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Background: To determine the role of topical β- blocker in the management of residual hemangioma after propranolol therapy. Method: A retrospective study of all pediatric patients presenting with hemangioma from April 2014 to March 2019 was performed. Topical timolol gel was applied over the residual hemangioma which persisted even after one year of propranolol therapy. Result: Out of 68 patients included in this study 45 (70.3%), patients had complete resolution by one year using the treatment with propranolol. In 14 patients (21.8%) had residual lesion even after 1 year of treatment, upon which we applied topical timolol 0.5% gel for further 4 to 6 months. (Mean 5.35 months). At the end of the treatment, hemangioma was almost resolved. Conclusion: Timolol is a safer alternative to propranolol for residual hemangioma as a sequential treatment. It augments the regression of residual hemangioma with minimal side effects.

IntroductionChildhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.MethodsProspective cohort study in 109 institutions in 41 countries. Inclusion criteria: children ResultsAll-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); pConclusionsChildren with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.

Although ganglion cysts are commonly encountered in surgical practice, recurrences have been reported with almost all modalities used in its management [1]. We report an unusual complication following intra-lesional steroid injection. Consent was taken from the father of the patient before presenting this case; permission was also taken from the Institutional Ethics Committee (Letter No. 106/IEC/2021/IGIMS, dated 12/05/2021).

Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management. Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings. Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of the surgical intervention, postoperative results and histopathological findings were collected from their records and analysed. Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perforations; perforation at atypical sites were found in four patients (one each at gastric, duodenal, caecal and rectal); one patient presented with Meckel’s band obstruction with multiple ulcers – this patient was sick and died despite a diverting ileostomy in the postoperative period. While 8/13 patients had primary closure of the perforation site, diversion through ileostomy was performed in five patients. All patients did well in the post-operative period except one patient of multiple ulcers and obstructing Meckel’s band who died in the post-operative period. Conclusion: On encountering a gastrointestinal perforation, no definite symptomatology or its pattern, no clinical examination findings, no intraoperative characteristics of the perforation and no biopsy can definitively point towards Typhoid as the cause. Therefore, we still have to depend on serological tests in correlation with clinical features to reach a conclusive diagnosis. Cultures and PCR, although sensitive are either time-taking or expensive to guide management. Typhoid perforation can have vivid and atypical presentation depending on the number and site of perforation.

Background: Coronavirus disease Pandemic has affected the health-care delivery at all institutions worldwide. Analysis of multi-institutional data would reflect the impact and challenges of this pandemic in managing pediatric surgical cases. To assess the impact of lockdown due to coronavirus disease 2019 (COVID-19) on the pediatric surgical cases operated at four tertiary care institutions. Materials and Methods: Retrospective data of all patients operated at four tertiary care centers in North India in three different states during the imposition of lockdown due to COVID-19 were collected and compared to the immediate prelockdown period. The impact of following the guidelines for surgery during this period was studied. Results: All the institutions involved in the study showed a significant fall in the number and nature of patients treated during the lockdown period when compared to the prelockdown data. No elective cases were operated; 100 children were operated during this period of which neonates (56%) formed the major group; most of them were cases of congenital anomalies which could not be deferred; solid tumours (3/100) were operated on semi-emergency basis; number of trauma patients fell down drastically (1/100); one patient had bronchoscopic foreign body removal; other patients were operated for different causes of acute abdomen. Several measures in the outpatient, intraoperative, and in-patient care were adopted to lessen the spread of virus to the patient and health-care team. Conclusion: Corona pandemic severely impacted both the number and types of patients operated. Strict adherence to the protocol delayed emergency treatment and increased the cost of definitive management.

