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Aim and Objective: To Evaluate the results of single incision trans scrotal orchidopexy in children with low lying palpable undescended testis. Materials and Methods: This study was conducted at the Paediatric Surgery Department M.T.I Lady Reading Hospital Peshawar from January 2018 to January 2021. A Total of 150 orchidopexies (140 Children) were included in this study, the length of vas gained after isolation and the division of the process vaginalis as well as the placement of the testis in the sub dartos pouch without tension were recorded. Children aged 1 years to 14 years diagnosed as cases of low lying palpable undescended testes surgical out comes, operative time, hospital stay and complications were noted. Results: In 150 cases the single scrotal incision orchidopexy was performed with no difficulties. Mean operative time and hospital stay were 30 minutes and 1-2 days respectively. About 100 patients had right sided undescended testes and 40 cases had left sided undescended testes and 10 patients it was bilateral. The conversion rate of surgery was 7 %. The complications like formation of scrotal heamatoma, wound infection and secondary ascent of testis were noted. In terms of the cosmetic appearance of the scar, patients in the trans scrotal orchidopexies had excellent cosmetic appearance as the scars were less visible and hidden in the rugal folds. Conclusion: Trans scrotal single incision orchidopexy for palpable undescended testis is simple, safe, effective and less invasive technique. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study was to observe the histopathological pattern and to know incidence of various pediatric intra-abdominalmalignancies of Intra-abdominal tumors in children less than 16 years. Material and Methods: This study was carried out at the department ofPediatric Surgery MTI/LRH Peshawar, over a period of 4 years from January 2014 to March 2018. Abdominal masses are often incidentally discovered by a parent while bathing the child, palpated unexpectedly on routine physical examination or detected on abdominal imaging. The commonly utilized techniques to aid diagnosis were ultra-sonographyand computerized tomographyscan and the commonly treatment modality was a combination of surgery and chemotherapy. Total of 63 intra-abdominal tumors of both sexes under 16 years of age was collected and analyzed to determine the various types of intra abdominal tumors in children in relation to histopathology, age and sex. Results: Wilms's tumor was the most common tumor constituting 29.3% of all cases. The others included non-Hodgkin's lymphoma (21.8%) neuroblastoma (12.3%), germ cell tumors and rhabdomyosarcoma (9%), Hepatoblastoma (9%) and a miscellaneous group. Majority of patient (65.2%) were under 5 years of age. The male to female ratio was 1.2:1. Conclusions: Wilm's tumor was the most common tumor. Most of the tumors were noted in children less than 5 years of age. Intra-abdominal tumors are more common in males. [ABSTRACT FROM AUTHOR]

Objective: Acute scrotum is an emergency condition needs early intervention. The aim of our study has been to evaluate the findings in boys operated on acute scrotum. Method and material: Descriptive study was conducted on 100 patients less than 14 years with acute scrotum admitted to MTI/LRH Peshawar from June 2016 to May 2018 data included history, age, primary symptoms/sign definite diagnosis, side involvement, clinical tests, imaging modalities, medical/surgical management and type of surgery. Results: Diagnosis was made mainly by clinical signs and symptoms and surgical exploration. spermatic cord torsion (n=40) was the most common cause of acute scrotum, followed by incarcerated inguinal torsion (n=25) of testicular appendage (n=20) epididymo orchitis (n=10), idiopathic scrotal oedema (n=2), hematocoele (n=3). Most 35% of patients were in the first year of life and the mean age was 5.5 years. the commonest signs were pain and swelling (70%) followed by pain, swelling and redness 20% and pain alone (15%). 60 patients consisting torsion of spermatic and torsion of testicular appendage, 25 patients with incarcerated inguinal hernia and 10 patients with epididymo orchitis underwent surgical exploration after care full physical examination. 10 out of 40 patients with torsion of testis had orchidectomy and orchidopexy of contralateral testis and the rest had detorsion and bilateral orchidopexy. 80% of the patients were referred to the hospital offer 12 hours of clinical onset of symptoms. Conclusion: Early exploration of acute scrotum based on care full physical examination is a relatively safe and simple procedure with good cosmetic results. It also allows an accurate diagnosis to be made. