Search

Background: Urethrocutaneous fistula is the most prevalent complication after urethroplasty. Many methods have been developed for correction, and the best technique is determined based on the size, location, and number of fistulas, as well as the status of the surrounding skin. Objective: To compare the outcome of local dartos flap and tunnelled tunica vaginalis coverage in cases of repair of urethrocutaneous fistula. Materials and Methods: In the period of 2015-2018, 51 patients with 51 fistulas with an average age of 81.3 months (range 21-156 months) were classified into coronal-19, distal penile-11, mid penile-14, proximal penile-5 and penoscrotal-2. Thirty six patients were repaired with local dartos flap coverage and 15 patients were repaired with tunnelled tunica vaginalis coverage. Results: The repair was successful in all patients of tunica vaginalis coverage but 7 patients of dartos flap coverage developed recurrent fistulas (p value 0.066). There was no patient of scrotal complications. There were no statistically significant differences regarding age (p=0.83), location of fistula (p=0.40), size of fistula (p=0.29). Conclusions: Though the result of this study with such a small sample was not statistically significant, tunica vaginalis coverage seems to be better than dartos flap coverage in preventing recurrence. Bang Med J (Khulna) 2019; 52 : 3-6

Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique. Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage. Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (8mm). Urethrocutaneous Fistula (UCF) was encountered in five patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient. Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation. J Bangladesh Coll Phys Surg 2020; 38(2): 64-67

Background: Evaluation of the result of early and delayed repair of anterior and distal penile hypospadias. A total number of 144 patients of anterior and distal penile hypospadias with/without chordee were evaluated by follow up study in our hospital and private hospital from January 2010 to July 2013. Redo cases, complex hypospadias and proximal hypospadias were excluded. Simple Random sampling technique was followed to the patients were grouped into Group-A (72 patients) and Group-B(72 patients) on the basis of age of the patients. Both Group-A, age between 6 to 18 months and Group-B, more than 18 month to 14 years were operated by Snodgrass procedure. We did follow up 12- 24 months postoperatvely. It can be recommended for repair of anterior and distal penile hypospadias within 6 to 18 months whenever the question of post urethroplasty cosmosis, wound disruption and formation of urethra cutaneous fistula.J Shaheed Suhrawardy Med Coll, December 2015, Vol.7(2); 69-72

Introduction : Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality. To explore whether abdominal ultrasound (AUS) provide additional information over plain radiography in cases of necrotizing enterocolitis (NEC). Materials & Methods : This study is a prospective study of 30 premature neonates with NEC in our neonatal intensive care unit between September 2013 and November 2014. Fifteen premature control neonates were also included in the study. Results: Patients were classified into two groups: the first group with suspected NEC (stage I) (n = 14) and the second with definite NEC (stage II or III) (n = 16). In group I abdominal ultrasound (AUS) revealed intramural air (n = 9) and portal venous gas (PVG) (n = 1) while plain radiography showed only gaseous distension. In group II, intramural air (n = 10), PVG (n = 2), free fluid (n = 6) focal fluid (n = 1) and free air (n = 6) detected by AUS compared to pneumatosis intestinalis (PI) (n = 2) PVG (n = 1) and free air (n = 5) by plain radiography. Additionally bowel wall thinning was detected in 2 neonates of group I and 3 of group II. Conclusion: Our results suggest AUS to be superior to plain radiography in early detection of complication as intestinal perforation by eliciting PVG and fluid collection and so early surgical management. Therefore this may decrease morbidity and mortality rates. J. Paediatr. Surg. Bangladesh 6 (2): 47-53, 2015 (July)

