Iranian Journal of Pediatric Surgery
Volume:5 Issue: 1, Jun 2019

To assess the role of Percutaneous nephrostomy in poorly functioning kidneys of ureteropelvic junction obstruction in pediatric patients. Several studies have addressed the unique management challenges in poorly functioning kidneys with ureteropelvic junction obstruction. Trial with percutaneous drainage of such kidneys as a guide to management would be a solution to this dilemma.  A prospective study was performed on poorly functioning kidneys (split renal function<10% on renal dynamic scan) of patients with unilateral ureteropelvic junction obstruction from August, 2016 to January, 2018. Ultrasound-guided nephrostomy was inserted in these patients. Data regarding the differential renal function and glomerular function rate was collected before and after nephrostomy insertion. Decision regarding pyeloplasty or nephrectomy of the involved kidney was taken if differential function and Glomerular filtration rate increased following drainage. Data collected was analyzed statistically.   33 patients of unilateral ureteropelvic junction obstruction with poorly functioning kidneys were treated during this period. 30 patients had significant increase in differential function and glomerular filtration rate. These patients underwent pyeloplasty. In 2 patients, these parameters did not increase much and they benefitted from nephrectomy. One patient had an infected kidney which did not improve significantly on drainage and had to be removed. Of the 30 patients who had pyeloplasty, two developed obstruction after 3 months of removal of double-J stent and had to be re-operated. Percutaneous nephrostomy in poorly functioning kidneys with ureteropelvic junction obstruction helps to identify potentially salvageable kidneys which merit pyeloplasty. Kidneys which do not improve with nephrostomy are unlikely to improve with pyeloplasty and therefore nephrectomy is done in such cases.

Hypospadias is a common pediatric surgical procedure. Early postoperative pain management is essential to inhibit pain impulses and endocrine responses leading to decreased mortality and morbidity and lower rate of agitation and faster return to normal functional status. Accordingly in this study the analgesic efficacy of bupivacaine alone versus bupivacaine plus dexmedetomidine in penile block for Hypospadias surgery was determined. In this randomized clinical trial, 64 children under Hypospadias surgery in a referral center in Tehran, Iran in 2018 were enrolled and randomly assigned to receive either bupivacaine 0.25% alone 0.2 ml/kg or bupivacaine 0.25% 0.2 ml/kg plus dexmedetomidine 0.3 μg/kg. After block, the patients were reversed and extubated after complete consciousness. Patients were followed-up to 24 hour for pain according to FLACC and also the analgesia and block duration. Mean analgesia duration was 2.03 ± 0.5 and 2.63 ± 0.9 hours in combination and alone group, respectively with significant difference (P=0.003). The mean duration of block was significantly longer in combination group (P=0.001). According to the results it may be concluded that addition of dexmedetomidine to bupivacaine in hypospadias surgeries would result in longer analgesia and block duration; without addition of adverse effects.Key words: Hypospadias, Penile Block, Pediatric, Surgery

Different countries have their own residency programmes to train new residents in field of medicine. Some of these programmes are very efficient while some have room to improve, especially in developing countries. These residency programmes can play an important role in producing great consultants in future. So it’s very important to evaluate the residency programme of a country to make sure quality training of residents. A cross-sectional survey conducted in Pakistan. PHEEM questioner was used for assessment of educational environment for PS post graduate residents (PGR’s) of Pakistan. Questioner was sent to all 95 pediatric surgery residents via E-mail in January 2017. SPSS 20 was used to analyze data. The response rate from PS PGR’s was 48.4% (n= 45 proforma). The mean age of participants was 29.69 ± 2.71 years. Most of the participants were male (76%) and in 5th year of residency (39.13%). The high scored items (mean >2.5) were only 3: question 9, 17 and 26. The mean PHEEM total score was found as 63.06 ± 16.77. When categorized into global scales, most of the residents (84.4%) labeled educational environment into level 2. Mean PHEEM score was found significantly higher among female, those residing in province ‘Sindh’. We conclude that educational environment although depends upon and varies with many factors; however, overall it is not reported to be satisfactory by PS PGR’s across the country. Authorities urgently need to look into matter and take serious actions in order to improve the quality of our future consultants.

