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The Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool is used to determine the unmet surgical needs in the community and has been validated in several countries. A major weakness is the absence of an objective assessment to verify patient-reported surgically treatable conditions. The goal of this study was to determine whether a picture portfolio, a tool previously shown to improve parental recognition of their child's congenital deformity, could improve the accuracy of the SOSAS tool by how it compares with physical examination. This study focused on children as many surgical conditions in them require prompt treatment but are often not promptly diagnosed.We conducted a descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions among children and adults in a mixed rural-urban area of Lagos, Southwest Nigeria. The picture portfolio was administered only to children and the surgical conditions to be assessed were predetermined using an e-Delphi process among pediatric surgeons. The modified The Surgeons OverSeas Assessment of Surgical Needs-Nigeria Survey Tool (SOSAS-NST) was administered to household members to collect other relevant data. Data were analyzed using the REDCap analytic tool.Eight hundred and fifty-six households were surveyed. There were 1984 adults (49.5%) and 2027 children (50.5%). Thirty-six children met the predetermined criteria for the picture portfolio-hydrocephalus (n = 1); lymphatic malformation (n = 1); umbilical hernia (n = 14); Hydrocele (n = 5); inguinal hernia (n = 10) and undescended testes (n = 5). The picture portfolio predicted all correctly except a case of undescended testis that was mistaken for a hernia. The sensitivity of the picture portfolio was therefore 35/36 or 97.2%.The SOSAS-NST has improved on the original SOSAS tool and within the limits of the small numbers, the picture portfolio has a high accuracy in predicting diagnosis in children in lieu of physical examination.

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (pConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

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.

Hirschsprung's disease is a relatively common disease in pediatric colorectal surgery. The treatment modalities have evolved from third-stage to single-stage in the past three decades. The single-stage procedure can be performed using the open, transanal or laparoscopy–assisted techniques. We use these cases to illustrate the first laparoscopically assisted procedures for Hirschsprung's disease in our center. The laparoscopic-assisted technique is described, and lessons in collaboration across institutions and within institutions are discussed.

Background:Surgery as a public health priority has received little attention until recently. There is a significant unmeasured and unmet burden of surgical illness in low- and middle-income countries (LMICs). Our aim was to generate a consensus among expert pediatric surgeons practicing in LMICs regarding the spectrum of pediatric surgical conditions that we should look out for in a community-based survey for Surgeons OverSeas Assessment of Surgical Needs Nigeria study.Materials and Methods: The Delphi methodology was utilized to identify sets of variables from among a panel of experts. Each variable was scored on a 5-point Likert scale. The experts were provided with an anonymous summary of the results after the first round. A consensus was achieved after two rounds, defined by an improvement in the standard deviation (SD) of scores for a particular variable over that of the previous round. We invited 76 pediatric surgeons through e-mail across Africa but predominantly from Nigeria. Results:Twenty-one pediatric surgeons gave consent to participate through return of mail. Thirteen (62%) answered the first round statements and 8 (38%) the second round. In general, the strength of agreement to all statements of the questionnaire improved between the first and second rounds. Overall consensus, as expressed by the decrease in the mean SD from 0.84 in the first round to 0.68 in the second round, also improved over time. The strength of consensus improved for 23 (74%) of the statements. The strength of consensus decreased for the remaining 8 (26%) of statements. Out of the 31 consensus-generating statements, 16 (51%) scored high agreement, 13 (42%) scored low agreement, and 2 (15%) scored perfect disagreement.Conclusion:We have successfully identified the pediatric surgical conditions to be included in any community survey of pediatric surgical need in an LMIC setting.

