inuence of subsequent infection.

Foley's Catheter Balloon Avulsion of Posterior Urethral Valve in Children: How Effective?

Background: Endoscopic ablation under direct vision is the gold standard for treatment of posterior urethral valve. However, when the facilities are not available, Foley’s catheter balloon avulsion of the valve suffices. The aim of this study was to evaluate the initial outcome of management of children with posterior urethral valve treated by Foley’s catheter balloon avulsion. Materials and Methods: This was a retrospective study of children, aged 15 years and younger, who were treated for posterior urethral valves at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The parameters evaluated included the age of the patient at presentation, duration of symptoms before presentation, time interval between presentation and intervention, presenting symptoms, procedure performed, post-intervention complications, duration of hospital stay and outcome of treatment. Results: A total of 24 children underwent catheter balloon avulsion during the study period. The mean age of the patients at presentation was 18 months and the mean duration of hospital stay was 18 days. Poor urinary stream and overflow incontinence were the most common presentations of the patients. Twenty-three out of 24 (96%) patients achieved full recovery with marked improvements in urinary stream and resolution of urinary symptoms. Patients who had hydronephrosis and vesicoureteric reflux before treatment, had resolutions of their pathologies during the period of follow up. However, one tenth of the patients each, experienced urethral injury and temporary urinary incontinence. Conclusion: In resource poor settings where the necessary facilities are not available, Foley catheter balloon avulsion of posterior urethral valve is a simple and effective modality of treatment.

Congenital granular cell mass of the alveolar ridge in a newborn

A 4-day-old female presented to the pediatric surgery unit with a large congenital, intraoral, lobulated mass causing difficulty in breast feeding, with a part of it appearing to undergo necrosis. Despite the ominous appearance of the mass, the girl was healthy, physically active, and her appetite was normal. A CT scan showed its contact with the upper alveolar ridge, its strict intraoral position, and also its independence from the tongue and other oral structures. Following resection of the mass, the pathology laboratory confirmed a diagnosis of congenital granular cell lesion (CGCL). In a follow-up after two weeks, the area on the upper alveolar ridge where the resected mass had originated has healed completely, and the girl has been healthy until the point of submitting this case report. There have been no reports of complications or recurrences of CGCL even with incomplete resection. The uneventful course of our case following surgery conforms with this finding. We recommend prompt resection of this rare lesion after clarifying its anatomical extension with the help of imaging techniques such as computed tomography. • The ominous appearance and large size of CGCL in some cases may cause great stress for the newborn's family and confusion to the attending healthcare providers who may not be familiar with this rare condition. • a CT scan should always be considered in cases of congenital intraoral lesions in order to investigate the lesion's full spatial extension and its relationship with oral structures such as the tongue and the palate, before deciding the surgical approach. • We recommend prompt resection of CGCL after clarifying its anatomical extension with the help of imaging techniques such as computed tomography.

Foreign body in the gastrointestinal tract in children: A tertiary hospital experience.

Foreign body (FB) ingestion in the gastrointestinal tract (GIT) in children is common. Although most foreign bodies will pass spontaneously, surgical intervention is required when they fail to pass. The aim of this study was to evaluate our experience in the management of children who presented with FB in the GIT. This was a retrospective study of children that underwent laparotomy for the removal of FB in the GIT at the paediatric surgery unit of Enugu State University Teaching Hospital, Enugu over a 10-year period. A total of 272 children presented with FB in the GIT during the study period, out of which 30 patients had laparotomy. This gave an operative incidence rate of 11%. There was a slight male predominance and the ages of the patients ranged from 6 months to 5 years (median 3 years). About half of the patients had no symptoms and all the patients were investigated with an abdominal radiograph. Only one-third of the patients had a predisposing factor that could have led to FB impaction. FB impaction was the most common indication for surgery, and enterotomy with FB removal was the most performed surgical procedure. The most common FB removed were tiny parts of toys, and the most common post-operative complication was surgical site infection. There was no mortality. FB in GIT in children could be associated with complications that require surgical treatment. FB ingestion is preventable. Focus should be placed on caregivers preventing children from ingesting FB.

Do not trust landmarks and your feelings while inserting pediatric central venous catheters

BackgroundCentral venous catheterization (CVC) is a commonly used procedure in pediatric surgery and intensive care units. For some reasons, catheterizations in children are technically more difficult in comparison to adult patients. The purpose of this study is to evaluate the CVC procedures performed with the aid of anatomic landmarks by experienced (35, 14, 4 years of experience) anesthesiologists and the associated complications. A total of 498 cases under the age of 18 who underwent CVC (temporary, port, or Hickman) between the years 2014 and 2017 were included in this retrospective study. All catheters were inserted with the aid of anatomic landmarks.ResultsThe mean age of the patients was 47.1 ± 59.2 months and 54.8% were male. By using anatomical landmarks, the average success rate in central venous catheterizations was calculated as 98.6%. Complications developed included arterial puncture in 8% (n 40), temporary arrhythmia in 6.2% (n 31) and pneumothorax in 1.4% (n 7) of the patients. Only using multiple punctures (p = 0.005) and catheterizations lasting more than 10 min (the time to blood return from the catheter, p = 0.017) were found to be associated with complications. The experience of the practitioner had no effect on the development of complications (p = 0.354).ConclusionsIn CVCs using anatomic landmarks, complications are seen more frequently in children. Even though a decrease in overall complication rates was detected in catheterizations performed by experienced hands, it is seen that experience does not eliminate complications in CVC insertions using anatomic landmarks.

