ABSTRACT: This short paper describes the key steps in the performance of primary transanal endorectal pull through which we believe can be used for a significant proportion of patients suffering form Hirschsprung's Disease (HD).

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ABSTRACT: Aim of the study: A prospective study to evaluate the incidence, mode of injury, socio economic status, educational background, initial phase management and the treatment of strictures if any, in children presenting with corrosive esophageal injuries. Materials and methods: During the period of 1999-2001, 13 children with history of corrosive esophageal injuries presenting in the age group of 1.5-10 years (mean age 4 years) at the outpatients Department of Pediatric Surgery at All India Institute of Medical Sciences, New Delhi, Were assessed for various epidemiological parameters. There were 10 boys and 3 girls. Eight patients had ingested acid while 5 had injuries with strong alkalis. During this period, no child presented to us with acute injury. Children were evaluated clinically for the degree of difficulty in swallowing with other symptoms, if any. A barium swallow was done in all for the status of esophagus, stomach and the pylorus. The initial treatment for the esophageal stricture included repeated dilatations (antegrade-5, retrograde-4, combined -4). Colonic interposition surgery was performed in children who failed to respond to repeated dilatations with six months-one year and had multiple esophageal strictures or very tight stricture resulting in loss of esophageal lumen. Results: Eight children responded to dilatations. Dilatation failed in 5 children requiring resection and end to end anastomosis (with continuation of postoperative dilatation program for next 3 and 4 months) in 2 and colonic interposition in other 3. Complications following colonic interposition included : dilatation proximal to distal anastomosis-1, food impaction-1 and stricture at the upper end of the anastomosis (within one year of surgery) requiring revision-1. Conclusion: Corrosive esophageal injuries, though uncommon in North India, have serious socio economic, educational and professional implications. Initial treatment is usually provided at home using traditional methods. The development of esophageal stricture required visits to the hospital for dilatations, surgery or to manage complications adding further stress especially to the poor and working class of parents with nuclear families. As most injuries are avoidable, a general awakening, needs to be created with the help of the media, and social and Governmental organizations

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ABSTRACT: The aim of the study was to evaluate the results of laparoscopic treatment of appendicitis from June 2000 to December 2002. Seventy cases of laparoscopic appendectomy were done for appendicitis after viewing the Yellow line of Meso-appendix. (Fat present in the Ceco-appendicular Junction at mesenteric side). Appendectomy done distal to this line was found to be safe. Dissection continued proximal to yellow line can injure the cecum. Seventy cases of Lap appendectomy between age group of 3 and 12 years was done over a study period of 2 1/2 years. Operating time ranged between 30 and 45 minutes. Length of hospital stay ranged from 2 to 3 days. There was no mortality. Our analytical study revealed no bowel injury. Laparoscopic appendectomy is very safe and effective, for both complicated and non-complicated appendicitis. Though it is technically simple we must be careful regarding bowel injury during dissection with electro-cautery. For the the yellow line is a very useful landmark.

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ABSTRACT: Splenic abscess is a condition that required splenectomy for treatment till recently. This may lead to compromised immunological functions in the pediatric patients. Authors describe a successfully treated case of splenic abscess by percutaneous aspiration and antibiotics.

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ABSTRACT: This is a prospective study of 77 patients to document the postoperative outcome of conventional management of undescended testes. Eighty five percent of the patients who under went surgery were available for follow up at 1 month and 6 months. The mean age at operation was 5.34 +/-3.48 years. Sixty percent of undescended testes were palpable, 80 percent of which were found in the superficial inguinal pouch at surgery. Ninety six percent of palpable undescended testes could be placed in the scrotal position initially. Ninety one percent remained in the scrotum at 6 month follow up. In 40 percent of cases, the testes were impalpable. Fifty percent of these testes were intra-abdominal and 10 percent were absent on exploration. Seventy percent could be placed in the scrotum. At 6 months follow up, of the total 32 cases, only 68.75 percent were in the scrotal position. Nineteen percent of impalpable testes and 6 percent of palpable testes had atrophied. There was a significant increases in the mean testicular volume, 6 months after successful orchiopexy as compared to the preoperative size. Age at operation did not alter the improvement in testicular volume after successful orchiopexy.

