Original Articles

Introduction: Elective inguinal herniorrhaphy is one of the most prevalent surgical procedures in pediatric age group. |Postoperative pain is prevalent in children undergoing inguinal hernia repair. This study was aimed to compare the analgesic effect of dexmedetomidine with bupivacaine combination versus bupivacaine alone for ilioinguinal nerve block in children undergoing inguinal herniorrhaphy.Materials and Methods: In this prospective randomized study, we studied 60 ASA class I and II patients with the age between 6 months to 6 years scheduled for unilateral inguinal herniorrhaphy. With the help of a computer-generated list, our patients were assigned randomly to two groups of 30 patients. Group A, received 5cc bupivacaine 0.25%, and group B received 5cc bupivacaine 0.25% with dexmedetomidine 0.3 μg/ kg. Statistical analysis was performed using SPSS. The t-student and Mann-Whitney tests were used to compare the variables between groups. The values were considered significant if P < 0.05.Results: There was no significant difference in blood pressure (systolic or diastolic) and heart rate between the two groups (P=0.624, P=0.784 and P=0.167, respectively).  Analgesia duration was significantly longer in bupivacaine with dexmedetomidine group in comparison to bupivacaine alone group (P=0.008). However, there were no significant difference in frequency of analgesic consumption (P = 0.175) and total dose of analgesic consumption (P = 0.634) in the first 24 h between the two groups. One patient in group B developed bradycardia.Conclusion: The use of dexmedetomidine, as an adjuvant to bupivacaine prolongs the length and the analgesic efficacy of the ilioinguinal nerve block after inguinal herniorrhaphy in pediatric age group.

Comparison of divided versus loop sigmoid colostomy in the management of anorectal malformation

Naveed Haider, Imran Hashim, Asif Iqbal, Armaghan Ahmad, Soban Hameed, Arsalan Raza Wasti, Muhammad Saleem

Iranian Journal of Pediatric Surgery, Vol. 5 No. 2 (2019), 4 February 2020, Page 54-59

Introduction: Anorectal malformation (ARM) is a birth defect of the digestive tract in which the anus and rectum are not normally developed. Surgical procedure such as colostomy (loop or divided) is suggested as the initial treatment for high variety ARM. Our objective was to compare frequency of stoma related complications of loop sigmoid colostomy versus divided sigmoid colostomy for high variety anorectal malformations.

Materials and Methods: A randomized controlled trial was carried out at children’s hospital and the institute of child health Lahore. A total of 180 patients were divided into two groups randomly using lottery method loop sigmoid colostomy (group-A) and divided sigmoid colostomy (group-B). After surgeries patients were followed weekly up till 4 weeks. Stoma related complications were noted.

Results: The mean age in group A and group B were 3.22 ± 1.26 days and 3.36 ± 0.97 days respectively. In group A there were 77 male & 13 were female, in group B there were 67 male & 23 female patients. In group A 24.5% patients had complications: 3.4% patients had retraction, 11.1% had prolapse, 2.2% had Obstruction, parastomal hernia was seen in 5.6%, stoma necrosis were seen in 2.2%. In group B 20% patients had different complications: 2.2% patients had retraction, 2.2% had prolapse, 5.6% had obstruction, parastomal hernia were seen in 2.2% and stoma necrosis were seen in 7.8%. The complications in group A were higher when compared to group B but were not significant, p-value > 0.05.

Conclusion: Divided sigmoid colostomy can be adopted to avoid stoma related complications in future.

Successful airway management with awake intubation in 40 newborns with tracheoesophageal fistula (TEF)

Hossein Moeini, Ahmad Eghbali

Iranian Journal of Pediatric Surgery, Vol. 5 No. 2 (2019), 4 February 2020, Page 60-66

Introduction: In this retrospective study a review of 40 cases of airway management for newborns with tracheoesophageal fistula (TEF) /esophageal atresia repair is presented. Almost all cases had associated cardiac anomalies.

