Iranian Journal of Pediatric Surgery
Volume:9 Issue: 2, Nov 2023

The study assessed whether effective pain management of the neonate could be achieved through topical approaches rather than acetaminophen in circumcision. Epinephrine and/or Lidocaine solutions with clinically proven safety were preferred for topical use. 

This study was conducted by separating 105 neonates into three groups, each of which consisted of 35 patients. The group I was followed up and assessed by performing pain management using only acetaminophen; in Group II topical liquid local anesthetic medication without Epinephrine. In Group III topical liquid local anesthetic medication with Epinephrine was used in pain management, including acetaminophen, to reduce oral medication if necessary. The pain was monitored using the Neonatal Infant Pain Scale.

In all three groups, it has been shown statistically that topical medication effectively relieves pain and reduces the need for oral medication. In the comparison of Group II and Group III, it was found that the presence of pain was lesser in the use of lidocaine containing epinephrine and less oral medication was required (p<0.001 & p<0.001). The frequency of topical application in Group II was statistically significantly lower compared to Group I (p<0.001). Topical administration containing Epinephrine was more effective compared to the group using only oral acetaminophen or liquid lidocaine without Epinephrine (p<0.001 & p<0.001). 

Painless procedures should be preferred in surgical procedures of neonates. If painful procedures need to be performed, effective pain management plans should be set up beforehand. Few oral medications can be used in the management of pain in neonates. In surgical procedures such as circumcision, intensive medication use is required, topical pain-relieving medications can be used to avoid or reduce the need for drugs that may have adverse effects.

The use of minimally invasive surgical techniques, such as VATS, has impacted the management of intrathoracic diseases, including empyema thoracis (ET). While VATS is superior to thoracotomy in various thoracic diseases, no specific intervention has been proven superior for ET, and its superiority in the pediatric population is not well-established. A retrospective study was conducted to compare outcomes between VATS and thoracotomy in managing ET.

This is a retrospective observational study of 80 patients who underwent surgery for empyema thoracis. The patients were divided into two groups: VATS and thoracotomy. The outcomes measured were length of stay, admission days after surgery, need for segmentectomy, wound infection, pneumothorax, retained hemothorax, emphysema, redo surgery, and mortality rate.

There were 42 patients in the thoracotomy group and 38 patients in the VATS group. The two groups did not differ significantly in terms of age, gender, involved side, etiology, and stage of the disease. The length of stay and admission days after surgery were slightly longer in the thoracotomy group than the VATS group, but the difference was not statistically significant. The incidence of wound infection, pneumothorax, retained hemothorax, and emphysema was significantly higher in the thoracotomy group than the VATS group. However, there was no significant difference between the two groups in terms of redo surgery and mortality rate.

VATS is associated with fewer complications, including wound infection, pneumothorax, retained hemothorax, and emphysema. Therefore, VATS should be considered as a safe surgical intervention for empyema thoracis.

 Sliding hernia is one of the most common types in children, and its proper treatment is crucial. Therefore, in this study, we compared the results of the children's sliding hernia surgery in bag inversion or organ incision methods.

 This study is a retrospective cohort observational study on 153 children with a sliding hernia who underwent surgical treatment with one of the two methods of sac inversion or organ dissection in Hazrat Masoumeh Hospital between 2011 and 2016 it was performed, and the rate of recurrence, length of operation, and complications in the two methods were compared.

 No complications occurred in any of the two groups. In the sac inversion group, zero percent, and in the sac dissection group, 1.6 percent of the patients had a recurrence, which was not a statistically significant difference (P=0.477). had a statistically significant difference (P=0.001).

 Finally, based on the results of this study, it can be concluded that the results of children's sliding hernia surgery are similar in the two methods of sac inversion or organ dissection.

Functional constipation (FC) is a common problem in childhood. It is estimated that 0.7 to30 percent of children suffer from CF all over the world. However, if the conservative treatments had no effects on constipation or symptoms are lasted for several years' surgery could be suggested. Unfortunately, there is no international standard definition of what failure of medical treatment actually means and to the surgeons and gastrointestinal (GI) physicians, this may not be the same in different centers.

This is a descriptive-analytical study which was done in Isfahan University of Medical Science, Isfahan, Iran, 2020. The aim was evaluation of outcomes of Duhamel operation in treating the children with megarectum suffering FC who admitted to Imam Hossein Hospital. Data were collected through a 3-part checklist. The first part was about demographic data such as age, gender, age of operation, and use of drugs before and after operation. Part 2 was Rintala-hall scoring system and part 3 was PICS for constipation.