Appendicitis is one of the most common causes of acute abdominal pain in pediatrics and is the most common indication for emergency abdominal surgery in childhood. The diagnosis of pediatric appendicitis remains challenging. To evaluate the role of pediatric appendicitis score (PAS) in the diagnosis of appendicitis of children. Methods: In this study, 200 suspected appendicitis patients attended in four private hospitals in old Dhaka city over a period of about 34 months from January 2011 to May 2014 were selected as study subjects. Patient age, sex and each of the eight PAS components were collected. Children who had PAS less than six were discharged and contacted by telephone upto 1 month to verify final outcome. Rest of the children with PAS equal or more than 6 were underwent appendectomy. Results: Two hundred patients were assessed in this study. Out of them 67 (33.5%) children had appendicitis and 76 (38.0%) children had PAS equal or more than 6. In appendicitis children, maximum (85.3%) children were in age group 10- 16 years and 10 (14.7%) patients were in age group 5-9 years. Male (73.5%) were predominant than female (26.5%) in appendicitis children. Migration of pain, nausea and anorexia were in 43 (63.2%), 45 (66.2%) and 48 (70.6%) appendicitis children respectively. Fever, cough/percussion tenderness and tenderness in RLQ were in 37 (54.4%), 52 (76.5%) and 59 (86.8%) appendicitis children respectively. Leukocytosis andneutophilia were present in 42 (61.8%) and 46 (67.6%) appendicitis children respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rate of PAS were 80.6%, 83.5%, 71.1%, 89.5% and 82.5% respectively. Conclusion: Paediatric Appendicitis Score is a good tool but not good enough for diagnosis of paediatirc appedicitis. It cannot be recommended for diagnosis of paediatric appendicitis because its negative appendicectomy rate as well as wrongly discharged rate is high. J. Paediatr. Surg. Bangladesh 6 (1): 16-19, 2015 (Jan)

Introduction: Myelomeningocele is a single most common congenital malformation that affects the entire central nervous system and because of extensive internal CNS involvement, its management remains controversial. Proper management of affected children can lead to a meaningful and productive life, and poorly managed cases of myelomeningocele can be a devastating obstacle not only for patient but also for the patient’s family.Materials and methods: This was a descriptive study, started in January, 2007 and completed in December 2014 in the Department of Pediatric Surgery and Department of Neurosurgery of Dhaka Medical College & Hospital (DMCH).The medical records of 42 children with myelomeningocele operated at our center were reviewed retrospectively. The surgical & medical management protocol used for different sites of myelomeningocele was studied.Results: The age of most of the patients at the time of myelomeningocele repair was between 45 days to 60 days; however, children with ruptured myelomeningocele were consistently repaired early after controlling infection. In our study, 16 patients (38.1%) of myelomeningocele with hydrocephalus were operated for medium pressure ventriculoperitoneal (VP) shunt first, and then repair after 7 days to 10 days. VP shunt was done 7 days after repair of myelomeningocele in 11 patients (26.19%), who developed hydrocephalus postoperatively. All 8 patients with ruptured myelomeningocele (19.05%) were treated for ventriculitis first, then by repair. Seven patients (16.67%) with intact lesion were repaired between 4 weeks to 8 weeks of age. Complications including CSF leak, wound infection, wound dehiscence, paraplegia, autonomic incontinence, shunt infection and malfunction after repair of myelomeningocele occurred in 27 patients (64.29%). Six patients (14.29%) died during treatment protocol. All the patients were followed up postoperatively for 6 months to 1 year.Conclusion: Surgical intervention with or without VP shunt of patients with myelomeningocele produced good results.J. Paediatr. Surg. Bangladesh 5(2): 54-57, 2014 (July)