Background:The practice of laparoscopy involves the use of training models that are different from conventional open surgery. These concepts are not captured in the traditional models of surgical residency training. Residency training in surgery has been seen as an ample opportunity for early introduction and training in laparoscopy.Objectives: This study aimed to assess the level of exposure and training experience of some surgical resident doctors in accredited training institutions in Nigeria on laparoscopy. Methodology:A cross-sectional survey was conducted among the resident doctors undergoing revision course in surgery at the National Orthopaedic Hospital, Igbobi, Lagos, and Lagos University Teaching Hospital, Lagos, in March 2018. Using the quantitative method of data collection, a pre-tested structured questionnaire was used to collect information on the demography and training exposure of the residents in laparoscopy.Results:A total of 54 of 96 residents surveyed returned the questionnaire, giving a response rate of 56%. There were 53 (98.1%) males and 1 (1.9%) female. The age range of the respondents was between 30 and 46 years, with a mean of 34.2 ± 3.96 years. Thirty-two (59.3%) respondents had spent at least 2 years training in surgery. Thirty-six (66.7%) respondents had not participated in more than four laparoscopic procedures during their rotation. Forty-six percent of respondents reported that their experience in laparoscopy was mainly by observation of the procedures. Forty-nine (90.7%) of respondents surveyed had not attended any training program in laparoscopy. Eighty-one (81.0%) of respondents had a strong motivation and desire for future practice of laparoscopy.Conclusion:This study revealed that few Nigerian postgraduate trainees sampled in the survey were exposed and had training experience in laparoscopy.

IntroductionIn vitro studies have shown the efficacy of Ivermectin (IV) to inhibit the SARS - CoV-2 viral replication, but questions remained as to In-vivo applications. We set out to explore the efficacy and safety of Ivermectin in persons infected with COVID19.MethodsWe conducted a translational proof of concept (PoC) randomized, double blind placebo controlled, dose response, parallel group study of IV efficacy in RT - PCR proven COVID 19 positive patients. 62 patients were randomized to 3 treatment groups. (A) IV 6mg regime, (B)IV 12 mg regime (given Q84hrs for 2weeks) (C, control) Lopinavir/Ritonavir. All groups plus standard of Care.ResultsThe Days to COVID negativity [DTN] was significantly and dose dependently reduced by IV (p = 0.0066). The DTN for Control were, = 9.1+/−5.2, for A 6.0 +/− 2.9, and for B 4.6 +/−3.2. 2 Way repeated measures ANOVA of ranked COVID 19 + / − scores at 0, 84, 168, 232 hours showed a significant IV treatment effect (p=0.035) and time effect (p 3/ml. The platelet count increase was inversely correlated to DTN (r = −0.52, p = 0.005). No SAE was reported.Conclusions12 mg IV regime may have superior efficacy. IV should be considered for use in clinical management of SARS-Cov-2, and may find applications in community prophylaxis in high-risk areas.

Background: For the benefits of less postoperative pain, early recovery and discharge, and better cosmesis, laparoscopic surgery is rapidly gaining acceptance amongst surgeons as a better alternative to traditional open procedures. In January 2015, bookings for laparoscopic surgery became a more regular feature on our operation list. Aims: We reported the indications, management outcome, and challenges in patients who had laparoscopic surgery in our institution. This is to document the trends in our surgical practice. Methodology: This is a descriptive study of 137 patients who had laparoscopic surgery for general surgical indications in our institution over a period of 5 years. Patients data as collected from the records department were evaluated for demographic characteristics, medical comorbidities, type of procedures done, and perioperative outcome. Data analysis was performed using Statistical Package for Social Sciences (SPSS). Results: A total of 137 Patients had laparoscopic general surgery between January 2015 and December 2019. There were 48 males and 89 females with a male-to-female ratio of 1:1.9. The mean age of the patients was 38.8 ± 3.4 years (range 16–87 years). Laparoscopic cholecystectomy (35%) and laparoscopic appendicectomy (29.9%) were the most common procedures performed. Five (3.7%) cases were converted to open surgery. Superficial surgical site infection (5.8%) following laparoscopic appendicectomy was the most common postoperative complication. There was no 30-day postoperative mortality. Conclusion: Laparoscopic surgery is safe and can be applied to wide variety of general surgical conditions in developing countries. Minimal postoperative morbidity of laparoscopy is a major benefit to the patients.

