Journal of Indian Association of Pediatric Surgeons最新文献

Aims: This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic excision of choledochal cysts (CDCs) with Roux-en-Y hepaticojejunostomy (HJ) in pediatric patients at a tertiary care teaching institution in India.

Methods: We conducted a retrospective review of electronic medical records from November 2019 to November 2024, involving 43 children who underwent laparoscopic CDC excision with Roux-en-Y HJ in a single surgical unit. Data collected included demographic information, clinical presentation, imaging features, CDC classification, preoperative interventions, surgical details, postoperative complications, and follow-up outcomes. Laparoscopic HJ was performed by a single surgeon with a four-port technique with extracorporeal jejunojejunostomy.

Results: The cohort consisted of 43 children (26 girls), with a mean age of 5.5 (0.33-17) years and a mean weight of 16.5 (6-48) kg, including seven infants. Preoperative interventions were required in 11 (25.6%) children. The mean operative time was 406 (315-545) min, with an 11.6% conversion rate to open surgery due to difficult anatomy. Postoperative complications were observed in 34.8% of patients, primarily minor (Clavien-Dindo Grade I or II), including bile leak in 6.9% of patients, managed without further intervention. Major complications included adhesive obstruction and anastomotic stricture, requiring reoperations in two patients. The mean time to full enteral feeds was 6.5 (4-9.5) days, and the mean hospital stay was 9.3 (5-25) days. Follow-up (mean duration: 27.2 months) showed no intrahepatic biliary radical dilation or recurrent cholangitis or pancreatitis, with normal liver function tests in all patients except one who developed liver decompensation and was lost to follow-up.

Conclusions: Laparoscopic excision of CDC with Roux-en-Y HJ in children is a safe, feasible, and effective approach, offering numerous benefits while presenting manageable risks and complications. With advancements in minimally invasive techniques and increased surgeon expertise, this method holds promise for becoming a widely adopted standard in pediatric surgery.

Introduction: Sacral ratio (SR) is currently the only measurement to quantitatively evaluate sacral development in patients with anorectal malformations (ARMs). This study proposes sacral curvature (SC) and sacral index (SI) as a new indicator to qualitatively assess the sacrum and hypothesizes that sacral development, both quantitatively and qualitatively, can be an indicator to predict the type of ARM. The study aims to investigate the difference of SI, SR, and SC between ARM types and the association with the type of ARM.

Materials and methods: This study was prospectively conducted for 18 months. Male patients with ARMs were enrolled and divided into three groups based on the types of ARM: (1) low ARM, (2) intermediate ARM, and (3) high ARM. SI was measured using anterioposterior radiograph (infantogram). SC was measured using lateral radiograph of the sacrum (prone cross-table lateral radiographs).

Results: Sixty-three male patients with ARMs were included in the study. SIs were 93.766 ± 8.2309, 99.878 ± 5.832, and 109.481 ± 7.4646 in low, intermediate, and high ARM, respectively (P < 0.0001). The SRs in low and intermediate ARM were significantly higher than that in high ARM (0.728 ± 0.05796, 0.625 ± 0.06577, and 0.547 ± 0.6702, P < 0.0001). SCs were 0.232 ± 0.02663, 0.211 ± 0.01621, and 0.1790 ± 0.02364 in low, intermediate, and high ARM, respectively (P < 0.0001).

Conclusions: The higher the rectal level is in an ARM, the lower are the objective measurements of the sacrum. SR was the most common and established parameter to assess the sacral development and its correlation with the level of ARM. However, this study demonstrated that in addition to SR, SC and SI can be a possible predictor for the assessment of the level of ARM.

Parental anxiety during the time leading up to a child's surgery is a major concern. One approach that's gained attention for helping ease this stress is preoperative education, but there's still no clear agreement on which type of educational method works best. This review looked into a range of educational strategies to find out which ones are most effective at lowering anxiety in parents. Between January and March 2024, researchers conducted an extensive search across databases like PubMed, EMBASE, Web of Science, and Google Scholar. They focused on studies that evaluated preoperative education for parents, specifically targeting those that measured parental anxiety using validated tools. From this search, 23 studies were included in the final review, and 19 of them, involving nearly 2,000 participants, were analyzed in a network meta-analysis. The interventions examined varied and included things like videos, web-based platforms, printed booklets, multimedia content, and educational games. When all the data were compared, web-based education stood out as the most effective, with a significant reduction in anxiety levels (SMD = -1.40). Video-based approaches also helped, though to a lesser extent (SMD = -0.42). On the other hand, booklets and game-based education didn't seem to have as strong an impact. In short, web-based educational tools appear to be the best option for helping parents manage the stress of their child's upcoming surgery. These findings could help hospitals and surgical teams choose the most effective ways to prepare and support families during this challenging time.