Background: Bacterial infection is a frequent complication following operations in the gastrointestinal tract. Despite prophylactic administration of antibiotics the incidence of postoperative infections ranges from 10%–30% in resection surgery. 1 Most infections are caused by bacteria of enteric origin. 2 In spite of restricted use of prophylactic antibiotics, the emergence of antibiotic resistance has increased significantly.3 Probiotics when consumed in adequate amounts, confer a health benefit on the host. In vitro, studies suggest that probiotics potentially act favorably on the host through several different mechanisms. They have an antimicrobial effect. Furthermore, administration of probiotics suppresses growth of potentially pathogenic microorganisms, e.g., E. coli and Enterobacteriaceae. The effects of these agents may go beyond the gastrointestinal tract to distant areas, such as the urogenital and respiratory mucosa. It has been hypothesized by several authors that these characteristics can be used in a clinical setting of preoperative prophylaxis for reduction of postoperative infections. Preoperative antibiotic prophylaxis constitutes more than 10% of antibiotic usage in surgery and a reduction could lead to a reduced pressure on development of antibiotic resistance. It may therefore be of interest to study if probiotics may be used in the preoperative preparation of patients undergoing gastrointestinal operations. Objective: The overall objective of this study is to evaluate the effectiveness of probiotics as prophylaxis for post operative infections in under-5 children undergoing gastrointestinal surgery. Materials and methods: We are conducting a prospective comparative study with the intention to observe the postoperative periods of 60 purposively selected patients of gastrointestinal surgery in the Department of Pediatric surgery, Dhaka Medical College Hospital (DMCH), Dhaka, over a period of 18 months from October, 2013 to March, 2015. The patients are going to be divided into 2 groups by random sampling- Group A (Control group- without probiotics) and Group B (Study group- with probiotics). Under-5 children are planned to be selected as study subjects. All children are subjected to investigate for white blood cell (WBC) count and Creactive protein (CRP) preoperatively and on 5 th postoperative day (POD) in addition to routine investigations. Structured questionnaire is used to collect information regarding fever, surgical site infection, WBC and CRP count before operation and 5 days after operation (i.e. on 5 th POD). Informed written consent from parents or legal guardian is taken after describing the study objectives. Ethical clearance has been sought from the Ethical Committee of Dhaka Medical College Results: Total 8 patients are studied till now, 4 in each group. From this limited data we have observed that there has been apparently minimum difference between the cases and controls regarding postoperative infections. Discussion: Post operative wound infections are quite common and an important reason for administering antibiotics for prolonged periods. 13 Probiotics given preoperatively tends to reduce the incidence of post operative infection, though the accurate mechanism is not known. The use in patients undergoing colorectal surgery does not seem to show any benefit. 18 The result of our study until now has not demonstrated any added benefit of prophylactic use of probiotis in the specified age group. So up to now the available data is compatible with the various data seen in other studies.18 In our study, it is very early to comment on the results. Conclusion: This is an on-going study. Definite conclusion could not be drawn at this preliminary stage J. Paediatr. Surg. Bangladesh 4 (2): 38-43, 2013 (July)

Background: Laparoscopic surgery for acute appendicitis in children has been proposed to have advantages over conventional surgery. Introduction: Appendicitis is the most common surgical emergency in childhood. 1 For decades, Open appendectomy (OA) has been the standard treatment for all forms of appendicitis with excellent results. 2 Since its description in the early 1980s, laparoscopic appendectomy (LA) became an acceptable approach for simple appendicitis in children. 3, 4, 5 However, its role in the treatment of complicated appendicitis is controversial. Today, in developed countries about 8% of the population is appendectomized for acute appendicitis during their lifetime. 7 Materials and method : We are conducting a prospective comparative study with the intention to observe the outcome of 60 purposively selected patients of acute appendicitis in the Department of Pediatric Surgery, Dhaka Medical College & Hospital (DMCH), Dhaka, over a period of 12 months from October, 2013 to October, 2014. The patients are going to be divided into 2 groups by random sampling- Group A- OA Group (patients underwent open appendectomy) and Group B- LA Group (patients underwent laparoscopic appendectomy) for uncomplicated appendicitis. Children up to 14 years are planned to be selected as study subjects. All children are subjected to investigate for white blood cell (WBC) count, plain X- ray KUB region, urine R/E, preoperatively and to observe the amount of analgesics in postoperative pain management and cosmesis on first week, first month, and third month of operation. Structured questionnaire is used to collect information regarding pain, fever, other association preoperatively and operative procedure, duration of operation, per operative findings and post operative follow up. Informed written consent from parents or legal guardian is taken after describing the study objectives. Ethical clearance has been sought from the Ethical Committee of Dhaka Medical College. Results: Total 23 patients are studied till now, 16 in LA group and 7 in OA group. From this limited data we have seen that there is apparently minimum difference between two groups of study population regarding postoperative outcomes. Conclusion: This is an on-going study. Definite conclusion could not be drawn at this preliminary stage. Laparoscopic appendectomy for uncomplicated appendicitis in children is feasible and safe. It is associated with a significantly less use of post operative pain killer, lower incidence of wound infection, and reduced length of hospital stay when compared with patients who had open appendectomy. J. Paediatr. Surg. Bangladesh 5 (1): 25-29, 2014 (January)

