Journal of Paediatric Surgeons of Bangladesh

The risk factors of gall stone formation in children

2024-04-11T11:41:33+00:00

Abstract not available

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2):1-4

Esophageal atresia and tracheoesophageal fistula: A review

2024-04-11T16:31:07+00:00

Esophageal atresia is one of the most common congenital malformations requiring surgical management in the newborn period. The first successful primary repair was done in 1941. Since then, with the advances in medical and surgical aspects of management, the survival rates have shown drastic improvement even in resource challenged areas. Early diagnosis, appropriate perioperative management, and regular follow-up are key to reducing disease-related morbidity and improving the quality of life in these children. This review is an attempt to highlight the etiopathogenesis of the anomaly and to sensitize the readers about the association of various other congenital malformations with EA/TEF in addition to the surgical management of the disease.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 49-61

The need for practice enhancements and parental empowerment during their child’s day surgery process: A pilot study

2024-04-11T12:02:19+00:00

Background: Perioperative experiences leave a lasting psychosocial impact on the parents of children undergoing surgery. Methods: A phenomenological study design recruited parents of children undergoing day surgery using purposive sampling. Semi-structured face to face interviews were conducted two weeks postoperatively. Results: Thematic analysis revealed 6 main themes with 12 sub-themes. Although the parents acknowledged the emotional support and tangible assistance from the healthcare team, mostly the themes revealed negative perceptions of the unique processes within paediatric day surgery. Conclusions: Parents’ feelings of anxiety, stress, helplessness and the pressure to be seen as a resource of physical and emotional support during their child’s perioperative period were expressed by them as their needs for additional information and counselling, remote access to the primary healthcare team postoperatively and advice on coping strategies. Practice enhancements using technology and innovative playtherapy in combination with active parental participation may make day surgery a positive experience for both parents and children.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 5-14

Management of paediatric surgical patients during the COVID-19 pandemic: Our challenges

2024-04-11T13:25:36+00:00

Purpose: Here we describe the challenges and procedures adopted to ensure safe paediatric surgery services during the COVID-19 pandemic at the paediatric surgery department in non-Covid-19 wing of Dhaka Medical College Hospital-1. Materials and Methods: Design: Retrospective study. Setting: Department of paediatric surgery in non-Covid- 19 wing of Dhaka Medical CollegeHospital-1, a tertiary care academic medical center in Dhaka, Bangladesh. Participants and duration: All patients who were admitted in the department of paediatric surgery in Dhaka Medical College Hospital-1 from March 1 through June 30, 2020. Methods: We identified patients with or without a rRTSARS- CoV-2 PCR receiving care at the department of paediatric surgery. The healthcare professionals were trained to clean, disinfect, use of PPEs, and other wastes were disposed of as per waste management protocols. Data collection & analysis: Patient data were manually abstracted from the medical record for evaluation. Responses were analysed using Microsoft Excels & SPSS, and presented as categorical data and percentages. Main outcome measures: We describe patient characteristics including demographics, presenting symptoms, type of treatment (Surgery vs Non Surgery), outcomes (morbidity & mortality), hospital stay, and distance travelled for treatment. Results: A total of 320 paediatric surgical patients were included in this study, among all patients about 66.87% patients were male child and 79.06% patients required surgeries. There were 5 patients with confirmed COVID- 19, who were transferred to the Covid-Surgical unit. During this period, there were 4 (1.25%) children who died due to non-COVID related causes. In surgical group only 24(7.5%) patients developed postoperative complications. Length of hospital stay of 44 (13.75%) of non-surgical patients were less than 72 hours, whereas 141 (40.06%) of surgical patients were more than 72 hours. Majority of patients of both groups travelled more than 100 km distance for treatment. Conclusions: This corona crisis has provided an opening for rational health care and formulating global policies. So that in future such pandemics can be tackled more carefully and consistently with advancing knowledge and better preparation.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 15-21

Safety and advantages of early oral feeding after intestinal anastomosis in children: Our experience

