Original Articles

Holmium-YAG Laser Cystolithotripsy for Bladder Stone in Children

Nandkishor Dhanvantrao Shinde, Anup Desai, Sagar Kathare

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 1-8

Introduction: Bladder stones are endemic in developing countries, transurethral cystolithotripsy, open cystolithotomy and percutaneous suprapubic cystolithotripsy are the modalities of treatment. Ho:YAG lasers are widely used recently for pediatric bladder stones with development of pediatric ureteroscopes and cystoscopes. Hence this study is done to evaluate the efficacy, safety and morbidities of holmium laser
lithotripsy for bladder stones in children.

Materials and Methods: This prospective study was conducted in our ins tute over a period of 5 years. All children under18 years who underwent transurethral laser cystolithotripsy were included in the study. 9.5 Fr cystoscopes were used for transurethral cystolithotripsy. The stone was fragmented to 2-3 mm in size in all with Holmium YAG laser. Demographic data, clinical features, stone size, outcome and complications were recorded.

Results: Total of 32 children underwent transurethral laser cystlithotripsy for bladder stone during the period of
study. Mean age were 8.7±5.3 years. The most common presenting symptom was difficulty in micturition, which
occurred in 15 children (46.9 %). Stone sizes ranged from 5 to 60 mm with mean 20.48±12.9 mm. The opera ng me was 3 5 m inutes w ith t he r ange o f 1 5–55 minutes. Complications were seen in 28.1% children among which hematuria was common seen in 18.8% children.

Conclusion: Laser cystolithotripsy is effective and safe with less morbidity for management of bladder stones on children.

Introduction: Laparoscopic pyeloplasty is considered one of the most challenging procedures in the paediatric urology. Long operating time and steep learning curve are drawbacks of the technique. The aim of this study is to assess the feasibility of laparoscopy-assisted pyeloplasty and its outcome.

Materials and Methods: It's a retrospective comparative study of patient undergoing pyeloplasty in Shri
Dharmasthala Manjunatheshwara(SDM) College of Medical Sciences since June 2018 !ll February 2020. The pa!ents were divided into two groups based on whether patients have undergone laparoscopy-assisted approach (group A) or open pyeloplasty (group B) and both groups were followed up for one year. Laparoscopy-assisted approach constituted of laparoscopic mobilization of pelvi-ureteric junction (PUJ) followed by hand-sewn anastomosis after exteriorising the PUJ.

Results: There were 12 patients in group A and 16 patients in group B. Duration of surgery was longer in group A. There were 4 pa!ents in group A, older than 3 years who needed conversion to open surgery. One patient had recurrence of PUJO needing re-do surgery. There was no major complication in open technique except
wound infection which required extended hospital stay up to 8 days. There were no significant differences between the two groups in analgesic usage.

Conclusion: Laparoscopy-assisted pyeloplasty is an intermediate path for surgeons with less experience in
advanced laparoscopy. The reasonable small incision without compromising outcome in ureteropelvic anastomosis is the major advantage of this technique. The procedure is useful in infants but not suitable for the age group of above 3 years.

Objective Evaluation of the Therapeutic Effects of Oral Steroids in the Management of Biliary Atresia

Leily Mohajerzadeh, Elahe Golverdi, Khashayar Atqiaee, Gholamreza Ebrahimisaraj, Saran Lotfollahzadeh, Naghi Dara, Mehdi Sarafi, Amirhossein Hosseini

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 19-27

Introduction: Biliary atresia is a progressive fibro-obliterativecholangiopathy that affects both intrahepatic and extrahepatic biliary ducts causing cholestasis and neonatal jaundice. The use of anti-inflammatory agents such as corticosteroids may decrease inflammation and recurrent stricture.

Materials and Methods: This clinical trial had been performed on 24 patients admitted to Children’s Hospital with biliary atresia. Prednisolone was not administered in the control group after the operation, but in the intervention group, 2 mg/kg/day of prednisolone was given for 6 weeks and then tapered. Then, its therapeutic effect in the management of biliary atresia was compared.