Background: Laparoscopic cholecystectomy has practically become the current gold standard for the removal of symptomatic gallbladders with clear advantages. Its development has been slow in Sub-Saharan Africa. We reviewed our experience of this procedure at a tertiary facility in the subregion. Patients and Methods: All patients who underwent laparoscopic cholecystectomy from October 2014 to April 2018, at Lagos University Teaching Hospital, Nigeria, were retrospectively analyzed. The focus of the study was on patients' demographics, duration of symptoms, indications for surgery, procedure performed, duration of surgery, length of hospital stay, and morbidityand mortality data. Results: A total of 33 laparoscopic cholecystectomies were performed. There were 27 (84.4%) females and 5(15.6%) males giving a male-to-female ratio of 5.4:1. The age range was from 9 to 78 years with a mean of 40.6 ± 2.9. The peak age of presentation was in the fourth decade. The most common indication was biliary colic. There was an instance of open re-exploration for a duodenal injury. There was no biliary injury during the procedures and no indication for common bile duct exploration. Most (18, 56.3%) of the patients were discharged within 24 h, 10 (30.3%) within 48 h, and the rest were discharged later. The relationship between the duration of hospital stay and the mean duration of surgery was significant (P = 0.014). There was no long-term morbidity or mortality. Conclusion: Laparoscopic cholecystectomy in our environment is safe and feasible with results comparable to other centers.

Intussusception is a very common surgical problem in infants. Double intussusception, however, is very rare in children. The authors report the successful management of a case of double-site antegrade and retrograde idiopathic intussusception in an 11-month-old boy. Keywords: antegrade, double-site intussusception, idiopathic, retrograde

Background/purpose Serum Intestinal Fatty-Acid Binding Protein (I-FABP) is a useful marker of bowel necrosis in pediatric intussusception. The aim of this study is to determine the sensitivity of this marker and correlate it with length of necrosed small bowel. Methods A single-centre prospective study of 50 children presenting to Lagos University Teaching Hospital, Nigeria, in whom a diagnosis of intussusception was made over 1 year was completed. Additionally, 25 age- and sex-matched controls (day case surgery) were recruited. They were grouped into three: 25 children with necrotic bowel, 25 without bowel necrosis, and 25 controls. The serum IFABP levels were compared between the cohorts with confirmed bowel necrosis at surgery and those with no necrosis, as well as controls. The cut-off values for the diagnosis of bowel necrosis were calculated using a receiver operating characteristic curve (ROC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results Twenty-five children were diagnosed with necrotic intussusception whose serum IFABP immunoassay has significantly higher median compared with those without necrosis and controls (2056.0ng/ml vs. 943.0ng/ml and 478.0ng/ml P =0.0002). Using a cut-off value of 1538ng/ml, the sensitivity, specificity, PPV, and NPV were 64%, 88%, 84%, and 71%, respectively. I-FABP titer greater than 1538ng/ml was found to have higher likelihood of necrotic bowel (p=0.002; odds ratio 13.04; 95% confidence interval; 0.618–0.891). Conclusion Serum I-FABP is moderately sensitive for discriminating between bowel necrosis, and it predicts increased likelihood of bowel resectability in intussusception. Level of evidence Level II – Development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard".

