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Introduction: Reconstruction of a cloacal defect in a girl is often difficult and complicated.[1] This is most often done either by the sacro-perineal route or through the posterior sagittal route.[2] The procedures may involve total mobilization of the cloaca with or without the creation of a lower vagina with the help of a loop of vascularized bowel.[3] In our approach, such defects can be corrected using the lower anorectum for the creation of a lower vagina and abdominoperineal pull-through of the proximal divided bowel. This method can be used both in short and long common channel cloaca. Materials and Methods: We have used this procedure in one patient of posterior cloaca and four patients of anterior cloaca. These operations were done in patients of 1 year and 6 months to 4 years. Only one patient is waiting for the closure of the colostomy. Results: In all the cases, the urethra, the vagina, and the anus were successfully separated. Conclusion: This operation restores normal pelvic anatomy and physiology with minimal mutilation of the pelvic floor. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) protocols after colorectal surgery focused on reduced bowel preparation, standardized feeding schedule, earlier return of bowel function, and earlier resumption of normal activities. ERAS in pediatric surgical practice is not well established. The present study aims to present the results of two colonic anastomosis techniques of interrupted single-layered closure: Halsted (Horizontal Mattress) and Matheson (serosubmucosal or appositional extramucosal) along with two different methods of colostomy wound closure and their influence on the adoption of ERAS protocol of early feeding and early discharge. Materials and Methods: This single institute-based randomized control study was conducted in a tertiary care facility in Kolkata for 2.4 years. Patients were chosen randomly for serosubmucosal (Group I) and full-thickness (Group II) anastomosis. Results: Among total of 91 patients (Group I-43 and Group II-48), Return of bowel sounds and passage of bowel averaged 1.51 ± 0.51 and 1.91 ± 0.55 days in Group I and 1.91 ± 0.57 and 3.9 ± 0.66 days in Group II, respectively. Postoperative hospital stay averaged 5.88 ± 1.12 days in Group I and 8.9 ± 1.17 days in Group II. Overall 15 (16.48%) patients had complications among which SSI (Suprficial surgical site infection) and minor leaks (Group I--3 and 1 and Group II--5 and 3, respectively) which were treated conservatively (Clavien--Dindo Grade-I) and three major leaks under Group II requiring surgical intervention (Clavien--Dindo Grade-III). Conclusion: This study concludes that the technique of colostomy closure in the form serosubmucosal closure helps in the implementation of ERAS protocol by producing early bowel movement, early initiation of food, and less postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Pancreatico-Duodenal injuries, though rare, pose a mighty challenge to the surgeon in both diagnosis and treatment. More so in children, where the patho-physiologic threshold is low. Added to this is the absence of any strong guidelines to guide and ensure standardised care in these children for best outcome. Materials and Methods: The trauma patients' records in the emergency department, operation theatre, inpatient departmrnt, outpatient department (OPD) for the period of December 2016 to December 2018 in the institution were retrospectively reviewed, to find out the cases of pancreaticoduodenal trauma proven radiologically, biochemically and/or on laparotomy. Those cases then studied with respect to diagnosis, treatment and short term outcome. Results: Of the 256 cases of abdominal trauma, suspected pancreatico duodenal (PD) trauma were in nine but on laparotomy actually eight of them had PD trauma. All were blunt abdominal traumas sustained in road traffic accidents. Of these one was combined pancreatico duodenal while three were pure pancreatic and four were pure duodenal. One had associated superior mesenteric vein trauma. All were managed operatively. There were no mortality, one fourth had major complications. Mean hospital stay was 22.25 days. Follow up period varied from six to 32 months. Conclusion: Though PD traumas are rare but are potentially very morbid and may prove fatal. Proactive individualized management, multidisciplinary approach and good perioperative support can yield good results. [ABSTRACT FROM AUTHOR]

