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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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   2021| May-June  | Volume 26 | Issue 3  
    Online since May 17, 2021

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A perspective upon systematic review and meta-analysis
Prabudh Goel
May-June 2021, 26(3):139-143
  1,110 98 -
Isolated fetal ascites: Etiology and prognosis – A 10-Year experience from a tertiary referral care center in India
Aanchal Sablok, Akshatha Sharma, Rachna Gupta, Seema Thakur, Anita Kaul
May-June 2021, 26(3):162-169
Introduction: Isolated fetal ascites is an uncommon finding, and it may be difficult to elucidate the underlying pathology. This is more so when there are limited resources to investigate the patient adequately. This study was undertaken to see the etiology of isolated fetal ascites and analyze the outcomes. Materials and Methods: Twenty-three cases of isolated fetal ascites were retrospectively analyzed from December 2007 to June 2018. All cases were investigated with detailed ultrasound with other investigations as required. Postnatal data included gestational age at birth, mode of delivery, weight, and postnatal outcome. Results: The mean age at diagnosis was 26 gestational weeks. Structural abnormalities without any underlying chromosomal or genetic cause were identified in 10/23 (43.4%) cases with the most common structural abnormality related to the gastrointestinal tract where ultrasound proved to the most useful tool. The overall good prognosis was seen in 13/23 (56.5%) cases. Conclusion: Appropriate perinatal care, timely referral and delivery at tertiary care setup, and timely surgical intervention are measures which can improve the outcome and survival in fetuses diagnosed with isolated fetal ascites.
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Comparison between suction rectal biopsy and full-thickness rectal biopsy in the diagnosis of hirschsprung's disease
Rajeev Redkar, Swathi Chigicherla, Shruti Tewari, Rahul Deo Sharma
May-June 2021, 26(3):144-147
Aim: The aim of this study is to compare suction rectal biopsy (SRB) with full-thickness rectal biopsy (FTRB) in suspected cases of Hirschsprung's disease (HD). Materials and Methods: Between 2014 and 2018, we enrolled 41 consecutive children with suspected HD. We analyzed demographics, sex, age, clinical symptoms, radiological images, and biopsy reports. All the children had undergone X-ray of the abdomen and pelvis and contrast enema. All of them have undergone both SRB and FTRB, and their results were compared. Results: Out of 41 children, 26 were male and 15 were female. The children were aged from 5 days to 12 years. All of them presented with delayed passage of meconium, abdominal distension, and severe constipation. They all were on oral laxatives. The sensitivity and specificity of SRB are 80.95% and 90.00% when compared to FTRB which has 100% and 100%, respectively. Conclusion: FTRB is the gold standard test for diagnosing HD. SRB may be a good screening test in suspected HD cases. SRB is not as equal and effective as FTRB for diagnosing HD.
  985 62 -
An analysis of safety and efficacy of day-care surgery in children in a tertiary care hospital in India
Ravikesh Kumar, Subhasis Roy Choudhury, Pratap Singh Yadav, Raksha Kundal, Amit Gupta, Nitin Hayaran, Rajiv Chadha
May-June 2021, 26(3):148-152
Background: Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice. Aims and Objectives: This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children. Materials and Methods: In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded. Results: Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent. Conclusions: DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.
  654 43 -
Congenital pouch colon: Case series and review of evidences for resection
Miriam Duci, Francesco Fascetti-Leon, Enrico La Pergola, Paola Midrio, Piergiorgio Gamba
May-June 2021, 26(3):153-161
Background: Congenital pouch colon (CPC) is a rare variant of anorectal malformations (ARM) with its highest reported incidence in India. We aimed to describe five patients affected by CPC, in which the tissue from the terminal dilated colon has been successfully used and to discuss our results on the light of an extended revision of the literature. Materials and Methods: The clinical details of five cases treated for CPC in two Italian Centers were retrospectively reviewed assessing the fate of the terminal dilated colon. Results: In all cases, the tissue from dilated colon has been used. The double vascular system of the dilated pouch allowed increasing bladder capacity (case 4), reconstruction of the vagina (case 3, 5), and lengthening of the colon (case 1, 2, 5). In our series, 3/5 have a good bowel control with daily bowel management after ARM correction. In literature, there are not differences in terms of dependence from bowel management in patients with pouch resected and in patients with pouch saved (P = 0.16). Conclusions: We acknowledge that the analysis of the available literature is limited by the absence of studies with high level of evidence and the removal or the preservation of the abnormal colon tissue seems to follow the surgeon preferences.
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Is it better to operate congenital lung malformations when patients are still asymptomatic?
