Iranian Journal of Pediatric Surgery

Introduction: Perioperative hypothermia is common during anesthesia and surgery and is accompanied by several complications. Compared to adults, children are at a greater risk of hypothermia and its complications. The aim of this study was to compare forced air and warmer in maintaining normothermia during pediatric surgery.

Materials and Methods: This randomized controlled trial was performed on 90 children undergoing elective hernia repair equally distributed in three groups of warmer, forced air and control. Patients’ body temperature was recorded preoperatively, intraoperatively, at the end of surgery and at the end of the postoperative care unit (PACU) stay. Time between anesthetic discontinuation and tracheal extubation and duration of PACU stay were also noted.

Results: Intraoperative and postoperative body temperature and body temperature on exit from PACU were significantly higher in forced air group in comparison to warmer and control groups and in warmer group in comparison to control group (P<0.05). Time between anesthetic discontinuation and tracheal extubation and duration of PACU stay were significantly shorter in forced air group compared to warmer and control groups and in warmer group compared to control group(P<0.05).

Conclusion: In comparison between the two methods (Warmer vs. Forced air), we found that forced air was significantly more effective in maintaining normothermia during pediatric hernia repair.

Introduction: Anorectal malformations (ARM) have an incidence of 1 in 5000 live births and affect male and female almost equally. Operative correction of pediatric ARM is of potential clinical interest; however, longterm outcome of patients in respect to probable complications requires precise follow up and surveillance. The aim of our study was to assess the outcomes of children undergoing surgical correction of ARMs.

Materials and Methods: In a prospective follow-up study, we wanted to assess occurrence of incontinence, constipation, soiling, abdominal distension, diarrhea, stenosis, dilated sphincter and failure to thrive (FTT) in ARM patients. In addition, management of these conditions has been discussed. Reoperations have also been reviewed. The primary outcome of the study was determination of occurrence of incontinence at follow-up visits. Secondary outcomes were occurrence of constipation, anal stenosis, soiling, abdominal distension, dilated sphincter, diarrhea and FTT at followup visits. In addition, the decision of research team on patients at followup visits was considered as secondary outcomes.

Results: Two hundred and ninety patients were studied. Of the study patients, 174 (60.4%) were boys and 114 (39.6%) were girls. Mean age of boys was 4.8 ± 2.0 years and mean age of girls was 5.0 ± 2.0 years. The mean follow-up period of our patients was 39.5 ± 29.1 months. During the study follow-up period, 63 patients (21.7%) had complications. The most common complication was constipation. It was present in 21 patients (33.3%). Soiling, incontinence, dilated sphincter, FTT, stenosis, abdominal distension and diarrhea were present in 21 (33.3%), 11 (17.5%), 9 (14.3%), 6 (9.5%), 6 (9.5%), 5 (7.9%), 3 (4.8%) and 2 (3.3%) patients respectively.

Conclusion: We found that the most common complications following ARM surgery are constipation, soiling, incontinence, dilated sphincter, FTT, stenosis, distension and diarrhea. The overall complication rate was 21.7%. 7.2 % and 3.1% of study population experienced constipation and incontinency respectively. In 3.1% of the study population reoperation was required. We revealed that outcome of surgical correction of ARMs is considerably good and complication rates are acceptable. Continence rate was also acceptable.

Introduction: Bone age determination is used in situations such a migration and sports. Radiography, MRI and ultrasound are different methods of determining bone age. This study was designed to evaluate the effectiveness of ultrasound in determining bone age in 14 -18 year olds.

Materials and Methods: One hundred male and 100 female students between 14 and 18 years of age were evaluated. The thickness of the epiphysis of the left distal radius in the ventral, dorsal and lateral views, were measured.

Results: In the females most of the growth plates were closed and the rest were inconclusive therefore ultrasound cannot be used in females in this age group. In the males, a minimum thickness of 0.7mm in dorsal and 0.8mm in ventral view in 14 and 15 year olds can be used to differentiate them from the 16 and 17 year olds. A maximum thickness of 1.6mm in dorsal and 1.1mm in ventral view can be used to differentiate 16 and 17 year olds from 14 and 15 year olds. Finally a maximum thickness of 0.8mm in the dorsal view can be used to differentiate 17 year olds from 16 year olds and younger.

