Journal of Paediatric Surgeons of Bangladesh

Role of USG and diuretic renogram in evaluation of outcome in children after Anderson-Hynes dismembered pyeloplasty for unilateral PUJ obstruction

Ipsita Biswas — 2023-07-31

Introduction: Pelvi-ureteric junction (PUJ) obstruction is one of the most common causes of Hydronephrosis in paediatric population. Anderson Hynes dismembered pyeloplasty is the standard surgical treatment of PUJ obstruction. Ultrasonogram (USG) and isotope renogram are widely used to assess the success of pyeloplasty. Changes in the anteroposterior diameter (APD) of renal pelvis, renal cortical thickness (CT) in USG and split renal function (SRF) in DTPA renogram can determine the postoperative outcome following pyeloplasty. Aim of the study: The aim of this study was to see the changes in APD, CT and split renal function after pyeloplasty.

Materials and Methods: A quasi experimental study was done among children with unilateral PUJ obstruction who underwent open Anderson-Hynes dismembered pyeloplasty from January 2020 to December 2021 at Bangladesh Shishu Hospital and Institute. All patients were evaluated with ultrasonography at 6 months and DTPA after 1 year of operation. Changes AP diameter of renal pelvis, renal parenchymal thickness and SRF were recorded to assess the prognosis. Increase of SRF, more than 5% on the obstructed side compared with preoperative result was regarded as significant improvement. A change in SRF of within 5% of the preoperative level was defined as stable renal function and a decrease of SRF >5% of the preoperative level was considered as deteriorating renal function.

Results: In the present study, we enrolled 30 patients. Mean age of the patients was 25.80 months. The mean APD was 44.03 mm preoperatively and 31.03 mm after 6 months of pyeloplasty. The mean CT was 3.24 mm preoperatively and 6 months after operation it was 4.77 mm. The comparison of mean changes of APD and CT revealed significant. Postoperative renal SRF increased 6.04% (± 7.39%) than preoperative SRF value which was statistically significant.

Conclusion: Changes of renal APD (Anteroposterior diameter) and CT (cortical thickness) and Split renal function occur after pyeloplasty. So USG and DTPA can be used to assess the outcome of pyeloplasty in children with unilateral PUJ obstruction.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1 & 2): 3-7

Evaluation of testis sparing surgery in paediatric testicular tumor

Partha Sarathy Majumder — 2023-07-31

Aim: To evaluate the outcome of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in paediatric patient with testicular tumor.

Methods & Materials: This prospective interventional study was conducted in Dhaka Medical College Hospital (DMCH) during January 2019 to June 2021 (total 30 months) and 0-14 years child with testicular tumor was included & child with advanced disease was excluded. Total 30 patients were selected with consecutive sampling. Postoperatively patients were followed up for 6 months.

Results: Germ cell tumor (GCT) was the most common (93.3%) paediatric testicular tumor and teratoma was the commonest among the GCT (76.7%). Benign tumor was predominant (83.3%) in paediatric testicular tumor and TSS was done in this group. No tumor recurrence or testicular atrophy occurred in 6 months follow-up.

Conclusion: TSS to preserve testis is preferable for paediatric testicular tumor.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1 & 2): 8-12

Outcome of posterior versus anterior sagittal ano-rectoplasty in patients of anorectal malformation (ARM) with vestibular fistula

Ayesha Sadia — 2023-07-31

Background: Vestibular fistula is the commonest ARM in females. Operative techniques described for treating vestibular fistula mainly include posterior sagittal anorectoplasty (PSARP) and anterior sagittal anorectoplasty (ASARP). Very few studies have been carried out to compare these two procedures. The study was aimed to compare the outcome following PSARP and ASARP for vestibular fistula.

Methods: This quasi-experimental study was performed in the Department of Paediatric Surgery, Chittagong Medical College Hospital. Twenty patients with vestibular fistula, both with and without colostomy, were subjected to anorectoplasty either through PSARP (n=10) or ASARP (n=10). Patients were followed up until 3 months. Patients of both groups were compared for peri-operative and postoperative complications, cosmetic outcomes, and bowel function.

Results: The two groups were comparable regarding age, maturity at birth, clinical presentation, sacral ratio, and associated congenital anomalies. Median operation time was 112.5 min for PSARP and 140.0 min for ASARP (p=0.280). Four cases had wound infection and subsequent wound dehiscence after ASARP operation and none after PSARP operation (p=0.08). Two cases had mucosal prolapse after ASARP and one after PSARP (p=1.0). All patients, irrespective of the surgical approaches, had good bowel function except one patient with ASARP who developed faecal incontinence.