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ABSTRACT: During the last 4-year period 25 children from 9 months to 15 years underwent esophageal reconstruction with interposed segment of colon or jejunum. The diagnosis was : long-gap atresia -17 cases, chemical burns-6 and Barrett's esophagus-2. Esophagus was reconstructed with colon in 18 cases and jejunum in 7 cases. Among early complications upper anastomotic fistula was diagnosed in 6 patients and upper anastomotic stricture in 1. There were 2 cases of graft necrosis. The follow up was from 3 month to 4 years. One patient died 12 month after surgery due to a reason not related to esophageal reconstruction. Six patients developed late stricture of upper amastomosis, 6 patients bled due to gastric reflux after colonic interposition. All remaining patients but one, who is still waiting for another reconstruction after graft necrosis, are doing well with only oral feeding.

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ABSTRACT: Urinary Tract Infection (UTI) in 30 patients of surgically treated congenital urinary anomalies was evaluated. Role of circumcision in prevention of UTI in these patients was studied. It was found that the patients who had positive urine culture inspite of chemoprophylaxis became negative after circumcision over an average period of 22 days. Circumcision reduces the incidence of persistent UTI in spite of surgical treatment in patients with congenital urinary tract anomaly and serves as a complement to chemoprophylaxis. To our knowledge this is the first study showing the efficacy of circumcision in preventing UTI in patients with congenital urinary tract anomaly.

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ABSTRACT: A retropleural drain after definitive repair of esophageal atresia and tracheoesophageal fistula (EA & TEF) is left by most of the surgeons to diagnose and treat anastomotic leak if it occurs in the postoperative period. Whether retropleural drainage is really necessary after doing a wide and tension free anastomosis is controversial. We operated on eight cases of EA & TEF without putting a retro pleural drain after the repair and found that all except one recovered without any complication. But those cases in whom a retropleural drain was put and had complication, did not improve even with the tube in-situ and needed some intervention. Thus a routine retropleural drain placed near the anastomosis is not necessary in all cases of EA & TEF in whom a satisfactory anastomosis had been performed without undue tension. Only complicated cases in which the anastomosis is not up to the surgeon's satisfaction need a retropleural drain as a safety mechanism to diagnose any anastomotic leak.

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ABSTRACT: Purpose: To review our experience of using the tabularised incised plate urethroplasty carried out for the treatment of hypospadias. Methods: From October 2000 to February 2002, tabularised incised plate urethroplasty was carried out in 62 boys, aged between 11 months and 11 years. Fifty cases had distal penile hypospadias, 7 cases had mid penile, 1 case had proximal penile and 4 cases had urethral fistula. Result: Tabularised incised plate urethroplasty resulted in a functional neourethra at the tip of glans penis. Fistula developed in 5 cases and all but one closed after regular anterior urethral dilatation. Mental stenosis developed in 7 cases that required dilation. Conclusion: Tabularised incised plate urethroplasty is a versatile operation that corrects not only distal but even proximal hypospadias and can also be utilized for the reconstruction of urethral fistula. Resultant neourethra is functionally adequate and an excellent cosmetic result with a vertically oriented meatus is obtained.

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ABSTRACT: Necrotizing enterocolitis (NEC) classically occurs in stressed low birth weight infants and carries a high mortality rate. Although it has been sporadically described in other setting, it has not been frequently cited as a postoperative complication. This paper presents a case of annular pancreas whose postoperative course was complicated by the development of NEC. There were no reliable diagnostic signs like pneumatosis intestinalis, portal vein gas or pneumoperitoneum. Awareness of NEC as a potential postoperative complication may help in early recognition and management.

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ABSTRACT: Urinoma may be one of the presenting features of urinary tract obstruction. We report a female neonate who presented with rapidly increasing abdominal mass due to an expanding urinoma around the right kidney as a result of right pelviureteric junction obstruction. Initial percutaneous drainage of the urinoma followed by pyeloplasty after two months resulted in a satisfactory outcome. The rarity of such presentation of pelviureteric junction obstruction in a neonate prompted us to report the case.

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ABSTRACT: Spontaneous perforation of a choledochal cyst is an uncommon pediatric surgical emergency. We present two cases with diverse presentation, one with acute abdomen and the other with biliary peritonitis. Both were managed differently, one with T tube drainage of the perforation and the other with a cholecystostomy. The causes of choledochal perforation and management protocol are discussed. It should be considered as differential diagnosis in children presenting with acute abdomen.

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