Introduction: Posterior urethral valve (PUV) is the most frequent cause of urethral obstruction in male child. These lesions usually result in lifelong disabilities with incontinence and decreased renal function despite optimal medical management. Primary fulguration without upper tract diversion is the preferred modality of treatment in most cases of PUV. Regular follow-up is needed to check completion of valve fulguration, renal function, status of hydronephrosis, vesicoureteric reflux (VUR), urinary tract infection (UTI), and bladder function.Materials and methods: We conducted interventional study among 30 purposively selected patients of PUV in the Department of Pediatric surgery, Dhaka Medical College Hospital (DMCH), Dhaka, over a period of 20 months from December 2009 to July 2011. Age of study subjects varied from 2 days to 14 years. Among the 30 patients, 16 were children in the age group between 1year to14 years (53.3%), 11(36.7%) were infants and the rest 03(10%) were neonates. Most of the patients presented with weak urinary stream, dribbling of urine, straining at micturition, UTI and palpable bladder. All children were subjected to ultrasonography (USG), blood urea, serum creatinine, routine urine examination and culture studies. Structured questionnaire was used to collect information regarding improvement or disappearance of VUR and renal functional status before & after primary fulguration of PUV.Results: Average serum creatinine level was found gradually decreased in subsequent follow up in comparison with the previous one. This difference of creatinine level was found statistically significant in t-test (p

General objective: To study the efficacy of Ultrasoundguided hydrostatic reduction of intussusception in children with early presentation. Methods: The study group included children aged 03 months to 02 years with early case of intussusception confirmed on ultrasonography. One litre of normal saline bag was suspended at 100 cm height from the patient’s level. After connecting the saline bag with Foley’s catheter introduced in the rectum, gradual distension of colon and retrograde movement of intussusceptum towards the caecum monitored by real time ultrasound.Successful reduction was assumed once mass was disappeared and passage of saline into the small intestine. If 1 st attempt failed but there is some movement of the mass was present and child had no abdominal signs, 2 nd and 3 rd attempts were taken at least 30 min interval. Result: The overall success rate of US-guided hydrostatic reduction of intussusception in children with early presentation was about 90%, with no immediate recurrence and no perforation. Conclusion: Ultrasound guided hydrostatic reduction should be the first line of the treatment in patients with early presentation of intussusceptions aged between 3 months and 2 years old. In cases with failed initial reduction, a second or even third attempt may provide successful reduction. J. Paediatr. Surg. Bangladesh 3 (2): 61-64, 2012 (July)

Introduction: The management of Wilms’ tumor still remains a matter of great challenge to pediatric surgeons and also to pediatric oncologists. The tumor continues to be the subject of intensive investigations that with the aid of co-operative protocols by the National Wilms’ Tumor Study (NWTS) have resulted in marked improvement in survival. Surgical excision remains the cornerstone of treatment of Wilms’ tumor; however the dramatic improvement in overall survival is the result of coordinated use of surgery, chemotherapy and radiation therapy. Materials and methods: This was a prospective study, started in September, 1999 and completed in November, 2000 in Pediatric Surgery department of Dhaka Shishu (Children) Hospital and Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Preoperative chemotherapy was given to all the patients of advanced Wilms’ tumor for four weeks with vincristine and actinomycin D according to the Societe Internationale d’ Oncologie Pediatrique (SIOP) protocol (Herdrich K, 1982). The patients were followed up every 2 weekly by ultrasonography, LFT, Hb% and chest X-ray for one month. The size of the tumor as well as the metastatic lesions in the prechemotherapeutic and postchemotherapeutic ultrasonographic findings was compared after one month. Results: After giving neoadjuvant chemotherapy, the size of the tumor was reduced in 08 patients and it was measured by USG after one month. The change in the metastatic lesions was also compared by USG at the same time. Two patients died during the course of neoadjuvant chemotherapy and nephroureterectomy was done in 08 patients. All the resected specimens were sent for histopathology. The reports revealed features of Wilms’ tumor with favorable histology (FH) in 07 cases and unfavorable histology (UH) in 01 case. Conclusion: It is evident from this study that advanced stage of Wilms’ tumor, where operative treatment was not primarily possible, preoperative chemotherapy downsized the tumor significantly. It is then possible to perform nephroureterectomy. J. Paediatr. Surg. Bangladesh 3 (2): 56-60, 2012 (July)

