ABSTRACT: We report 2 cases of Hirschsprung's disease treated by laparoscopy assisted transanal single stage pull through. The procedure utilises minimally invasive abdominal approach to identify the transitional zone and the operation has been completed through the transanal route. The operative technique has been described.

ABSTRACT: Transanal endorectal pull through procedure was done on 10 new borns with Hirschsprung's disease involving the rectosigmoid region. The age varies from 19-32 days in 7 boys and 3 girls. The disease was diagnosed in these babies by Barium Enema, 24 hrs follow through pictures and biopsy. The diagnosis was confirmed by a small left lower quadrant incision and a marker was placed in the transitional zone of the sigmoid colon. The rest of the procedure was completed through transanal approach and a single layer coloanal anastomotis was completed. All these babies are doing well for 6 months to 1 year without any major complications. We are awaiting long term follow up results.

ABSTRACT: About 20 percent of patients who have had Modified Duhamel's Operation for Hirschsprung's Disease (HD), have recurrence of symptoms like incomplete evacuation, fecaloma formation and/or repeated gaseous distension. The cause of these symptoms could be anything from retained aganglionic segment, inadequately divided internal sphincter, to rectal inertia. The authors have analyzed 2 groups of patients (Total No 66) who have been investigated and treated on similar lines but differed only at the site of the lower anal incision. In Group A (26 patients) the lower anal incision was 1 cm above the mucocutaneus junction, whereas in Group B (40 patients), the incision was made at the muco-cutaneus junction. The patients in Group B had no recurrence of symptoms. The authors conclude that if one analyses the failure of Duhamel's operation for HD where diagnosis and treatment are comparable, the crux of the problem lies with the site of the lower anal incision. The anal incision at the muco-cutaneus junction during the modified Duhamel's operation gives better long term results.

ABSTRACT: A good number of patients have to have colostomy or ilestomy as a part of a staged procedure during correction of complex surgical problems involving the gastrointestinal tract. Dressing of such enterostomy stomas with betel nut leaves (pan) is a very cheap and effective option, specially in a developing country like India. The authors' 9-year experience with 62 patients is described here. The results have been excellent in all but 2 cases of ileostomy.

ABSTRACT: Surgical repair of 37 patients (2 weeks - 8 years of age) with EXSTROPHY-EPISPADIAS Complex were carried out in our Institute between February 1990 and December 2000. Thirty of the total 37 patients had primary closure of bladder; 20 with osteotomy and the remaining 10 without osteotomy. Seven babies had very small and fibrotic patch bladder and all of them underwent permanent diversion in the form of ileo-cecal bladder. Nineteen children have completed all stages of operation, primary closure, epispadias repair and bladder neck reconstruction. Common problems encountered during repair of bladder exstropy included vesical fistula, failure of bladder to heal and inguinal hernia in postoperative period. The dry interval period achieved in successful cases varied from 1 to 2 hours with growing age and they are in follow up for last 11 years.

ABSTRACT: A 4 1/2 month old girl was presented with a lump in the right iliac fossa. CT Scan revealed a cystic lesion at the Rt. iliac fossa behind the cecum and ascending colon. On exploration of the abscess cavity a cecal perforation on the posterior wall of cecum was revealed. Excision of cecum and ileocolic anastomosis was done. Postoperative period was uneventful.

ABSTRACT: Esophageal atresia (EA) with or without Tracheoesophageal fistula (TEF) represents significant number of neonatal surgical emergencies and its survival testifies the level of advancement in neonatal care, as it is considered as epitome of neonatal surgery even today. Here we report a female neonate presented on 16th day of life with classical history of EA with TEF. It was a type-C anomaly with extensive bilateral pneumonitis on 20th day of life. Higher antibiotics, TPN and prolonged postoperative oxygenation were continued till 20th postoperative day and the baby was discharged from the hospital once she started sucking adequately and there was improvement in lung pathology. A 2-D echo was done at this stage which revealed an ASD with left-to-right shunt. She is alive and healthy at 6 months of age at the time of reporting. Delayed reference from the primary physician with history of continued oral feeding are not uncommon features of neonates with EA & TEF in developing countries like India. This calls for spreading awareness amongst the rural physicians.

ABSTRACT: Bronchogenic cysts are congenital lesions derived from abnormal budding of the primitive tracheobronchial tree. Many cases of bronchogenic cysts have been reported, but only a few have caused obstructive emphysema severe enough to warrant early thoracotomy in infancy. We report a case of an 8-month old male who presented to us with cough, dyspnea, stridor and wheezing. The symptoms were due to a bronchogenic cyst compressing the left main bronchus causing unilateral obstructive emphysema. He required thoracotomy and excision of the cyst resulting in complete relief of his symptoms.

ABSTRACT: Multiple polyposis of the gastro-intestinal tract is a well-understood entity in the surgery of adults. In the pediatric population, it is quite uncommon to come across multiple polyposis coli whilst solitary juvenile (inflammatory) polyps are common digital finding, in rectal examination of cases of bleeding per rectum in young children. We report a case of multiple polyposis of the colon in a 3-year old child who was treated by total colectomy, rectal mucosectomy and S-shaped ileal reservoir and anastomosis with a perfect result. Extensive review of the literature showed that this is the youngest patient of its kind, treated by this technique.

ABSTRACT: A 3-year old male child presented with complaints of fever with chills for 1 month and pain in the right flank with vomiting on and off for two weeks. Computed tomography scan [CT scan] elaborated it to be a renal abscess mostly of tubercular origin extending into perirenal space, right psoas muscle and eroding lumbar vertebrae also. Operative intervention revealed that the upper pole of the right kidney was fused with the perirenal tissue by caseous and necrotic material. On histology tubercular caseation was demonstrated. Antituberculous therapy was initiated.