African journal of paediatric surgery : AJPS最新文献

{"title":"Post-operative Pain Control: A Comparison between Bupivacaine and Tramadol Local Wound Infiltration in Children Undergoing Herniotomy and Orchidopexy.","authors":"Efosa Aisien, Chukwuemeka Ndubuisi Chibuzom, David Osarumwense Osifo, Iyekeoretin Evbuomwan","doi":"10.4103/ajps.ajps_172_22","DOIUrl":"10.4103/ajps.ajps_172_22","url":null,"abstract":"<p><strong>Background: </strong>Post-operative pain control improves patient's satisfaction and affects the period of admission. Local wound infiltration following hernia surgery using xylocaine or bupivacaine has been a common practice. The use of tramadol for such infiltration is relatively new and has not been studied in our environment. This study compared the efficacy of post-operative pain control between Bupivacaine and Tramadol wound infiltration in children who underwent herniotomy and orchidopexy.</p><p><strong>Materials and methods: </strong>This was a prospective randomised study involving 104 patients. A simple random method was used to allocate the study group into two equal groups (A, n = 52 and B, n = 52) using sealed envelopes with contents labelled A or B. Pre- and post-operative respiratory rate, heart rate, and C-reactive protein (CRP) were all recorded. Time to first and subsequent analgesia was determined using face, legs, activity, cry, consolability (FLACC) pain score.</p><p><strong>Results: </strong>Fifteen patients in Group A and 18 patients in Group B received each two doses of supplemental analgesia within the first 24 h, ( P = 0.527). Time to first analgesia was significantly different between the two groups, (6.93 ± 0.80 h and 6.11 ± 1.08 h, P = 0.020). The mean FLACC pain score at the time of first analgesia in hours was 4.93 ± 0.59 and 4.72 ± 0.67 for Group A and B, respectively, P = 0.350. The changes in CRP were not different in the two groups, ( P = 0.665). Four patients in Group A, but none in Group B had an episode each of post-operative vomiting.</p><p><strong>Conclusion: </strong>Tramadol showed comparable efficacy with bupivacaine in post-operative pain control by wound infiltration in children who had unilateral herniotomy or orchidopexy. Tramadol, however, achieves a longer duration of action before rescue analgesic is required. Caution is necessary to avoid post-operative vomiting.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":" ","pages":"217-222"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative Serum Albumin Predicts Native Liver Survival in Biliary Atresia.","authors":"Kakeru Machino, Kotaro Mimori, Seiya Ogata, Yosuke Minami, Hirofumi Shimizu, Michitoshi Yamashita, Hideaki Tanaka","doi":"10.4103/ajps.ajps_158_22","DOIUrl":"10.4103/ajps.ajps_158_22","url":null,"abstract":"<p><strong>Background: </strong>To predict native liver survival (NLS) after Kasai portoenterostomy (KP) for biliary atresia (BA) using pre-operative clinical data.</p><p><strong>Materials and methods: </strong>Pre-operative data were collected from 29 patients with BA who underwent KP at our department between 1989 and 2017 and were analysed including serum albumin, bilirubin, prothrombin time-international normalised ratio, body height, body weight, age at KP, paediatric end-stage liver disease score calculated using the pre-operative data and the period of NLS.</p><p><strong>Results: </strong>The 10-year NLS rate of all patients was 51%. A multivariate analysis revealed that among all factors, the pre-KP serum albumin level was the only independent predictor of NLS ( P = 0.04, hazard ratio = 0.269, 95% confidence interval = 0.077-0.934). The area under the receiver operating characteristic curve for NLS, determined using pre-KP serum albumin was 0.760 and 3.75 mg/dl was selected as the cut-off value. There was a significant difference in NLS between patients with high (≥3.8 mg/dl) and low (≤3.7 mg/dl) pre-KP serum albumin (90.0% vs. 31.5%, P < 0.01).</p><p><strong>Conclusions: </strong>Decreased pre-KP serum albumin may reflect not only functional impairment of the liver, but also the inflammatory process, which is hypothesized to occur during its advancement. The pre-KP serum albumin level may be a good prognostic factor for NLS in post-KP BA patients.