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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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   2014| April-June  | Volume 19 | Issue 2  
    Online since March 29, 2014

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Herlyn-Weber-Wunderlich syndrome with ectopic ureter in prepubertal female
Saurabh Garge, Deepak Bagga, Sameer Kant Acharya, Devendra Kumar Yadav, Tanvir Roshan Khan, Ram Kumar, Vinod Kumar, Srinivas Kumar, Divya Gupta, Ashish Prasad
April-June 2014, 19(2):103-105
DOI:10.4103/0971-9261.129607  PMID:24741215
We report a rare case of uterovaginal duplication in a prepubertal female. The patient also had a permeable ureter (ureter with urine passing through it) subtending a poorly functioning kidney with ectopic insertion in the obstructed hemivagina.
  6,625 171 -
Ovarian preservation in children for adenexal pathology, current trends in laparoscopic management and our experience
Preet Agarwal, Prakash Agarwal, Rajkishore Bagdi, Subramaniam Balagopal, Madhu Ramasundaram, Balamourougane Paramaswamy
April-June 2014, 19(2):65-69
DOI:10.4103/0971-9261.129594  PMID:24741207
Aims: Primary cysts and tumors of the ovary alongwith torsion are often regarded as an indication for open oophorectomy because of the fear of leaving an ischemic organ inside and chances of recurrence. We wish to report our experience of both modalities of management where we initially removed adenexal torsion by either laparoscopic salpingo-oophorectomy or oophorectomy, but later followed a more conservative approach of adenexal lesion removal with ovarian preservation. Materials and Methods: Retrospective review of clinical records of patients with ovarian pathology who were managed laparoscopically. Results: 46 cases of pediatric ovarian pathology were managed between March 2006 and March 2013 in two centers by a team of surgeons. The age ranged from 1 days to 18 years (average 14.3 years) and the pathology varied from 30 cases of a simple ovarian cyst with torsion, 3 cases of ovarian torsion without any cyst, 7 cases of a dermoid cyst with torsion in all, 1 case of secreting ovarian tumor and 5 cases of a paraovarian cyst with torsion. All patients had a normal tumor marker except 1 girl with a functional ovarian tumor who had elevated LDH and estrogen levels alongwith suppressed LH and FSH. In the initial period of our study we did 1 salpingo-oophorectomy for a suspected complex lesion and two oophorectomies for torsion with a simple cyst. In the later part of our study we performed laparoscopic cystectomy and ovarian preservation in 40 cases, including 7 cases of dermoid, where we performed laparoscopic detorsion with dermoid cystectomy and ovarian preservation in the same sitting. In three cases of chronic torsion who presented to us late, we could not preserve the ovary and had to resort to salpingo-ophorectomy. Histology showed a simple corpus luteal and follicular ovarian cyst in 31 cases, a paraovarian cyst in 5 cases with mature teratoma in 7 cases. Twenty-five patients with ovarian preservation following detorsion were subjected to follow-up ultrasound, who were found to have normal shape, size and blood flow compared to the contra lateral side. Conclusion: We outline our experience from the management of 46 cases of various ovarian pathologies with and without ischemia and found that ovarian torsion with a benign pathology and ischemia is not a contraindication for ovarian preservation, as pointed out in the current literature.
  5,490 214 -
Laparoscopic-assisted transanal pull-through for Hirschsprung's disease: Comparison between partial and near total laparoscopic mobilization of rectum
Mohit Kumar Mathur, Satish Kumar Aggarwal, Simmi K Ratan, Shandip Kumar Sinha
April-June 2014, 19(2):70-75
DOI:10.4103/0971-9261.129596  PMID:24741208
Background: Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson's operation - the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson's technique and minimizes the problems of a transanal procedure. Materials and Methods: Twenty patients (19 boys and one girl, newborn to 6 years) with Hirschsprung's disease (HD) were randomized for laparoscopic-assisted transanal pull-through (LATAPT) either by near complete (Group A) or partial (Group B) laparoscopic mobilization of rectum. Patients were followed up for at least 3 months. Demographic profile; operative details (time taken, blood loss, operative difficulty, and complications); postoperative course (duration of urinary catheter, oral feeding, and hospital stay); and follow-up stooling pattern, consistency, and continence were compared in the two groups. Results: The time taken for laparoscopic mobilization was marginally higher in group A, but the time taken for transanal dissection in this group was significantly less than in group B. All other comparisons showed no significant difference in the two groups. Stool frequency and continence improved with time in both groups. Conclusion: Extent of laparoscopic mobilization of rectum does not appear to be a factor deciding the outcomes. No recommendations could be made in view of the small number of cases. However, it shows that laparoscopic assistance can be used to maximize the benefits of Swenson type of operation and a transanal pull-through.