Conclusions: PSARP was associated with lesser complications and better cosmetic outcomes than ASARP for the treatment of vestibular fistula but these were not statistically significant.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 13-20

Laparoscopic assisted transanal pull through and Duhamel pull through for the treatment of short segment Hirschsprung’s disease: A comparative study of outcome

Shah Md Ahsan Shahid — 2023-07-31

Background: The goal of surgical management for Hirschsprung’s disease is to remove the aganglionic bowel and reconstruct the intestinal tract by bringing the normally innervated bowel down to the anus while preserving normal sphincter function.

Objectives: Present study aimed to determine a better procedure of pull through operative procedure for Hirschsprung’s disease by a randomized comparison.

Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of one year (from March 2022 to April 2023). A total of 53 patients who were suffering from short segment Hirschsprung’s disease, were included in present study as per inclusion and exclusion criteria and randomized into two groups under study, namely; Laparoscopic assisted transanal pull-through and Duhamel pull-through operations. Primary outcome measured by persistent obstructive symptoms, anastomotic strictures, persistent or acquired aganglionosis and fecal incontinence.

Results: Early per operative and postoperative complications, including bleeding, infection, injury to adjacent organs were not troublesome but differences in two groups under study, were significant and findings were in favour of laparoscopic procedure. Persistent obstructive symptoms and aganglionosis occurred in greater percentage in Duhamel procedure but anastomotic strictures and fecal incontinence were commoner in percentage in the laparoscopic variant.

Conclusion: The advantages of laparoscopic assisted transanal pull-through include its improved cosmesis, reduced hospital costs, hospital stay, operating time. But anastomotic strictures and fecal incontinence remain as a critical issue for long term outcome.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 21-27

Abdominal trauma in children: Experience from north-west region of Bangladesh

Md Zamil Hossain — 2023-07-31

Background: Abdominal trauma is one of the most common causes of children’s death and fatal injury. Due to advances in technology, available facilities, and improved trauma transport, the management of trauma victims becomes earlier and easier in developed countries. In underdeveloped and developing countries, it is difficult as early recognition, timely reaching to health facilities, and management initiation become delayed.

Objectives: This study was aimed at analyzing the mechanisms and causes, organ involvement, management, and outcome of childhood abdominal trauma in a tertiary centre in Bangladesh.

Methods: This was a retrospective review of children from 0 – 12 years admitted to the department of Paediatric Surgery, Rajshahi Medical College Hospital, Bangladesh, with blunt and penetrating abdominal injuries from January 2020 to December 2021. Children with blunt abdominal trauma with either solid or hollow viscus injury and penetrating trauma with peritoneal breach and/or organ injury were included. Injuries only to the abdominal wall without organ injury were excluded.

Results: 154 patients met the inclusion criteria with a 2.2:1 male-to-female ratio. The majority were 6 – 12 years of age (47.4%), most of them were presented with blunt trauma (142, 92.2%), and the leading cause of trauma was a road traffic accident (63.6%), which was followed by a fall from height (16.9%) and fall on a sharp object (6.5%). Out of 98 patients with road traffic accidents, only 16 (16.3%) were traumatized from traffic-traffic collisions, and the rest (83.7%) were injured during the crossing or running on the road. Commonly injured organ was the liver (52.6%), spleen (14.2%), and small intestine (9.7%). Most (70.1%) were treated conservatively, and 3 out of 4 died within 24 hours of admission.

Conclusion: Road traffic accident was the most common cause of abdominal trauma, and the liver was the most commonly injured organ. Most of the victims were pedestrians. The cause is a lack of awareness and attendance to children and unsafe vehicles on the road.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 28-32

Inguinal herniotomy in children with and without peri-operative chemoprophylaxis

Md Mizanur Rahman — 2023-07-31

Purpose: The aim of the study is to find out any difference in the outcome regarding wound infection of inguinal herniotomy in children with and without peri-operative chemoprophylaxis.

Patients and Methods: This prospective interventional comparative study was conducted in the department of Paediatric Surgery, Dhaka Medical College Hospital from July, 2014 to June, 2016. Children (1 month to 12 years) with inguinal hernia attended in out patient department were included and children with other varieties like irreducible, obstructed, strangulated and infected inguinal hernias were excluded from the study. Patients were divided in Group A (Patient with peri-operative chemoprophylaxis) and Group B (Patient without peri-operative chemoprophylaxis). Ethical clearance was taken from the ethical review committee (ERC) of Dhaka Medical College. Local rise of temperature, redness, swelling, serous discharge in post-operative wounds, cost effectiveness, hypersensitivity reaction were compared between study groups.

Results: Total 100 patients were studied, 50 in each group. There was no significant difference between Group A and Group B regarding local rise of temperature (P =0.75), redness (P =0.75), swelling (P =0.75), serous discharge in wound (P =0.32) but highly significant (P ˂0.001) regarding cost of treatment in taka. There was no record of any hypersensitivity reaction during or following the treatment in any group.

