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Intra bronchial and intra tracheal tumors are very rare in pediatric age group. Most of the literature clubs primary pulmonary tumors with these; hence actual incidences are not well defined. Amongst this mucoepidermoid carcinoma (MEC), whether low or high-grade account for only 0.1–0.5% of lung carcinomas. We report such a rare case of an eight year old girl presenting with history of recurrent lower respiratory tract infections with respiratory distress. CT scan of chest was suggestive of a mediastinal mass. She underwent rigid bronchoscopic biopsy, histopathology showed it to be mucus gland adenoma. She underwent right thoracotomy with complete excision of mass along with right lower lobectomy. Histopathology reported it to be a low-grade MEC with clear margins. She did not require any chemotherapy or radiotherapy and has no recurrence at 1-year follow up.

Background: Evaluation of our 10 year’s experience and analyze the prognostic factors affecting renal outcome in children with posterior urethral valves (PUV).Methods: We retrospectively reviewed the medical records of 129 patients diagnosed and managed as posterior urethral valves from 2009 till 2019 in our institution age of presentation, signs and symptoms, anthropometry, surgical interventions, and biochemical investigations were recorded and data were analyzed on an excel spreadsheet.Results: Mean age of presentation was 3 years and mean follow up was 4 years. 99 underwent primary valve ablation and 30 patients underwent diversion as primary treatment, the most common presenting symptom was poor urinary stream (90), enuresis (88), and fever (60). Correlation of resolution of symptoms pre and postoperatively was statistically not significant. 26% patients developed chronic renal failure (CRF) and 8.5% patients progressed to end stage renal disease (ESRD). Correlation of mean nadir serum creatinine >1 mg/dl (p=0.030), presence of protenuria (p=0.020), bladder dysfunction (p=0.029), bilateral high grade vesicoureteric reflux (VUR) (p=0.019), hypertension (p=0.01) was statistically significant. Correlation of age of presentation (p=0.341), outcome for patients treated with diversion or valve ablation in relation to CRF (p=0.239), incontinence (p=0.209), malnutrition (p=0.194) was statistically insignificant.Conclusions: Nadir serum creatinine >1 mg/dl, presence of protenuria, bladder dysfunction, bilateral high grade VUR are significant prognostic factors affecting long term outcome in PUV. Early detection and timely management may lead to a better outcome in these patients.

Larygeotrache oseophageal cleft is a rare anomaly in a newborn presenting with respiratory distress and choking with feeding symptoms identical with oesophageal atresia with or without tracheo-oesophageal fistula .It is an abnormal communication of the larynx and the trachea with the oesophagus occurring during fifth to seventh week of gestation as a result of circoid cartilage failing to fuse dorsally. LTOC varies greatly in anatomical extent and clinical severity; more severe forms in which the some or all of the tracheal cartilaginous rings are incomplete are fatal unless corrected surgically. LTOC occurs in less than 1/10,000 to 1/20,000 live births with slightly male predilection and has a autosomal dominant mode of inheritance. Routine chest X-rays and barium oesophagogram are usually not conclusive but bronchoscopy will delineate anatomy of cleft clearly. We present detailed case report of neonate with respiratory distress and choking on feeding and illustrating maneuvers at endoscopy and subsequent individualized surgical management of child.

Background: The objective of the study was to evaluate long term efficacy and outcome of use of buccal mucosal graft (BMG) for urethral reconstruction in varied urologic conditions in children.Methods: We retrospectively reviewed the medical records of 41 patients from 2009 till 2019 in our institution in which BMG was used for urethral reconstruction. Clinical findings along with surgical techniques used were noted for these patients. Postoperative outcome and complications were evaluated.Results: Mean age was 6.8 years and mean follow up was for 4 years. Out of 41 patients, BMG for substitution urethroplasty was used in 25 cases of hypospadias, 4 cases of urethral stricture, 6 cases of 46 XY disorders of sexual disorders, 4 cases of Y-duplication of urethra, and 2 cases of redo-epispadias repair. 11 patients underwent one stage repairs with a success rate of 63% and 30 patients underwent two stage repair with a success rate of 66%. Analysis and comparison of the outcome in relation to the type of repair, meatal position and number of surgical procedures prior to BMG urethroplasty was statistically insignificant.Conclusions: Buccal mucosa is an ideal graft substitute for urethroplasty. Two stage reconstructions has a slightly higher success rate than one stage reconstruction but the choice of the technique must be based on patients characteristics and on surgeons preference.

