Iranian Journal of Pediatric Surgery

Introduction: The most common umbilical disorders in infants is umbilical granuloma. To date, various therapeutic methods have been proposed to treat umbilical granuloma. This study aimed to compare the clinical results of salt therapy with surgery in the treatment of umbilical granuloma in infants.

Materials and Methods: In a clinical trial study, 50 infants with umbilical granuloma visited at the Children Educational-Medical Hospital of Tabriz University of Medical Sciences were selected and randomly allocated into two groups. In the first group, 25 patients were treated with sterile salt, and in the second group; 25 patients underwent surgery using electro cauterization. Patients were followed for three months, and the cure rate, relapse rate, and side effects of each method were evaluated.

Results: Results showed that cure rate in the salt therapy group was 96.0% but in the surgery group it was 100%. There was no statistically significant difference between the two group regarding the cure rate (p=1.000). No relapse or side effects were seen in any of the study groups.

Conclusion: Based on the findings of the present study, salt therapy is a safe and effective method in the treatment of umbilical granuloma which can be an alternative to surgical methods in this regard.

Introduction: Scientific progress is one of the main parts of development in any country. One of the means of assessing it is the number of scientific papers which are published in internationally approved journals. In this article we will compare scientific production in the field of pediatric surgery between Iran and three other Asian countries: Turkey, India and Pakistan during 25 years.

Material and methods: Using scientometric methods we analyzed scientific productions in the field of pediatric surgery indexed in bibliographic databases such as PubMed and Scopus during 25 years from 1990-2015 by 4 Asian countries: Iran, Turkey, India and Pakistan.

Results: Turkey had the most articles indexed in ISI web of Science with 843 articles, India had 545 articles, Iran had 127 articles and Pakistan had 29 articles in 25 years.

Conclusion: Our main intention was to assess the research activity of pediatric surgeons in Iran. And what we found showed that despite similarity in the population and budget among neighboring countries our scientific production is lower.

Introduction: Mild anterior displacement of the anus may be a cause of constipation. Routinely for detection of the anterior anus, the mean anal position index is used but in this study we introduce another modality for this purpose.

Material and Methods: In this prospective study, patients with intractable constipation with onset bellow one year of age, normal rectal manometry, normal rectal biopsy and abnormal shape of anal verge, were include. The location of the anus was checked by muscle stimulator and according to the severity of the anteriority mini anorectoplasty or simpleY-V transposition of the anus was performed.

Results: Ten patients were studied. All were female with a mean age of 7 months. In 2 cases anorectoplasty and in the others Y-V anoplasty was done. All patients ultimately were cured.

Conclusion: Using muscle stimulator in external sphincter is reliable for detection of anterior displacement of the anus. Anorectoplasty or Y-V anoplasty for resolving constipation in these patients are effective.

Introduction: Although radiologic guided abscess drainage with a drainage catheter has been a successful method for treatment of appendicular abscess after surgery, single stage aspiration technique could also be used as a good option in children with intra-abdominal abscess. The aim of this study was to compare efficacy, safety and clinical outcome of percutaneous abscess drainage versus aspiration in pediatric patients with post-appendectomy abscess formation.

Materials and Methods: This randomized control trial was conducted under the supervision of Mashhad University of medical sciences. Children were enrolled in the study with suspicion of post-appendectomy abscess formation. Patients were divided into two groups (drainage or aspiration) with simple sampling method. Demographic characteristics and clinical outcome were compared between the two groups. Data analysis was done using SPSS version 16.

Results: Fifty children with post-appendectomy abscess were enrolled in this study. Their mean age was 10.4 ± 4.1 year (range from 5 to 19yrs). Drainage was successful in 88% of patients and the succeed rate in aspiration group was 96% and this difference was not significant statistically (p=0.609). Duration of hospital stay was longer in the drainage group in comparison with aspiration (2.8 ± 0.55 vs. 2.1 ± 0.47, p-value < 0.001).

