Journal of Indian Association of Pediatric Surgeons最新文献

The authors report a neonate with an antenatally diagnosed left renal lesion that was preoperatively diagnosed to be a unilateral nonsyndromic Wilms' tumor (WT). He is the youngest patient with WT treated with nephron-sparing surgery, ever reported in the world.

Aim: This prospective single-center study aimed to evaluate the nonhepatobiliary applications of indocyanine green fluorescence-guided surgery (ICG FGS) in pediatric patients, assessing its utility as an adjunct for intraoperative imaging.

Materials and methods: Over a 30-month period from January 2021 to July 2023, pediatric patients undergoing various surgical procedures, excluding hepatobiliary cases, were included in the study. ICG (Aurogreen™) was administered intravenously or directly injected in tissue, and fluorescence imaging was conducted using specialized equipment (KARL STORZ GmbH and Co. KG). Patient demographics, diagnoses, surgical procedures, ICG protocols, intraoperative findings, and perioperative outcomes were analyzed.

Results: The study included seventeen pediatric cases including Hirschsprung disease, anorectal malformations, undescended testes, varicocele, Mayer-Rokitansky-Kustner-Hauser syndrome, ovarian torsion, chylous ascites, chylothorax, and Wilms' tumor. ICG aided in the real-time assessment of vascular, intestinal perfusion in Hirschsprung disease, anorectal malformations, delineation of lymphatics from vessels in varicocele, confirmation of preserved vascularity after detorsion of ovary, identification of lymphatics for ligation in chylothorax, and chylous ascites. ICG thus aided in precise dissection and confirming tissue viability without reported adverse events.

Conclusion: ICG FGS demonstrates significant potential as a tool for enhancing surgical outcomes in pediatric surgeries including indications beyond hepatobiliary cases. The findings suggest that ICG FGS can improve surgical precision by providing real-time assessment of tissue perfusion, and lymphatic mapping, thereby potentially reducing intraoperative complications. Further research and prospective studies are essential to validate its efficacy and establish standardized protocols, aiming to integrate ICG FGS as a routine adjunct in pediatric surgical practice.

Introduction: Anastomotic narrowing post-Type 3 esophageal atresia (EA) primary repair has been linked to life-threatening respiratory complications and failure to thrive during infancy. It becomes important to find some method to ensure anastomotic adequacy in these patients. We in the study here aimed to find the role of follow-up esophagogram and esophagoscopy in detecting anastomotic stricture (AS) in the early stage and to find whether these help in reducing the morbidity in these patients.

Materials and methods: Neonates with EA Type 3, who were successfully managed with primary anastomosis were prospectively enrolled and followed up in the study. Irrespective of symptoms, contrast esophagography and esophagoscopy were performed at the age of 2-4 months. Those with AS on endoscopy were followed for the need of dilatations required, respiratory complications, and failure to thrive if any.

Results: Out of 64 patients, 32 patients could be followed up till the completion of the study. An esophagogram conducted at 2 months of age revealed significant dye retention in 10 patients, esophageal narrowing in two patients, and normal results in the remaining 18 patients. Endoscopy confirmed AS in 11 out of 32 (34.4%). Preendoscopy, 44% of patients exhibited respiratory morbidity. After endoscopic dilation, none of the patients developed pneumonia requiring admission. Failure to thrive was noted in 9% of the cases.

Conclusion: The use of esophagograms and endoscopies during the healing phase of anastomosis not only aids in the detection of ASs during its formation but also eases the process of their management.

Background: The use of silver nanoparticles (AgNPs) in biomedicine has emerged in a big way owing to its antibacterial and anti-inflammatory properties. We hypothesize that combining the AgNPs with antibiotics for coating sutures will enhance the antibacterial property of sutures with the added advantage of the immunomodulatory effect of AgNPs on tissue healing.

Materials and methods: Polyglactin sutures were coated with AgNPs using the dip-coating method. The uniform coating and morphology of AgNPs on the suture surface were confirmed using scanning electron microscopy (SEM). Each type of suture - polyglactin plain, antibiotic coated (Triclosan), AgNP coated, and dually coated (antibiotic and AgNP) - was assessed for their antibacterial properties against Gram-positive bacteria, Gram-negative bacteria, and anaerobes. These sutures were utilized in an abdominal and systemic inflammatory mice model for ileal anastomosis. The intestinal tissue was evaluated for acute and chronic inflammation and collagen deposition to assess the healing and inflammatory response.

Results: The SEM and energy dispersive X-ray analysis showed successful coating of AgNPs on plain and antibiotic-coated sutures. In comparison with the other groups, the dually coated suture had the best in vitro antibacterial efficacy. The AgNP-coated sutures were able to decrease both acute and chronic inflammatory cell infiltration, but the collagen synthesis and deposition were enhanced.