  4,307 234 -
Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children
Nitin Sharma, Minu Bajpai, Arbinder Kumar, Shashi Paul, Manisha Jana
April-June 2014, 19(2):80-84
DOI:10.4103/0971-9261.129599  PMID:24741210
Background: Extrahepatic portal venous obstruction (EHPVO) is the most common cause of pediatric portal hypertension. We analyzed the investigative protocol and results of portosystemic shunts in this group of patients. Materials and Methods: A total of 40 consecutive children aged below 12 years operated with a diagnosis of extra-hepatic portal hypertension formed the study group. Historical data and clinical data were collected. All patients underwent upper gastrointestinal endoscopy, ultrasound Doppler and computed tomographic portogram pre-operatively and post-operatively. Results with respect to shunt patency, hypersplenism and efficacy of different radiological investigations were collected. Results: A total of 40 patients, 28 boys and 12 girls constituted the study group. Lienorenal shunt (LRS) was performed in 14 patients; distal splenorenal shunt in 21 patients and side-to-side lienorenal shunt in 4 patients, inferior mesenteric renal shunt was performed in 1 patient. Follow-up ranged from 36 to 70 months. At a minimum follow-up of 3 years, 32 (80%) patients were found to have patent shunts. Patent shunts could be visualized in 30/32 patients with computer tomographic portogram (CTP) and 28/32 with ultrasound. Varices regressed completely in 26/32 patients and in the rest incomplete regression was seen. Spleen completely regressed in 19/25 patients. Hypersplenism resolved in all patients with patent shunts. Conclusions: Portosystemic shunting in children with EHPVO is a viable option. While long-term cure rates are comparable with sclerotherapy, repeated hospital visits are reduced with one time surgery. Pre-operative and post-operative assessment can be performed with complimentary use of ultrasound, CTP and endoscopy.
  3,078 208 -
Impact of image guided fine needle aspiration cytology in diagnosis of pediatric hepatic mass and cytohistologic concordance
Chhanda Das, Madhumita Mukhopadhyay, Moumita Sengupta, Ashis Kumar Saha, Biswanath Mukhopadhyay
April-June 2014, 19(2):90-95
DOI:10.4103/0971-9261.129602  PMID:24741212
Background: Pediatric hepatic mass is a heterogeneous group of benign and malignant lesions. Percutaneous fine needle aspiration cytology (FNAC) can be utilized as a diagnostic modality to assess the nature of radiologically demonstrated hepatic lesions and thus facilitate individualized treatment. Aims and Objective: The objective of the present study was to determine the diagnostic accuracy of percutaneous FNAC of pediatric liver masses, a procedure that is less invasive than open biopsy. Materials and Methods: A prospective, observational study was carried out in the Department of Pathology in collaboration with Department of Pediatric surgery and Radio-diagnosis including 31 pediatric patients presenting over last two years (June 2011 to May 2013) with focal hepatic lesion on ultrasound and computed tomography (CT) scan. FNAC was carried out under image guidance and cytodiagnosis was reached after appropriate staining. By comparing with histopathology reports, diagnostic accuracy of cytology was evaluated. Result: Among 31 cases included in the study, 51.6% cases were cytologically benign and hemangioma was the most common benign lesion. Hepatoblastoma was the most accounted malignant tumour (12.9%). FNAC provided 94% sensitivity and 92% specificity in diagnosing benign and malignant tumours. Overall diagnostic accuracy was 93.10%. No significant complication was noted. Conclusion: Percutaneous FNAC under image guidance is an effective diagnostic tool for diagnosis of primary and metastatic tumours of liver in pediatric patients.