Conclusion: Efficacy, safety and other clinical outcomes of percutaneous abscess drainage and aspiration were the same in pediatric patients with smaller than 5 cm post-appendectomy abscess. Due to lower cost and parental satisfaction, aspiration would be a good choice in children with small post-appendectomy abscess.

Introduction: A wide spectrum of pathologies can cause thoracotomy in the pediatric population. The aim of this study was to determine the frequency of causes of thoracotomy in Amirkola Children’s Hospital.

Materials and Methods: This cross sectional study was done on all patients that underwent thoracotomy in Amirkola Children’s Hospital. All information was obtained from the patient medical records admitted between 2001- 2016. The causes of thoracotomy were considered.

Results: Overall 60 patients were studied. Esophageal atresia type C with 37 cases (61.7%) was the most common cause of thoracotomy among children. In the study of associated diseases, 5 cases (8.3%) of patients suffered from Imperforate Anus. 44 cases (%88) of infants and only 6 cases (%12) of non-infants had congenital anomalies, and all 4 patients (100%) of non-infants had mediastinal masses. Five cases (83.3%) of non-infants and only one case (16.7%) of infants underwent thoracotomy because of infectious disease (p <0.001). No significant relationship was found between the causes of thoracotomy and gender (p = 0.41).

Conclusion: Based on the results of this study, esophageal atresia type C is the most common cause of thoracotomy in infants. Additionally, congenital anomalies in infants and the mediastinal mass and infectious disease were more common in children.

Introduction: Umbilical hernia is common in infants and children. The true incidence is unknown because many umbilical hernias resolve spontaneously. Historically, incarceration is considered rare (1-2); however, it seems to occur more frequently than it is generally believed. Most of the literature related to incarceration comes from African countries, where the black community predominates. It should be noted that umbilical hernias tend to occur more commonly in the African population; nearly 10 times more, than in whites. It seems that this trend is increasing in France and England as well, where most of the population is white. The same change appears to be happening in Iran.

Materials and Methods: A retrospective analysis of umbilical hernias at our institution was performed. Patients presented to our institution over a period of eight months, from March 21st to October 20th 2006.

Results: Of the fifteen cases of umbilical hernias during the 8 month 4 had incarceration (26%). There were 3 girls (75%) and 1 boy (25%). In all the 4 cases of incarceration hernias had a diameter of more than 1.5 cm. Two patients underwent manual reduction and the hernia was repaired the following morning and two patients underwent operation the same day the symptoms began, since the hernia was irreducible. Intestinal resection was not indicated in any of our patients; however omental resection was done in one of them. All patients had an uneventful postoperative course and there was no mortality.

Conclusion: Incarcerated umbilical hernia is not as uncommon as it was thought to be. Therefore, a more active therapeutic approach is recommended even in smaller hernias.

The acronym VACTERL is actually a combination of associated anomalies. We found a case of VACTERL association with hypertrophic pyloric stenosis. A six-weeks-old male infant was referred to us with hypertrophic pyloric stenosis. He had a history of esophageal atresia, imperforated anus and cardiac anomalies. This case shows hypertrophic pyloric stenosis in a patient with ‘VACTERL’ anomalies.

Nonpigmented villonodular synovitis is a very uncommon and benign proliferative disorder involving the synovium. It is mostly seen in the knee. Here we present a 13-year old girl with a 2 year history of left wrist mass without any pain, tenderness or limitation in range of motion. We believe it is necessary to considere villonodular synovitis in a child with chronic joint effusion as a differential diagnosis.

Inguinal hernia is more common in premature male babies. Using
General Anesthesia (GA) for the repair operation may cause apnea in
them. Caudal anesthesia on the other hand provides effective anesthesia
and analgesia without the complication of GA. Here we discuss different
methods of anesthesia in inguinal herniorrhaphy and their merits and
downfalls.