Materials and Methods: Selected management was awake intubation with flow of oxygen via Mapelson F. Sedated awake intubation was performed using Atropine 0.02 mg/kg and Fentanyl1 µg/kg, and then occlusion of the fistula with ligation.

Result: In patients with small TEF, there was no problem in intubation and ventilation. Anesthesia management and post operative NICU care was performed for 26 cases with no problem, but in 14 cases there was difficulty for anesthesia management and NICU care.

Conclusion: We had no complication with performing the awake intubation technique.


Surgical Outcome of Corrosive Induced Antropyloric strictures

Asif Iqbal, Nabila Talat, Naeem Liaqat, Imran Hashim, Naveed Haider, Muhammad Saleem, Gohar Rasheed

Iranian Journal of Pediatric Surgery, Vol. 5 No. 2 (2019), 4 February 2020, Page 67-72

Introduction: Corrosive induced upper gastrointestinal tract injuries in pediatric patients, is not easy to treat. Interestingly only few reports are available in English literature highlighting the management and surgical outcome of corrosive induced antropyloric strictures. The aim of this study was to determine the presenting features, management and outcome of patients treated at our institute with corrosive induced antropyloric strictures.

Methods: This retrospective descriptive study was conducted at Paediatric Surgery Department of Children Hospital & Institute of Child Health, Lahore. Medical records of patients admitted for corrosive-induced gastric out let obstruction from January 2013 to December 2018 were included. The demographic, preoperative assessment, investigations, surgical procedure and follow up details were noted in a proforma. Results were analyzed by descriptive statistics using SPSS version 20. The quantitative variables were presented as mean ± SD. Qualitative variables were presented as frequency and percentages.

Results: A total of 62 patients were included in this study. The mean age at presentation was 4.9 ±3.9 years. Of these 67.7% were male and the mean weight of children at the time of surgery was 12.6 ± 5.0 kilo grams. Bathroom cleaner was ingested by 77.4%. Vomiting was seen 100% cases while abdominal pain and weight loss was seen in 38.7 %, and 80.6% respectively. We preformed Heinke-mikulicz pyloroplasty in 59(95.2%) patients, Billroth II in 1(1.6%) and gastrojejunostomy in 2(3.2) cases. Postoperatively 40 children remained well during early post- op period while leak and respiratory issue were seen in 11.9% and 13.6% patients respectively. The mean hospital stay was 27.9±11.5 days. Two patients died after surgery and the rest were discharged. Mean fallow up 15.2±70 months. Of 60 discharged children 37 (62.7%) had no issue while 4 (6.8%) had leakage from previous jejunostomy site leak other 19 patients were lost to follow up.

Conclusion:We conclude that surgical treatment for Antropyloric strictures due to corrosive injuries is an acceptable option with minimal complications. However, we emphasize on the preventive measure, child-proof containers and legislations to be taken by authorities and social welfare societies

Evaluation of surgical outcomes and causes of recurrence in thyroglossal duct cyst referring a referral children hospital in Iran from 2011 to 2018

Leili Mohajerzadeh, Sadaf Yazdani, Mehdi Sarafi, Ahmad Eghbali, AmirMohammad Zakeri

Iranian Journal of Pediatric Surgery, Vol. 5 No. 2 (2019), 4 February 2020, Page 73-79

Introduction: Thyroglossal duct cyst is amongst the most common congenital anomalies in the neck region which is only properly treated with surgery. However, the long-term result remains uncertain. The present study aimed to assess surgical outcomes and predictors of recurrence in cases of thyroglossal duct cyst that have been referred to a tertiary level children hospital in Iran.

Materials and Methods:  In this cross-sectional study, 29 children with thyroglossal duct cyst that had undergone Sistrunk procedure in Mofid hospital between 2011 and 2018 were evaluated. The study information was collected by reviewing the hospital charts.