Testicular Atrophy Following Unilateral Herniotomy in Children: A Single Centre Experience

Background: A reduction in testicular mass (testicular atrophy) may occur as a complication of hydrocele/hernia repair in children (herniotomy). The aim of this study was to evaluate for testicular atrophy in children who underwent herniotomy for hernia or hydrocele repair. Materials and Methods: This was a prospective study of children aged 15 years and younger who had unilateral herniotomy at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Preoperatively and postoperatively (at least 6 months apart), the volumes of both testes were assessed using ultrasound. These specific testicular volumes were compared to determine the degree of change in unilateral testicular volumes relative to the contralateral testis. For the index study, any reduction in testicular volume of more than 20 percent is considered testicular atrophy. Results: A total of 258 cases of herniotomies were seen during the study period. The mean age of the patients, at diagnosis of testicular atrophy, was 2 years, range of 1 to 3 years. About one-fifth (53) of the patient showed more than 20% reduction in testicular volume relative to the contralateral testis. There were more hydroceles than hernias and all the patients had herniotomy. Stitch related complications were the most common post-operative complication. Conclusion: Herniotomy for pediatric inguinal hernia and hydrocele is one of the most commonly performed surgical procedures in children. However, this procedure is not without complications, testicular atrophy may occur. This study has shown that up to 20% of the children who underwent herniotomy may come down with testicular atrophy.

Establishing Pediatric Cardiac Surgery Unit in Underprivileged Area. An Audit of First 100 Cases &amp; Challenges Faced

Nevertheless, congenital anomalies predominantly cardiac are still leading cause of under five-year-old mortality. There is significant global improvement has been observed in declining of under 5-year mortality from 93 deaths per 1,000 births in 1990 to 39 in 2017 (58%).Objective: The aim of this audit was to present our experiences of first hundred cases of congenital heart defects surgeries along with the challenges faced during the establishment of new pediatric cardiac surgery center in underprivileged area. Methods: This was an audit of the first 100 cardiac surgeries performed for congenital heart defects at Gambat Institute of Medical Science from 15- 3- 2021 to1-10-2022. During the period challenges other then related with surgical interventions; more than an investment of money but political, cultural, and social faced. Results: The mean age was 9+/-6.5 years, with female predominance of 57. Sever pulmonary hypertension was present in 6 patients. The majority of our patients were from RACHS1 score category 1. Out of 100 patient open heart surgeries were 89(89%) and close heart were 11(11%). We have single mortality of patient underwent Tetralogy of Fallot correction developed massive stroke and expired at 5th postoperative day. Three patients were re explored for bleeding while one required emergency reopening in PICU for cardiac arrest. Post clamp removal arrhythmias were observed in 7(7%) patients. We received three patients in emergency from Pediatric cardiology post intervention including device embolization, device malposition and acute Mitral regurgitation post intervention. Conclusions: Providing Pediatric cardiac surgery services to the children of remote and socioeconomically deprived area is a greatly rewarding. It has many challenges other than providing direct patient care.

Results of Laparoschisis Management in Mali Hospital

Laparoschisis is a congenital malformation characterized by externalization of the abdominal viscera trough a paraumbilical orifice. Its prevalence rose from 0.29 per 10,000 births in 1974 to 1.66 per 10,000 births in 1998. In Africa, very few studies have been devoted to this malformation. Its overall incidence is not known there but the studies carried out find a lower incidence compared to western countries. We conducted a retrospective, descriptive study which was conducted from May 1, 2018 to April 30, 2021, a period of three years, in the pediatric Surgery Unit of the Mali Hospital. The objective of this study is to report our difficulties in the management of this pathology. During our study we had collected 10 patients; the diagnoses were made in all cases post Nataly. Most of our patients i.e.90% was Lefort type I. All patients were seen within the first 24 hours and two patients died before surgery. We performed a one-stage closure in all our patients. Complications were marked by respiratory distress and hypothermia in all our patient. Mortality was 100%.

The Treatment Perspective of Pediatric Condyle Fractures and Long-Term Outcomes.

In our study, the characteristics, treatment approach and long-term outcomes of condyle fractures treated in the pediatric plastic surgery and reconstruction unit in the last 10 years were evaluated. This study consisted of two retrospective and prospective sections with the participation of pediatric patients with condylar fractures who were treated in the Plastic, Reconstructive and Aesthetic Surgery clinic of a university hospital in the last 10 years. In the retrospective section, data were obtained from the electronic patient records and patient files regarding the treatment applied, as well as the characteristics of the patient and condyle fractures. In the perspective section, patients were invited to the clinic and the effectiveness of the treatment was evaluated. Statistical analyses were performed with SPSS (Statistical Package for Social Sciences) for IBM 25 package program. It was determined that 55.8% of the pediatric patients had accompanying facial fractures, and 72.4% had unilateral condyle fractures. It was determined that 59.5% of the pediatric patients underwent intermaxillary fixation (IMF). Physical complications were seen in 6.75% in the long term after treatment. Falling from height and traffic accidents, which are the most important factors in the occurrence of condyle fractures, should be eliminated by increasing parental attention and awareness. Surgical treatment should be considered in the treatment of pediatric condyle fractures, especially if there are accompanying facial and mandible bone fractures.