Journal of Indian Association of Pediatric Surgeons最新文献

Background: Various risk factors were contributed to hypospadias and may be varied by region and hypospadias severity. The study aims to analyze the nongenetic risk factors associated with severe hypospadias in a provincial referral hospital in West Java, Indonesia.

Methods: A case-control study was conducted in hypospadias patients and boys with normal penis treated in our institution during 6-month period. Risk factors of hypospadias were compared between severe and mild hypospadias and the control group and analyzed with Chi-square/Fisher exact test and multivariate logistic regression analysis (P < 0.05 = significant).

Results: We studied 84 subjects consist of 46 hypospadias patients (severe: 30 and mild: 16) and 38 control groups. Maternal workplace, primipara, age >35 years old, overweight, the absence of nausea, hypertension, bleeding, alcohol, cigarette smoking, medication, and vegetarian during pregnancy, as well as prematurity, were not significantly different between groups. The use of hormonal contraception and low birth weight infants were significantly higher in severe hypospadias (P = 0.033; P = 0.023; respectively). Multivariate logistic regression analysis showed that hormonal contraception, primipara, and age >35 years old were the risk factors of severe hypospadias (P = 0.008; P = 0.003, P = 0.049, respectively).

Conclusions: Hormonal contraception, primipara, and maternal age >35 years old are among the nongenetic risk factors of severe hypospadias in West Java.

The early stages of life pose feeding challenges for infants with Congenital Diaphragmatic Hernia (CDH), necessitating feeding tube placement to prevent growth failure. Predicting the factors prompting this intervention has yielded inconclusive findings in prior research. Thus, this review explored prenatal, perinatal, and postnatal variables associated with feeding tube placement in CDH. Retrospective cohort or case-control reporting outcomes linked to prenatal, antenatal or postnatal predictors of feeding tube placement were included, following PRISMA 2020 guidelines. Reports, case series, conference abstracts, book sections, commentary, reviews, and editorials were excluded. Database searches were conducted in August 2023 encompassed Cochrane, MEDLINE, ProQuest, Wiley, and Google Scholar. Quality assessment using the Newcastle-Ottawa Scale and Review Manager 5.4 performed meta-analysis. Within eight studies, four exhibited a low risk of bias and the other was categorized as moderate. Analysis revealed significant effects for liver herniation (OR = 3.24, 95%CI 1.64-6.39, P = 0.0007), size of herniated defects classified as C or D (OR = 7.12, 95%CI 3.46-14.65, P < 0.00001), Extracorporeal Membrane Oxygenation treatment (ECMO) (OR = 6.05, 95%CI 4.51-8.12, P < 0.00001), and patch repair (OR = 5.07, 95%CI 3.89-6.62, P < 0.00001). ECMO treatment and patch repair surgery are robust predictors of feeding tube placement in CDH infants. Although liver herniation and size of herniated defect also showed associations, further studies are needed to address heterogeneity concerns. The review was registered in PROSPERO with the number CRD42023480109. No funding was received.

Congenital diaphragmatic malformations include congenital diaphragmatic hernia (CDH) and eventration of the diaphragm. The clinical presentation is variable, and the prognosis depends on multiple factors. The coexistence of CDH and diaphragmatic eventration in the same patient is extremely unusual and has not been reported previously in the literature. We report this rare association in a 3-month-old male infant who was managed successfully by minimally invasive approach.

Trichobezoar with Rapunzel syndrome is a rare condition seen in young females. Refeeding syndrome is a rare phenomenon that can occur in any chronically malnourished person after starting feeds. We discuss and review available literature of extremely rare cases of 11-year-old girl, with trichobezoar with refeeding syndrome with subacute intestinal obstruction in the postoperative period.

Purpose: The purpose of this study was to synthesize evidence and propose a technique for estimation of stretched penile length (SPL) applicable to children.

Materials and methods: This review has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Embase, and Scopus databases were queried on penile length (PL) measurement techniques in humans published from 1990 onward. The devices and the techniques used for PL measurement, state of the penis, the habitus of the participants, proximal and distal landmarks for measurement, handling the foreskin and pubic pad of fat, optimal stretching of the penis, and other factors (including the environment) which should be accounted for in the technique were identified from the study cohort (90895 participants across 145 included studies).