Conclusion: AgNPs can be coated on Polyglactin suture either alone or in combination with antibiotics with preserved antibacterial effects. The dual coating of sutures gives a synergistic antibacterial effect. The AgNP diminishes immune response in the presence of preserved extracellular matrix generation.

Background and aims: Outcome analysis of patients with Wilms' tumors (WT) is presented.

Materials and methods: A retrospective analysis of 23 children having WT managed by a single surgeon over 3 years (2021-2024) using the International Society of Paediatric Oncology Umbrella protocol was done.

Results: The median age at presentation was 36 months; 32 months and 24 months for the unilateral WT (uWT) (n = 19) and bilateral WT (bWT) (n = 4), respectively. M: F ratio was 2.3: 1. WTs were localized in 19 (uWT-16; bWT-3) and metastatic in 4 (uWT-3; bWT-1) patients. Core-needle biopsy was done in 22 patients (26 renal units). Pre-therapy contrast-enhanced computed tomography volumetry (n = 20) showed a median tumor volume of 1023 ml (range: 47-2680 ml). Post-neoadjuvant chemotherapy (NACT) median tumor burden (n = 19) was 612 ml (range 59-3775 ml). Post-NACT, tumor volume decreased in 11/18 patients but increased in seven patients. NACT was avoided in one neonate. Nephroureterectomy (including one with excision of bladder cuff) and nephron-sparing surgery were done in 17 and 10 renal units including 3 with multifocal WT, respectively. Risk stratification was intermediate in 21 and High in 2. Overall staging in 19 uWT included Stage I-7, Stage II-5, Stage III-4, and Stage IV-3 (local staging-stage I in 1 and stage II in 2). Local staging in 8 renal units with bWT was Stage I in 7 and II in 1. One stage IV uWT had bilateral pulmonary metastatectomy. Adjuvant chemotherapy has been completed in 18 patients; two patients are still on adjuvant chemotherapy; flank radiation was administered in six patients. Three patients with synchronous bWT died; two due to acute kidney injury in the immediate postoperative period and one with metastatic disease who had abandoned adjuvant chemotherapy after the 1^st cycle. Another patient died of a huge metachronous tumor in the contralateral kidney after a year of completion of therapy. One patient had successful multimodality treatment of local relapse with liver metastasis. 1-year overall and event-free survivals are 84% and 76%, respectively.

Conclusions: Excellent short-term results for localized uWT from a center in a low-middle-income country are reported.

Pentalogy of Cantrell (PC) presents a distinctive challenge for clinicians and surgeons. In this case report, we have discussed the presentation, management, and literature review of a case of PC in a 17-month-old female child. The child was successfully managed with single-stage operation by a multidisciplinary team without any postoperative complications.

Enteric duplication cysts and reversed intestinal rotation (RIR) are rare congenital anomalies, with their coexistence being exceptionally uncommon. We report a 4-year-old girl who presented with chronic anemia and intermittent abdominal symptoms since infancy. Detailed workup for medical causes of anemia was inconclusive. Computed tomography of the abdomen revealed intestinal malrotation with a grossly dilated small bowel loop. Intraoperative findings revealed a long duodenojejunal tubular duplication with a separate mesentery (Type 1a) and RIR. The patient underwent a Ladd's procedure, resection of the duplication cyst, and end-to-end anastomosis. This case underscores the anatomical rarity, varied clinical presentation, and challenges in making an accurate and timely diagnosis in such a case.

Background: Consent is never truly exercised in children as parents act as their proxy and often do not understand the advantages, disadvantages, risks, and benefits of the procedure. Their high anxiety state is mirrored in the child, leading to slower recovery. Hence, this study was designed to understand if an intervention can impact the effect of consent on parents' anxiety, satisfaction, and knowledge.

Methodology: A two-arm, parallel design, randomized controlled trial was conducted from March 2020 to March 2022 to analyze the effect of an educational video in comparison to an informational leaflet in parents giving proxy consents for various listed pediatric surgical procedures.

Results: Parents in the video group had a higher mean knowledge score (6.97 vs. 6.77, P = 0.40), comparable satisfaction scores (27.45 vs. 27.58, P = 0.88), and statistically insignificant difference between anxiety scores. We noted highest score of satisfaction (28.5/40) in the parents educated up to High School level or less. Knowledge scores were lowest in pelvic-ureteric junction obstruction (5.1/10) patients.

Conclusions: Our study done over a period of 2 years included a variety of diagnoses, and the videos and information leaflets were self-designed. It showed comparable anxiety, knowledge, or satisfaction in parents. Studies with more participants would be needed to take this research forward.

Spontaneous biliary perforation is a rare condition, predominantly observed in infants, characterized by the leakage of bile into the peritoneal cavity without any apparent cause. This case report discusses a 3-month-old female infant who presented with symptoms of jaundice and abdominal distension. The successful management of this case with a combination of ultrasound-guided percutaneous drainage and laparoscopic cholecystostomy is detailed, highlighting the importance of minimally invasive techniques in treating this condition.