Paediatric Surgery

ORIGINAL ARTICLES
	A comparison of hydrostatic reduction in children with intussusception versus surgery: Single-centre experience	p. 61
	Mohamed El-sayed Eraki DOI:10.4103/ajps.AJPS_102_16   Background: Intussusception is the most common cause of bowel obstruction in infancy and childhood. Early diagnosis and effective management have reduced its morbidity and mortality in developed countries. Non-surgical reduction remains the first-line treatment of choice for intussusception. The major complication of air enema reduction is bowel perforation and portal venous gas. In recent years, several techniques have been recommended for intussusception treatment. In this study, an evaluation was made of intussusception cases that presented at our clinic and had reduction applied together with saline under ultrasonography and cases, which were surgically treated. Our aim of this study is to evaluate the results of hydrostatic reduction under ultrasound guided and to compare the results with patients treated by surgery for the management of intussusception. Patients and Methods: A retrospective study was done of the records of 100 cases treated for a diagnosis of intussusception between April 2011 and April 2013, in Department of Paediatric Surgery, Zagazig University Hospital. Patients were evaluated demographics, clinical presentation and management strategy, during the hospitalisation and outcome. Results: This study includes 100 patients diagnosed with intussusception, sixty males and forty females, the age ranged between 1 month and 7 years old. Ultrasound was applied for all patients as a part of diagnosis. Hydrostatic reduction under ultrasound guide was applied to fifty patients, successful hydrostatic reduction was seen in thirty patients and unsuccessful hydrostatic reduction was seen in twenty patients which admitted for surgery, we did not do another chance of hydrostatic reduction for unsuccessful patients, open surgery was done for seventy patients, during surgery, we found ileocolic intussusception in forty patients, ileoileal in twenty patients and colocolic intussusception in ten patients. Leading point of intussusception was seen in 22 patients, Meckel's diverticulum in ten patients, polyp in five patients and lymphoma in seven patients. Manual reduction was done in forty patients and resection anastomosis was done in thirty patients. No mortality in any case. Conclusion: Ultrasound-guided hydrostatic reduction of intussusception is a safe technique which reduces the duration of hospitalisation and treatment costs.
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	Laparoscopy in the management of impalpable testis (Series of 64 Cases)	p. 65
	Khalid A Ismail, Mohamed H. M. Ashour, Mahmoud A El-Afifi, Amel A Hashish, Nagay E El-Dosouky, Mohamed Negm, Mohamed S Hashish DOI:10.4103/ajps.AJPS_103_08   Background: The undescended testis represents one of the most common disorders of childhood. Laparoscopy has been widely used both in the diagnosis and treatment of non-palpable testis. In this study, we investigated and evaluated the usefulness of laparoscopy in the diagnosis and treatment of no palpable testis. Patients and Methods: From January 2003 to January 2008, we used laparoscopy in the management of 64 patients with 75 impalpable testes. Their ages varied from 1 to 15 years (median age = 4.6 years). The site and the size of the testes were localised by abdominopelvic ultrasonography in all 64 children for accurate diagnosis. One stage laparoscopic orchiopexy was performed in 26 testes, staged Fowler-Stephens orchiopexy was underwent in 17 testes, while laparoscopic orchidectomy was done in 5 testes. Follow-up by clinical examination and colour Doppler ultrasound was performed in every patient who underwent orchiopexy. Results: There were 11 patients with bilateral non-palpable testes. The overall diagnostic agreement of ultrasound with laparoscopy was seen in only 16 out of 75 testes (21.3%). The results of diagnostic laparoscopy were varied and showed various pathological. Conditions and positioned of the testes, such as 20 low intra-abdominal testes (26.6%), 17 testes were high intra-abdominal (22.7%), and 18 testes (24%) entered the inguinal canal. Associated inguinal hernia was present in 4 patients. After a mean follow-up period of 26 months (6 months – 5 years), all testes were in the bottom of the scrotum except 3 testes were retracted to the neck of the scrotum and atrophy of the testis occurred in 2 patients (2.7%). Conclusion: Laparoscopy has proven to be the only diagnostic modality where the findings provide a clear dependable direction for the definitive management of impalpable testes, so it allows an accurate diagnosis and definitive treatment in the same sitting.
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	Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria	p. 70
	Akan W Inyang, Usang E Usang, Ademola O Talabi, Lofty-John C Anyanwu, Oludayo A Sowande, Olusanya Adejuyigbe DOI:10.4103/ajps.AJPS_166_14   Background: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion. Patients and Methods: The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16. Results: Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123). Conclusion: DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.
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CASE REPORTS
	Let us save the brain with cerebral oximeter: Two case reports	p. 74
	Ilknur Suidiye Seker, Onur Özlü, Aybars Özkan, Hakan Uzun, Ali Ümit Esbah, Pelin Çetin DOI:10.4103/ajps.AJPS_117_16   In the neonates, tracheal atresia and tracheoesophageal fistula (TEF) surgery may result in hemodynamic instabilization, leading to cerebral perfusion insufficiency due to the retraction of the pulmonary vessels and truncus brachiocephalicus. We represented one male and one female neonates which were performed thoracoscopic primary repair of TEF through right thoracotomy at the 3th and 4th postpartum day. Anesthesia was induced using sodium thiopental (5 mg/kg), fentanyl 4 mcg, and rocuronium (0.5 mg/kg) given through intravenous route. Sevoflurane 2% and 50% O2in air were used for the maintenance therapy. During the right lung compression to expose posterior esophagus, no value was observed on the pulse oximeter (PO) probe placed on the right hand, and radial artery was not palpated. At the same time, oxygen saturation was observed as 96%–97% on the left foot probe. As the right cerebral oximeter values (rSO2) were rapidly decreased to 31%, the lung compression was ceased. Right pulse oximeter and right rSO2measurements return to the baseline levels. For the second case - different from the first case -both left and right rSO2was rapidly decreased to 40% levels and return to the baseline levels after was removed the retractors. Right PO and right and left cerebral rSO2values returned to baseline immediately when the retractor compression was ended During the operations involving the great vessels in neonates, cerebral perfusion could be preserved using cerebral oximeter. Cerebral oximeter is more efficient than pulse oximeter for detecting cerebral tissue oxygenation and could be helpful to minimize neuronal damage in the neonates.
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	An unusual surgical cause of pyloric stenosis in an 8-month-old infant	p. 79
	Francis Msume Banda, MG Mutapanduwa, C Goutam, A Steenhoff, Dipesalema Joel DOI:10.4103/ajps.AJPS_118_16   Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious, projectile vomiting in children. Its incidence is estimated to be 2–5/1000 live births and has been noted to be quite rare in African-Americans, Asians, and Indians. It is more common in infants under 6 months of age and is quite rare in older infants. While IHPS is invariably intrinsic in nature, extrinsic pyloric stenosis is very rare. Children who present with nonbilious, projectile vomiting after the age of 6 months should, therefore, be thoroughly investigated for causes other than IHPS. This is a case report of an 8-month-old child who had a band of tissue constricting the pylorus which mimicked IHPS.
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