Aims : Nitric oxide (NO) in peripheral venous blood has been shown to be elevated in experimental portal hypertension. This study aims to determine the serum NO levels in patients with extrahepatic portal venous hypertension (EHPVO) pre- and postoperatively and to analyze whether these can serve as a reliable and early indicator of shunt blockage or malfunction. Materials and Methods: During the period 2006-2010, 48 children with EHPVO were included in this prospective study; 40 underwent porto-systemic shunt and eight underwent splenectomy with devascularization. NO was evaluated preoperatively, 14 days after surgery, at 3 months and then 6 monthly thereafter. The median follow-up duration was 21 months. Shunt patency was confirmed with Doppler and computed tomography portography. Forty-eight age-matched children with hypospadias served as controls. Results : NO was higher in EHPVO patients as compared with controls (43.16 ± 16.27 vs. 5.76 ± 2.62 μmol/l) (P = 0.0001). There was a significant decline in the NO levels (4.64 ± 3.18 μmol/l) following shunt surgery (P = 0.0001), and it continued to remain low till the shunt was patent. A shunt block was indicated by rising NO levels in all five patients. The devascularization group also demonstrated a significant decline in the NO levels (27.06 ± 3.56 μmol/l) (P = 0.002), but it was less as compared with the shunted patients. The decline in the portal pressure after shunt surgery was found to correlate with the decline in the serum NO levels. Conclusions : The blood levels of NO can be used in the diagnosis of portal hypertension, and are useful for monitoring the patency of the shunt.

Background: Pediatric laparoscopy (LS) is claimed to be superior to open surgery (OS). This review questions the scientific veracity of this assertion by systematic analysis of published evidences comparing LS versus OS in infants and children. Materials and Methods: Search of PubMed data base and the available literature on pediatric LS is analyzed. Results: One hundred and eight articles out of a total of 426 papers were studied in detail. Conclusions: High quality evidences indicate that LS is, at the best, as invasive as OS; and is at the worst, more invasive than conventional surgery. There are no high quality evidences to suggest that LS is minimally invasive, economically profitable and is associated with fewer complications than OS. Evidences are equally distributed for and against the benefits of LS regarding postoperative pain. Proof of cosmetic superiority of LS or otherwise is not available. The author concludes that pediatric laparoscopy, at the best, is simply comparable to laparotomy and its superiority over the latter could not be sustained on the basis of available scientific evidences. Benefits of laparoscopy appear to recede with younger age. Concerns are raised on the quick adoption, undue promotion and frequent misuse of laparoscopy in children.

Aims: Foreign body aspiration (FBA) is one of the main causes of accidental death in childhood. This study was designed to evaluate the level of awareness of FBA and its resultant dangers in the community. Materials and Methods: Sixty-three primary caregivers were interviewed about their awareness of FBA, its attendant dangers, preventive measures taken, and how will they take care of a child in the event of a FBA according to an agreed protocol. Results: Awareness levels about FBA were abysmally low in the population that was studied. Twenty-five percentage of the study population had not heard about this condition, and 46% could not recognize a FBA if it happened. Also, 76% of the study group did not know about the attendant dangers of this condition. Conclusions: There is a dire need to spread awareness about both prevention and treatment of this morbid condition. Health care professionals need to increase their efforts to spread more knowledge in the community about FBA.

The transport of sick neonates to the surgical centers or transportation within the center is an essential requirement of neonatal surgery. Neonatal transport incubators are costly, space occupying, and are not available at many places in the developing countries. We report here a cheap yet effective and easy to make, alternate neonatal carrier device.

This study reports a 1-year-old boy with unilateral partial duplication of vas deferens, diagnosed during surgery for undescended testis. Pediatric surgeons need to be aware of this kind of anomaly in order to avoid injury to this vital structure.

This is a report on the use of transperineal intraoperative ultrasound imaging in a case of Currarino's triad for the first time in the literature.

We report two cases of children who presented with acute abdomen due to gall bladder perforation and biliary peritonitis. Cholecystectomy with peritoneal lavage proved curative.

Although rare in children, aggressive fibromatosis or desmoid tumors require wide surgical excision for durable relief. The resultant defect poses many challenges for reconstruction. The authors report reconstruction of such a wound using a pedicled omental split skin graft, which resulted from the excision of a locally recurrent desmoid tumor.

This is a report of a case of multicystic dysplastic half of a horseshoe kidney (HSK) at surgery for multicystic kidney. During the surgery, through a lumbotomy approach, there was inadvertent injury to a lower polar artery and the pelvis of the normal contralateral half of the HSK, leading to a stormy postoperative course. This report emphasizes the need for accurate preoperative diagnosis before embarking on a lumbotomy, and also reviews the entity of multicystic dysplasia in one half of a HSK.

Report of a gastrointestinal stromal tumor in an 11-year-old girl who presented with a large lump in the upper abdomen. After complete surgical excision and histopathology, postoperative immunotherapy with imatinib led to an excellent outcome and a tumor-free survival of 3 years.