Pneumoperitoneum, the presence of free air in the peritoneal cavity, is most commonly associated with hollow viscus perforation, necessitating urgent surgical intervention. However, in rare cases, pneumoperitoneum can result from thoracic air leaks and may be managed conservatively unless it is causing diaphragmatic splinting. The aim of the study was to raise awareness about pneumoperitoneum secondary to pneumothorax, emphasizing nonoperative management to prevent unnecessary surgical interventions and associated morbidity. A 1-month-old female infant presented with respiratory distress requiring mechanical ventilation. Following intubation, the child deteriorated clinically, developing significant abdominal distension. Chest X-ray and abdominal X-ray revealed bilateral pneumothorax and pneumoperitoneum. Bilateral intercostal drains (ICDs) were placed, but due to worsening abdominal distension, an exploratory laparotomy was performed within a few hours. No evidence of hollow viscus perforation was found. Tense pneumoperitoneum confirmed with gush of air on opening the abdomen. The presence of air inside the left paracolic gutter extending to the diaphragm indicating it is from pneumothorax. The abdomen was closed with a drain, which was removed after 48 h. Feeds were initiated after 48 h. ICD was removed after 5 days and she was discharged after 7 days. Spontaneous pneumoperitoneum secondary to pneumothorax is an uncommon but important differential diagnosis. Recognizing key clinical clues, such as absence of gastrointestinal symptoms, history of respiratory distress, and extraperitoneal air on imaging, can facilitate conservative management, avoiding unnecessary surgical intervention.

Duplication of the trachea is a rare anomaly, with few reported cases. This report presents a neonate with tracheoesophageal fistula (TEF), where tracheal duplication was incidentally discovered during repair. It is an effort to discuss the rare congenital anomaly and management options when faced with such surprises intraoperatively.

Background: Urethral stricture (US) refers to the scarring process involving the corpus spongiosum (spongiofibrosis). Incidence in children is quite low as compared to adults, with anterior urethra (penile and bulbar) being the most common site. Iatrogenic and posttraumatic causes in the US are more frequent than the idiopathic, infective, and inflammatory causes. Either endoscopic internal urethrotomy (IU) (size < 2 cm US) or open reconstructive procedures (size > 2 cm US) are the main treatment options. However, additional therapy, such as the local application of Mitomycin C (MtMC), improves endoscopic success rates. In the current communication, we present a series of children with recurrent short US (<2 cm) following IU and even after reconstructive procedures, wherein we have tried to extend the benefit of MtMC application in combination with IU.

Materials and methods: Five consecutive children with recurrent short US (<2 cm) (following reconstructive procedures in traumatic US [n = 2], post fulguration of posterior urethral valves, i.e. iatrogenic US [n = 2] and congenital US [n = 1]) underwent treatment by IU and local application of MtMC. Cystoscopic local instillation of 2 ml of MtMC at a concentration of 0.5 mg/ml was done after IU with simultaneous per rectal finger occlusion of the bladder neck. The symptom score (International Prostate Symptom Score [I-PSS]) was utilized in all the patients to gauge the severity of symptoms. Periodic subjective assessment of symptom relief and urinary stream, cystoscopic reassessment for adequacy of intraluminal diameter, ultrasonography, uroflowmetry, retrograde urethrograms, and dimercaptosuccinic acid scans were carried out at different time points during the 6-month follow-up.

Results: The mean age of the patients was 8.4 ± 1.9 years. The mean pre-MtMC I-PSS score was 24 (severe). Post-MtMC application, the patients reported a symptomatically better urinary stream that was sustained beyond 4 weeks of catheter removal. When the urinary stream used to get thinned out, additional sittings of MtMC application were carried out. The time interval for re-intervention increased by 4-6 weeks, and on subsequent cystoscopic examinations at different time intervals, the urethral lumen was far much better (70%-80% improvement). The mean post-MtMC I-PSS score was 11 (moderate). During the early follow-up, the upper urinary tracts did not show any further deterioration as evidenced by DMSA scan done at 6 months. Uroflowmetry (plateau-shaped suggestive of static bladder outflow obstruction either anatomical or functional) and postvoid residual urine findings (~50% residual) were less encouraging.

Conclusion: In terms of symptomatic relief, MtMC application has demonstrated its potential benefit on short follow-up for treating resistant US, as evidenced by a 40%-50% improvement in I-PSS score observed in

Introduction: The objective was to study the factors affecting the survival of newborns with gastroschisis from a tertiary care children's hospital.

Materials and methods: A retrospective chart review was done, wherein the data of neonates with gastroschisis managed at our tertiary care center between December 2018 and March 2024 were analyzed. Parameters noted were gestational age, birth weight, mode and center of delivery, surgical technique of closure, associated bowel atresia, need for neonatal intensive care unit (NICU) care with postoperative ventilation, and time to full feeds. The effects of different factors on overall survival were analyzed.

Results: Out of the total 29 patients, 21 (72.41%) survived and 8 (27.6%) expired. Male: female ratio was 3:1. Among the neonates who survived, 16/21 (76.2%) were inborn and 5/21 (23.8%) were outborn (P < 0.0281). The mean gestational age was 37.5 ± 0.7 weeks among the survivors and 34 ± 4.2 weeks in the non-survivors (P < 0.0008). Of those who survived, 19/21 (90.5%) had a birth weight of >1.5 kg versus the 5/8 (62.5%) who expired and had a birth weight ≤1.5 kg (P < 0.0079). Among the survivors, surgical closure was done within 24 h in 81% (17/21) versus the non-survivors in whom 75% (6/8) had surgical closure after 24 h (P < 0.0089). Of those who survived, 85.7% had undergone primary skin closure and 9.5% silo closure (P < 0.0079). All the patients received NICU care with ventilator support as required. The mean time to full feeds was 17.1 ± 4.5 days among the survivors.

Conclusion: Term gestational age, birth weight >1.5 kg, in-house delivery, early surgery within 24 h of delivery, and primary skin closure were associated with higher survival for gastroschisis.