Aim: To analyze our experience of choledochal cysts. The results of complete excision of cyst and hepaticodochoduodenostomy have been analyzed in particular. Material and Methods: Period of study: January 1993 to August 2010. Apart from basic investigations, we did ultrasonography (USG) of abdomen, contrast-enhanced computerized axial tomography scan (CECT), endoscopic retrograde cholangiopancreatography (ERCP), operative cholangiogram, hepatic isotope scan (HIDA), magnetic resonance cholangiopancreatogram (MRCP) and choledochoscopy. The patients were divided into six groups according to the management done and the results analyzed. Results: The total number of cases was 79 (Male : Female = 26 : 53). The mean age of presentation was 5.18 years. The most common mode of presentation was abdominal pain in 86% cases. Types of cysts -- Type I: 63; Type IV: 12; Forme fruste: 1; Caroli's disease: 1; Cyst with atresia in the lower end of common bile duct: 2. Two patients of group A (cyst excision and Roux-en-Y hepaticojejunostomy) had recurrent pain and cholangitis. One patient required revision for stricture. In group E (n=53) (excision of cyst and hepaticodochoduodenostomy), three patients developed occasional epigastric pain and they responded to omeprazole. One patient developed anastomotic stricture and was lost to follow up. One patient of cyst with biliary atresia with biliary cirrhosis died. Conclusions: In choledochal cyst, complete excision of cyst and good bilioenteric anastomosis with wide stoma should be done. Hepaticodochoduodenostomy with wide stoma is a simple, quick procedure with preservation of normal anatomy and physiology and minimum complications. It also avoids multiple intestinal anastomoses and so should be the preferred approach. [ABSTRACT FROM AUTHOR]

Aim of the Study: The aim of this study is to assess the role of early feeding after elective colorectal surgery in children and compare the outcome of feeding practice early versus traditional feeding., Study Design: A randomized controlled, single-center study was conducted over a period of 3 years (November 2015-October 2018) at a tertiary care center., Materials and Methods: Patients ( n = 147), after colostomy closure (as elective colorectal surgery), were randomly selected for postoperative feeding initiation and were divided into two groups, namely the control (traditional feeding) group and study group (early feeding). In early group, feeding was initiated on the postoperative day 1 after the removal of nasogastric tube (removed after 16 h of surgery). Postoperative hospital stay and complications were compared among them., Statistical Analysis Used: Data were tabulated and analyzed in Microsoft Excel 2010., Results: Among 147 patients (boys[70] and girls [77]), the average age of colostomy closure was 4.36 years. Forty-five patients had early feeding and 102 traditional feeding. Average postoperative hospital stay was noted 5.62 ± 1.11 days for "Study group" and 8.1 ± 1.04 days for "Control group." Postoperative complications were found in 17 patients; 11 (7.5%) superficial surgical site infection (9 [8.8%] in control and 2 [4.4%] in study group) and 6 (4%) minor fecal fistulae (5 [4.9%] in control group and 1 [2.2%] in study group). None required any further surgical intervention. No mortality was reported., Conclusions: Early feeding initiation after elective colorectal surgery is safe, and postoperative hospital stay is significantly reduced. It is definitely a step forward in the era of fast track surgery in pediatric population., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Indian Association of Pediatric Surgeons.)

Background: Choledochal cyst is a fairly common hepatobiliary condition in pediatric surgical practice. For the most common type (type I), it is well established that the total excision of the cyst with an wide biliary-enteric anastomosis is key for long-term good result. Multiple options remain for biliary-enteric reconstruction after excision. Jejunal interposition loop reconstruction is thought to be the most physiologic., Materials and Methods: We have retrospectively reviewed the data of patients of type I choledochal cysts which were operated between January 2010 and September 2018 and undergone jejunal interposition loop reconstruction. Clinical presentation, investigations, operative procedure morbidity and complications were reviewed., Results: There were 33 patients, with a male-to-female ratio of 1:3 and a mean age of 4.63 years (mean ± standard deviation [SD] = 4.63 ± 2.98 years). The follow-up period ranged from 3 to 81 months (mean ± SD = 36.30 ± 19.24 months). There was no stricture or cholangitis. Reoperation required in one due to leak at biliary-enteric anastomosis leading to biliary peritonitis. One each had pancreatitis and prolonged ileus. Two bile leaks stopped spontaneously. Operative time and postoperative hospital stay were 228.78 ± 40.43 min (mean ± SD) and 8.96 ± 3.63 days (mean ± SD), respectively., Conclusion: Jejunal interposition loop reconstruction is safe and reproducible with acceptable morbidity. However, if this procedure is abandoned, the long-term benefits may remain ever elusive., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Indian Association of Pediatric Surgeons.)