Conclusion: Bone age determination via sonographic evaluation of the distal radius is an easy, fast and radiation free method that if confirmed by future studies can be used to differentiate 15 and younger from 16 and older boys. Ultrasound cannot be used to differentiate 14 to 18 year old girls

Introduction: Since abdominal tumors are one of the common causes of childhood death, studying the clinico-pathologic features of them is important for early diagnosis. Our aim in this study was to determine these features in Iranian children and to evaluate the accuracy of ultrasonography in diagnosing abdominal masses in children.

Materials and Methods: In this retrospective case series study, data about sex, age, primary chief complaint, physical examination, imaging report and pathology finding of 156 children with abdominal tumor, who were admitted to the Children Medical Center in the last 6 years were gathered.

Results: Male to female ratio was 0.69. The most common type of tumor in this study was Willm’s (37.5%) and Neuroblastoma (35.7%). Mean age of children with Willm’s tumor and Neuroblastoma was 38.95 and 26.65 months respectively. Ultrasonography has a lower accuracy in patients with tenderness, children with Willm’s tumor, female patients and children under 5 years old.

Conclusion: Our different findings regarding tumor type and distribution as opposed to previous studies may be due to genetic and geographic variations. In addition, this study shows that the accuracy of Ultrasonography in children with abdominal tumors depends on children’s sex, age, pain and the type of tumor.

Introduction: One-stage Transanal Endorectal Pull-Through (TERPT) is one of the methods used for the treatment of Hirschsprung’s disease. The purpose of our study was to evaluate complications of surgery specially does related to defecation in patients undergoing pull-through surgery in Tehran Pediatrics Medical Center during the past 10 years.

Materials and Methods: This descriptive study was performed on patients undergoing one-stage TERPT operation in Tehran Pediatrics Medical Center over the past 10 years. Exclusion Criteria included: the parent’s lack of consent to participate in the study, age below 3 years and inability to complete the checklist. For all patients, a check list was completed that included: Age, family history of the disease, readmission, follow-up period, presence of soiling, complete or partial fecal incontinence, constipation, use of laxative, use of boogie, presence or absence of RectoAnal Inhibitory Reflex (RAIR) in manometers, stricture in rectal examination and enterocolitis before and after surgery. Data analysis was performed using SPSS software version 19.

Results: Our patients were 4.81% male and 3.9% of them had an underlying disease, such as heart or kidney disease. Only 6.81% of them had to be re-admitted due to enterocolitis. Soiling was found in 5.39% of patients, complete and partial fecal incontinence were noted in 3.2% and 7.4% of them respectively. The incidence of fecal incontinency was 7%. Constipation occurred in 6.11% of cases and 3.9% of cases did not have RAIR in manometry. The incidence of rectal stenosis was 7% and 93% of patients had transitional zone (TZ) in barium enema before the operation. The result showed that there was no significant relationship between post- operative complications in both sexes (p<0.05).

Conclusion: This study shows that the complications of Endorectal Transanal pull-through surgery as a method for treatment of Hirschsprung disease are infrequent. Therefore, this method can be considered as a selective method. Further investigations are recommended to prove this matter

Introduction: Hidden penis may have different categories: Concealed, trapped, and buried types. The aim of this study was to evaluate the results and outcomes of repaired cases.

Material and Methods: A total of 40patients (5months -12years old) underwent surgical repair for different types of hidden penis from April 2010 to December 2015 in our hospital. Multiple surgical procedures were performed for each type. Data were collected and evaluated for number of patient’s, type of anomalies, surgical techniques, outcome and follow-up.

Results: All forty cases underwent surgical repair. In all cases of concealed and buried penis penile degloving and penile fixation was used. In all of our cases improved function and good outcome was reported.

Conclusions: Patients with hidden penis are in great psychological risks. The aim of hidden penis repair is to restore an aesthetic and functional penis which we are happy that we provided for our patients.

Foreign bodies ingestion is considered as a common pediatric problem, it is mostly encountred in infants between 6months and 2 years. Ingestion of magnets was documented in only few reports. We report two uncommon cases of bowel perforations owing to magnets ingestion. Patients were respectively aged of 10 months and 20 months .they were successfully managed. Once ingested, magnetic objects would attach each other through intestinal wall leading subsequently to intestinal necrosis. Thus their surgical removal is unavoidable.

Peutz - jegher’s syndrome (PJS) is a rare autosomal dominant disorder with gastro intestinal and mucosal pigmentations. We present a 2 y/o boy with a lesion prolapsing from his rectum that could not be reducted. We found him to have PJS and a familial history of PJS in his parents.