Conclusions: This study revealed that peri-operative chemoprophylaxis is not superior to peri-operative without chemoprophylaxis in regards to local rise of temperature, redness, swelling, serous discharge in wound. It is concluded that the peri-operative chemoprophylaxis may not be necessary in clean surgery like inguinal herniotomy in children.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 33-38

Outcome of circumcision in children with or without antibiotics in a tertiary Hospital

Supratim Howlader — 2023-07-31

Introduction: As circumcision is a common paediatric operation in Bangladesh, it logically demands costeffectiveness and safety for people’s benefit. Antibiotics abuse or its irrational use is a problem in our country. This study will help other surgeons to do clean surgery without antibiotics, which will ensure cost-effectiveness and preserving natural body immunity.

Objective: The study was conducted to determine the outcome of circumcision in children with or without antibiotics.

Methodology: It was a quasi-experimental study done at Paediatric Surgery unit of Institute of Child and Mother Health (ICMH), Matuail, Dhaka from August 2019 to January 2020 after taking approval for this protocol from the ethical committee of ICMH. The male infants and children who attended Paediatric Surgery OPD of Institute of Child and Mother Health (ICMH) with an intention to do circumcision voluntarily for religious cause or other reasons, included in this study excluding congenital anomaly and randomly allocated in two groups. They were counseled properly and enrolled in the study with taking written informed consent. On the scheduled operation day of every Wednesday, circumcision was done after doing investigations and anesthetic check-up. One group of 30 patients received antibiotics and another group of 30 patients were without antibiotics. They were discharged on the same day as a day care surgery and advised for follow up in a follow-up schedule of 1 week, 2 weeks and 1 month. The recovery outcomes were assessed and recorded in the data sheets.

Results: 02 participants (07%) among all 30 participants without antibiotics after circumcision developed postoperative wound infection like pus in the wound, rest 28 participants (93%) without antibiotics recovered uneventful with only pain management therapy and regular cleaning by warm water bathing. Another group of 30 participants with antibiotics recovered without any post- operative complications after doing circumcision.

Conclusion: Antibiotics are not necessarily mandatory for circumcision wounds. Clean surgery and proper maintenance of asepsis during per-operative and postoperative period played important role in good recovery outcome, without or treatable mild postoperative complications.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 39-43

Benign Phyllodes tumor in an 11-year-old premenarchal girl

Shahnoor Islam — 2023-07-31

Phyllodes tumors are rare fibroepithelial tumors that account for less than 0.5% of all breast tumors. Presentation in children is even rarer. In this paper, we describe a case of an 11-year-old adolescent girl with a benign phyllodes tumor. The rare presentation at this age, its distinguishing features, the preoperative diagnostic difficulties, and the management protocols, surgical resection and reconstructive approach of this uncommon tumor may provide useful insight and perspective for patients and clinicians facing similar challenges in the paediatric population.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 50-52

Razor blade ingestion in an infant: A case report

Nazmul Islam — 2023-07-31

Background: Foreign body (FB) ingestion is common in children and most are observed to be between the age of 6 months and 3 years. Usually, majority of cases require no specific treatment and the swallowed foreign body passes through the digestive tract spontaneously without causing significant complications. Less than 1% of the cases complicate by gastrointestinal tract perforation, which is often caused by sharp objects, and warrants surgical intervention. The majority of razor blade ingestions involve prisoners and psychiatric patients, but in paediatric patients it is rare and no cases are reported yet. Our patient is a 9-month-old girl who ingested a razor blade while playing. On radiological investigation, a razor blade like foreign body was found in the stomach. After emergency laparotomy, a single 2.5×1 cm razor blade was detected and carefully and safely removed. The patient was subsequently discharged home on the 5th POD with recommended family diet.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 53-56

Surgical care in birth defects

Tahmina Banu — 2023-07-31

Abstract not available

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 1-2

Operative complications of urogenital tract during repair of anorectal malformation (ARM) in boys: A review

Md Samiul Hasan — 2023-07-31

Despite advancements in reconstructive surgery and a growing understanding of anorectal malformation (ARM) anatomy, boys still commonly experience urinary tract injuries after ARM reconstruction. These injuries include postoperative rectourethral fistula (RUF), urethral stricture or stenosis, bladder dysfunction or injury, prostatic injury, ureteral injury, and vas & seminal vesicle injury. Some of these injuries are immediately apparent during surgery, while others present later in follow-up. This article details the causes, symptoms, management, and prevention protocols for urogenital tract injuries during ARM reconstruction in boys.

Journal of Paediatric Surgeons of Bangladesh (2018) Vol. 9 (1&2): 44-49