Results: Patient's age ranged between 20 and 40 months. The disease in boys was twice as prevalent as girls and hence male to female ratio was almost equal to 2 to 1. Palpable cervical mass was the most prevalent which we found in 62.1%, followed by painful neck mass (13.8%), discharging cutaneous fistula (13.8%), palpable mass with dysphagia (6.9%) and abscess (3.4%). Preoperative antibiotics were prescribed for infection in 34.5%. Regarding the position of the thyroglossal duct cyst, suprahyoid position was reported in 72.4%. In terms of type of surgery, 23 cases (79.3%) underwent sistrunk procedure and 6 cases (20.7%) underwent simple incision. The mean follow-up time for patients was 3.32 ± 1.42 years. The relapse rate after surgery was 6.9% and the rate of postoperative complications was 10.3%. The percentage of relapse-free survival was 91.3% during the follow up period. The presence of discharging fistula as the predominant manifestation (p = 0.009), preoperative infection (p = 0.043), and thyrohyoid position (p = 0.016) were related to the disease recurrence.

Conclusion: Surgical complications rate including relapse or infections was 10.3% and the incidence of recurrence after surgery during the follow-up period with a mean of three years was 6.9%; that is more prevalent in patients with the presence of discharging fistula, preoperative infection, or thyrohyoid position. Preoperative infections, rather than postoperative infections, are associated with more recurrence. Thus infection is very important factor in the recurrence of thyroglossal duct cyst.


Bogota Bag and Negative-pressure wound therapy (NPWT) Experience in Children

Ahmet Atıcı, Mehmet Emin Çelikkaya, Çiğdem El, Bülent Akçora

Iranian Journal of Pediatric Surgery, Vol. 5 No. 2 (2019), 4 February 2020, Page 80-89

Introduction: as the war that took place in Syria caused many tragedies, it also brought children with open abdominal wounds which are not very common in pediatric surgery practice. In this study, we present the results of ten children treated with BB and NPWT for open-abdomen. Material and methods

Materials and Methods: we retrospectively reviewed the hospital records of ten children who were treated with BB and NPWT in our clinic between February 2016 and June 2018.

Results: Ten of the patients had sustained firearm injuries during the war in Syria. There were four girls and six boys. The average age was 8.1 years (2-14 years). Five patients received BB in emergency conditions followed by NPWT. Five patients received NPWT only. Abdomen could be closed in all 10 patients who treated with combined BB and/or NWPT. Enteroatmospheric fistula developed in one patient and ventral hernia developed in one patient. No mortality occurred in our patients.

Conclusion: BB and NPWT techniques can be applied fast and easy and have a high success rate in children with an open abdomen.

Case Report

Surgical complications of Pica syndrome: About 3 cases

Coulibaly Yacaria, Doumbia Aliou Aliou, Amadou Issa, Keita Mamby, Coulibaly Oumar, Kamaté Benoi, Djiré Mamadou Kassim, Coulibaly Youssouf, Camara Sadio, Diallo G

Iranian Journal of Pediatric Surgery, Vol. 5 No. 2 (2019), 4 February 2020, Page 90-97

The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse natured foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain asymptomatic for a long time. Treatment is surgical. We report 3 cases of digestive complications of Pica syndrome.

A Case of Giant Gastric Trichobezoar

Saeed Aslanabadi, Davoud Badebarin, Sina Parsay, Masoud Jamshidi, Ebrahim Farhadi, Amirhossein Ladan

Iranian Journal of Pediatric Surgery, Vol. 5 No. 2 (2019), 4 February 2020, Page 98-101

Trichobezoar is an unusual form of bezoar found in the digestive tract, mostly in the stomach. The patient is often a female in her adolescence who pulls out and swallows her hair. This habit could stem from anxiety and the trichotillomania disorder. These hairs accumulate in the stomach and cause gastrointestinal symptoms. Our patient is a 14-year-old girl who came to us complaining of abdominal pain. Upon further evaluation by ultrasonography and endoscopy, trichobezoar was diagnosed. Laparotomy and gastrotomy were performed,and a large bezoar was removed. Although the occurrence of trichobezoar is rare, surgeons should always consider the situation in patients with vague gastrointestinal symptoms and psychological problems, especially in young female individuals.