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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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   Table of Contents - Current issue
Sep-Oct 2020
Volume 25 | Issue 5
Page Nos. 263-335

Online since Tuesday, September 1, 2020

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Why is clinical research important for a pediatric surgeon? Highly accessed article p. 263
Ramesh Babu
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A qualitative evaluation of the scientific program in IAPSCON 2014–2018 Highly accessed article p. 265
Govind V S Murthi, Srinivas Rao Mukkavilli
Aim: To evaluate the range and scientific nature of oral presentations in the Scientific Program of IAPSCON from 2014-18 Methods: The oral presentations in Scientific Program of IAPSCON from 2014 – 18 were tabulated and categorised as per: type of presentation, Paediatric Surgery related clinical subject heading, nature of the content and scientific quality as per Oxford levels of clinical evidence. Results: Most oral presentations were in the form of Short papers. The most common clinical section and clinical condition presented were Urology and Hypospadias respectively. Clinical management followed by operative management represent the majority of the presentations when categorized by the type of content. Certain sections of clinical practice were not represented at all, notably anterior abdominal wall defects and gastro-oesophageal reflux. Most presentations (82.5%) are in Level 4 and 5 as per Oxford levels of clinical evidence, with Levels 1–3 accounting for 5% of presentations. Minimally Invasive Surgery (including robotic) accounted for 8.4% presentations. Conclusions: This qualitative evaluation shows the variety of oral presentations and areas of greater and lesser interest in the conference meetings. It shows that the scientific quality of the presentations can be improved and highlights certain areas of clinical and scientific research for future consideration.
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Modified duhamel's two-staged procedure for hirschsprung's disease: Further modifications for improved outcomes Highly accessed article p. 269
Nitin James Peters, Prema Menon, KL N. Rao, Ram Samujh
Aims and Objectives: We studied the short- and long-term outcomes and quality of life (QOL) in patients undergoing a two-staged modified Duhamel's procedure for Hirschsprung's disease. Materials and Methods: Patients who had undergone this modified procedure, with initial Hartmann's procedure based on contrast enema, followed by bowel preparation and low colo-anal anastomosis below the dentate line were included. The patient who underwent this procedure over 10 years with a minimum 2-year follow-up were analysed based on an interview-based questionnaire. Results: Of the 152 patients, 69 responded. Mean age at the time of interview was 7.72 ± 3.04 years with mean follow-up of 4.9 years (2–11 years). Perineal excoriation and soiling was present in 60.9% and 36.2% of patients initially which reduced to 0 and 4.3% by the end of 2 years. In the first 6 months, postoperative period, 15.9% of patients had constipation and 78.2% had altered stool consistency. Good fecal continence score was present in 97.1% of patients in the long term. About 95.4% had good QOL scores. There was no mortality in this series. Conclusions: Although short-term outcomes showed altered bowel function, soiling, and perineal excoriation, this improved significantly in the long term, with good QOL scores in the majority.
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A 1-year study on association between peripherally inserted central catheter tip position and complications in neonates p. 276
Kshitija Patil, SM Dhaded, Manisha Bhandankar
Aims: A peripherally inserted central catheter (PICC) is required in preterm neonates, especially those with low birth weight. However, PICC is associated with various complications resulting in increased morbidity and mortality. The objective of the study was to evaluate the association between PICC tip position and complications in neonates. Materials and Methods: One hundred neonates were recruited in a 1-year hospital-based, longitudinal, observational study. Radiographs were obtained to confirm the position of the catheter tip as central or noncentral in relation to vertebral level (T9–L5). The variables studied included site of insertion, duration of stay of PICC, time of removal, reason for removal, and associated complications. These were compared between the groups using SPSS version 20. Fisher's exact test was used to find the associations. Results: Most of the neonates were preterm (78%) and 81% were low birth weight. Catheter was placed in the right lower limb in most of the neonates (85%), and the catheter tip was central in position in 84% of neonates. The incidence of complications was observed in 29%. Noninfectious complications were common (26%) compared to infectious (3%). The most frequent PICC-induced complication was phlebitis (11%). Incidence of complications (P = 0.020), especially occlusion (P = 0.008), was significantly higher in neonates with noncentral catheter tip compared to the central tip. Conclusion: We observed a high incidence of PICC-induced complications in neonates, with phlebitis being most common. Further, the incidence of complications is influenced by noncentral tip position.
