Journal of Indian Association of Pediatric Surgeons最新文献

Aims: Despite clear guidelines recommending reduced fasting durations, extended fasting remains a concern. This study aimed to evaluate actual fasting durations for solids and clear liquids in pediatric patients undergoing elective surgery; examine correlations between fasting durations and thirst/hunger scores, blood glucose levels, and hemodynamic parameters; and identify reasons for noncompliance with guidelines.

Materials and methods: This prospective observational study included 150 children aged 5-12 years scheduled for elective surgery under general anesthesia. Fasting durations for solids and liquids, hunger and thirst scores, blood glucose levels, and hemodynamic changes were recorded. Pearson's correlation analysis was conducted to assess the strength of associations between fasting durations for solids and liquids and corresponding hunger scores, thirst scores, blood glucose levels, parental satisfaction, and hemodynamics. P < 0.05 was considered statistically significant.

Results: The median fasting durations for clear liquids and solids were 8 h and 10 h, respectively. A positive correlation was observed between hunger and thirst scores and fasting durations for solids and clear liquids (r = 0.55 and r = 0.62; P < 0.0001). Longer fasting durations were associated with lower blood glucose levels postinduction (r = -0.6; P < 0.0001) and lower parental satisfaction (r = 0.4; P < 0.0001). Key reasons for prolonged fasting included unclear instructions, surgeon-directed orders, and fear of surgery cancellation.

Conclusions: Preoperative fasting durations in pediatric patients are often unnecessarily prolonged, leading to negative perioperative experiences. These findings highlight the critical need for improved adherence to fasting guidelines.

A 3-month-old child underwent ritual circumcision, resulting in severe complications that were initially managed with dressings and later through reconstructive surgery. This case report describes the challenges of improper circumcision and the novel use of a full-thickness skin graft for penile skin loss.

Background: Anorectal malformations (ARMs) include a group of congenital anomalies affecting the distal anorectum with frequent involvement of the urogenital tract. As modern surgical advancements have improved survival, attention has shifted toward assessment and optimization of bowel function, to improve the overall quality of life for affected children.

Objective: The objective of this study was to evaluate the bowel functional outcomes for individual types of female ARMs after standardized management at a tertiary center.

Materials and methods: The present study included 35 female patients with anorectal malformations aged >3 years, who underwent single staged/staged ARM repair, and finished dilatation program. Patient demographics, type of ARM, surgeries performed, and postoperative complications were noted. Bowel function was assessed using the Krickenbeck scoring system for postoperative results. Those with continence issues underwent contrast enema and magnetic resonance imaging (MRI) pelvis.

Results: The study included 24 patients with vestibular fistula, 7 with perineal fistula, 2 with rectovaginal fistula, and 2 with perineal canal. Voluntary bowel movement (VBM) was achieved in 34 (97.15%) patients post-ARM repair, constipation in 8 (22.85%) patients, and soiling in 2 (5.7%) patients. Of these, 3 patients had abnormal findings on contrast enema and 2 on MRI pelvis.

Conclusion: VBM was achieved by majority of the females following ARM repair. Constipation was the most common functional complication. Soiling noted in 2 cases was due to overflow incontinence secondary to constipation. Early initiation of targeted bowel management showed improvement in affected subjects. The Krickenbeck scoring system for postoperative results is a quick, easy method of identifying patients with functional incontinence based on symptoms.

Background: Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although the majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Few authors have suggested that a delayed cortical transit time (CTT) on diuretic renography is a reliable prognostic factor for both the need for surgery and renal functional improvement after surgery.

Methodology: We designed this prospective observational study on CTT in ^99mTc-EC renal scan of all the unilateral UPJO patients of mean age were 2.15 years (0-5 years) managed in our institute. All patients diagnosed antenatally or postnatally with unilateral hydronephrosis, possibly due to UPJO, were evaluated and investigated. ^99mTc-EC renogram was done. The detailed data were collected on CTT, differential renal function, the drainage pattern, and other parameters measured in a diuretic renogram. The management of these patients was done as per the standard institutional protocol, and there was no deviation due to inclusion in this study. Linear correlation between two continuous variables was explored using Pearson's correlation (if the data were normally distributed) and Spearman's correlation (for nonnormally distributed data).

Results: We found a CTT of more than 210 s to be associated with a 95% sensitivity and 74% specificity for the requirement of surgery in children with unilateral UPJO. The limitation of our study was the small sample size (n = 36). However, a multicentric study with a large sample size may confirm our findings.

Conclusion: The predictive value of CTT as a reliable and sensitive indicator of surgery and early recovery even after 3 months of surgery. CTT can be used to identify reliably those subset of patients with unilateral UPJO who will deteriorate irreversibly. We are proposing the cutoff value of CTT to be 210 s, unlike several previous researchers, who have found a cutoff value of 180 to be significant.

Ureteral atresia is a rare congenital anomaly of the ureter often associated with renal dysplasia. We report a case showing the rare occurrence of ureteral atresia and horseshoe kidney in a 1-year-old male, presenting with a flank mass. The report aims to contribute to the existing literature on pediatric renal anomalies by detailing the diagnostic process, surgical intervention, and subsequent outcomes in the context of this complex presentation.

Background and aims: There is no robust data to support the practice of not reducing the pelvis during laparoscopic/robotic pyeloplasty. Very few authors have compared reduction pyeloplasty (RP) against nonreduction pyeloplasty (NRP).

Methods: Databases were searched using the terms: Pyeloplasty AND (reduction vs. no reduction of pelvis) AND outcome to identify all papers pertaining to pyeloplasty outcomes in the pediatric population. Meta-analysis of proportions was carried out using MetaXL 5.3 and an odds ratio plot was constructed using Review Manager (RevMan) Version 5.4.

Results: Between 2003 and 2023, 189 abstracts were identified, and 121 articles were selected for full-text review. After excluding those which did not meet the criteria (n = 116), 5 articles were included. In four studies (pelvis size <40 mm), there was no recurrence in either the RP or NRP group. Only in one study (pelvis size >40-50 mm), there were slightly higher odds of failure with NRP (2/20 RP vs. 3/20 NRP; odds ratio 0.63). There was no significant difference in pooled failure rate between RP and NRP in this meta-analysis. Improvement in renal pelvis size or drainage curve after surgery was faster in the RP group, but during late follow-up, this advantage was not obvious. There was no significant difference in functional recovery between RP and NRP.

Conclusions: In cases with a large renal pelvis (>40-50 mm), one may elect for RP, while in the remaining, one may resort to NRP. Larger randomized controlled trials are necessary to better understand the impact of pelvic reduction on outcomes in pyeloplasty.