Mario Lima, Simone D’Antonio, Neil Di Salvo, Giovanni Parente, Beatrice Randi, Michele Libri, Tommaso Gargano, Giovanni Ruggeri, Vincenzo Davide Catania
May-June 2021, 26(3):170-176
Context: Congenital lung malformation (CLM) is a rare developmental anomaly of the lower respiratory tract. The purposes are to define if the presence of respiratory symptoms, in CLM may affect surgical outcomes and to define optimal timing for surgery in asymptomatic patients. Settings and Design: Retrospective review of patients with CLM from 2004 to 2018. Asymptomatic and symptomatic patients were compared. Moreover, asymptomatic patients were stratified according to age at surgery (< or >6 months). Subjects and Methods: Demographic data, prenatal diagnosis, symptoms, CLM's characteristics, operative and postoperative data were collected. Patients were divided into two groups based on the presence or none of respiratory symptoms. Statistical Analysis: Data were compared using the Fisher's exact test for qualitative values and Mann-Whitney test for quantitative values P < 0.05 was statistically significant. Results: One hundred and eighty-six patients were treated. Asymptomatic were 137 (74%), while symptomatic were 49 (26%). The most common presenting symptoms were respiratory distress (n = 30, 61%) followed by pneumonia (n = 18, 38%). Prenatal diagnosis of CLM was performed in 98% of asymptomatic patients compared to 30% of symptomatic (P = 0.001). Surgical excision was performed in all cases, and in 50% by thoracoscopy, without difference between the two groups. In 97% of all cases, a lung sparing surgery was performed without difference between the groups. Symptoms are significantly associated with older age, location in the upper lobe, and lobar emphysema. Length of stay in intensive care, postoperative complications, and reintervention rate were higher in the symptomatic group. Eighty-one asymptomatic patients underwent surgery <6 months of life; they had a lower rate of surgical complications (2%) compared with those >6 months (7%). Conclusions: The present study describes a comprehensive picture of CLM. In addition, we emphasize the role of early postnatal management and thoracoscopic surgery, also before 6 months of life, to prevent the onset of symptoms that are associated with worse outcomes.
  348 30 -
Insight into posterior urethral valve management: My two cents
Yogesh Kumar Sarin
May-June 2021, 26(3):210-212
  306 43 -
Isolated penile injury in boys: Accident, negligence, or abuse?
Nitin Pant, Sudhir Singh, Anand Pandey, Ashish Wakhlu
May-June 2021, 26(3):177-181
Aim: The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys. Methods: A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital. Results: Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet (n = 5), postcircumcision (n = 2), dog bite (n = 1), and scald injury (n = 1). Extent of injury includes complete urethral transection at corona (n = 4); loss of urethral plate in a case of hypospadias (n = 1); complete loss of glans (n = 1); penile transection at corona (n = 1); total penile amputation (n = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin (n = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus (n = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end–end anastomoses (n = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty (n = 1); and Bracka's staged urethroplasty (n = 1). Complications include wound infection following trauma (n = 4), postsurgical infection (n = 3), urethrocutaneous fistula (n = 2), and reapplication of penile hair tourniquet (n = 1). Conclusion: Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.
  314 32 -
Mesenchymal hamartoma of the chest wall in an infant – A benign entity masquerading as malignancy
Harshavardhan Mahalingam, Madhu Ramasundaram, Swaminathan Rajendiran, Dhaarani Jayaraman
May-June 2021, 26(3):184-187
Mesenchymal hamartoma of the chest wall is a rare tumor-like lesion encountered in neonates and infants. Although typically benign with no metastatic potential, it has alarming imaging and pathological features that mimic malignancy. We describe the imaging, surgical, and pathological features of this rare entity in a 1-month-old infant.
  300 29 -
Antenatally detected multiple mediastinal enterogenous cysts in a newborn presenting with severe cardio-respiratory compromise and early life-saving management
Abhijit Modak, Shashi Kant Dhir, Adil Ahmed Khan, Pulkit Rastogi, Nitin James Peters, Kanya Mukhopadhyay
May-June 2021, 26(3):192-194
Posterior mediastinal enterogenous cyst is a rare entity in neonate. The neonate can present with severe cardio-respiratory compromise in the form of respiratory distress, shock, cardiac failure or arrhythmia soon after birth which may require immediate surgical intervention. Antenatal screening can demonstrate the cystic mass in fetus early and can help in quick postnatal management. Multidisciplinary management with aspiration of the cysts was life-saving in the present case.