In this study 40 children with FC suffering megarectum were studied and 38.1 percent (15) of children were boys. The mean± SD age of operation was 5.85± 2.92 years. The mean± SD score of incontinence were 10.85± 2.26 and 14.00± 2.38 before and after Duhamel, respectively. The mean score of constipation was 18.20± 3.00 before and 20.50± 2.39 after Duhamel. Paired t test showed that the mean score of incontinence and constipation were different significantly in 3, 6, 12 months after surgery (p< 0.05). So Duhamehh surgery can be concerned good method to treat megarectum due to FC.

Our findings indicated that Duhamel operation could help reliving the sign and symptoms of constipation and fecal incontinence in FC children.

 Meconium ileus is one of the most common causes of intestinal obstruction in the newborn, accounting for 9–33% of neonatal intestinal obstructions1. It is characterized by the lack of excretion of meconium caused by impaction of thick, desiccated protein rich pallet like meconium in the distal part of ileum, associated with clinical and specific radiological findings of intestinal obstruction2. It is the intestinal obstructive variant of cystic fibrosis3, Recent studies demonstrate that it can occur frequently without association of cystic fibrosis. The exact pathogenesis of MI in the absence of cystic fibrosis is yet to be known, a spectrum of genetic and pathological abnormalities may play a role4. Two forms of meconium ileus can be described, simple and complex meconium ileus4,5. In 1969, Noblett suggested the use of Gastrografin enema to treat uncomplicated meconium ileus7.Many surgical options have been used in the surgical treatment of meconium ileus including resection with Primary anastomosis, Mikulicz ileostomy, Bishop–Koop operation, and Santulli stoma. Resection with primary anastomosis was first described in 1962 9,15. An alternative to this approach was small bowel resection with creation of a stoma and eventual closure of the stoma with an end-to-end anastomosis. A distal chimney enterostomy (Bishop-Koop procedure) involves resection of disparately enlarged ileal loop filled with inspissated meconium and anastomosis between the end of the appropriately sized proximal segment to the side of the distal segment of bowel approximately 4 cm from the opening of the distal segment and the distal end is brought out as the ileostomy8, the reverse of the distal chimney enterostomy is the Santulli and Blanc proximal enterostomy. The Mikulicz double-barreled enterostomy where both proximal and distal loop was exteriorized. Bishop-Koop enterostomy has advantages over other procedure16,17,18as 1) it provides access for insertion of a catheter into distal bowel for post operative instillation of solubilizing agents for irrigation, 2) there is also decreased ostomy drainage after 12- 24 hrs of post operative period, so there will be less fluid and electrolyte loss, and 3) Permits an eventual enterostomy closure by bedside ligation of chimney stoma, avoiding another laparotomy for resection and anastomosis of bowel. Here we compare between various methods of treatment of meconium ileus and relative outcome and complications for each method.

  This is Retrospective study was conducted from March 2016- February 2022 in the Department of Paediatric Surgery, SVPPGIP, S.C.B Medical College and Hospital Cuttack, Odisha. Patients with clinical and radiological suspicion of meconium ileus were included in the study. They were grouped according to the severity as simple or complicated meconium ileus. Then Many surgical options have been used in the surgical treatment of meconium ileus including resection with Primary anastomosis, Mikulicz ileostomy, Bishop–Koop operation, and Santulli stoma. Resection with primary anastomosis was first described in 1962 9,15. An alternative to this approach was small bowel resection with creation of a stoma and eventual closure of the stoma with an end-to-end anastomosis. A distal chimney enterostomy (Bishop-Koop procedure) involves resection of disparately enlarged ileal loop filled with inspissated meconium and anastomosis between the end of the appropriately sized proximal segment to the side of the distal segment of bowel approximately 4 cm from the opening of the distal segment and the distal end is brought out as the ileostomy8, the reverse of the distal chimney enterostomy is the Santulli and Blanc proximal enterostomy. The Mikulicz double-barreled enterostomy where both proximal and distal loop was exteriorized. Bishop-Koop enterostomy has advantages over other procedure16,17,18as 1) it provides access for insertion of a catheter into distal bowel for post operative instillation of solubilizing agents for irrigation, 2) there is also decreased ostomy drainage after 12- 24 hrs of post operative period, so there will be less fluid and electrolyte loss, and 3) Permits an eventual enterostomy closure by bedside ligation of chimney stoma, avoiding another laparotomy for resection and anastomosis of bowel. Here we compare between various methods of treatment of meconium ileus and relative outcome and complications for each method.