Background: With evidence of increasing incidence, Liver abscesses remain an important cause of morbidity in children. Evaluation of the clinical profile and management outcomes of pediatric liver abscess would guide evidence-based management. Objectives: To determine how physical characteristics of Paediatric liver abscesses guide intervention and eventual treatment outcome. Methods: A retrospective, observational, cohort study was conducted on all LA patients managed from February 2011 to August 2016. Data regarding symptoms, possible predisposing factors, method of diagnosis, any interventions, and duration of stay were collected and analyzed. Sonographic characteristics of the lesion guided management in the study. Results: Thirty two patients with a mean age of 5.52 years were managed during this period. The clinical features were fever (25, 78%), pain in right hypochondrium (19, 59%), abdominal distension (4, 12.5%), subacute intestinal obstruction (2, 6.25%), and peritonitis (2, 6.25%). Three patients experienced abscess rupture. In three patients, conservative treatment was successful. In five individuals with a size of less than 100ml, USG guided needle aspiration was effective. In 21 patients with bigger lesions, pigtail insertion was required. In three individuals, a laparotomy was performed. One patient died as a result of severe sepsis and coagulopathy. All of the other patients were released. Conclusions: LA is an important cause for morbidity in children. It could lead to rupture and death if it isn't treated. High suspicion, early screening, and proper intervention in form-tailored management may yield positive outcomes.

Background: Large wounds following surgery for neural tube defects are difficult to close; physical wound characteristics such as position and dimension would serve as a guide for their surgical closure. Aim: To study how wound dimension determines the choice between primary and rhomboid flap closure of skin defects following surgery for neural tube defects. Materials And Methods: A retrospective study was carried out on cases of neural tube defects operated in the department of paediatric surgery at a tertiary center for 3 years from January 2015 to December 2017. Data regarding clinical features, location, wound dimensions following surgery, any bony deformity, method of closure used, distance of wound from anus, and postoperative complications were collected and analyzed. Results: A total of 114 cases were operated during this period; 86/114 had primary closure, whereas 28/114 needed rhomboid flap for tension-free cover. Primarily closed wounds had a biphasic distribution of (long axis)/(short axis) ratio (with values either >1.65 or

VACTERL association is a heterogeneous condition that includes at least three out of six core structural defects which occur together more commonly than would be expected by chance alone. We report a rare association of VACTERL with unilateral proximal focal femoral deficiency and trisomy 18 syndrome.

Aim: To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Materials and Methods: Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. Results: At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. Conclusions: The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.

Post-operative intussusception is a recognised cause of intestinal obstruction in child especially during post-operative period. The diagnosis of post-operative intussusception may be difficult due to inconsistent clinical manifestation. It should be considered in any patient who develops abdominal distension, pain, and vomiting after partial return of gastrointestinal function especially after Ladd’s procedure.

Very few cases of cervical oesophageal duplication cysts have been reported in literature. Proper diagnosis and precise excision are the key to favourable outcome in this potentially dangerous lesion. Keywords: Duplication cyst, cervicaloesophagus Cite this Article Vinit K. Thakur, Vijayendra Kumar, Z. Hasan, Ramdhani Yadav, Digamber Chaubey, Sandip Kumar Rahul Cervical Oesophageal Duplication Cyst: A Case Report. Research & Reviews: Journal of Surgery . 2018; 7(2): 15–17p.

Background: Corona-virus disease pandemic affected the health-care delivery at all institutions worldwide. Analysis of institutional data regarding management of surgical paediatric patients would reflect the impact and challenges which this pandemic brought by affecting the only functioning Paediatric surgery center in a poor province of a developing country. Objective was assessment of the impact of the COVID pandemic on the paediatric surgical services of a tertiary care center.Methods: Retrospective data of all patients operated at the only functioning tertiary center in Bihar with pediatric surgical services during the COVID-related lockdown period were collected and compared to the immediate pre-lockdown period and after the lockdown period. The impact of following the guidelines for surgery during this period was studied.Results: Both the number (0.8 cases/day) and types of patients operated in the lockdown period varied from the pre-lockdown period (3.62 cases/day). Elective cases were most significantly affected; neonatal, traumatic and malignancy cases could not be deferred and were therefore managed during the lockdown. Although the number of surgeries increased in unlock-down period (2.07 cases/day) and reached to a peak of 2.99 cases/day in the normal period between two phases of the pandemic; this increase was short-lived as the second phase of the pandemic again severely impacted the surgical care (1.38 cases/day).Conclusions: Corona pandemic severely impacted both the number and types of patients operated. Strict adherence to the protocol delayed emergency treatment and increased the cost of definitive management.