Results: The mean age of the patients in the case and control groups was 2.19 and 2 months, respectively. Cholangitis (P= 0.3), direct hyperbilirubinemia (P= 0.6), ascites (P= 0.5), pigmented stools (P= 0.7), and esophageal varices (P= 0.1) between the two groups was not significant. But the age of the patients, outcome of treatment (P= 0.05), total hyperbilirubinemia (P= 0.05), growth failure (P=0.03), worsening grade of splenomegaly (P= 0.04), hepatomegaly (P= 0.03), fecal pigmentation (P= 0.003), death (P= 0.01), and portal hypertension (P= 0.02) in two groups were significant.

Conclusion: Regarding the results, corticosteroids have a significant effect on reducing the bilirubin levels, improving the survival rate, and decreasing the mortality rate, although these results are closely related to the patient’s age at the time of surgery.

Diaphragmatic Hernia in Children Admitted to Pediatric Hospital during 10 Years from 2009-19

Malihe Seddighi, Majid Sezavar, Reza Shojaeian, Zahra Abbasi, Maryam Naseri, Gholamreza Khademi

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 28-37

Introduction: Diaphragmatic hernia is a congenital anomaly with significant mortality even in the best centers of the world. Numerous risk factors have been identified in studies as predictors of patient outcome. The aim of this study was to determine the status of diaphragmatic hernia and related outcomes in children admitted to pediatric hospital.

Materials and Methods: Data of diaphragmatic hernia was extracted from patients’ records in Dr. Sheikh Hospital in Northeast of Iran who were admitted since 2009 till 2019. Demographic and birth information, disease diagnostic findings along with developmental defects or syndromes were recorded. In addition, more information about the patient and surgery was collected, including the length of the patient's stay in the intensive care unit (ICU), and the patient's condition before and after surgery. Also, data about recurrence of the disease, postoperative growth and development status of the child were gathered.

Results: Study included 153 patients, of whom 61.4% were male. Term gestational age, vaginal delivery, respiratory distress, and organ defects were seen in 81.7%, 54.9%, 91.5 %, and 24.2 % respectively. The overall hospital mortality of patients was 24.8%.The Apgar score of the live group was significantly higher than that of the deceased group. The length of ICU stay before surgery was significantly higher in the deceased group.Pco2 levels were significantly higher before and after surgery in the deceased group.HCo3 levels in the dead group were significantly higher than that of the living group.

Conclusion: The results of our study suggested that Apgar score and VBG (venous blood gas) status were probably related to patients' outcome.

Financial Analysis of the Video Assisted Thoracoscopic Surgery versus Open Thoracotomy in Management of Pediatric Parapneumonic Empyema

Leily Mohajerzadeh, Iman Harirforoosh, Gholamreza Ebrahimisaraj, Khashayar Atqiaee

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 38-48

Introduction: In this article we will evaluate the cost of these two techniques for management of parapneumonic empyema.  Aim of this study is comparison of the Cost- benefit of the less invasive Thoracoscopic Approach (VATS) versus Open Thoracotomy in pediatric patients with.

Materials and Methods: A prospective study was done on 42 patients referred to Department of Pediatric Surgery, between 2015 and 2017.

Patients were divided randomly into two groups of open thoracotomy(group I) and VATS (group II). Both groups were similar by terms of age (mean 6 years), number of patients (22/20), sex (1.1 male/female)and comorbidities. Routine preliminary workups were ordered for all patients. Patients were followed up for a course of 90 days to evaluate the results of the treatment and the incidence of complications and death. To calculate the cost of each method we take into account the defined parameters:

Results: The mean operative time (60versus45 minutes), the average of drainage time (7 versus 5 days), average length of hospital stay (23 versus 13 days) (p=0.007), and duration of pain–relief medications (10 versus 5 days) (p=0.004), were longer in group I. 27.3% of group I had surgical wound infection but no such case was seen in group II (p = .003). Redo thoracotomy due to lack of clinical improvement in group I and II, was observed in 9.1% versus 20%, respectively. Death due to pulmonary complications during the first 30 days after the surgery was seen in one case in the group I. The mean cost for VATS is about 1045.9$ versus 976,32$ for open thoracotomy technique.

Conclusion: Apart from other benefits of VATS technique such as less postoperative hospital stay, that has been shown in the previous article published by our team, now we can highly recommend this technique because of the lack of any significant cost difference between the VATS and open thoracotomy technique.

