Showing papers in "Journal of Indian Association of Pediatric Surgeons in 1996"

Anastomotic leakage following repair of esophageal atresia and tracheo-esophageal fistula.

Abstract: Eighty neonates with esophageal atresia and tracheo-esophageal fistula underwent end-to0end esophageal anastomosis. Of these, 15 (18.75 percent) developed anastomotic leakage; all but one had 'major' leaks. Patients with major leaks (n=14) developed respiratory distress with saliva or gastric juice in chest drain within one week of surgery. Only one of these was taken up for re-thoracotomy, others had respositioning of drains and some had extra tubes inserted. Only 2 out of 13 survived the catastrophe. One neonate had a minor radiological leak only and was successfully managed conservatively. Of the various risk factors studied, use of braided silk suture, and distance between esophageal pouches were found to be statistically significant. Livaditi's myotomy was associated with high leak rate, possibly because of learning phase. Retropleural approach was found to have no advantage over transpleural, once a major leak had occurred. We conclude that anastomotic leak following esophageal repair still has high morbidity and mortality and an aggressive surgical intervention is needed for improved outcome.

Foreign bodies in the air passage of children

Abstract: Seventy-two children between the ages of three months and four years had bronchoscopy for suspected foreign bodies (F.B.) in their air passages between December 1988 and September 1995. Sixty two of them had foreign bodies in their air passage. In forty eight of these patients a specific history of inhalation of F.B. were present. Reduced air entry on the affected side was present in fifty eight patients who had F.B. in the bronchus. F.B. could be removed by bronchoscopy in sixty patients. In one patient, it was removed by bronchotomy while in another patient a right upper lobectomy had to be pulmonary suppuration. Peanut was the commonest F.B. removed. Post bronchoscopy complications include incomplete removal in three, failure in one and stridor in eleven. There was no mortality

Management of pouch colon with anorectal malformation.

Abstract: Management of pouch colon (congenital short colon) with anorectal malformation is still very controversial. This series of 98 cases of congenital pouch colon managed during the period of 1984 to 1995 at our centre wound be the largest series published so far. Salient features regarding its incidence, distribution of types, etiological hypothesis and prognosis have been discussed with review of literature. Based on the out come of surgery, a proper management protocol has also been derived.

Morbidity and mortality with reference to gap between two segments in esophageal atresia : 8 years experience with 200 cases.

Abstract: Two hundred patients of esophageal atresia with or without tracheo-esophageal fistula treated during a period of 8 years were studied with emphasis on magnitude of gap between two wnds of esophagus. Patients were divided in two groups, one group (154 patients) with gap less than 2 cm and other group (46 patients) with gap more than 2 cm. Mortality and complications were noted with reference to distance between the two ends of esophagus. There was high morbidity and mortality in patients with long gap. Surgical technique, proper mobilization of proximal pouch and tension free anastomosis are prerequisite for a final outcome.

Relationship between threatened abortion and congenital malformations

Abstract: It is established that the incidence of major congenital malformations among the preterm infants was higher-almost 1 in 12 preterm in fants. This study is aimed to find out whether congenitally malformed foetuses are naturally aborted and conversely whether spontaneous abortions are atleast in some cases due to foetal anomaly. A three fold targetting was envisaged to study this relationship between spontaneous abortion and congenital malformations. 1) A retrospective study of woman who had threatened abortion, during the year 1984, 1985 and 1986. 2) A prospective study of women who were admitted with threatened abortion during the year 1988-89. 3) All infants and children who had multiple congenital anomalies were included in this group. A thorough antenatal history of their mothers were taken for the presence of uterine bleeding indicating abortion. In this retrospective study of women, who had threatened abortion, but did not complete the process of abortion, incidence of major life threatening congenital malformations come to 1 in 12.8. Prospective study of women yield an incidence of major congenital anomalies of 1 in 8.6. In children with major congenital malformations observed during the period, the abortion related risk factors were present in 1/3rd. Overall incidence of major congenital anomalies was 1:400 deliveries. Thus a high positive relationship between threatened abortion and major life threatening congenital malformation is proved in this study. It is therefore concluded that interfering with the process of abortion with drugs is not to be recommended except in extraordinary circumstances

Place of selective shunt surgery in portal hypertension in children.

Abstract: 52 patients with Portal Hypertension were treated by Distal Splenorenal Shunt (DSRS) (15 percent) convential shunts (33 percent) and by nonshunt surgical procedures (52 percent). The results of the various procedures were compared retrospectively. Our experience suggests that DSRS, whenever, technically feasible should be preferred to the conventional shunts.

Neonatal intestinal obstruction : 10 years review of 765 cases

Abstract: Intestinal obstruction in neonates is one of the commonest neonatal surgical emergency in pediatric surgery. Most of the literature on neonatal intestinal obstruction is from western countries. Very few contributions are available from India. A 10 year review was carried out from 1984 to 1994 at our centre to find out the various causes of neonatal intestinal obstruction in eastern U.P., Bihar and part of M.P. It constituted 38.6 percent, of intestinal obstruction in children. The commonest cause was ano-rectal malformation (50.3 percent) followed by Hirschsprung's disease, (15.7 percent 1), Bowelatresia (7.8 percent) and Maloration of gut (5.9 percent) in order of decreasing frequency (Table 1). Its presentation and outcome of management are being discussed.

Splenic cyst : aspiration, laparoscopic derooling, or surgical excision and omentopexy.

Abstract: Congenital non-parasitic splenic cysts are rare. Differentiation of true cysts with epithelial lining of the cyst wall from pseudocysts without such lining is important from the management point of view. True cysts are resistant to non surgical methods of treatment like aspiration or sclerosis. Presented is the case of a 16 year old boy with an epidermoid cyst of the spleen which failed to respond to repeated aspirations and recurred following laparoscopic deroofing. This was effectively managed with surgical near total excision and omentopexy of the residual cavity.

Creation of an isolated bowel segment by omento - enteropexy evaluation by fluorescein angiography and histopathology.

Abstract: An isolated bowel segment (IBS) was created in 10 rats by a two staged procedure: (1) Co-optation of the omentum to the submucosa of the bowel segment and (2) division of the mesentery of this segment 6 weeks later. Fluorescein angiography was done in 5 rats and showed that the IBS was sustained by collateral from the omentum. Histological evaluation in 5 other rats showed no adverse changes in the wall or mucous of the IBS. Stomal stenosis has been shown to be of potential advantage for the use of IBS in bowel elongation procedures.

H-type tracheo-esophageal Fistula.

Abstract: During an 11-year study period at the All India Institute of Medical Sciences, New Delhi, 'H'-type tracheo-esophageal fistula was diagnosed in 10 patients representing approximately 2 percent of all babies seen with esophageal atresia and/or tracheo-esophageal fistula. The average age at presentation in this group was higher (2 months) than the common variety (2-3 days). Delay in diagnosis primarily stems from poor sensitivity of radiological studies. Once the diagnosis is made thee treatment is straightforward. Bronchoscopic localization and cannulation of the fistula, just before definite surgery was possible in all the cases and is strongly recommended.