Congenital mucocele presenting over the anterior dorsum of the tongue is an uncommon condition where the infant is usually presented with fluctuant swelling in the oral cavity rarely with respiratory distress along with feeding difficulty. It was successfully managed by initial aspiration, followed by marsupialization in a neonate.

Pulmonary sequestrations (PSs) are rare anatomical aberrations of pulmonary development. We describe an unusual case of intradiaphragmatic extralobar PSs associated with eventration of the diaphragm on the left side. This association complicated the clinical presentation and intraoperative management of the patient.

Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerve sheath. Although a common tumor of the head and neck region, its location in the oral cavity is uncommon. We found lingual schwannoma in a 4-year-old baby. The patient underwent magnetic resonance imaging and complete surgical excision of the mass. Histopathology confirmed the diagnosis.

Background: Anorectal malformation (ARM) is common cause of neonatal intestinal obstruction and is one of the most common neonatal surgical emergency encountered by paediatric surgeons. There is no published study about the prevalence of ARM cases within the referral zone of the hospital. This study was done to demonstrate the burden of Anorectal malformation and their surgical intervention as seen in Indira Gandhi Institute of medical science, Patna, Bihar.Methods: Data were retrospectively collected over a period of four years between January 2015 and December 2018. The data collected were demographic status of the patient, diagnosis, associated anomaly, duration of hospital stay and their surgical intervention.Results: There were 395 cases of anorectal malformation out of 93203 OPD patients (0.42%). Male to female ratio of 3.01:1. ARM also represented 25.3% of neonatal emergency surgical procedures. The majority of the patient had presented in the neonatal period (51.6%) with mean weight of 2.6 kg. The most common type of ARM found in male patient was rectourethral fistula n=215 (54.4%) in which 164 (76.2%) patients were with rectobulbar fistula and 51 (23.8%) patients had rectoprostatic fistula. Sixty nine (17.4%) female patients presented with perineal fistula.Conclusions: We found a clear male preponderance of anorectal malformation in our study. Patients affected were mostly from poor socioeconomic strata of the society. Present study confirms huge work load of anorectal malformation in this region. This will be helpful in future planning and effective management including financial constraints of the treatment for our poor patients.

Typhoid fever is common in developing countries. It may lead to bowel perforation. Terminal ileum is the most frequent site of perforation. However, perforation at uncommon sites such as rectosigmoid junction may occur occasionally. In this study we report a patient who we treated for perforation peritonitis; on exploratory laparotomy, it turned out to be a rectal perforation. The patient was operated successfully. As an unusual presentation, it is being reported with a review of the relevant literature.

A 4-year-old boy child presented with abdominal pain, haematuria, lower abdominal mass and urinary retention. There was no family history of bleeding. Ultrasound abdomen revealed an intravesical blood clot, rupture of the anterior bladder wall and perivesical haematoma. Contrast-enhanced CT (CECT) confirmed the findings. The child had a history of previous gum bleeding which prompted work-up for coagulation disorder. Investigations confirmed haemophilia. Following clotting factor replacement, surgical exploration was done. Intraoperatively, a 3 cm extraperitoneal, longitudinal tear on the anterior bladder wall was found along with haematoma in the bladder and perivesical space. Evacuation of the haematoma and repair of the bladder tear was performed. Postoperative period was uneventful, and the child was asymptomatic at 6-month follow-up. To the best of our knowledge, spontaneous bladder rupture has not been reported in a haemophilic child.