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Risk prediction scoring system to predict the postsurgical outcomes of biliary atresia p. 280
Rajeev Redkar, Vinod Raj, Swathi Chigicherla, Shruti Tewari, Chandralekha Tampi, Shirin Joshi
Aim: To find out association between liver function, liver histopathology and outcomes of biliary atresia (BA) following Kasai Portoenterostomy (KPE). Materials and Methods: This is a retrospective study of children who underwent KPE at a single institute by single surgeon. The patient records analyzed and data of complete blood counts, liver function tests, coagulation profile and histopathology reports collected. The outcomes recorded as alive and jaundice free, alive but jaundiced, and deceased. Statistical analysis done using SPSS 23. Observations: Total of 148 children operated during January 2000 to December 2018. Of these, 26 matched inclusion criteria. The parameters assessed were percentage of direct bilirubin, ratios of Aspartate transaminase (AST) to Alanine transaminase (ALT); Gamma glutamyl transferase (GGT) to AST; GGT to ALT and Aspartate transaminase to platelet ratio index (APRi). Among histopathology reports, fibrosis grade and bile ductular size noted. Among 26, 16 alive and ten are deceased. Among 16 alive, all are jaundice free. Of the parameters, ratio of AST to ALT, APRi and grade of fibrosis found statistically significant and further analysis showed if AST to ALT ratio < 2.1, APRi < 1.8 and grade of fibrosis < four, irrespective of age at surgery, had 96.2 % probability of successful KPE. Based on these observations, a scoring system and risk prediction model constructed based on Receiver operating characteristic (ROC) curves which are first in BA management. Results and Conclusion: Although numbers are sufficient for statistical analysis, we further intend to validate the scoring system in a prospective trial. BA children can be subjected to risk prediction model and KPE performed in those who have a score less than seven and offered to those with score between eight and 16 out of 20. Key Message: The scoring system and risk prediction model can guide in the management and post-operative follow up of children with biliary atresia.
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Implantable venous access devices in pediatric malignancies – Institutional experience in a developing nation p. 286
Jegadeesh Sundaram, Prakash Agarwal, Madhu Ramasundaram, Selvapriya Barathi
Background: Implantable venous access devices (IVAD) are preferred over long term external catheters in children due to less infection rates and better patient compliance in pediatric malignancies. Use of IVAD is a routine practice in developed part of the world. However it needs more emphasis for its widespread use in developing nation in order to improve the quality of care in children with malignancy. Aims and Objectives: We aimed at analyzing the outcome of IVAD in pediatric malignancies in a tertiary care set up of developing nation. Our objective is to enlighten the importance and feasibility of IVAD in childhood malignancies with review of literature. Materials and Methods: There were 152 children who underwent IVAD insertion in the study period. The parameters analyzed were indications, patient demography, size of the port, laterality of insertion, method of access to internal jugular vein (IJV), duration of surgery, time for access, complications, indication for removal and the parental satisfaction. Results: Mean age was 48 months. 112/152 patients had hematological malignancies. Right sided IJV was used by default in 97.4% patients, while remaining 2.6% had their left IJV cannulated. Open venotomy was used in 14 cases and 138 underwent ultrasound guided IJV access. The position of the catheter was reconfirmed in the X-ray, 6-8 hours after surgery. 149/152 ports were accessed 12 hours after surgery, whereas remaining 3 had a delay in access for 24 hours. Post operative complications were divided into early and late. 141 ports were removed after completion of chemotherapy, 4 were removed due to complications. 93 of parents gave the response as “satisfied” Conclusion: With proper training and expertise, insertion and care of IVAD is safe in pediatric malignancies without significant complications.