  2,964 132 -
Mitra shunt (spleen preserving, side to side lieno-renal shunt) for portal hypertension with hypersplenism in early infancy
Sangram Shinde, Sarath Gopalan, Deepak K Kandpal, Sujit K Chowdhary
April-June 2014, 19(2):96-99
DOI:10.4103/0971-9261.129604  PMID:24741213
Extrahepatic portal vein obstruction (EHPVO) is the commonest cause of portal hypertension presenting with gastrointestinal bleeding and splenomegaly. Medical management of this condition may provide relief, but involves repeated hospital visits and endoscopic procedures. Surgery is an effective curative solution by lowering portal venous pressure with effective shunting of venous blood from splanchnic to systemic circulation. Shunt surgery for such a small baby has not been previously reported and splenectomy has its own problems. Similarly, banding or sclerotherapy in such babies is not without risk. Among the various shunt options, Mitra shunt (spleen preserving, side-to-side lienorenal shunt), developed and standardized in our own country, stands out as the most optimum surgical treatment for EHPVO in early infancy. We report a 4-month-old baby, youngest recipient of Mitra shunt reported in literature with successful outcome.
  2,528 115 -
Day case laparoscopic cholecystectomy in children: A review of 11 cases
Prakash Agarwal, Raj Kishore Bagdi
April-June 2014, 19(2):61-64
DOI:10.4103/0971-9261.129593  PMID:24741206
Aim: The aim of this paper is to study the outcome of day case laparoscopic cholecystectomy (DCLC) in children. Materials and Methods: A clinical pathway for day care laparoscopic cholecystectomy was followed with emphasis on the analgesia, post-operative nausea and vomiting (PONV), feeding, mobilization, pain scoring and patient satisfaction. Demographic and clinical data were recorded prospectively from March 2013 to November 2013. The setup allowed easy access to an overnight stay if needed. Hospital stay, complications, the need for medical advice after discharge, convalescence and patients satisfaction were analyzed. Results: We admitted 11 children with symptomatic cholelithiasis for day case laparoscopic surgery. There were no intra- or post-operative complications. The incidence of PONV was 0/11. There was no readmission. 4/11 patients complained of shoulder tip pain on follow-up next day. There was no overnight stay. Conclusions: Adoption of a DCLC pathway is feasible and safe for children. Emphasis on adequate pain management and avoidance of PONV results in a high rate of day case surgery equivalent to that achieved in adult practice.
  2,455 180 -
Laparoscopic repair of hernia in children: Comparison between ligation and nonligation of sac
Nitin Pant, Satish Kumar Aggarwal, Simmi K Ratan
April-June 2014, 19(2):76-79
DOI:10.4103/0971-9261.129597  PMID:24741209
Aim: The essence of the current techniques of laparoscopic hernia repair in children is suture ligation of the neck of the hernia sac at the deep ring with or without its transection. Some studies show that during open hernia repair, after transection at the neck it can be left unsutured without any consequence. This study was aimed to see if the same holds true for laparoscopic hernia repair. Materials and Methods: Sixty patients (52 boys and eight girls, 12-144 months) with indirect inguinal hernia were randomized for laparoscopic repair either by transection of the sac alone (Group I) or transection plus suture ligation of sac at the neck (Group II). Outcome was assessed in terms of time taken for surgery, recurrence, and other complications. Result: Thirty-eight hernia units in 28 patients were repaired by transection alone (Group I) and 34 hernia units in 29 patients were repaired by transection and suture ligation (Group II). Three patients were found to have no hernia on laparoscopy. Recurrence rate and other complications were not significantly different in the two groups. All recurrences occurred in hernias with ring size more than 10 mm. Conclusion: Laparoscopic repair of hernia by circumferential incision of the peritoneum at the deep ring is as effective as incision plus ligation of the sac.
  2,158 191 -
Cat eye syndrome, anorectal malformation, and Hirschsprung's disease
Mohammad M Saleem, Mohammad N AlZuobi, Awni D Shahait
April-June 2014, 19(2):119-120
DOI:10.4103/0971-9261.129613  PMID:24741221
  2,042 87 -
Extraperitoneal Pelvic laparoscopic disconnection of accessory urethra from normal urethra in a case of urethral duplication
Nitin Pant, Satish Kumar Aggarwal
April-June 2014, 19(2):115-117
DOI:10.4103/0971-9261.129611  PMID:24741219
We report an extraperitoneal pelvic laparoscopic approach to disconnect accessory urethra from normal urethra in complete urethral duplication. First stage consisted of chordee correction, partial excision of the accessory urethra and glansplasty. In the second stage the remaining accessory urethra was disconnected from the normal urethra through a pre-peritoneal minimal access approach to the retropubic space. The remaining distal mucosa was ablated using monopolar cautery.