 During the study period of six years, total 91 cases (7.5%) were diagnosed to be MI and included in this study. Among 91, 50 were male and 41 were female, 30 cases were Uncomplicated or simple, and 61 cases were complicated MI. Out of 30 simple MI, 18 were managed conservatively and rest 13 cases were managed with operative procedures. Among patient treated with nonoperative management only 7 responded and improved and 9 didn’t responded. 84 cases including all cases of complicated MI were treated by exploratory laparotomy. 49 cases were treated by Bishop-Koop ileostomy, 19 Mickulitz double barrel ileostomy and Santuli procedure were done in 11 patients. Primary anastomosis was done only in 5 cases. All cases were followed up for post-operative complications. 13 cases expired during follow up.

  MI is a neonatal emergency which need early diagnosis, referral from peripheral hospital and early intervention by Pediatric surgeons. Proper evaluations, careful applications of conservative management, timely and proper surgical interventions may improve survival. Among all surgical procedure Bishop Koop ileostomy procedure is better option to treat MI both in uncomplicated and complicated groups.

 Acute appendicitis is one of the most common abdominal emergencies worldwide. The Modified Alvarado score is 9-point scoring system for diagnosis of appendicitis based on clinical signs and symptoms and differential leucocyte count. Previous studies have suggested that Alvarado score alone is inadequate as a diagnostic test, but it has been advocated as a means of select ing patients who should undergo imaging.To evaluate the effectiveness of Modified Alvarado Score and Focused Appendicitis Ultrasonography in predicting acute appendicitis and to compare the accuracy of two modalities alone and combined.

The study was performed in the postgraduate department of General Surgery, Government Medical College, Jammu over a period of one year from November 2021 to October 2022. 100 patients who were under the age of 18 years irrespective of their gender suspected to have appendicitis were included in the study.

 There were 64 males and 36 females. The majority of patients were in the age group of 12-15 years (51%). Modified Alvarado Score alone has sensitivity of 84.51%, specificity of 33.33%, Positive predictive value of 83.53%, negative predictive value of 34.98% and accuracy of 74.27%. Focused ultrasonography alone has sensitivity of 100% and accuracy of 80.00%, positive predictive value of 80%. The combined sensitivity of MAS+ focused appendicitis ultrasonography is 98.80 % with specificity of 11.76%, positive predictive value of 81.75%, negative predictive value of 70.94% and accuracy of 81.39%. The percentage of negative appendectomies was 14.45%.

  The sensitivity of Modified Alvarado Score is less than the sensitivity of Focused Appendicitis Ultrasonography. When both investigations combined together, their sensitivity, specificity, positive value, negative predictive value and the accuracy improves the diagnosis of acute appendicitis.

Foreign body aspiration (FBA) is a life-threating event in pediatric especially under 3 years of age. Chest radiography and computed tomography are the most available imaging modalities and rigid bronchoscopy is the treatment of choice. Sometimes incidental findings may be detected in the course of FBA management. In this study we report a case of 4-year-old girl who was admitted due to sudden onset of cough and cyanosis. Based on history and examination, diagnosis of foreign body aspiration was made but chest radiograph showed a round mass in the right upper hemithorax. The Foreign body was removed with Rigid bronchoscopy then the mediastinal mass was surgically removed completely. Pathological study reported a neuroblastic tumor.

Choledochal cyst presents with various clinical features and complications. Presentations and complications vary across the various age groups. Early identification and early surgical intervention have shown to reduce the complications related to the disease. The treatment of choice is Roux -en-Y hepaticojejunostomy. We present a case of 7 years-old boy who presented with biliary peritonitis due to choledochal cyst. The perforation was in the proximal biliary tree near the confluence which is not a common site of perforation, either in the case of spontaneous biliary tree rupture or in the choledochal cyst. The patient also had chronic calcific pancreatitis. Such a combination is not mentioned in the literature. Unconventional surgical procedure (hepaticoduodenostomy) was performed as a part of treatment, reserving jejunum for future pancreatic drainage, if the need arises.

Posterior urethral valve is common congenital cause of lower urinary tract obstruction leading to chronic renal damage. Anterior urethral valve although 7 times less common compared to the former but can lead to similar outcome. There are various case reports suggesting concomitant anterior and posterior urethral obstruction. We are reporting a 2-year-old boy with anterior urethral diverticulum in two places. A high index of suspicion and a thorough micturating cystourethrogram is a key in successful management of the condition.