Introduction: Congenital obstruction of the urethra is one of the most devastating anomalies to occur in the urinary tract and one of the few that are life-threatening in the neonatal period. Posterior urethral valve (PUV) is the most frequent cause of urethral obstruction in male child. These lesions usually result in lifelong disabilities with incontinence and decreased renal function despite optimal medical management. Primary fulguration without upper tract diversion is the preferred modality of treatment in most cases of PUV. Regular follow-up is needed to check completion of valve fulguration, renal function, status of hydronephrosis, vesicoureteric reflux (VUR), urinary tract infection (UTI), and bladder function.Materials and methods: We conducted interventional study among 30 purposively selected patients of PUV in the Department of Pediatric surgery, Dhaka Medical College Hospital (DMCH), Dhaka, over a period of 16 months from December 2009 to March 2011. Age of study subjects varied from 2 days to 14 years. Among the 30 patients, 16 were children in the age group between 1year to14 years (53.3%), 11(36.7%) were infants and the rest 03(10%) were neonates. Most of the patients presented with weak urinary stream, dribbling of urine, straining at micturition, UTI and palpable bladder. All children were subjected to ultrasonography(USG),blood urea, serum creatinine, routine urine examination and culture studies. Structured questionnaire was used to collect information regarding improvement of VUR and renal functional status before & after primary fulguration of PUV.Results: Average serum creatinine level was found gradually decreased in subsequent follow up in comparison with the previous one. This difference of creatinine level was found statistically significant in t test (p

Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedt’s pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition. Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy(DY) and the next by aRamstedt’s Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group (1.21 ± 0.45days) vs Ramstedt’s pyloromyotomy (RP) group(3.03 ± 0.37days) p= 0.0001.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (676.67±149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2months (741.33± 278.74 gm vs 490±80.62 gm, p=0.002) and after 3 months (582±36.01gm vs 453.33±51.64 gm, p=0.0001).No long-term complications were reported and no re-do yloromyotomy was needed. Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532

Lumbar hernias are rare in children. We report a case of bilateral lumbar hernia in a 39 days old boy who was admitted at pediatric surgery department in Dhaka Medical College Hospital with the chief complaints of bilateral flank swellings since birth. There were no urinary or bowel complaints. Palpation revealed reducible, non-tender, soft to firm swellings involving iliolumbar region in left and lumbar region in right . These were increased on crying. On auscultation bowel sounds were present in left side and absent in right side. There were no other congenital anomalies.Ultrasonography revealed herniated bowel loops in left iliolumbar region and mild pelvicalicial dilatation in left kidney and slightly bigger right kidney in right lumbar region. On the basis of these findings a diagnosis of congenital bilateral lumbar hernias were made. Closer of the defects were done by prosthetic material and non- absorbable suture material. He came back for follow-up after 2 weeks, 4 weeks and 6 weeks. Defects were clinically absent and the patient was pain and recurrence-free.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19537

Introduction: Approximately one in three men is circumcised globally, but there are relatively few data on the safety of the procedure1. Circumcision is a surgical procedure performed for centuries for medical, religious and several other reasons. Circumcision is the most common surgical procedure performed in boys through out the world. Meatal stenosis is one of its late complications. We evaluated the topical use of lubricant jelly (Vaseline- petroleum jelly) after circumcision in boys in order to reduce or prevent the risk of meatal stenosis. Objective: To see the effectiveness of use of lubricants and to determine the functional outcome, that is prevention of post circumcision meatal stenosis. Materials and Methods: A randomized control trial was performed, in which two groups of boys younger than two years old underwent circumcision according to dissection (sleeve) method . The parents in the study groups were strictly instructed to use petroleum jelly on the meatus and circumcision site at every morning or after each diaper change where necessary for three months, on the other hand parents in the control group were instructed not to use any lubricants or topical medication on the same site. The boys were followed up regularly and evaluated for meatal stenosis, bleeding and infection. Results: A total of 120 boys, 60 in each group completed the study. None of the boys in the study group develop meatal stenosis , but 6(10%) in the control group develop meatal stenosis ( p < 0.05 ). Infection of the circumcision site was seen in 1 (0.6%) and 3 (5%) children in the lubricant and control groups, respectively (p

