Journal of Indian Association of Pediatric Surgeons最新文献

Background: The radial artery is the most preferred site for arterial cannulation in pediatric patients. The optimal wrist position which provides the largest size of the radial artery in pediatric patients is unknown.

Aim: We aimed to compare the sonoanatomy of the radial artery in different wrist positions (0°, 15°, 30°, 45°, 60°, and 75° extension) in pediatric patients to identify the optimal position which offered the largest diameter of the radial artery.

Materials and methods: Ninety-six patients aged 1-12 years undergoing elective surgery were included. After induction of general anesthesia, an ultrasound examination of bilateral radial arteries was done. The wrist was placed in six different positions: 0°, 15°, 30°, 45°, 60°, and 75° extension, and radial artery anteroposterior diameter (APD), transverse diameter (TD), and depth from the skin (depth) were measured bilaterally using ultrasound.

Results: The mean (±standard deviation [SD]) APD in the neutral wrist position was 1.79 (±0.45) mm and 1.76 (±0.47) mm on the right and left side, respectively. The mean (±SD) TD in the neutral wrist position was 2.32 (±0.47) mm and 2.35 (±0.68) mm on the right and left side, respectively. The mean (±SD) depth of the radial artery in the neutral wrist position was 1.75 (±0.70) mm and 1.65 (±0.76) mm on the right and left side, respectively. With increasing wrist angulation, both APD and TD did not show any significant change; however, depth decreased with increasing angulation. All measurements were comparable bilaterally.

Conclusions: In 1-12-year-old children, increasing wrist angulation leads to decreasing depth of the artery; however, the anteroposterior and Transverse diameter show no significant change.

Aim: The aim of the study was to assess the awareness and identify the issues faced by pediatric surgeons in India concerning laparoscopic ergonomics.

Methods: An online survey was conducted by circulating a questionnaire consisting of 18 questions among pediatric surgical consultants and trainees in 2023. The questions were used to assess the musculoskeletal issues faced by the surgeons while operating and they included gender, height, experience, complexity of the procedure performed, position of the monitor, operating table height, length of instruments used, and health issues faced due to bad ergonomics.

Statistical analysis used: Chi-square test, Pearson's score for correlation, ANOVA.

Results: A total of 152 pediatric surgeons participated, of which 119 were males and 32 were females, with 96 (62%) working at a teaching institution. 73 (48%) were senior consultants with >10 years of experience. 79 (52%) performed advanced laparoscopic procedures. Neonatal surgeries (71%) were the most challenging. Fifty-four (36%) surgeons faced musculoskeletal illnesses. This was more prevalent among senior grade consultants (58%), female surgeons (50%), surgeons with heights between 155 and 175 cm (81.2%), surgeons older than 60 years (58%), and those performing advanced procedures (75%). Most participants (98%) were keen on improving their laparoscopic ergonomics. 140 (93%) surgeons noted that laparoscopic ergonomics was overlooked at their hospitals and 84 (56%) lacked institutional support for acquiring the necessary infrastructure.

Conclusion: Thirty-six percent of surgeons experienced musculoskeletal disorders while performing advanced procedures (75%), and height, female gender, and complexity of procedures were noted to have a positive correlation with the injury.

Aims: The aims of this study were to compare surgical outcomes of conventional open inguinal hernia repair (OR) with laparoscopic repair of inguinal hernia (LR) repair in Indian children operated by a single surgeon.

Materials and methods: This is a retrospective (historical) nonrandomized cohort study of 1595 children with unilateral inguinal hernia for 10 years. All children who presented with unilateral inguinal hernia were included in this study. The study was divided into two phases of 5 years each, and patients were classified into Group 1 and Group 2. In the first 5 years (Group 1), all the children with unilateral inguinal hernia underwent conventional open repair. Over the next 5 years (Group 2), all the children with unilateral inguinal hernia underwent laparoscopic repair. All the operations were performed by the same surgeon who was well acquainted with laparoscopic surgery. Parameters studied included gender, side of the hernia, time of surgery, incidence of contralateral patent processus vaginalis (PPV), development of metachronous contralateral hernia, and complications.

Results: A total of 1595 children with unilateral inguinal hernia were studied. Nine hundred and forty-five patients underwent OR (Group 1), and 650 patients underwent LR (Group 2). The male-to-female ratio in Group 1 was 2.5:1, and in Group 2 was 2.4:1. Right inguinal hernia was present in 59%, whereas 41% had a left inguinal hernia. In Group 1, 8% of children developed metachronous contralateral hernias. In Group 2, the contralateral processus vaginalis was found to be patent in 260 children. However, only 10% (26) of these children developed metachronous contralateral hernia on follow-up. In the present study, a significantly higher recurrence rate (2.5%) was observed in the LR group as compared to the OR group (0.3%). The overall operative time was lesser in the OR group (15 ± 8.4 min) versus LR group (25 ± 10 min).

Conclusions: Only 10% of children with contralateral PPV in our study went on to develop a symptomatic hernia. Hence, we believe that upfront closure of the contralateral PPV with unilateral inguinal hernia may not be necessary. LR has a longer operating time and higher recurrence rates. The choice of technique depends on factors such as the availability of laparoscopic equipment and infrastructure, surgeon's preference, and expertise.