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Early feeding after colorectal surgery in children: Is it safe? p. 291
Arindam Ghosh, Somak Krishna Biswas, Kalyani Saha Basu, Sumitra Kumar Biswas
Aim of the Study: The aim of this study is to assess the role of early feeding after elective colorectal surgery in children and compare the outcome of feeding practice early versus traditional feeding. Study Design: A randomized controlled, single-center study was conducted over a period of 3 years (November 2015–October 2018) at a tertiary care center. Materials and Methods: Patients (n = 147), after colostomy closure (as elective colorectal surgery), were randomly selected for postoperative feeding initiation and were divided into two groups, namely the control (traditional feeding) group and study group (early feeding). In early group, feeding was initiated on the postoperative day 1 after the removal of nasogastric tube (removed after 16 h of surgery). Postoperative hospital stay and complications were compared among them. Statistical Analysis Used: Data were tabulated and analyzed in Microsoft Excel 2010. Results: Among 147 patients (boys[70] and girls [77]), the average age of colostomy closure was 4.36 years. Forty-five patients had early feeding and 102 traditional feeding. Average postoperative hospital stay was noted 5.62 ± 1.11 days for “Study group” and 8.1 ± 1.04 days for “Control group.” Postoperative complications were found in 17 patients; 11 (7.5%) superficial surgical site infection (9 [8.8%] in control and 2 [4.4%] in study group) and 6 (4%) minor fecal fistulae (5 [4.9%] in control group and 1 [2.2%] in study group). None required any further surgical intervention. No mortality was reported. Conclusions: Early feeding initiation after elective colorectal surgery is safe, and postoperative hospital stay is significantly reduced. It is definitely a step forward in the era of fast track surgery in pediatric population.
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Insight into posterior urethral valve from our experience: Paradigm appended to abate renal failure p. 297
Uday Sankar Chatterjee, Ashoke Kumar Basu, Debashis Mitra
Objective: The objective of the study was to share our experience of management of posterior urethral valve (PUV) and to suggest a paradigm to impede upstaging of chronic kidney disease (CKD) and prevent end-stage renal failure (ESRF). Patients and Methods: We have treated 332 patient of PUV from March 2005 to April 2016, Of which 272 case records had adequate data to be analyzed. The mean age was 2.48 years (range: 1 day–18 years). We did primary fulguration in 231 patients, of which five patients needed bilateral ureterostomy for obstinate high creatinine level. The remaining 36 patients had primary fulguration done elsewhere. Results: The mean duration of follow-up was 7.8 years (range 3–14 years). In the end of this study, 10 patients had down staging in CKD, 36 patients had up staging in CKD, and 9 patients ended in ESRF (3.8%). Conclusions: Detection of deterioration of renal function with creatinine clearance along with identifying the causes of deterioration and necessary interventions would help to arrest upstaging of CKD otherwise that might end in ESRF. From this study and reviewing the literature, we presume that the rhabdosphincter spasm underneath actually renders bladder outlet obstruction, and cusps of PUV, particularly in neonates, amplify the obstruction, following that bladder outlet obstruction cascades detrusor hypertrophy, bladder neck hypertrophy/obstructions, and ureterovesical junction obstruction/reflux, causing gradual damage to the bladder and upper tract and deterioration of renal function as a consequence.
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Segmental ileal dilatation presenting with neonatal intestinal obstruction p. 306
Sachit Anand, Anjan Kumar Dhua, Jeeva Sankar, Prasenjit Das, Prabudh Goel, Minu Bajpai, Akash Sharma
Segmental ileal dilatation is an uncommon cause of neonatal intestinal obstruction. This report highlights a rare combination of abnormal distribution of muscles in the muscularis propria and partial loss of interstitial cells of Cajal as causative factors for segmental intestinal dilatation.