Introduction: The aim of this study was to determine the feasibility, safety, cost effectiveness and functional outcome between single stage and multiple stage operation of anorectal malformation (ARM) with rectovestibular fistula (RVF).Materials & Methods: This interventional study was conducted on 40 female children born with ARM with RVF from July 2007 to June 2009 in the Department of Pediatric Surgery, Dhaka Medical College Hospital. Their age range was from 3 months to 7 years. Anterior sagittal anorectoplasty (ASARP) was done as definitive treatment of RVF. 20 out of 40 patients underwent single stage procedure and the rest underwent multiple stage procedure. Good preoperative bowel preparation and postoperative wound care were ensured for optimum outcome.Results: Mean operating time was 70 minutes in single stage and 80 minutes in multi stage definitive procedure. Average hospital stay was 10 days in single stage procedure where as 22-24 days in multi stage procedure. Partial perineal wound dehiscence occurred in two patients with single stage procedure and one patient with multi stage procedure. Wound infection was seen in two patients of single stage and also two patients of multi stage procedures. Fecal continence was good in all patients older than 3 years. Average number of bowel movement was 2-3 times daily in older patients and 2-4 in younger patients. Constipation developed in three patients with multiple stage procedure and in two patients with single stage procedure. Both groups were managed conservatively for all complications. In Dhaka Medical College Hospital, treatment cost is mostly free, so we could not compare this cost but the incidental expenses in single stage treatment was Tk. 10,000.00 and Tk. 30,000.00 in multistage treatment in three settings.Conclusion: Adequate preoperative bowel preparation, good surgical skill, proper analgesia and postoperative wound care remain the key factors to produce a cost effective excellent outcome of single stage correction of RVF.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19523

Background: Various innovative approach have been tried for the surgical management of vestibular fistula, most of them have post operative complication like wound infection, wound dehiscence, more hospital stay which compromise the functional out come, financial burden and aesthetic appearance of the perineum. This article details a new technique, Transfistula Anorectoplasty (TFARP), which includes minimal dissection without interruption of perineal body and perineal skin. Materials and methods: This cross sectional comparative study on 43 patients with vestibular fistula conducted in Dhaka Shishu (Children) Hospital from September 2008 to April 2010, about 20 months. Patients were operated according to parent choice after obtaining informed consent and standard bowel preparation. Data on demographics, operation time and ostoperative complications were analyzed systematically by SPSS program. Patients were followed up for a period of 2½ months postoperatively. Results: There is no statistical difference in patient population regarding age, geographical distribution and clinical presentation. Mean operation time was 76.5 min for TFARP and 84.34 min for ASARP. Two cases had wound infection after TFARP operation and 11 patients after ASARP operation. One patient developed partial wound dehiscence after TFARP and was healed after conservative treatment within 7 days. On the other hand 5 patients developed partial wound dehiscence and 4 patients developed complete wound disruption after ASARP which were also treated conservatively need more than 02 week on an average. Mean hospital stay were 6.45 days after TFARP operation and mean hospital stay were 7.87 days after ASARP peration. Twenty neonates and infant who were treated by TFARP operation have good bowel movement without laxative and symmetrical anal contraction after stimulation. Conclusion: TFARP is an operation which produces less morbidity and is more effective and superior procedure than that of ASARP operation and gives better aesthetic appearance of the perineum. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19525

Background: Circumcision is the most common surgical procedure performed in boys through out the world. Meatal stenosis is one of its late complications. Objective: The aim of the present study is to see the effectiveness of use of lubricants vaseline-petrelium jelly) during arumcision meatal stenosis. Methodology: A randomized control trial was performed, in which two groups of boys younger than two years old underwent circumcision according to dissection (sleeve) method. The parents in the study groups were strictly instructed to use petroleum jelly on the meatus and circumcision site at every morning or after each diaper change where necessary for three months. On the other hand parents in the control group were instructed not to use any lubricants or topical medication on the same site. The boys were followed up regularly and evaluated for meatal stenosis, bleeding and infection. Results: A total of 120 boys were recruited & in each group comprised of 60 boys. None of the boys in the study group develop meatal stenosis , but 6(10%) in the control group develop meatal stenosis (p< 0.05 ). Infection of the circumcision site was seen in 1 (0.6%) and 3 (5%) children in the lubricant and control groups, respectively (p