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":" ","pages":"232-235"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of the Postural Difference in Antero-Posterior Diameter of Renal Pelvis on Ultrasonography of Unilateral Ureteropelvic Junction Obstruction in Determining the Need For Surgery.","authors":"Bijay Kumar Suman, Ram Jeewan Singh, Aditya Arvind Manekar, Subrat Kumar Sahoo, Bikasha Bihari Tripathy, Manoj Kumar Mohanty, Sudipta Mohakud","doi":"10.4103/ajps.ajps_25_23","DOIUrl":"10.4103/ajps.ajps_25_23","url":null,"abstract":"<p><strong>Background: </strong>Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Postural variations in the anteroposterior pelvic diameter (APPD) of the hydronephrotic kidney in children during follow-up postnatal ultrasonography (USG) reflect the intrapelvic tension, which might help in predicting the need of surgery amongst these patients.</p><p><strong>Materials and methods: </strong>We designed this prospective observational study in all unilateral UPJO patients on postural variation in the APPD of renal pelvis on ultrasonography. The mean age of all patients were 2.15 years (0-5 years) and managed at our institute at All India Institute of Medical Sciences, Bhubaneswar. The study duration was from July 2019 to May 2021. The management of these patients was done as per the standard institutional protocol and there was no deviation due to inclusion in this study. We documented the variations in postural APPD both amongst the conservatively managed group and the surgically managed group of patients. Linear correlation between two continuous variables was explored using Pearson's correlation (if the data were normally distributed) and Spearman's correlation (for non-normally distributed data).</p><p><strong>Results: </strong>We found a higher prone APPD than supine APPD in all these patients indicating the obstruction at ureteropelvic junction. However, in the surgical group, there was less variation in the postural APPD compared to the conservative group, and when there was no variation in the postural APPD, the need of surgery was 100%. The limitation of our study was the small sample size (n = 36). A study involving a larger population or involving multiple institutions may further add significance to our findings.</p><p><strong>Conclusion: </strong>We found less postural variation in APPD on USG to be more likely associated with severe UPJO requiring early surgery. This may indicate a non-compliant renal pelvis. However, it was statistically not significant.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":"21 4","pages":"242-246"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Role of Pleural Wrap and Post-operative Neonatal Protocol in Long-gap Oesophageal Atresia: A Team Effort.","authors":"Sanat Kumar Khanna, Vishal Vishnu Tiwari, Gurjot Singh, Gaurav Panchal","doi":"10.4103/ajps.ajps_148_22","DOIUrl":"10.4103/ajps.ajps_148_22","url":null,"abstract":"<p><strong>Background: </strong>The objectives of this study were to bring out the results of application of pleural wrap in primary repair of tracheo - esophageal fistula (TEF) with long-gap oesophageal atresia (LGEA) and also define the role of neonatologists and paediatric intensivists in post-operative management in these patients by laying down standard neonatal management protocol.</p><p><strong>Materials and methods: </strong>This was a retrospective descriptive observational study conducted between March 2011 and April 2019 on 23 cases of LGEA with TEF. The study was conducted at two tertiary care paediatric surgery centres in Northern part of India wherein these newborn babies were operated by two paediatric surgeons with variable experience of 8-12 years. It also describes the neonatal management protocol used in post-operative period.</p><p><strong>Results: </strong>Out of 23 patients, 15 were boys and 8 were girls, with a mean age of 32.25 weeks and a mean birth weight of 2.02 kg. The mean hospital stay was 23.5 ± 8 days. Eleven cases had gap between 3 and 3.5 cm, 8 cases between 3.5 and 4 cm and 4 cases had gap more than 4 cm. The incidence of associated anomalies was 52%. Anastomotic leak rate was 8.69%, and 3 (13.04%) patients died in the post-operative period. All the operated patients were managed postoperatively as per strict neonatal management protocol exclusively by the team of neonatologists and neonatal intensivists.