  2,031 95 -
Ex-utero intrapartum treatment in the Indian scenario: Anesthetic challenges and positioning
Prabha Udayakumar, Pavai Arunachalam, Vinodhadevi Vijayakumar, Gunavathi Kandappan
April-June 2014, 19(2):106-108
DOI:10.4103/0971-9261.129608  PMID:24741216
Ex-utero intrapartum treatment (EXIT) is performed for fetuses diagnosed with large neck masses. A case report of a fetus diagnosed with a large cystic hygroma and cord around the neck who was delivered by EXIT is presented. The airway challenges and optimal positioning is discussed.
  2,031 90 -
Local peritonitis as the first manifestation of Crohn's disease in a child
Katerina Kambouri, Stefanos Gardikis, Maria Agelidou, George Vaos
April-June 2014, 19(2):100-102
DOI:10.4103/0971-9261.129606  PMID:24741214
Crohn's disease (CD) can occur anywhere in the gastrointestinal tract from the mouth to the anus and sometimes it presents in a nonspecific manner. Herein we describe a case of local peritonitis as the first manifestation of CD in an 11-year-old girl, and the subsequent method of treatment.
  1,996 78 -
Pyloric stenosis in a patient with pure esophageal atresia: A difficult diagnosis
Anindya Chattopadhyay
April-June 2014, 19(2):112-114
DOI:10.4103/0971-9261.129610  PMID:24741218
Hypertrophic pyloric stenosis is brought to attention by its characteristic non-bilious vomiting. In a patient with pure esophageal atresia and a feeding gastrostomy, the symptoms were modified and the diagnosis was delayed. This case report highlights the clinical features of this rare combination, whose diagnosis was easily established once the entity was considered.
  1,797 102 -
Minimal access surgery in Pediatric Surgery
Sandesh Vinod Parelkar
April-June 2014, 19(2):59-60
DOI:10.4103/0971-9261.129591  PMID:24741205
  1,682 186 -
Meckel's diverticulum and ectopic epithelium: Evaluation of a complex relationship
Sathyaprasad Burjonrappa, Phue Khaing
April-June 2014, 19(2):85-89
DOI:10.4103/0971-9261.129601  PMID:24741211
Introduction: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. Currently, for any incidentally discovered Meckel's diverticulum, the management approach is based on weighing the statistical odds of future complications against the risks of a diverticulectomy. Materials and Methods: The temporal relationship between age at Meckel's diverticulectomy and the presence of ectopic epithelium was evaluated in our series. A meta-analysis of all reported recent literature on this condition was subsequently performed to evaluate the strength of the relationship between ectopic epithelium and symptomatic Meckel's diverticulum. Results: There was a paucity of ectopic epithelium in Meckel's diverticulectomy specimens in infants operated on at less than 1 year of age. Having two or more ectopic epithelia in a diverticulum does not appear to carry an additive risk for complications. The meta-analysis confirmed that ectopic epithelium was the most significant factor that influenced surgical intervention in all series of Meckel's diverticulum. Conclusion: The relationship between ectopic epithelium and the development of symptomatic Meckel's diverticulum is complex. Further understanding of the development of ectopic rests in the diverticulum will facilitate elucidating the pathophysiology in symptomatic cases.
  1,737 119 -
Subglosso-palatal membrane a rare cause of neonatal respiratory distress: A case report
Vaibhav Pandey, Preeti Tiwari, Jayanto Tapadar, Ajay Narayan Gangopadhyay
April-June 2014, 19(2):109-111
DOI:10.4103/0971-9261.129609  PMID:24741217
Subglosso-palatal membrane is a rare cause of acute respiratory distress in newborn. Contrary to the earlier reported cases in which immediate splitting or excision of membrane has been described as measure to relief respiratory distress, we managed our case successfully without any emergency surgical procedure.
  1,703 83 -
Horseshoe kidney with multicystic dysplastic left moiety
Shasanka Shekhar Panda, Amit Singh, Minu Bajpai, Manisha Jana
April-June 2014, 19(2):118-119
DOI:10.4103/0971-9261.129612  PMID:24741220
  1,369 71 -
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