Determine the Appropriate Size of the Endotracheal Tube by Method Air Leak Test in Infants Weighing Less Than 2500 Grams and Compare It with Common Standards

Dariush Sheikhzadeh, Behzad Aliakbari Sharabiani , Issa Eslami, Mahin Seyed Hejazi , Sina Nasirzadeh

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 49-58

Introduction: Endotracheal intubation is common in premature infants due to the need for respiratory support. Therefore, choosing the right size of endotracheal tube to prevent damage and minimize air leakage seems necessary. The aim of this study was to determine the appropriate size of endotracheal tube in infants weighing less than 2500 grams (g) and compare it with common standards.

Materials and Methods: This is a cross-sectional descriptive-analytical study, which was performed on infants weighing less than 2500 g; undergone endotracheal intubation in Tabriz Children's Hospital in 2016. The infants were divided into different weight groups (2000 to 2500 g,1500 to 2000 g,1000 to 1500 g and under 1000 g). First, they were intubated by using the suggested size, based on weight. Then an air leak test is performed and if the test is positive, a larger endotracheal tube size has been tested to reach the appropriate size. This obtained size was compared with the proposed size based on existing standards.

Results: Needing for re-intubation was high among all infants and most of them needed re-intubation at least once. In the weight group 1500 to 2500 g, the initial size of 3.5 for the endotracheal tube seems to be optimal (as opposed to the suggested size 3). In the weight group less than 1500 g, size 3 endotracheal tube was the most frequently used tube (as opposed to the recommended sizes 2 and 2.5).

Conclusion: The results of this study show that using the recommended endotracheal tube size for infants is erroneous and most infants are intubated with at least one larger endotracheal tube size due to the positive air leakage test.

Case Report

Congenital Band Compression: A Rare Cause of Small Bowel Obstruction in Newborns

Rachida LAAMIRI, Dorsaf Makhlouf, Nahla Kechiche, Salma Mani, Amine Ksia, Lassaad Sahnoun, Mongi Mekki, Mohsen Belghith

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 59-64

Anomalous congenital band is a very rare cause of intestinal obstructions in newborns. It should be considered
as one of the etiologies of acute small bowel obstruction in neonatal period. We report here a retrospective study of three newborns with anomalous congenital bands who underwent surgical intervention between 2015 and 2018. There were 2 girls and 1 boy, aged respectively 1, 27 and 30 days. All the newborns were admitted with clinical diagnosis of acute small bowel obstruction. While band excision was done in all, one case received resection and anastomosis for intestinal necrosis. There are no specific signs that can help make the diagnosis of anomalous congenital band before surgical exploration.

Meckel’s Diverticulum: A Rare Entity with Diverse Presentations in Neonatal Age

Fatima Al-Zahra, Nadeem Akhtar, Naeem Liaqat

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 65-69

Meckel’s diverticulum (MD) is a common occurrence in pediatric population but it rarely presents in the neonatal period and when it does,it may have a range of presentations. We present two cases, one of which was a preterm newborn and had bleeding per rectum, while other had volvulus of MD.

Spontaneous Pneumomediastinum due to Hookah Smoking in Children: Two Case Reports

Ahmet Atıcı, Esra Doymaz, Rıza Fırıncıoğulları, Mehmet Emin Çelikkaya, Bülent Akçora

Iranian Journal of Pediatric Surgery, Vol. 8 No. 1 (2022), , Page 70-76

Spontaneous pneumomediastinum (SPM) is defined as free air within the mediastinum without any trauma, surgical procedure, medical attention or apparent precipitating causes. Pneumomediastinum (PM) is divided into two groups: (i) SPM and (ii) secondary PM. While smoking is accepted as a risk factor for PM in the literature, there is no concrete evidence linking hookah smoking with PM. In this article, our purpose is to present two children of SPM due to the sole effect of smoking hookah – without any other precipitating factor.
A 15-year-old male presented to the emergency department complaining of chest pain and dyspnea. He stated that shortness of breath had begun after his most recent hookah smoking.. On the second day of hospitalization, the patient was discharged uneventfully.
A 14-year-old male presented to the emergency department complaining of suffering dyspnea for 4 days.
It is stated that he had been smoking hookah for two months and that his shortness of breath had begun after his most recent hookah smoking. On the second day of hospitalization, the patient was discharged uneventfully. Although SPM is rare in pediatric-age patients, hookah smoking should be queried. In terms of treatment, conservative therapy is generally sufficient and no sequelae or recurrence is expected in follow-up.