Introduction: Posterior urethral valve (PUV) is the most frequent cause of urethral obstruction in male child. These lesions may result in lifelong disabilities with incontinence and decreased renal function despite optimal medical management. Primary fulguration without upper tract diversion is the preferred modality of treatment in most cases of PUV. Regular follow-up is needed to check completion of valve fulguration, renal function, status of hydronephrosis, vesicoureteric reflux (VUR), urinary tract infection (UTI), and bladder function. Materials and Methods: An interventional study among 30 purposively selected patients of PUV was conducted from December 2009 to July 2011. Most of the patients presented with weak urinary stream, dribbling of urine, straining at micturition, UTI, and palpable bladder. All children were subjected to ultrasonography (USG), blood urea, serum creatinine, routine urine examination, and culture studies. Structured questionnaire was used to collect information regarding improvement or disappearance of VUR and renal functional status before and after primary fulguration of PUV. Results: Ages ranged from 10 days to 14 years; 16 were between 1year and 14 years (53.3%), 11(36.7%) were infants, and the rest 03(10%) were neonates. Average serum creatinine levels were found gradually decreasing significantly (p < 0.01) in subsequent follow-ups. Average blood urea nitrogen (BUN) was also decreased significantly (p < 0.05). VUR was present in 63.3% cases. Non-VUR was found in 60% cases on right side and 50% cases on left side. On the third follow-up after 3 months it became 73.3% on right side and 63.3% on left side. Positive correlation found in Pearson correlation test about the changes of reflux grades before and after fulguration was significant (p < 0.001). It was significant on both left and right kidneys. Positive correlation found in Pearson correlation test about the changes of GFR before and after fulguration was also significant (p < 0.001). Collected data was cleaned, edited, and analyzed with the help of software SPSS window version 15.0. Conclusion: VUR disappeared in some cases and decreased in majority of the cases by 3 months after adequate restoration of urethral patency. Renal function came to normal range in two thirds of the cases. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0013 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 23-28

Purpose: Inguinal hernia is one of the commonest conditions in paediatric surgical practice that requires surgical repair. Open repair is a conventional procedure. With the advance of minimally invasive surgery, laparoscopic repair of childhood inguinal hernia has been attempted. Now many centres practice it routinely. From different studies, reported advantages are excellent visual exposure, minimal dissection, and thus fewer trauma to the inguinal canal and its content, detection, and repair of contralateral hernia (if present) in same setting, less post-operative pain, early recovery, and better cosmesis. To date, despite increased interest in laparoscopic repair, there is no published study focusing on paediatric inguinal hernia in Bangladesh. So the present study is designed to assess the above mentioned clinical benefits of this method and to compare the laparoscopic repair and open repair of paediatric inguinal hernia. Materials and Methods: This prospective comparative interventional study was carried out in the Department of Paediatric Surgery, DMCH, Dhaka, during the period of May 2009 to June 2012. Total 60 patients were included in this study. Among them 30 patients in Group-L were repaired by laparoscopic procedure and another 30 patients in Group-O were repaired by open procedure. Both groups were followed-up for 3 months. The early post-operative complications were almost same and there was no recurrence in any groups. Results: It was found that laparoscopic repair is superior to open repair with regards to early pain relief and cosmesis. Moreover, on laparoscopy, detection of contralateral hernia or contralateral patent processus vaginalis and repair is possible in the same setting. Conclusions: Laparoscopic repair is superior with regard to early pain relief and cosmesis, but needs to be evaluated on wider group of patients and long period of follow-up. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0014 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 29-34

Introduction : Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are impalpable. In these cases, the laparoscopic technique is the method of choice for diagnosis and treatment. Materials and Methods : From 1 April 2009 to 31 October 2010, 37 testicles of 30 patients were submitted to diagnostic laparoscopy for impalpable testes. This was a prospective study seeking the diagnostic accuracy and therapeutic outcomes of use of laparoscopy in impalpable testes. Age, operative techniques, complications, the cosmetic aspect and outcomes were also recorded. Results : Mean age was 6.64 ± 3.96 years and 23% cases were bilateral. Twenty-one cases had primary orchiopexy, 9 had 1st stage Fowler- Stephens (FS) procedure, 3 had 2nd stage FS, 13 cases needed inguinal exploration and there was one vanishing testicles. Average operating time was 40 min for diagnostic laparoscopy, 90 min for unilateral and 120 min for the bilateral cases. Two of the patients had late postoperative complications e.g. one uretereral obstruction and one recurrence. Conclusions : In pediatric age group, the laparoscopic approach is safe and feasible. The purpose of study is to see whether the laparoscopic procedure presents excellent results in terms of diagnosis and therapy of the impalpable testis. DOI: http://dx.doi.org/10.11593/bje.2013.0101.0005 Bangladesh Journal of Endosurgery Vol.1(1) January 2013: 16-20