Background/purpose Hydrostatic reduction for intussusception has the benefit of achieving reduction without the need for general anaesthesia or surgery and the possible attendant complications. This has made it the most popular interventional modality in many centres today. Hydrostatic reduction was added to our armamentarium in the treatment of childhood intussusception recently and this report represents our initial experience. Methods This study is a prospective review of all cases of intussusception that presented at the Emergency Department at the Lagos University Teaching Hospital between February 2012 and May 2014. Eligibility for hydrostatic reduction was based on internationally recognized criteria, which included absence of peritonitis and shock. Data were analyzed using the statistical package for social sciences (version 20). The v2-test was used to compare categorical variables, and a P value of 0.05 was considered significant. Results A total of 66 patients were seen within the study period. Thirty-eight were male (57.6%) and 28 were female (42.4%). The age range was 3–84 months and the mean age was 12.0 ± 30.8 months. Twenty-six patients (39.4%) underwent hydrostatic reduction, of which 11 (42.3%) were successful. There was a correlation between the duration of symptoms and successful hydrostatic reduction (P < 0.05), with five of the 11 (45.5%) presenting within 24 h of symptoms. Conclusion Although less than half of the patients presenting with childhood intussusception were eligible for hydrostatic reduction, the method remains a feasible option in our environment in spite of late presentation by most of our patients. The duration of presenting symptoms was the most important determinant of successful hydrostatic reduction. Keywords : childhood intussusception, hydrostatic reduction, sonography

Background: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its accuracy. This study was designed to ascertain the accuracy, sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children.Patients and Methods: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching Hospital, Idi-Araba, Lagos, over a 12 month period was performed. Thepre-operative clinical and ultrasound fi ndings were compared with the fi ndings on surgical exploration.Results: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11 years). Fortysix (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasoundevaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specifi city of 33.3%, PPV of 95.7% and a NPV of 16.7%.Conclusion: Ultrasound assessment is beneficial in pre-operative evaluation of children with undescended testes. Key words: Children, pre-operative assessment, ultrasonography, undescended testes

Aims: Hypospadias is a common congenital anomaly of the urethra and phallus, which is not life threatening. It is thus less prioritised in a resource-limited setting. The aim of this study was to evaluate the management of hypospadias by our paediatric surgery unit and determine the factors affecting the delay between presentation and surgical repair while proffering possible solutions to such delay in hypospadias repair surgery. Patients and Methods: This was a retrospective review of all hypospadias repair surgeries carried out by our paediatric surgery unit over a 38-month period, evaluating the period between presentation and first surgery for each patient. Data were analysed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Released 2011, Armonk, NY, USA). Chi-square test was used to compare categorical variables and P ≤ 0.05 was considered significant. Results: In 38 months, 47 operations for hypospadias were carried out on 42 boys. Thirty-seven patients (88.1%) had >3 months delay to surgery. The most frequent contributory factor to delay was unavailable theatre space (13 patients, 31%). Surgical outcome was good in only 16 patients (44%). Of the 16 patients with good outcome, 10 (63%) were operated between the ages of 2-4 years ( P > 0.05). Conclusions: Multiple factors are responsible for delays in carrying out hypospadias surgery in resource-limited environments, notably securing a functional operating theatre suite in the light of more urgent conditions. To combat these delays, we recommend having dedicated hypospadias repair sessions and surgeons dedicated to hypospadias repair. Hypospadias outreach camps are also proposed.

The West African College of Surgeons (WACS) was formed almost 50 years ago to foster friendship and greater interaction amongst the first crop of surgeons of West African origin freshly returning from overseas training. Under the College's umbrella, seven different surgical Faculties-Anaesthesiology, Dental Surgery, Obstetrics & Gynaecology, Ophthalmology, Otorhinolaryngology, Radiology/Radiotherapy, and Surgery-have been nurtured into viable entities. The WACS is a leading institution for surgical training, accreditation, and collaboration with international bodies in the subregion. With more than 3000 Fellows, the WACS' surgical training programs and diplomas have remained the standard format for a population of >140 million in the five Anglophone West African countries for decades. The College has assumed increasing roles in attracting donor agencies as well as West Africans in the Diaspora desirous of establishing training links with credible institutions in the subregion. This paper discusses the history of the WACS, its examination process and other functions, as well as its contributions toward and challenges in surgical manpower development in the West African subregion.