</p><p><strong>Conclusion: </strong>Application of pleural wrap over anastomosis following primary repair of LGEA with TEF significantly reduced the incidence of anastomotic leak in our study. Apart from the pleural wrap, the key to successful outcome also is contributed by the little prolonged, controlled ventilation and patience and perseverance in post-operative feeds. This post-operative management protocol that has been followed by us in our study is easily reproducible and can be adopted by paediatric surgeons working alongside neonatologists as a team.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":"21 4","pages":"247-253"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged Shoulder and Elbow Reconstruction in a Child with Obstetric Brachial Plexus Palsy: Six-year Follow-up.","authors":"Shady Samir El-Beshry, Ahmad Saeed Aly, Tamer A El-Sobky","doi":"10.4103/ajps.ajps_47_23","DOIUrl":"10.4103/ajps.ajps_47_23","url":null,"abstract":"<p><strong>Abstract: </strong>The management of obstetric brachial plexus palsy (OBPP) can be challenging, particularly in neglected patients. We report the long-term results of the surgical management of a late-presenting adolescent girl with severe left shoulder and elbow flexor paralysis secondary to OBPP. She was subjected to staged shoulder and elbow reconstruction in the form of trapezius transfer and latissimus and teres major transfer to enhance shoulder abduction and lateral rotation, and flexor-pronator transfer to the anterior distal humerus to enhance elbow flexion. Flexor-pronator plasty was successful in restoring elbow flexion and function and maintaining joint stability in the long term in a patient with severe OBPP. This further consolidates its role as a feasible secondary reconstructive procedure in carefully selected patients with elbow flexor paralysis. Shoulder function improved less remarkably, yet it augmented the overall upper extremity function and correlated with pre-operative residual shoulder function. Fulfilling the candidacy for each surgical procedure is important to a successful outcome.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":"21 4","pages":"273-277"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wound Healing and Cosmetic Outcomes in Neonatal Circumcision Using Three Different Techniques.","authors":"Taiye Taibat Ibiyeye, Jones Olaoluwa Taiwo, Abdulrasheed A Nasir, Ademola A Popoola","doi":"10.4103/ajps.ajps_13_23","DOIUrl":"10.4103/ajps.ajps_13_23","url":null,"abstract":"<p><strong>Background: </strong>Circumcision of a male child is an integral part of some African cultures. An ideal technique of neonatal circumcision should be simple, safe and heal satisfactorily with good cosmetic appeal. The aim was to compare conventional dissection (CD), Plastibell (PB) and Gomco (GM) techniques of circumcision in neonates in terms of wound healing, wound healing complications, cosmetic outcome and parental satisfaction.</p><p><strong>Materials and methods: </strong>A total of 144 male neonates were randomised into three study groups: CD, GM and PB groups. All procedures were performed under local anaesthesia as day case. Superficial wound healing was assessed on the 7 th post-operative day. The cosmetic outcome of the three techniques was assessed by a plastic surgeon and the parents using a 4-point Likert scale on the 4 th post-operative week.</p><p><strong>Results: </strong>The three groups were comparable in terms of age ( P = 0.207) and weight ( P = 0.098) at circumcision. There was satisfactory wound healing in 48 (100%) patients in the GM group, compared to 47 (97.8%) in the CD group and 45 (93.8%) in the PB group ( P = 0.324). Wound healing complications were recorded in seven patients, 1 (2.1%) in the CD group with wound infection, 5 (10.4%) in the PB group with moderate pain despite the use of analgesia and 1 (2.1%) patient with skin bridge in the CD group. The plastic surgeon and the parents rated the cosmetic outcome of CD higher than the other two techniques.