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Adrenocortical carcinoma in a 6-month-old infant p. 310
Seema Rahar, Devender Singh Chauhan, Shashikant Singh, Arvind Ahuja, Minakshi Bhardwaj, Amita Sen
Adrenocortical carcinoma (ACC) is a rare malignant tumor arising from the adrenal cortex and it is even rarer in infancy. These tumors are usually hormonally active. We report a case of ACC in a 6-month-old infant who was brought by her mother with complaints of hirsutism and abnormally looking genitalia. Serum 17-alpha-hydroxyprogesterone and serum cortisol levels were raised. Subsequently, imaging studies revealed a large well-circumscribed soft-tissue mass in the right suprarenal region. The tumor was excised, and on histopathology in conjunction with immunohistochemistry, a diagnosis of ACC was given. Only four other cases of ACC have been reported till date in the literature, with an age of 6 months or younger. Hereby, we present a case of ACC in a young infant.
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Tracheal bronchus: An unusual cause of recurrent lower respiratory tract infection p. 314
Nikhil Rajendra Dhorje, Shivali Kailas Patekar, Shahaji Satish Deshmukh, Kshitij Dhaval Shah
A 14-month-old male child presented with a history of recurrent pneumonia of the right upper lobe of the lung. Computed tomography scan showed an accessory bronchus proximal to the carina on the right side with collapse consolidation of the lobe.
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A rare case of pediatric osteochondroma presenting as hemothorax p. 316
Pavai Arunachalam, Cenita J Sam, K Jothi Lakshmi, Hari Baskar Shanmugham
Isolated osteochondroma presenting as hemothorax is a rare entity. A 7-year-old boy presented with respiratory distress and diagnosed with hemothorax, and computed tomography showed osteochondroma and removal with resection of the rib was curative.
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Congenital pouch colon with segmental dilatation of ileum: Congenital pouch colon type 6 p. 319
Rahul Gupta, Pramila Sharma, Arka Chatterjee, Arvind Kumar Shukla, Arun Kumar Gupta, Lila Dhar Agrawal, Ram Babu Goyal
Congenital pouch colon (CPC) is classified on the basis of anatomic morphology into five types. Congenital segmental intestinal dilatation associated with anorectal malformation (ARM) is very rare. We are adding two neonates of CPC type 2 associated with segmental dilatation of the ileum to single similar case described in the literature till date. Temporary stomas with excision of either of the pouches should be considered. “Defective mesenchyme formation during organogenesis” due to abnormal mesenchymal precursor cells is hypothesized as the cause for both ARM and different types of CPC.
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Torsion of a wandering spleen managed conservatively: Rare and interesting p. 323
Rohen Skiba, Dhruva Nath Ghosh, Andrew Barker
Wandering spleen is a rare pathology. A 2-year-old child with abdominal pain was diagnosed to have a torted, avascular wandering spleen. On conservative management, she remains well with no radiological evidence of the spleen. Splenic torsion usually warrants surgery. Nonoperative management in selected cases allows the natural process of autosplenectomy.
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Repair of recurrent eventration of the diaphragm by latissimus dorsi flap: A novel technique p. 326
Veerabhadra Radhakrishna, Chittur Narendra Radhakrishnan, Sudarshan Reddy Nagireddy, Yellambalase Nagaraja Rao Anantheswar
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Currarino syndrome variant: Revisited p. 328
Rahul Gupta, Arun Kumar Gupta, Ramesh Tanger, Mohan Lal
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Adnexal mass with ascites and high cancer antigen -125 in a young female: Not always malignancy! p. 329
Gyanendra Chaudhary, Enono Yhoshu, Intezar Ahmed
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Poorly differentiated ovarian sertoli–Leydig cell tumor in a 12-month-old girl p. 331
Kriti Chauhan, Jyotsna Singh
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Three-centimeter chicken bone aspiration: The rare missed case p. 333
Mohammad Ashkan Moslehi
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Hypospadias surgery: Science and art p. 335
VR Ravikumar
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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

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