  304 24 -
Needling for suture track fistula
Uday Sankar Chatterjee, Ashoke Kumar Basu, Kuntal Bhaumik
May-June 2021, 26(3):203-205
A day care procedure for ablation of epithelium of suture track fistula (STF) is described with a tip of hypodermic needle under surface anesthesia. STF is a minor but annoying and frustrating complication following hypospadias surgery. Parents and patients are worried of soiling of dress from dribbling of urine through STF during urination. It is embarrassing particularly in the presence of peers. Nevertheless, no specific treatment is found in literature for its remedy other than the conventional procedures for repair of fistula. Here, we describe a simple day care procedure under surface anesthesia with prilocaine ointment. Thirty-five out of 42 STFs healed in single or repeat attempts with this 'needling' procedure.
  293 29 -
Endoscopic appendectomy for inverted appendix: A case report and review of literature
MM Zameer, Sanjay Rao, Gayathri Gopalakrishnan, Ashley D’cruz
May-June 2021, 26(3):198-199
Inverted appendix is a very rare anomaly and presents a diagnostic challenge. We report a case of inverted appendix in a 10-year-old boy and its management.
  273 31 -
Superior mesenteric artery injury during radical nephrectomy in an infant: Delayed diagnosis and successful management
Mainak Deb, Harish Jayaram, Jamir Arlikar
May-June 2021, 26(3):188-191
Superior mesenteric artery (SMA) injury during a left radical nephrectomy is an uncommon complication in children with a potentially devastating outcome. Successful management depends on early diagnosis and re-establishing SMA perfusion. We report the successful management of an iatrogenic SMA injury during radical nephrectomy in a 10-month-old boy with left upper polar Wilms' tumor.
  266 28 -
Mucosal schwann cell hamartoma of the gall bladder
Kanika Sharma, Anjan Kumar Dhua, Prabudh Goel, Vishesh Jain, Devendra Kumar Yadav, Prashant Ramteke
May-June 2021, 26(3):182-183
Mucosal Schwann cell hamartoma (M-SCH) of the intestinal mucosa is a rare entity and incidental finding in histological examination. Histological characteristics are Schwannonian cell proliferation in lamina propria with S100-positivity. M-SCH-like lesion in the gall bladder is even rarer and is a recently reported entity. We report this extremely rare lesion in a cholecystectomy specimen of a 4-year-old boy, which makes it the youngest patient to be having M-SCH-like lesion in the gall bladder.
  266 27 -
On the evaluation of scientific papers presented in IAPS conferences
Venkatachalam Raveenthiran
May-June 2021, 26(3):208-209
  234 31 -
Pelviureteric junction obstruction in ectopic kidneys with extrarenal calyces: A rare renal anomaly
Ravi Prakash Kanojia, Karmon Janssen, Andrew Kirsch
May-June 2021, 26(3):195-197
Extrarenal calyces (ERC) is a rare renal anomaly where calyces lie outside the renal parenchyma and are connected to pelvis by draining infundibulum. Its presentation with pelviureteric junction obstruction presents a confusing intraoperative finding. We report two cases of ERC with pelviureteric junction obstruction in the ectopic kidney. Emphasis is laid on the defining the anatomy so that reader can identify the condition if he comes across similar situation. The two patients were managed by minimal access approach. Management of these cases and review of pediatric cases reported in literature are discussed.
  216 30 -
VACTERL associated with a rare limb anomaly combined with edward (trisomy 18) syndrome
Zaheer Hasan, Vinit Kumar Thakur, Digamber Chaubey, Sandip Kumar Rahul, Sujit Kumar
May-June 2021, 26(3):206-207
VACTERL association is a heterogeneous condition that includes at least three out of six core structural defects which occur together more commonly than would be expected by chance alone. We report a rare association of VACTERL with unilateral proximal focal femoral deficiency and trisomy 18 syndrome.
  210 26 -
Simultaneous endoscopic management of urethral duplication and postposterior sagittal anorectoplasty urethral diverticulum in a boy with anorectal malformation
Simmi K Ratan, Chiranjiv Kumar, Satish Kumar Aggarwal
May-June 2021, 26(3):200-202
We report a case of urethral duplication with high anorectal malformation (ARM). A 12-year-old boy who had undergone transverse colostomy on day 2 of life and posterior sagittal anorectoplasty (PSARP) for ARM (rectobulbar fistula) at 8 years and also had urinary dribbling from a midscrotal opening in addition to normal voiding, presented with recurrent urinary tract infections and dysuria. Midscrotal dribbling had continued postoperatively. Colostomy had been closed 3 months after PSARP. Investigations revealed a large urethral diverticulum at the site of rectourethral fistula due to a segment of the gut being left behind during fistula closure. In addition, he had a sagittal urethral duplication originating at bulbar urethra and opening externally at midscrotum. The highlight of this report is successful endoscopic management of both the urethral duplication and the diverticulum.
  192 23 -
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