Background: Many approach have been tried for management of vestibular fistula, most of them have post operative complication like wound infection, wound dehiscence, more hospital stay which compromise the functional out come and aesthetic appearance of the perineum. Objective: The aim of present study was to see the effectiveness of Transfistula Anorectplasty (TFARP) Which was required minimal dissection without interruption of perineal body and perineal skin. Methodology: The cross sectional study on 43 patients with vestibular fistula were held in Dhaka Shishu Hospital from September 2008 to April 2010. Patients were operated after obtaining informed consent and standard bowel preparation. Data on demographics, operation time and postoperative complications were collected as a questionnaire and plotted on Microsoft Excel and analyzed systematically by SPSS version 17. Patients were followed up for a period of 2½ months postoperatively. Results: There is no statistical deference in patient population regarding age, geographical distribution, and clinical presentation. Mean operation time was 76.5 min for TFARP and 84.34 min for ASARP. Two (02) cases had wound infection after TFARP operation and 11 patients after ASARP operation. One patient develops partial wound dehiscence after TFARP and was healed after conservative treatment within 7 days. On the other hand 05 patients developed partial wound dehiscence and 04 patients developed complete wound disruption after ASARP which were also treated conservatively need more than 2 weeks on an average. Mean hospital stay were 6.45 days after TFARP operation and mean hospital stay were 7.87 days after ASARP operation. 20 neonates and infant who were treated by TFARP operation have good bowel movement without laxative and symmetrical anal contraction after stimulation. Conclusion: TFARP is an operation produce less morbidity and is more effective procedures and superior procedures than that of ASARP operation and give aesthetic appearance of the perineum. DOI: http://dx.doi.org/10.3329/jssmc.v4i1.11996 J Shaheed Suhrawardy Med Coll, 2012;4(1):10-14

We are reporting two cases in a family, Elder sister was 10 year old & younger one was 8 years old. Both of them were presented to us with the features of gastric outlet obstruction. Further examination revealed that there is pigmentation on their muco–cutanious junction of lips. Their father also had pigmentation on the muco– cutanious junction of lips.DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19471

Background: Various treatment modalities have been applied for the management of infantile hypertrophic pyloric stenosis. However surgery remains the mainstay of treatment for IHPS of which Ramstedt's pyloromyotomy remains the surgical technique of choice. Objective: To see the outcome of surgical management of infantile hypertrophic pyloric stenosis by double-Y pyloromyotomy. Methods: A prospective interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. All patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy (DY) and the next by a Ramstedt's Pyloromyotomy (RP). Data on patient demographics, operative time, anaesthesia complications and postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, forty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group vs Ramstedt's pyloromyotomy (RP) group was significant (p= 0.0001). Weight gain after 1st 10 days DY vs RP is 298 ± 57.94 gm vs 193±19.8 gm (p=0.0014), after 1 month 676.67±149.84 gm vs 466.67 ± 127.71 gm (p=0.0001), after 2 months 741.33± 278.74 gm vs 490±80.62 gm (p=0.002) and after 3 months 582±36.01gm vs 453.33±51.64 gm (p=0.0001). No long-term complications were reported and no re-do pyloromyotomy was needed. Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain. J Shaheed Suhrawardy Med Coll, 2011;3 (2): 38-40 DOI: http://dx.doi.org/10.3329/jssmc.v3i2.12076

J Shaheed Suhrawardy Med Coll, 2011; 3 (1): 18-20 DOI: http://dx.doi.org/10.3329/jssmc.v3i1.12055

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infant. The prevalence of IHPS ranges from 1.5 to 4.0 in 1000 live birth. But the incidence of IHPS has been increasing approximately from 1.5 to 4.0 in 1000 live birth to 1:150. Though pyloric atresia is a very uncommon cause of gastric outlet obstruction in infant but atresia in this region occurs in the form of web, membrane/diaphragm or rarely solid cord. Membrane/ diaphragm may be single or double and may be perforated or imperforated. If the size of perforation is less than 10 mm, it causes complete obstruction. We report the presentation and management of such a child. DOI: 10.3329/bjch.v33i1.5674Bangladesh Journal of Child Health 2009; Vol.33(1): 35-36