To identify complications requiring early reoperation and to determine associated risk factors in the pediatric surgery of the TEACHING HOSPITAL Gabriel Toure. It was about a retrospective study done in 4 years (from January, 2014 to December, 2017) of children 0-15 years old presenting with a post-operative complication requiring a reoperation and taken care of during the period of study. Observation of bowels or the liquid stools through the incisional wound, the presence of hydro-aerics levels on an abdominal plain X-ray and the absence of resumption of intestinal transit allowed us to make a decision to reoperate. in 4 years, we have re-intervened on 103 patients because of early post-operative complication out of 4730 operated on. This represented 1.54 % of our total surgical activities. The average age was a 5.2±2.3 year ranging from 2 months to 15 years. The sex ratio was 0.94. Eighty four (81.55 %) of our patients have been received and operated on in emergency. Peritonitis of digestive system perforation represented 45.28 % of the indications followed by the acute intestinal intussusceptions (10.7 %) and traumatic eviscerations (9.7 %). During the first operation the realized procedure was the sutures in perforated cases up to 40.8 % of them, manual intestinal reduction with appendectomy in 10.7 % of the cases. The average duration before the first intervention was 80±13.6mn. The post-operative evisceration was the 1st cause of reoperation followed by the post-operative peritonitis and then post-operative occlusion. The average time to reoperation was 6.9 ± 4.2 days. The risk factors leading to reoperation depended on: indication of first surgery, the operating technique, the quality the operator, malnutrition and anaemia (p<0.05). The sex, age and the duration of surgery were not determining in the indication of early reoperation (p > 0.05).

To evaluate the effects of transdermal dihydrotestosterone treatment based on the results of hypospadias repair and complications rates in children with primary hypospadias. A total of 79 randomized children who were a mean of 38.2 ±2.8 months old and had primary hypospadias were included in the study between January 2012 and December 2017. 36 children were treated with 2.5% dihydrotestosterone transdermal gel twice a day, applied directly onto the penile shaft and glans for one month prior surgery (group 1), and 43 children did not receive any treatment preoperatively (group 2). Mean ages of the children in groups 1 and 2 were similar (37.3 ± 6.3 months and 39.1±5.9 months, respectively). The urethral meatus was coronal in 30.5%, penile in 69.5 % of the patients in group 1, while it was coronal in 46.5 % and penile in 53.5% of the patients in group 2. Postoperative complications included urethrocutaneous fistula in 6 patients (13.9%) in group 2, compared to 1 patient (2.7%) in group 1. There were 2 patients with meatal stenosis in group 2 (4.7%), and 3 (8.3%) patients with meatal stenosis in group 1. Finally, there was a significant difference between the overall reoperation rates of group 2 (8 patients, 18.6%) and group 1 (1 patient, 2.7%) (p<0.05). Pretreatment with 2.5% dihydrotestosterone transdermal gel before hypospadias repair is beneficial in decreasing complication rates.

. A hydrocele is a collection of fluid within the processus vaginalis (PV) that produces swelling in the inguinal region or scrotum And its treatment depends on age ,symptoms and conection with abdomen. Preferred method of treatment is  subject of debate. in this study we assessed  two different method ofhydrocele repair in childrens.hydrocelotomy and hydrocelectomy  and compared their complications and recurrences rate. 70 children with noncomunicating hydrocele  included in study, allocating every other subject to each treatment group (alternating allocation) for the hydrocelotomy group(incision and evacuation of hydrocele sac)and hydrocelectomygroup(excision and removing of heydrocele sac.The complications  and recurrence rate were recorded in both groups and compared together .                                                                                                                                              . from 70 children 25 patient had right side hydrocele(%35/7) and in 45 children hydrocele found in left side.(%64/3). no statistical difference was found  for complications  like bleeding ,wound infection,spermatic cord damage ,recurrent hydrocele beetween two group  in post operation  Period                                                                                                   . although there not found very different result  in rate of complications and recurrency  between two group but it seems that hydrocelotomy is enough treatment with less probablity of spermatic cord damage and other complication

Congenital diaphragmatic hernia (CDH) is associated with high mortality due to pulmonary hypoplasia, pulmonary hypertension, and concomitant anomalies. This condition is identified by the presence of an orifice in the diaphragm (mostly to the left and posterolateral), leading to the herniation of the abdominal contents into the thorax. Morgagni hernia is a less common CDH, accounting for only 5-10% of CDH cases. It is an uncommon congenital herniation of the abdominal content through the triangular parasternal gaps of the anterior diaphragm. This condition usually affects the right side, and the patients are usually asymptomatic. Herein, we presented the case of a 15-month-old male infant with large Morgagni hernia resulting in poor weight gain. The presentation was unique due to its huge orifice, its accompaniment with gastrointestinal obstruction, and also its unremarkable radiologic findings. The patient was monitored by the follow-up team for 12 months. The follow-up revealed no recurrence, and the patient had favorable weight gain without any gastrointestinal symptoms.

Xeroderma pigmentosum (XP) is a rare genetic disorder with a recessive autosomal inheritance. It appears that total intravenous anesthesia (TIVA) is more appropriate than inhalational anesthesia as a method for maintaining general anesthesia for XP patients and airway manipulation must be performed as little and as noninvasively as possible. The aim of this report was to evaluate the specific considerations for airway management and anesthesia in these patients. .