Results: PL has been represented through flaccid (33.79%), stretched (81.3%), and erect (12.41%) PLs as well as the greatest corporeal length (1.4%). Following devices have been used to measure the PL in the study cohort: rulers [54.68%], calipers [9.7%], measuring tapes [14.5%], coloured measuring strips [2.06%], spatulas/tongue depressors [11.03%], FitKit, syringe [1.4%], cotton swab (and ruler), titan cylinders, slide gauge and ultrasonography [1.37%]. The factors relevant to SPL measurement have been incorporated into the proposed SPL INdicator Technique (SPLINT) which is essentially a holistic extension of the "Conventional PL Measurement" technique.

Conclusions: There is a wide range of heterogeneity in the technique for estimation of PL across the study cohort; the underlying factors have been identified along with the respective variables, and the SPLINT for SPL has been described.

Background: Thoracoscopic surgery is an increasingly popular surgical technique for the repair of congenital diaphragmatic hernias. We performed a meta-analysis to compare the efficacy, safety of thoracoscopic surgery and the conventional open surgical approach for congenital diaphragmatic hernia in neonates.

Materials and methods: A systematic search of electronic databases such as PubMed, Google, and Web of Science was performed to identify studies comparing thoracoscopic surgery and open surgery for congenital diaphragmatic hernia. A total of 6 studies with 3348 patients were found. Parameters such as operation time, hospital stay, recurrence rate, postoperative mortality, and postoperative complications were pooled and compared by meta-analysis.

Results: Of the 3348 children with congenital diaphragmatic hernia included in the 6 studies, 615 underwent thoracoscopic surgery and 2733 underwent open surgery. All studies were nonrandomized controlled trials. The operation times were shorter for thoracoscopic surgery than for open surgery in three studies, but there was no significant difference (standard mean difference = 1.25, confidence interval [CI] = [-0.48-2.98], P = 0.16). In the thoracoscopic surgery group, the rate of postoperative deaths was significantly lower (95% CI = 1.24-2.75), but the occurrence of recurrences was more frequent (95% CI = 0.08-0.23). The hospital stay varied significantly across studies. There was a statistically significant difference (standard mean difference = -1.47, CI = [-2.24--0.70], P < 0.001) in the overall effect between the groups. The complication rate was significantly lower with thoracoscopic surgery compared to open surgery (odds ratio = 0.26, CI = [0.10-0.66], P = 0.004) for the overall effect between the groups. The thoracoscopic procedure, however, was planned for milder and stable cases.

Conclusion: Thoracoscopic repair of congenital diaphragmatic hernia in neonates is associated with a shorter length of hospital stay, fewer complications, and less postoperative mortality than traditional open repair. However, the rate of recurrence was found to be higher in those who underwent thoracoscopic surgery.

Diffuse esophageal leiomyomatosis (DEL) is a rare condition characterized by the growth of multiple benign smooth muscle tumors (leiomyomas) in the esophagus. These tumors can cause obstruction and functional impairment of the esophagus, leading to symptoms such as difficulty swallowing, chest pain, and weight loss. The disease can present with leiomyomas or glomerular nephropathy in other body parts, hearing defects, astigmatism, or myopia (Alport's syndrome). However, isolated cases are also reported in the literature. Surgical management of DEL presents several challenges due to the location and extent of the tumors. Herein, we describe a girl afflicted with DEL and required multiple surgeries for management, highlighting the unique challenges faced by the surgical team in restoring esophageal function and improving the patient's quality of life.

Background: Empyema thoracis poses a clinical conundrum due to its diverse clinical presentations and management options.

Aims and objectives: The study aimed to investigate the variability in clinical practice across centres and disciplines in the management of empyema in children.

Materials and methods: An online questionnaire focusing on paediatric empyema management was circulated among clinicians in India. Data on demographics, clinical experience, treatment modalities, and intervention indications were collected, and responses were analysed.

Results: The survey amongst 252 participants uncovered notable discrepancies in the viewpoints of pediatricians and pediatric surgeons on the use of fibrinolytic and the indication for video assisted thoracoscopic surgery in pediatric thoracic empyema. While surgeons tended to favour surgical interventions, paediatricians leaned towards conservative management and fibrinolytic therapy.

Conclusion: This study highlights substantial differences in clinical practice and underscores the need for standardized guidelines and interdisciplinary collaboration to optimize patient care and outcomes.