Objectif Determiner la capacite de predire les difficultes de visuali-sation du larynx (DVL) a partir des indices preoperatoires suivants, pris isolement et en combinaison : le test de Mallampati modifie (TMM), la distance thyromentonniere (DTM), la distance sternomentionniere (DSM), la longueur horizontale de la mandibule (LHM) et l’espace inter-incisive (EII).

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants, presenting with nonbilious projectile vomiting. The authors report a rare case of bilious vomiting in a neonate with intraoperatively diagnosed IHPS and no other gastrointestinal anomalies.

Background: Esophageal Atresia and Tracheo-Esophageal Fistula (EA/TEF) occurs sporadically and its eti-ology is poorly understood. We observed six cases of EA/TEF within three weeks of October 2007 at the Lagos University Teaching Hospital (LUTH), Nigeria. Aims: To analyze the monthly trends of presentation of EA/TEF at the LUTH from 2002-7, test the hypothesis that the October figures were not due to chance and correlate data with known local disease patterns. Setting: Lagos University Teaching Hospital, Nigeria. Patients, Materials, Method: A retrospective analysis of all EA/TEFs managed at the LUTH within stated period. Results: 25 babies with EA/TEF presented over the period. 10 (40%) were seen in the month of Oc-tober, 5 (20%) occurred in May while the rest were spread over the rest of the months. Chi-square analysis confirmed that the EA/TEF cases occurred significantly more frequently in October (P < 0.001) and this ob-servation was unlikely due to chance. Conclusions: There seems to be a seasonal variation in the occurrence of EA/TEF in Lagos, with a significantly higher frequency in the month of October. 96% of mothers of ba-bies with EA/TEF lived in low socioeconomic parts of Lagos. This study highlights the possibility of local viral etiology of EA/TEF.

Background: Although much concern has been expressed about the occupational risk posed to surgeons by the HIV pandemic infection, the paediatric age group is often seen as less likely to harbor the disease. Aim: To determine the HIV infection rate among children presenting for surgical operations at the Lagos University Teaching Hospital (LUTH), Lagos. Materials, patients and method: Blood was taken from 1000 consecutive children referred to LUTH for surgical conditions and tested for HIV sero-positivity using the Western blot method. Consenting parents of sero-positive patients were also tested. Result: Five children tested positive for HIV, giving an overall infection rate of 0.5%. Four mothers and three consenting fathers were also positive. In one child, none of the parents was positive and he was suspected to have developed the disease from a previous blood transfusion prior to presentation in LUTH. This possibly resulted from transfusion of infected blood during its window period. Conclusion: Although the HIV infection rate of 0.5% in paediatric surgical group in Lagos is low, surgeons should vigilantly apply universal precautions to prevent needle-stick injuries while the rate of HIV infection should be periodically monitored to determine the trend.

Alimentary tract duplications are uncommon congenital anomalies that may be found anywhere along the gastrointestinal tract. They have a diverse presentation and often times present with complications of intestinal obstruction and/or lower gastrointestinal haemorrhage. We report a very rare fi nding of a colonic duplication cyst which presented as an ileal volvulus in a young girl. While available investigations were non-specifi c, the child survived on account of an early decision to operate. She had resection of the duplication cyst and ileo-colic anastomosis. She made good recovery postoperatively. A high index of suspicion is necessary on the part of clinicians to recognise this condition. Early operative intervention is necessary in the developing world setting where state of the art investigations are not available for accurate pre-operative diagnosis.Key words: Congenital anomalies, colonic duplication cysts, complications, ileo-colic anastomosis, volvulus

