Journal of Indian Association of Pediatric Surgeons最新文献

Context: Gender dysphoria (GD) is an entity, in which the patient's gender identity does not correspond with the biological sex.

Aim: The aim of the study was to analyze the prevalence of GD in adolescent and adult patients with GD as well as to describe the approach used in those patients presenting with GD.

Materials and methods: This is a retrospective study, in which patients in the adolescent (between 10-19 years of age) and adult age groups (20 years and above) with disorders of sexual development (DSD) who underwent surgery during the period of 2017-2024 were included in the study. A retrospective analysis was done to assess the prevalence as well as the approach used to treat GD in such patients. All patients underwent surgery after a detailed psychological analysis before surgery.

Results: Thirty-six patients were included in the study, ages ranging from 11 to 47 years. The mean age of presentation was 18.9 years. GD was found to be most common in patients with 5 alpha-reductase deficiency and least in patients with congenital adrenal hyperplasia and complete androgen insensitivity syndrome as per our analysis.

Conclusion: Surgical intervention in youth with DSD is a controversial topic. Psychosocial support is extremely important in such patients to help the decision-making process. The main goal of surgical intervention is to normalize appearance and function and forestalling physical and psychosocial morbidity. A multidisciplinary approach is always important in the treatment of DSD to ensure physical as well as psychological welfare of patients.

Aim: The aim of the study was to evaluate the role of pancreatic divisum (PD) in children with pancreatitis.

Methods: A retrospective observational study was conducted at a pediatric surgery tertiary center which included children aged <18 years who presented with pancreatitis between January 2013 and June 2024. The children with pancreatitis having PD (PD pancreatitis group) were compared to the children with pancreatitis not having PD (non-PD pancreatitis group).

Results: A total of 275 children with pancreatitis were included in the study and 15 (5.5%) of them had PD. Type 1 (Classical) PD was seen in 11 (69%) of the children and nine (60%) children presented with acute recurrent pancreatitis (ARP). The children with PD pancreatitis presented at a younger age (9.8 ± 4.3 years vs. 12.2 ± 3.7 years; P = 0.02; independent sample t-test) and tend to have a significantly higher incidence of ARP (9 [60%] vs. 58 [22%]; P < 0.001; Chi-square test) compared to the children with non-PD pancreatitis.

Conclusion: Children with PD present at a younger age with pancreatitis and are at increased risk of developing ARP. This suggests that PD is an independent etiology for developing pancreatitis in children.

Background: Surgery for hypospadias is usually performed under general anesthesia, with anesthesiologists employing caudal, epidural, and penile blocks to provide postoperative analgesia. Recent research suggests a possible association between increased incidence of complications (especially urethrocutaneous fistulae [UCFs]) and perioperative use of caudal blocks. The increased incidence of complications was attributed to the vasodilatation and penile engorgement following the regional block. The purpose of this study is to determine the overall incidence of complications following urethroplasty in our institute and determine if there is a causal association with neuraxial block.

Methods: Electronic medical records of all children who underwent primary urethroplasty for distal hypospadias in our institutre from 2011 to 2020 were reviewed and statistical analysis done.

Results: A total of 333 children with a mean age of 4.6 years were included in the study. Caudal block was given for 229 children and single-dose epidural for 32 children. Seventy-two children did not receive any regional block. The incidence of glanular dehiscence was 6% and UCF was 19% in neuraxial blocks compared to 3% and 15% in the other group (P = 0.2 and 0.4). Multivariate regression analysis of level of hypospadias, severity of chordee, surgeon's experience, and type of local anesthetic or additive used showed no other significant independent variable affecting the outcome.

Conclusion: Postoperative urethral fistula formation was observed in children who received and did not receive neuraxial analgesia for urethroplasty surgery, with the incidence being marginally higher in the neuraxial block group.

Background: Ureteropelvic junction obstruction (UPJO) is a common cause of pediatric hydronephrosis, yet only one-third of affected children require surgery. Differentiating obstructive from non-obstructive cases remains challenging with current imaging methods. This systematic review and meta-analysis evaluated the role of ureteric jets, assessed via color Doppler ultrasonography (USG), as an adjuvant diagnostic modality to complement gray-scale USG in children with UPJO.

Materials and methods: A systematic search of PubMed, Embase, Scopus, and Web of Science databases was conducted to identify studies reporting on ureteric jet frequency (UJF) in UPJO. Standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated for the pooled data, while the I² statistic assessed heterogeneity. Methodological quality was evaluated using the Newcastle-Ottawa scale.

Results: Five studies (111 patients) met inclusion criteria. Ureteric jets were absent in 67.3% of UPJO cases, with diagnostic accuracy reaching 94%. Meta-analysis revealed a significant reduction in UJF in obstructed kidneys (SMD = -2.01, 95% CI: -3.09 to -0.94, P = 0.0002), though heterogeneity was substantial (I² = 80%, P = 0.006). The methodological quality of the included studies was good in four studies and poor in one study.