Children with high-pressure bladders are at an increased risk of upper tract deterioration, potentially leading to chronic renal failure if not adequately managed. Regular bladder pressure monitoring is essential, especially in patients with neurogenic bladders, often resulting from spinal dysraphism. Urodynamic studies (UDSs) are the gold standard for assessing bladder pressure but are invasive, resource-intensive, and uncomfortable for patients. Over the last many decades, there have been regular attempts to characterize the morphology of the neurogenic bladder, including the classical subjective appearance of the "Christmas Tree" bladder, to objectively define the shape of the bladder via the use of height-to-width ratio. The study explores the evolution of scientific efforts to define bladder morphology in neurogenic bladder and to describe the current state of evidence regarding the correlation of the shape of the bladder with the detrusor pressures and upper tract changes in children with neurogenic bladder.

Background: The etiology of spina bifida is multifactorial; the phenotype is the end result of both genetic and environmental influences. While whole exome sequencing has identified several pathogenic variants in Indian cohorts, the role of chromosomal imbalances and long contiguous stretches of homozygosity (LCSHs) remains largely unexplored in this population. Chromosomal microarray analysis (CMA) is an important tool that provides insights into such genetic aberrations, making it significant for evaluating patients with spina bifida.

Objective: To identify LCSHs and chromosomal imbalances in three spina bifida patients through CMA analysis as a pilot investigation.

Materials and methods: Genomic DNA was isolated from three spina bifida patients (P1: 10-year-old female, P2: 1-year-old male, and P3: 2.8-year-old male) and subjected to CMA using the Affymetrix 750K high-density array platform. The submicroscopic chromosomal imbalances and LCSHs were cross-referenced with public databases (Database of Genomic Variants, ClinVar, and OMIM) to evaluate their clinical significance. Functional annotations of the affected genes were performed to understand their role in neural tube development.

Results: CMA revealed significant LCSH on chromosomes 2, 3, and 7 involving the genes SOX11, WNT7A, FZD9, SEMA3A, and VHL, all of which are involved in neural tube closure. Mosaic Klinefelter syndrome (25.9% mosaicism) was identified in the second patient while the third patient had a normal genetic profile. The detection of significant genetic variations in two of three cases underscores the potential utility of CMA in spina bifida patients.

Conclusions: This study has generated valuable insights into the complex genetic landscape underlying the multifactorial etiopathogenesis of spina bifida. The findings not only underscore the importance of an integrated approach but also support the cause of a platform for large-scale investigations in the Indian population.

Background: Adrenal tumors account for 0.2%-1% of all tumors in children. They can be benign or malignant, secretory or nonsecretory, and can arise either from the cortex or medulla. The common indication in children undergoing laparoscopic adrenalectomy (LA) is neuroblastic tumors (neuroblastoma, ganglioneuroma, and ganglioneuroblastoma).

Methodology: This is a retrospective observational study conducted from October 2021 to February 2024 (28 months) in the pediatric surgery unit at our institute. All children under 18 years of age referred to us for surgery of adrenal mass were included in this study. Any children with image-defined risk factors (IDRFs + ve) were excluded from the study. Children were worked up and managed according to the protocol of the Institute Pediatric Tumor Board. The laparoscopic transperitoneal approach was used for all. All adrenal lesions with IDRF +ve were excluded from the study and resected via open approaches.

Results: A total of six patients were included (three each in male and female groups). The mean age was 31 months (range 22 months-39 months). There were two cases of neuroblastoma, and one each of pheochromocytoma, adrenal adenoma, adrenocortical carcinoma, and paraganglioma. The median follow-up period was 24 months (range 7-32 months). On follow-up, there are no recurrences reported till date with zero mortality.

Conclusion: LA is a safe and feasible operation in children without any IDRF. It should be preferred in children with small lesion with good plane between the tumor and normal tissues. For larger lesion and ACC, it should be used cautiously to prevent spillage. Thought difficult, laparoscopic resection is a safe approach for these adrenal tumors.

Purpose: The meta-analysis investigates the effects of redo pull-through (PT) surgeries on bowel function outcomes in patients with rectosigmoid and long-segment Hirschsprung's disease (HD) who have already undergone an initial PT. By comparing different redo PT techniques, this study explores whether specific approaches yield better postoperative bowel function.

Methodology: A literature search was conducted for articles on redo PT for HD; this included PubMed and ScienceDirect databases. The search terms or MeSH words "Hirschsprung disease" OR "congenital megacolon" AND "re-do pull through" OR "re-do" OR "reoperation," connected by two Boolean operators "OR" and "AND," were used to search the databases for relevant articles.

Results: Fifteen articles of interest comprising 374 patients receiving redo PT were selected for analysis. The results suggest that selecting a redo PT method tailored to the patient's unique anatomical and surgical history may substantially improve functional outcomes, highlighting the potential for individualized strategies to enhance recovery and long-term quality of life for those requiring reoperation.

Conclusion: The findings indicate that the Swenson redo PT approach yielded better bowel function outcomes compared to other techniques. While redo PT procedures were effective in reducing fecal incontinence, the incidence of enterocolitis remained consistent across the various approaches.

Hepatic artery branch dissection is a lesser-known complication after biliary atresia surgery. The presentation is massive upper gastrointestinal bleeding and rapid drop in hemoglobin levels. We present a 6-week-old infant with biliary atresia who had dissection of a branch of the right hepatic artery which was managed by angioembolization.

Adipose tumors constitute only 6% of all soft-tissue neoplasms in the first two decades of life, with lipoblastomas accounting for one-third of these cases. Predominantly seen in children under 3 years old, preoperative diagnosis is challenging due to their heterogeneity and similarity to other lipomatous tumors. Surgical excision and histology remain essential for definitive diagnosis. We report the case of a 2-year-old girl with a right infraclavicular lipoblastoma.