To determine the ability to predict difficult visualization of the larynx (DVL) from the following preoperative airway predictive indices, in isolation and combination: modified Mallampati test (MMT), thyromental distance (TMD), sternomental distance (SMD), horizontal length of the mandible (HLM) and inter-incisor gap (IIG).Three hundred and eighty consecutive patients undergoing general anesthesia were evaluated using the MMT, TMD, SMD, HLM and IIG and the cut-off points for the airway predictors were Mallampati III and IV;or = 6.5 cm,or = 13.5 cm,or = 9.0 cm andor = 4.0 cm respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult visualization. Sensitivity, specificity and positive predictive value for each airway predictor in isolation and in combination were determined. Logistic regression analysis was used to determine independent predictors of DVL.Difficulty to visualize the larynx was found in 13 (3.4%) patients. The sensitivity, specificity and the positive predictive value for the five airway predictors were: MMT (61.5%; 98.4%; 57.1%), TMD (15.4%; 98.1%; 22.2%), SMD (0%; 100%; 0%), HLM (30.8%, 76.0%; 4.3%) and IIG (30.8%; 97.3%; 28.6%). The best combination of predictors was MMT/TMD/IIG with a sensitivity, specificity and positive predictive value of 84.6%; 94.6%; 35.5% respectively. Logistic regression analysis showed that weight, MMT, IIG and TMD were independent predictors of DVL.MMT, TMD and IIG appear to provide the optimal combination in prediction of DVL in a West African population.

Background: In recent past, there has been a gradual increase in the volume of patients treated on a day case basis in our center. However, no study has been conducted to audit pediatric day case surgery practice at the Lagos University Teaching Hospital. Objectives: To determine the level of parental satisfaction with pediatric day case surgery at the Lagos University Teaching Hospital. Patients and Methods: A total of 101 parents or the patient′s caretakers whose wards had day case surgery were administered a self-completed questionnaire on the first postoperative day visit at the surgical outpatient clinic. The questions assessed parental satisfaction with the following: (a) Communication with doctors (surgeons and anesthesiologists), (b) Physical conditions of the theatre environment, (c) Staff′s care, (d) Need to care for the child at home, and (e) Postoperative complication. Result: There were 101 respondents with an age range of 22-56 years (mean 35.05 ± 6.85). Eighty-seven (86%) of the respondents were satisfied with the amount of information they obtained from their doctors before the operation; 43 (42.6%) were satisfied with the waiting time, whereas 47 (46.5%) were satisfied with the fasting time. However, 26 (25.7%) of the respondents were dissatisfied with the waiting room environment and 87 parents (87.1%) were dissatisfied with the nursing care. Conclusion: Most parents are satisfied with pediatric day case surgery care. Some adjustments, however, need to be made on reducing the waiting and fasting time of the patients and improving both the waiting room environment and the nursing care in order to increase its acceptance.

The management of oesophageal atresia and tracheo-oesophageal atresia (OATOF) is very challenging. While in developed countries survival of patients with this condition has improved, the outcome in many developing countries has been poor. Primary repair through a thoracotomy (or video-assisted thoracoscopic surgery where available) is the gold standard treatment of OATOF. However, in our setting where patients typically present late and with minimum support resources such as Neonatal Intensive Care Unit and total parenteral nutrition; staged repair may be the only hope of survival of these patients and this communication highlights the essential steps of this mode of treatment.

Hirschsprung's disease is commonly diagnosed (up to 90% in developed countries) in the neonatal period and infancy although late presentation into adulthood still occurs albeit uncommon. Adult Hirschsprung's disease (AHD) is defined as the presentation with features of Hirschsprung's disease to the hospital for the 1 st time or being diagnosed for the 1 st time after the age of 10 years. The standard treatment for AHD is staged: An initial colostomy, a pull-through procedure and a closure of the colostomy. The colostomy is performed to decompress the bowel of the huge fecal load, to allow the proximal megacolon to shrink and thus reduce the coloanal disproportion that will result during anastomosis and also to allow the nutritional rehabilitation of the patient resulting from the chronic constipation. Recent reports suggest that primary pull-through is possible in adults either as an open procedure or laparoscopically assisted. This is a report two cases of AHD managed in our center and who had primary Swenson's pull-through without a stoma. The need for patient selection is emphasized for a good outcome.