Conclusions: The current systematic review demonstrated the absence of ureteric jets and a significant reduction in the UJF in the obstructed kidneys. However, due to heterogeneity among the included studies, further studies are needed to standardize the protocols before any definite conclusions are drawn.

Lumbo-Costo-vertebral syndrome is associated with congenital lumbar hernia, costal defect, and vertebral anomalies. We present a case of a 3-year-old male with progressive enlarging swelling in the lumbar region and kyphoscoliosis with left nonpalpable undescended testis. Laparoscopic mesh repair with staged Fowler-Stephen orchidopexy was done.

Introduction: Anastomotic leak after primary repair of esophageal atresia is usually managed by conservative measures with excellent outcome. We have analyzed results in our patients with anastomotic leak after primary repair of esophageal atresia type C.

Methodology: We did a retrospective review of patients of esophageal atresia operated at our center from January 1, 2019, to December 31, 2023. The data were retrieved from the Hospital Information Management System and analyzed.

Results: A total of 162 patients were operated for esophageal atresia. Among these, primary anastomosis could be achieved in 125 patients. Anastomotic leak was documented in 49 (39.2%) patients. Forty-five among these patients were managed conservatively, while four underwent esophageal diversion. Among the patients managed conservatively, 52.38% survived and were discharged. A statistical comparison was done between patients who survived to discharge and those who expired. Two groups were compared to ascertain the factors associated with increased risk of mortality. Sepsis at admission, anastomotic tension, duration of period for stabilization before surgery, duration of surgery, time to presentation of anastomotic leak, time to attain full feeds, and cardiac anomaly were found to affect survival on univariate analysis. However, on multivariate analysis, only sepsis at admission was found to have a significant effect on survival.

Conclusion: Conservative management is usually successful if adequate enteral feeds and control of leaked contents or sepsis can be ensured.

Hypospadias is a common congenital anomaly of the male genitalia requiring surgical correction. During hypospadias repair, there are two broad approaches to deal with prepuce-foreskin reconstruction (FR) and conventional circumcision (CC). While FR preserves and reshapes the dorsal prepuce to mimic the normal appearance, CC involves excision or rearrangement of the prepuce leading to a circumcised appearance. The choice between these techniques is influenced by cultural, religious, and personal preferences; the techniques themselves differ in surgical complexity and complication risks. This systematic review and meta-analysis compares FR and CC in hypospadias repair focussing on surgical outcomes and complications. A comprehensive search of relevant randomized controlled trials and prospective studies were performed across PubMed, Embase, Scopus, and Cochrane Library. Studies were assessed for risk of bias using ROB-2 and ROBINS-I tools. Primary outcomes included urethra-cutaneous fistula (UCF), meatal stenosis (MS), and glans dehiscence (GD). Secondary outcomes included preputial complications and operative time. Both FR and CC yield comparable results in terms of major complications such as UCF, MS, and GD. Operative time shows variability, with no clear difference between the groups. However, FR carries a higher risk of preputial complications.

Background: Hydronephrosis is the most common congenital anomalies of the urinary tract. There are various diagnostic modalities which are currently used for diagnosis and follow-up such as ultrasound, renal scintigraphy, intravenous urography, and magnetic resonance urography. Renal arterial Doppler resistance index can be used as a complimentary tool.

Materials and methods: A prospective observational study of 30 infants and children with unilateral hydronephrosis were selected using consecutive sampling. Ultrasonography with renal biometry for diagnosis and Technetium 99m-diethylene triamine penta-acetic acid (99mTc-DTPA) Renogram was used for functional assessment. Doppler ultrasonography was done in all on to determine mean resistive index in each subject.

Results: Altogether 30 patients have been studied in this series, out of which 7 are females and 23 males. Fourteen patients had left-sided ureteropelvic junction (UPJ) obstruction and 16 had right-sided UPJ obstruction. Operative procedure (Anderson-Hyne's pyeloplasty) was done in all 30 patients. Preoperatively differential renal function was assessed by renal scintigraphy using 99 mTc-DTPA and Doppler ultrasonography done to measure renal resistive index (RRI). In this study, in preoperative group mean peak systolic velocity (PSV) - 52.663 cm/s, mean end diastolic velocity (EDV) - 10.305 cm/s, mean RRI - 0.797, mean DTPA - 43.630. In the postoperative period after 3 months, mean PSV - 41.223, mean EDV - 14.640, mean DTPA - 47.449, and mean RRI - 0.638.

Conclusion: This study has shown that the mean renal arterial resistive index was higher (mean RRI - 0.797) in preoperative period and decreased after intervention (mean RRI - 0.638). These values correlate well with DTPA result. Hence, this is a reliable tool for diagnosis and follow-up after intervention.