Background: The aim of the study was to evaluate long term efficacy and complications of augmentation cystoplasty in patients with bladder dysfunction. Methods: Our series comprises of 30 patients undergoing enterocystoplasty from March 2009 till December 2019. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age of patients was 7 years and their mean follow up was for 4 years. Major complications occurred in 5 patients which were successfully managed and minor complication in 8 patients. Of these 16 patients were with neurogenic bladder and 14 with non-neurogenic bladder. The primary etiology of non-neurogenic bladder was extrophy epispadias complex (10 patients), posterior uretheral valves (2 patients), anterior uretheral valve (1 patient), and bilateral ectopic ureter (1 patient). The primary etiology of neurogenic bladder was meningomyocele (4 patients), anorectal malformation with vertebral anomalies (7 patients), partial sacral ageneis (4), nonneurogenic neurogenic bladder (1 patient). Relative continence was achieved in 97%. The preoperative serum creatinine and blood urea nitrogen (BUN) at the time of bladder augmentation (termed creatinine-1 and BUN-1)and the serum creatinine and BUN at the last follow up after bladder augmentation (termed creatinine-2 and BUN-2)were sought and compared using chi square test showed statistically significant improvement (p

Background: To evaluate long term efficacy and complications of Mitrofanoffs procedure in patients with bladder dysfunction.Methods: Authors retrospectively reviewed the medical records of 51 patients who underwent construction of a continent catherisable channel (mitrofanoffs and monti) from 2009 till 2019 in our institution. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age was 7 years and mean follow up was for 3 years. 27 patients were with neurogenic bladder and 24 with non-neurogenic bladder. The most common type of conduit was appendicovesicostomy (38) followed by illeal monti (12) and ureter (1). The most common stomal site was umbilicus (44) followed by right lower abdominal quadrant (6). Catherterizable conduit complications included stomal leakage in 3, mucosal prolapse at the stoma site in1 and an intra peritoneal leak requiring exploratory laprotomy and revision in1. Relative stomal continence was achieved in 98%. The preoperative serum creatinine & blood urea nitrogen (BUN) at the time of mitrofanoffs procedure at the last follow up after the procedure were sought and compared using Chi square test showed statistically significant improvement (p

The association of lung agenesis with esophageal atresia (EA) & tracheoesophageal fistula (TEF) is exceedingly rare with a lethal outcome. We describe two neonates with this association who underwent primary repair shortly after birth. One of these neonates also had gross hydrocephalus, bilateral microtia and right thumb deformity. The goal in the management of these patients is early protection and preservation of respiratory units which is best accomplished by primary repair.

The search for tiny bits of broken pediatric minimal access surgery (MAS) instruments in an operative field is akin to the search for a needle in a haystack. With the extension of MAS to the pediatric age group, instruments are becoming smaller and equitably more prone to breakage. When breakages occur, retrieval, especially in the pediatric abdominal cavity, can be challenging. Inability to do so would affect patient safety and also lead to a web of medico legal and ethical issues. We present two cases of intraoperative breakage: An eyeless 3-0 polyamide suture needle and a 2-mm grasper blade both of which were successfully retrieved and fortuitously escaped becoming retained surgical items.

Background: The incidence of hypertrophic pyloric stenosis is approximately 1-3 per 1,000 live births. Hypertrophic pyloric stenosis is seen more often in males, with a male-to female ratio of 4:1. Laparoscopic pyloromyotomy is becoming increasingly popular as the standard treatment for hypertrophic pyloric stenosis. Materials and Methods: We describe our initial experience with laparoscopic pyloromyotomy in 16 infants using conventional laparoscopic instruments. Laparoscopic pyloromyotomy was performed through 5-mm umbilical port with 5mm 30 endoscope. Two 3-mm working instruments were inserted directly into the abdomen via separate lateral incisions. Results: All patients were prospectively evaluated. The procedure was performed in 16 infants with a mean age of 36 days and mean weight of 3.1 kg. All procedures, except two, were completed laparoscopically with standard instruments. Average operating time was 28 mins, and average postoperative length of stay was 2.8 days. There were no major intraoperative and postoperative complications. Conclusion: Laparoscopic pyloromyotomy can be safely performed by using standard conventional laparoscopic trocarless instruments.