</p><p><strong>Conclusion: </strong>There is no significant difference in superficial wound healing amongst the three circumcision techniques. The cosmetic outcome of CD was significantly better than that of GM and PB circumcisions.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":" ","pages":"223-227"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Duodenal Injury in Blunt Abdominal Trauma in Children: A Series of Five Cases.","authors":"Reyaz Ahmad Wani, Sandeep Singh Sen","doi":"10.4103/ajps.ajps_164_22","DOIUrl":"10.4103/ajps.ajps_164_22","url":null,"abstract":"<p><strong>Abstract: </strong>Blunt abdominal trauma is one of the leading causes of trauma-related deaths in children. The commonly affected organs include the spleen, liver and kidneys, followed by uncommon ones such as the pancreas and intestine. Isolated duodenal injury is very rare and, at times, poses a diagnostic challenge due to the paucity of clinical symptoms and signs. Hence, delayed presentation is not uncommon. In this write-up, five such cases are presented with emphasis on their clinical presentation, diagnosis, management and outcome.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":" ","pages":"267-270"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Complete Colonic Stricture after Posterior Sagittal Anorectoplasty: Iatrogenic or Inflammatory?","authors":"Ram Jeewan Singh, Amit Kumar Sinha, Bindey Kumar","doi":"10.4103/ajps.ajps_29_23","DOIUrl":"10.4103/ajps.ajps_29_23","url":null,"abstract":"","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":" ","pages":"283-284"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perineal Bowel - An Isolated Anomaly or Part of a Complex?","authors":"Khyati Kiran Janapareddy, Jai Kumar Mahajan, Shailesh Solanki, Aravind Sekar","doi":"10.4103/ajps.ajps_36_23","DOIUrl":"10.4103/ajps.ajps_36_23","url":null,"abstract":"","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":"21 4","pages":"285-286"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Glans Dehiscence Associated with Vascular Flap Coverage of the Glanular Neourethra during Primary Urethroplasty: A Randomised Controlled Trial.","authors":"Janjala Narahari, Aditya Arvind Manekar, Bikasha Bihary Tripathy, Subrat Kumar Sahoo, Manoj Kumar Mohanty","doi":"10.4103/ajps.ajps_6_23","DOIUrl":"10.4103/ajps.ajps_6_23","url":null,"abstract":"<p><strong>Background: </strong>Hypospadias is one of the common congenital anomalies of male genitalia. Although over 300 different operative techniques have been described, post-operative complications are still common, of which glans dehiscence (GD) is the most severe complication requiring redo urethroplasty. Some surgeons use the vascular flap to cover the glanular part of the neourethra to prevent GD, but there are controversies regarding its usefulness. There is a paucity in the literature, about articles evaluating the risk of GD associated with vascular flap coverage of the glanular neourethra during primary urethroplasty.</p><p><strong>Materials and methods: </strong>We planned a single-blinded, parallel-design, randomised controlled trial involving 56 cases of hypospadias treated with single-stage urethroplasty amongst the admitted cases of hypospadias for primary urethroplasty in the Department of Paediatric Surgery, AIIMS, Bhubaneswar, from November 2017 to December 2019 as an M.Ch. thesis project. This was approved by the Institutional Ethics Committee and enrolled in the national registry of clinical trial. 28 patients were randomised into Group A (without flap coverage of the glanular part of the neourethra) and 28 patients were randomised into Group B (with flap coverage of the glanular neourethra).</p><p><strong>Results: </strong>Only 2 (7.1%) cases amongst the Group A patients developed GD, while 9 (32.1%) cases of Group B had GD (P = 0.013).</p><p><strong>Conclusions: </strong>Extending the vascular flap coverage up to the glanular part of the neourethra till the neo-meatus during primary urethroplasty is significantly associated with GD.</p>","PeriodicalId":72123,"journal":{"name":"African journal of paediatric surgery : AJPS","volume":"21 4","pages":"257-262"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}