Iranian Journal of Pediatric Surgery

Introduction: Traditionally, open groin exploration has been done for congenital inguinal hernia and hydrocele, but recently, laparoscopic herniotomy has gained popularity and has become a successful alternative to open herniotomy. This study compares Laparoscopic herniotomy [LH] and Open herniotomy [OH] regarding operative time, patency of contralateral internal ring, post-op complications, recurrence rates, and parental satisfaction.

Materials and Methods: A multicentric randomized prospective comparative study was done at two tertiary care centers in North India. A total of 180 patients (newborn to 12 years) with congenital inguinal hernia and congenital hydrocele were included based on the inclusion criteria and were randomized using computer-generated numbers to assign to open and laparoscopic herniotomy surgery groups. Various parameters were evaluated during the pre-op, intra-op, and post-op periods.

Results: The study was carried out from Nov 2014 to April 2019. The majority of the patients operated on had a right inguinal hernia in both groups (50% in each group). For bilateral inguinal hernia or hydrocele mean time taken by open technique was 41.16 minutes, and by laparoscopy was 37.75 minutes. In the case of unilateral hernia/hydrocele, it was 20.24 minutes by open technique compared to 24.3 minutes by laparoscopy. But the difference in operative time was statistically not significant.

Conclusion: Based on our observation and results, we conclude that both laparoscopic and open techniques are equally effective and comparable in managing inguinal hernia and hydrocele, with advantages and disadvantages. Claims of one procedure being better than the other and counterclaims of one being more complicated than the other are ill-founded, and the efficacy of each procedure must be viewed with an unbiased approach.

Abstract

Introduction: Esophageal stenosis is a complication that can occur following surgical treatment of esophageal atresia. Esophageal stenosis should be treated with some methods. One of these methods is using dilation and there are different devices for dilation. In this study we compared the outcome of the Balloon dilation and Bougie dilation for endoscopic treatment after esophageal atresia.

material and methods: this is a cross-sectional study that was performed on 40 pediatrics in two groups including the Bougie group and the Balloon group with equal members. The balloon and bougie dilations were performed for patients and data of these procedures were collected and analyzed.

Result: there were 20 pediatrics in both groups and the mean age of all of them was 21/33±12/46 months. All of stenosis symptoms were resolved by performing the bougie or the balloon dilation and these procedures were significantly effective but there was no difference about the balloon dilation or bougie dilation method.

Conclusion: there is no difference between balloon and bougie dilation. Both of them can be use for esophageal stenosis

Background: Although Duplication anomalies are common in the Gastro-intestinal tract, appendicular anomalies are rare with variable anatomy.

Objectives: To describe the series of appendicular duplication cases managed at a tertiary care center.

Methods: Data regarding the clinical features, associated anomalies and management of cases of appendicular duplication at a tertiary care center from January, 2019 to December, 2020 were collected retrospectively and analyzed.

Results: Four children with appendicular duplication were managed during this period; three neonates presented with high anorectal malformation and type two pouch colons with a large colovesical fistula. They had a single caecum with two separate appendices symmetrically on either side (type B1). They were managed by division of colo-vesical fistula, mobilization of colonic pouch after limited pouchoplasty and anoplasty as a single stage procedure. None of the appendix was removed. In one of these cases, bilateral ureters were dilated. The fourth case presented as a 3 year-old with pain abdomen and during surgery for suspected appendicitis, partial duplication of inflamed appendix was found (type A). Appendicectomy relieved this child of his symptoms. All patients are doing well on follow-up.

Conclusion: The position, anatomy and associated anomalies of appendicular duplication can be variable complicating its presentation and management.

Background: Ureteropelvic junction obstruction(UPJO) is one of the most common anomalies in children. The gold standard method for follow-up of these patients after pyeloplasty is a nuclear scan, but due to its high cost and limited access, it has recently been replaced with ultrasound. In this study, we want to assess ultrasound parameter changes after pyeloplasty.

Methods: In this cross-sectional analytical study, 124 patients from 2006 to 2012 who had undergone open pyeloplasty were enrolled. They were evaluated with ultrasound and nuclear scans before, 3, and 6 months after surgery. We analogized the results of these two methods and described the modifications in ultrasound parameters.

Results: Of all 124 patients with a median age of 30 months, according to nuclear scan results, kidney functions have improved by 96.77%. The average AP(anteroposterior) diameter of kidneys before, 3, and 6 months after surgery were 34.28 mm, 18 mm, and 15.19 mm respectively. In patients with successful surgery; PI (percentage improvement) of AP was above 15% after 3 months and above 26% after 6 months, thickness of the cortex raised at least 10 percent, and a reduction of at least 16% and 18% was seen in pelvic/cortex ratio in 3, and 6 months respectively.

Conclusions: After pyeloplasty, a reduction in AP diameter, PI of AP, pelvic/cortex ratio, and an expansion in thickness of the cortex have been seen. Ultrasound in 3 months has high sensitivity but low specificity, and in 6 months have high sensitivity and specificity.

Colorectal conditions such as Hirschsprung disease, anorectal malformation, fecal incontinence and spinal condition cause a significant stress among patients and their caregivers. Managing such disorders requires not only a one-time definitive surgery but a significant number of follow up visits, dietary modifications and long-term medication. The aim of this study was to estimate the psychosocial wellbeing of caregivers and patients suffering from these conditions.

Introduction: Paediatric abdominal trauma incidence increasing due to rising population, industrialization, modernization, increase in the vehicular traffic, terrorist activities and riots. This study is done to know the prognostic factors in paediatric abdominal trauma which help in decreasing morbidity and mortality.