2024-04-11T14:53:57+00:00

Background: Restoration of enteral feeding is believed to enhance recovery after surgery, but intestinal anastomosis is a matter of apprehension for surgeons to start enteral feeding early. Before 2022, our standard practice was to wait three to four days to begin oral feeding after intestinal anastomosis. Since 2022, we have allowed oral feeding to start within 24 hours of intestinal anastomosis. This study compares the safety and benefits of early oral feeding after intestinal anastomosis in children. Methods: This retrospective study was done in the neonatal and paediatric surgery department, BSH&I, from January 2021 to December 2022. Children who received early oral feeding in 2022 compared with children who received oral feeding after three days in 2021. Children with duodenal anastomosis and anastomosis with a covering stoma were excluded. Demographic and clinical data were extracted from hospital records using a predefined questionnaire. Data were analyzed in SPSS 26, and a p-value <0.05 was considered significant. Results: One hundred thirty-three children (90 in 2022 and 43 in 2021) underwent intestinal anastomosis. Fiftynine (44.4%) children had small gut anastomosis, 62 (46.6%) children had large gut anastomosis, and 12 (9%) children had ileocolic anastomosis. There was no difference in gender and mean age at the surgery between the two groups. The mean time to start oral feeding was 19.9±0.59 hours in the case group and 79.1±13.9 hours in the control group (p<0.001). The mean time to full oral feeding was 61.05±4.5 hours in the case group and 125.67±25.51 hours in the control group (p<0.001). The mean hospital stay was 4.16±1.18 days in the case group and 7.06±1.96 days in the control group (p<0.001). The two groups had no significant differences in anastomotic and wound complications. Conclusion: Early oral feeding after intestinal anastomosis is safe in children and reduces postoperative hospital stay without any added risk.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 22-25

Histopathological study of the fertility components of undescended testes in boys of different age group

2024-04-11T15:10:48+00:00

Background: Undescended testes presents the most common male developmental abnormalities, with infertility frequently observed in unilateral as well as bilateral forms. In that study, we evaluated the histological parameters of Undescended testes based on patient’s age and we recommended for the optimal timing for orchiopexy. Objective: To evaluate the histological parameters of undescended testis and determine the optimal timing for orchiopexy. Methods and Materials: This cross-sectional study included 30 patients with undescended testis(es) in the department of paediatric surgery, BSMMU. After taking relevant history, examination findings and investigation reports of all the study subjects were recorded in the pretested data collection sheet. Then biopsy specimens were collected from the selected testes during orchiopexy and analyzed the parameters including mean tubular diameter (MTD), mean tubular fertility index (MTFI) germ cell count (GCC), Sertoli cell index (SCI) and interstitial fibrosis index (IFI) Results: The MTFI and GCC in children <1 years of age were significantly higher than those of other older age group. (P= 0.011 & P= 0.003) The MTFI, GCC and IFI were significantly better in patients <2 years of age when compared to those of > 2years. IFI in the > 5-years group was significantly higher than those of any of the other younger age groups (P < 0.05). Other parameters such as testicular volume, MTD and SCI showed no statistically significant difference between the age groups studied. Conclusions: This study revealed that higher number of germ cells exists in the tubules between 6 months and 1 year. After first year of life, the major germ cell parameters deteriorate continuously, thus we recommended that orchipexy should be performed, between 6 months and 1 year but no later than 2 years for preserving future fertility.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol.10 (1 & 2): 26-31

Comparison between tubularisation of an intact and laterally augmented urethral plate urethroplasty and tubularised incised plate (TIP) urethroplasty for hypospadias repair

2024-04-11T15:23:55+00:00

Objectives: The aim of this study was to compare the outcome of hypospadias repair by tubularisation of an intact and laterally augmented urethral plate urethroplasty and TIP urethroplasty. Methods: This prospective comparative study was conducted from July 2018 to January 2020 and included 35 patients with primary distal and mid penile hypospadias. All had urethral plate widths of 8–10 mm. Exclusion criteria were mega meatus intact prepuce, previous repair, circumcision, urethral plate of >10 mm or <8 mm in diameter, chordee >30°. In Group A underwent tubularisation of an intact and laterally augmented urethral plate urethroplasty and in Group B underwent tubularised incised-plate (TIP) urethroplasty. The follow up period was 06 months. Results: The success rate without any complication was 88.89% and 76.48% in Group A and B respectively. Meatal stenosis occurred 0% and 11.76% in Group A and B respectively. Wound dehiscence rate was 5.55% and 5.88% in Group A and B respectively. Urethrocutaneous fistula occurred 5.55% and 5.88% in Group A versus Group B. Overall complication occurred 11.11 in Group A and 23.52% in Group B. Conclusion: The outcome of tubularisation of intact and laterally augmented urethral plate urethroplasty was better than TIP urethroplasty.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 32-36