Background: Hirschsprung's disease (HD) was initially treated as a multistage procedure. Subsequently, it has been recognized that surgery can be done as a single-stage at an early age as this approach is safe, cost-effective, and avoids the morbidity associated with stomas. We study the effectiveness and safety of single-stage management of HD using Langer's or Georgeson's techniques, to analyze the outcome of surgery, and its comparison with other similar studies. Patients and Method: The study was retrospectively carried out in our institution from October 2016 to September 2019. They were operated in a single-stage either by Langer's procedure or by laparoscopy-assisted Georgeson's procedure. Inclusion criteria were clinically diagnosed cases of HD with an obvious transition zone. Patients without a funnel (on barium enema films) were excluded. Results were analyzed using IBM SPSS statistics 20.00 software. Result: The present series included 28 patients. The mean age of the patients was 16.24 months. Mean intra operative blood loss for Langer's series was 30 ml and Georgeson's series was 20 ml. The mean operative time for Georgeson's procedure was 150 min and for Langer's, it was 90 min. Postoperative enterocolitis 3 (10.7%), persistent constipation 2 (7.5%), and perianal excoriation 9 (32.14%) were some of the important complications noted. Conclusion: Single-stage surgery for HD is safe and avoids the need for multiple operations including stoma and its related complications.

Neural tube defects are common congenital malformations of the central nervous system. The 3 most common neural tube defects are anencephaly, myelomeningocele, and encephalocele. Lipoencephalocele is an extremely uncommon entity with sporadic reports in the literature. We treated a 4-year-old gild with occipital lipoencephalocele. This report presents the clinical presentation and management of the patient along with a review of the relevant literature.

Background: With increasing survival of patients suffering from necrotizing enterocolitis (NEC) colonic strictures, as its late sequelae, is increasingly being seen and most of these patients present with chronic constipation. Case Series: Five patients of acquired colonic stricture presenting with abdominal distension and constipation are being reported here. All five patients varied in clinical features, age at presentation and surgical manage-ment. Three of them had abdominal distension and constipation with poor nutritional status. Primary resection with anastomosis could be done in only one while stoma was made initially in other patients. One patient pre-sented with sealed perforation and fistula between jejunum and colon. All, except one patient, had stricture at splenic flexure. Histopathology of colon reported normal ganglion cells in all patients. Conclusion: All survivors of necrotizing enterocolitis, should be followed for the development of colonic stricture; It should be kept as important differential diagnoses of chronic constipation in children.

Type V is the rarest form of congenital pouch colon with only four cases reported till date. We report this anomaly in a 6-month-old boy. He was managed successfully with excision of distal pouch and coloplasty of proximal pouch along with abdominoperineal posterior sagittal anorectoplasty. We recommend preservation of proximal pouch in such cases.

A case of multiple terminal ileal atresia with associated undiagnosed duplication of mid-ileum found intraoperatively is reported here.

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Background: A Congenital Choledochal Malformations (CCM) is common congenital defect of biliary tree in Asian subcontinent. Presentations of CCM are vague from asymptomatic to life threatening cholangitis or pancreatitis. Complete cyst excision and bilioenteric anastomosis is now accepted surgical treatment.Methods: This is a retrospective study of five years duration. In this study the clinical presentation, haematological, biochemical and radiological findings, operative procedure and outcome were studied from case records.Results: Total of 20 patients were studied, with clinical presentation of recurrent abdominal pain in eight cases, previous history of cholangitis in five cases, acute cholangitis two cases, biliary peritonitis in four cases and previous history of pancreatitis in one case. In 13 cases Roux-en-Y hepaticojejunostomy (RYHJ) and in 4 cases hepaticoduodenostomy (HD) done after cyst excision. One case of type II CCM managed with only cyst excision, in two cases Lilly’s procedure, one case requires temporary external drainage and in two cases temporary internal drainage done in view on cholangitis and jaundice.Conclusions: However, the definitive treatment of CCM is complete cyst excision and bilioenteric anastomosis, though lot of other temporary majors are also required at different stages of disease.

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Congenital prepubic sinus (CPS) is a very rare congenital anomaly. The baby generally present with discharge from an opening situated in midline below umbilicus to root of penis in male or clitoris in female child. The etiology of this congenital anomaly is not exactly known. There is debate in etiology as one theory support anomalous anterior abdominal wall closure and another support variant of dorsal urethral duplication. Here we are presenting the six cases of CPS with their management and brief discussion on theories that have been proposed for their etiology.

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