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Introduction: Undescended testis is one of the commonest presentations in pediatric population. Conventionally, high ligation of the hernia sac was done after vas and vessels were dissected in order to prevent post-operative hernia. However, recent studies have shown that hernia sac ligation was unnecessary. Aims: To evaluate the role of hernia sac ligation during orchidopexy to prevent the development of postoperative hernia and to compare the mean operative time with and without sac ligation. Methods: A prospective comparative study was conducted with a total of 94 patients with undescended testis, age ranging from six months to 16 years were included in the study from November 2018 to May 2021. Cases were randomly divided into two groups. In Group A cases, orchidopexy was carried out with sac ligation, while in Group B, the hernia sac was not ligated. Mean operative time was recorded in each case. All the patients were followed up at one, four and eight weeks post-operatively and examined for postoperative hernia. Results: Of the total 94 cases, there were 18 bilateral and 76 unilateral cases of which 56 were right-sided and 22 left-sided. Most of the patients (45) of the study were between six months and 2 years. None of the patients of either group developed post-operative hernia or any significant complications. The mean operative time for group A and B were 36.72 and 46.96 minutes respectively. Conclusion: It was concluded that ligation of processus vaginalis was unnecessary during orchidopexy and sac ligation consumed more operative time.

Introduction: Acute appendicitis is the most common presentation in the pediatric emergency department. Presentation ranges from mild inflammation to perforation and peritonitis. Frequently, patients present late with lump formation. Traditionally, an appendicular lump is managed conservatively followed by interval appendectomy six weeks later when the inflammation has resolved. Aims: This study was designed to evaluate the outcome of early appendectomy in cases of appendicular lump and their complications compared to the conventional method of conservative management followed by interval appendectomy. Methods: A prospective comparative study was conducted between November 2018 and October 2021. All the patients with appendicular lump of up to 7 days duration diagnosed clinically or by ultrasonography were randomly divided into two groups. Group I patients were conservatively managed as per the Ochsner-Sherren regimen. Patients in Group II were operated within 24 hours of admission. Mean operative time was recorded in each case. Complications following the respective interventions were observed. Results: Sixty-two patients of which 42 males and 20 females were diagnosed to have an appendicular lump. The age of the patients ranged from seven to 15 years. Duration of onset ranged from three to seven days at the time of presentation in the emergency room. All the patients in Group I except two patients underwent conservative management. There were four readmissions among Group I patients and one in Group II. The average operating time was 67 minutes for patients undergoing open appendectomy. Complications following surgery were more in patients presenting with history of over five days duration. Group I patients had a comparatively greater number of hospital admission days compared to Group II (7.1 and 4.8 days). Conclusion: The appendicular lump can be explored early as it confirms the diagnosis, shortens the financial burden and hospital stay and avoids follow-up visits for interval surgery.

Background: Enteric duplication (ED) cysts include a wide variety of cystic lesions, which can involve any part of the gastrointestinal tract (GIT). They can be referred to foregut, midgut, hindgut derived, depending upon the portion of GIT involved. The main purpose of this study was to document the variety of presentation, investigations, and treatment options employed.Patients and Methods: This was a retrospective study at Paediatric Surgery Department of Services Hospital, Lahore from August, 2011 to August, 2013. The details of all the patients, including gender, and age, presenting complaint, abdominal examination fi ndings, diagnostic modality, site, type, associated malformations, surgical option, and outcome were analysed. Results: A total of eight patients with histopathological diagnosis of EDs managed were included in the study. Of these eight patients, six were males and two were females, with an average age of 2.4 years. The main diagnostic tool used was ultrasound in almost all patients. The most commonly involved site was ileum in 5 of 8 (62.5%) patients. Two cases had gastric involvement, while one patient had involvement of the descending colon. Six of eight were of tubular type (75%), while remaining 2 (25%) were of cystic type. Excision was possible in all these patients.Conclusion: ED can present with a wide spectrum of symptomatology. It can present as mass abdomen, intestinal obstruction or even can mimic as hydrocoele. High index of suspicion is therefore required. Ultimate aim of treatment is excision of cyst with preservation of vascularity of native gut.Key words: Duplication cyst, enteric, hydrocoele, intestine, mass abdomen