Result of simple versus layered repair of urethro-cutaneous fistula developing after hypospadias surgery

2024-04-11T15:44:10+00:00

Background: Urethro-cutaneous fistula (UCF) after hypospadias surgery occurs regardless of the location of the meatus, procedure performed or experience of the surgeon. Hypospadias repair continues to be a singularly demanding form of surgical expression with considerable artistic latitude. The commonest complication of hypospadias surgery is fistula formation, which almost always requires repeat and similarly demanding surgery. Aims and Objectives: The aim of our study was to compare the result between simple and layered repair of UCF developing after hypospadias surgery. Materials and Methods: This comparative type of study was carried out in the Department of Paediatric Surgery, BSMMU, Dhaka from June 2015 to August 2016 for a period of 15 (fifteen) months. Forty (40) diagnosed cases of UCF were included in the study. All the participants were randomized into two groups named Group A & Group B. Group A was assigned to the simple repair technique & Group B was assigned to the layered repair technique. Relevant data were collected in a predesigned questionnaire. Results: The recurrent fistula formation rate was much higher in Group A (30%) than in Group B (05%), which was statistically significant in between the two groups. The majority of the fistulae recurred within a few days of the removal of the stent (from 7th to 10th POD). 6, out of 7 recurrent UCF were observed in this period. No recurrent fistula was observed beyond 4 weeks after operation. Conclusions: This study revealed that, the layered repair technique, with the addition of vascularized dorsal dartos fascia reduces the recurrent fistula formation rate in a significant number. Though more time consuming and technically difficult, we recommend wide application of layered repair technique in the management of post hypospadias UCF.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 37-42

Prognostic value of serum lactate dehydrogenase and serum ferritin for abdominal neuroblastoma in children

2024-04-11T16:10:13+00:00

Backgrounds: For decades, age, MYCN status, stage, and histology have been used as neuroblastoma risk factors. Serum Lactate dehydrogenase (LDH) and ferritin are reproducible, easy to obtain, and prognostic, but they are never used in risk stratification. Purpose/Objective: The purpose of this study was to find out the prognostic value of serum LDH and ferritin in children with abdominal neuroblastoma. Materials/Methods: Nine children with abdominal neuroblastoma from 2020-2021 in four tertiary centers of Dhaka, who treated according to Socie’te’ Internationaled’OncologiePe’diatrique selected as study population and divided into low and high-risk groups. Age, sex, stage, histology, serum LDH, serum ferritin and events were analyzed using SPSS 22. Survival was calculated by Kaplan-Meier procedure Results: Sensitivity, specificity, positive predictive value and negative predictive value of serum LDH were 100%, 85.7%, 66.7% and 100% respectively in the prognosis of abdominal neuroblastoma in children at a cut-off point =1527.5. Sensitivity, specificity, positive predictive value, and negative predictive value of serum ferritin were 100%, 71.4%, 50% and 100% respectively in the prognosis of abdominal neuroblastoma in children at a cut-off point=581.There was no significant difference between the survival curves of both risk groups (p= 0.180) and between serum ferritin >581 and £581 group (p= 0.089) according to log rank test. But there was significant difference between the survival curves of LDH >1527 and LDH £1527.5 group according to log rank test (p= 0.027). Conclusion: Analysis of this study revealed that the risk of a worse event for children with abdominal neuroblastoma was greater and outcome was also worse for patients with serum LDH >1527.5 IU/L and serum ferritin >581 ng /ml. These markers can also be used for risk stratification in low to middle income countries. But further multi-centered study with longer period of follow up on larger sample size will be required to demonstrate the independent prognostic value of serum LDH and ferritin for abdominal neuroblastoma in children.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 43-48

Isolated congenital urethrocutaneous fistula: Two case reports

2024-04-11T16:47:52+00:00

A common complication after hypospadias surgery is a urethrocuteneous fistula. But when it is congenital and present in isolated form, it becomes extremely uncommon and usually present in the paediatric age group and associated with hypospadias, chordee, or anorectal malformation. In this report, we are presenting 2 cases of uncircumcised boys with this rare entity of Isolated congenital anterior uretrocuteneous fistula, highlighting etiology, embryology, and surgical reconstructions for management.

Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 62-65