Material and Methods:

This retrospective study was conducted at a tertiary care centre, from May 2016 to April 2022. Retrospectively records of all the paediatric patients with a history of abdominal trauma were analysed from case files. Demographic data, mode of injury, mechanism of injury, nature of the injury, definitive treatment and outcome of patients were analysed.

Results:

There were 110 paediatric abdominal trauma patients. Road traffic accidents was the most common mode of trauma seen in 70% of cases, followed by fall which comprises25.5% cases. 25 (22.7%) cases were hemodynamically unstable on presentation.70 (63.6%) cases required transfusion of blood or blood products. Penetrating abdominal trauma was seen in 19 (17.3%) cases, while blunt trauma seen in 91 (82.7%) cases, most common solid organ of injury was spleen seen in 46 (41.8%) cases, Surgical interventions were required in 29(26.4%) cases, however 81(73.6%) cases were managed conservatively. All patients of traumatic bowel perforation required surgical intervention. Nine (08.1%) patients were succumbed to death. Among the factors leading to mortality, delayed presentation (78%), hemodynamic instability (89%), requirement of transfusion (100%), penetrating abdominal trauma (78%), higher grade injury (67%), surgical interventions (89%) were commonly identified and were poor prognostic factors.

Conclusion: Delayed presentation, hemodynamic instability, penetrating abdominal trauma, higher grade of injury, surgical intervention are the poor prognostic factors. Site of injury, mechanism and the mode of injury are other factors contributing and deciding prognosis in paediatric abdominal trauma.

Abstract

Introduction: Central venous catheter placement (CVC) is an accepted venous access method in the treatment of critically ill neonates & infants, evaluation of factors that induce complications are nescessary. Therefore, the aim of this study was to investigate the effective factors in causing early and late complications of central venous catheter placement in infants less than one year hospitalized in Imam Khomeini and Golestan hospitals.

Methods: This study was performed on 400 infants less than one year old. Patients informations,early and delayed complications were recorded. Data were compared based on Chi-square and Fisher tests.

Results: The most common complication of central venous catheter placement in the neonates and infants were as followed, infection (5.5%), venous thrombosis (5%), thrombophlebitis (4.3%), bleeding (3.8 %), hematoma (2.5%), arterial injury (0.3%) and pneumothorax (0.3%). Hemothorax and malposition were not observed. Frequency of bleeding in patients in whom catheterization was attempted 3 times was significantly higher (75%) than  patients that had been tried twice (26.3%). Also, the frequency of hematoma and arterial injury were higher in cases who had tried twice. Finally, one case of pneumothorax was observed in cases who had been tried three times (25%). Also, the incidence of infection and thrombophlebitis in patients who had a catheter for more than 14 days was significantly higher than patients who had a catheter less than 14 days. However, it was found that the frequency of complications was not related to age, sex, height and weight, underlying disease of the infant, catheter location and catheter needle.

Conclusion: The incidence of central venous catheter complications in infants is low and has a significant relationship with the attempting times of placement and duration of catheter placement. This is a suitable venous access method for the treatment of infants and had no association with the underlying disease and neonatal demographic indicators.

Keywords: Central venous catheter, Early and late complications, Infant

Abstractter, Early and late complications, Infant

 Wilms’ tumor is one of the most common abdominal tumor of childhood, primarily a malignant renal tumor.  Extrarenal wilms’ tumor, however, is a rare disease, more commonly reported in Indian subcontinent. The locations of an extrarenal wilms’ tumor include retroperitoneum, uterus, skin and thorax.

Juvenile granulosa tumor is a rare tumor in infant. The diagnosis should be discussed in any ovarian tumor of children, especially in front of the early signs of puberty. The prognosis of granulosa cell tumors remains good. The main prognostic factor is the stage of local extension. Early diagnosis at early signs of puberty is an important prognostic factor. We describe the case of a girl aged 2 years and 5 months who presented signs of early puberty. The diagnosis was a secreting ovarian tumor but was very large at that time. We focus by this observation on the value of early diagnosis of this tumor type which remains a key prognostic factor.

Introduction

Müllerian duct abnormalities (MDAs) are the most common congenital genital abnormalities in females and included defects ranging from minor anomalies such as bicornuate or septate uterus to major defects such as uterus aplasia (1)Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare müllerian anomaly characterized by uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. The syndrome is usually associated with non-specific symptoms such as progressive pelvic pain after the menarche, dysmenorrhea, and palpable mass in the vagina caused by hematocolpos and hematometra.
Case report:
A 15-year-old single patient was admitted with abdominal pain and a feeling of heaviness. On examination of the abdomen and rectum, he had a palpable tactile mass about 10 cm in diameter. Heterogeneously attached to the right side of the uterine body through a base. The size and appearance of the left ovary was normal, but the right ovary was not observed. In the appendix on the right, a complex mass 46 mm in diameter was presented, indicating the presence of a serrated uterine fibroid or ovarian mass. The uterus was normal. Because virgin MRI was performed on abdominal MRI with and without contrast, renal failure and 80x56 mm cystic lesion with several thin internal septa were found in the right appendix.

Conclusion

The rarity of Herlyn-Werner-Wunderlich syndrome(HWWS) results in complicated diagnostic and therapeutic procedures.  Appropriate imaging techniques and correct interpretation is an attempt for faster diagnosis and treatment to avoid complications such as endometriosis and adhesions caused by chronic infections, and infertility. For these cases that had low age, due to the lack of a kidney and also negative impact of multiple surgeries on fertility, it is better the first decision to be made as a group in a medical joint commission. By increasing the number of case reports in the future, the etiology, best diagnostic and treatment methods will be more identified.