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the results of aggressive approach in the treatment of complicated appendicitis in children. Material and Methods: This study was conducted on Paediatric patients with complicated appendicitis at the department of Paediatric Surgery, Medical Teaching Institute, Lady Reading Hospital Peshawar from January 2016 to December 2016. After clinical examination, relevant investigations and primary assessment those children with proven diagnosis of complicated appendicitis were included in this trial. After admission and primary resuscitating, patients kept NPO at least for 6 hours, antibiotic therapy was initiated and laparotomy through right transverse incision was performed under general anesthesia. In this approach there is no need for further treatment, waste of time, performing final treatment in one stage. Control of infection and not to let the puss to spread in peritoneal cavity is the prime requirement. Results: Among 70 children with acute complicated appendicitis, male to female ratio was 4:1 and age range was from 3 years to 13 years. Through upper right transverse incision 42 cases were operated and 28 cases by lower right small transverse incision. The most common final diagnosis was appendicular abscess, observed in 40 patients. Primary wound closure was performed in all 70 patients and placement of drain in peritoneal cavity in right lower quadrant was done only in 14 cases. Safe appendectomy was performed in all 70 cases and post operative complications included 6 cases with wound infection and 4 cases with chronic abdominal pain that were managed conservatively. Only one patient was re-admitted and underwent re-laparotomy because of bowel obstruction. Conclusion : According to our findings the current non-operative approach to complicated appendicitis in children needs a revision. [ABSTRACT FROM AUTHOR]

Objective: Approximately one in three men are circumcised globally, but there are relatively few data on the safety of the procedure. In this study we evaluated cases referred to our pediatric surgical unit with complications of circumcision which may or may not be needed secondary surgical intervention. Materials and Methods: This study was conducted on male neonates, infants and children with complicated circumcision done in the periphery, referred to the department of paediatric surgery MTI LRH Peshawar for proper management from January 2014 to December 2016. 38 complicated circumcision cases were evaluated. The circumcisions were done at various paramedical clinics, home are communal circumcision ceremonies held in villages. Various methods of circumcisions are commonly used in the KPK today. The choice of circumcision method depends on the physician's level of comfort and training. The time between the complications of circumcision and the admission of the patient to the hospital from the age of one day to 9 years. The most commonly utilized techniques are Qalam blade method, bone cutter, different type clamps applications and open surgical procedures. Each instrument and technique carries its own benefits and complication risks. Results: Circumcision like any surgical procedure does carry the risk of complications, which depends on multiple factors, including anatomic abnormalities, medical comorbidities, surgical techniques and patient's age. Age range was from one day to 13 years. Death, bleeding, loss of skin/wound dehiscence, trapped/concealed penis, redundant foreskin, preputial adhesions/skin bridges, meatal stenosis, Ureteral injury (UC fistula + hypospadias) and glanular necrosis/glanular amputation were present in 1, 14, 2, 8, 2, 4, 1, 4 and 2 cases respectively. Bleeding was controlled by simple pressure bandage/ligation with chromic or vicryl 4/0 in most of cases. Bleeding due to hemophilia treated accordingly either with fresh blood transfusion/FFP or by factor 8 injection. Trapped on concealed penis was treated by repeated circumcision. Urethral fistulae treated by simple closure. Hypospadias repair was performed with tubular incised plate urethroplasty technique. Glanular necrosis was put on hyperbaric oxygen treatment. Adhesions freeing and revision were performed to all the cases with preputio-glanular fusion. The patient with partial are total glans amputation were admitted to our ward late and since glanular anastomosis was not possible for these patients, a cosmetic improvement was achieved by covering the glans with surrounding tissue. Conclusion: Risk reduction strategies including improved training of providers and provisions of appropriate sterile equipment, are urgently needed. [ABSTRACT FROM AUTHOR]