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Introduction: Compared with younger patients, older patients undergoing surgery have been found t... more Introduction: Compared with younger patients, older patients undergoing surgery have been found to have more cardiopulmonary postoperative complications and an increased length of hospital stay. Several factors are thought to relate to the postoperative outcome. The present study was carried out to identify some of those prognostic factors that are associated with poor outcome of abdominal surgical procedures in elderly patients and to observe the various associated intra-op and postoperative complications. Material and Methods: The present retrospective and prospective descriptive observational study was conducted among 40 patients undergoing Major abdominal surgery. These patients were observed from the time of admission till discharge. During their stay in hospital, their clinical presentation, hematological and biochemical reports, anesthesia records, surgical procedures performed and outcomes post-surgery was documented. All the collected data was analyzed using SPSS-17. Association between variables was assessed using Chi-Square test and unpaired t-test and p value ≤ 0.05 was considered statistically significant. Results: Out of total 40 patients, 27 (67.5%) patients survived while mortality was observed in remaining 32.5%. Significantly poor outcome in elderly (Mortality: 41.9% vs 0%) was observed in patients with associated co-morbidities (p< 0.05). The multivariate analysis showed that significant predictors of poor outcome in elderly patients undergoing emergency major abdominal surgeries were ASA (above III), tachycardia, anaemia, high TLC count, raised serum billirubin and reduced serum albumin, high serum creatinine and increased duration of surgery. conclusion: Thus to conclude, surgical outcome of a major abdominal operation in the elderly will be dependent on the physical status of the patient preoperatively demonstrated by the ASA grade.
Wadia Journal of Women and Child Health
Wadia Journal of Women and Child Health
Inflammatory myofibroblastic tumor (IMFT) is a rare mesenchymal tumor predominantly seen in the l... more Inflammatory myofibroblastic tumor (IMFT) is a rare mesenchymal tumor predominantly seen in the lungs. Intestinal IMFT is extremely rare and may cause intussusception. Surgery is the mainstay of treatment as IMFTs are resistant to conventional chemoradiation. Long term follow up is required as there is high recurrence risk. About 50% of IMFTs have translocations involving the anaplastic lymphoma kinase (ALK) gene which has been therapeutically targeted using Crizotinib. We report a 1-year-old boy with ileo-ileal intussusception who was operated after a trial of conservative management. Laparotomy revealed an ileal mass that was resected and histopathology confirmed IMFT. Recovery was uneventful.
Wadia Journal of Women and Child Health
Wadia Journal of Women and Child Health
Objectives: A way of identifying significant works from a plethora of published material is by a ... more Objectives: A way of identifying significant works from a plethora of published material is by a bibliometric analysis. The citation count of a particular article indicates its influence within the readership. A survey of the top 10 articles (in terms of citations per year) in pediatric surgery from each of the three leading international journals (Journal of Pediatric Surgery [JPS], European Journal of Pediatric Surgery [EurJPS], and Pediatric Surgery International [PSI]) and the foremost Indian journal (Journal of Indian Association of Pediatric Surgeons [JIAPS]) should give an insight into the research that has been quoted the most in the last decade. Through an extensive literature search, this paper aims to identify, analyse and categorize the characteristics of the most cited papers in pediatric surgery in the last decade, worldwide and in India. Material and Methods: The number of citations of all articles from 4 journals (JPS, EurJPS, PSI, JIAPS) published between January 20...
Journal of Pediatric Surgery Case Reports
IP International Journal of Medical Paediatrics and Oncology, 2021
Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague s... more Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a c...
Journal of Pediatric Surgery, 2021
BACKGROUND Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis... more BACKGROUND Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis. However, in patients with complicated appendicitis (CA), the best approach is still unclear though laparoscopy is being increasingly preferred over open appendicectomy (OA) nowadays. AIM To comprehensively review the current literature and compare the associations of LA and OA concerning various postoperative outcomes in order to determine the best approach for children with CA. METHODS The PRISMA guidelines were adhered to and an electronic database search was extensively performed. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Methodological and statistical heterogeneity, as well as publication bias of the included studies, were assessed. RESULTS Four randomized controlled trials (266 LA versus 354 OA) and thirty-six case-controlled trials (2580 LA versus 3043 OA) were included in the analysis. Compared to OA, LA has a shorter length of stay, a lower rate of surgical site infection as well as a significantly lower overall complication rate. The rates of intraabdominal abscess formation, post-operative fever, pneumonia and ileus are similar in the two groups. So are the rates of readmissions and reoperations. LA was also shown to have a shorter time taken to oral intake and a lesser requirement of analgesics as well as intravenous antibiotics. Operative time for OA was found to be significantly shorter than that for LA. CONCLUSION This meta-analysis objectively demonstrates that laparoscopy has a better overall complication profile compared to OA and should be the procedure of choice in children with complicated appendicitis.
IP International Journal of Medical Paediatrics and Oncology, 2021
Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of ... more Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of lung hernia, secondary to congenital absence of ribs – A 4‐year‐old girl without any antecedent history of chronic cough or chest trauma presenting with a left lower lobe hernia secondary to an absent left 9th rib; a 7 month‐old girl with recurrent pneumonia presenting with severe respiratory distress, fever and severe malnourishment, found to have absent 6th-9th ribs on right side with associated liver and lung herniation. The older girl has been kept on observation without surgery but the infant expired within 48 hours of admission due to respiratory failure. The clinical scenario is a rarity and can be managed conservatively in most cases. Surgical treatment should be considered in symptomatic patients and in those with severe complications. Repair for cosmetic reasons is sometimes justified.
Wadia Journal of Women and Child Health
Introduction: Compared with younger patients, older patients undergoing surgery have been found t... more Introduction: Compared with younger patients, older patients undergoing surgery have been found to have more cardiopulmonary postoperative complications and an increased length of hospital stay. Several factors are thought to relate to the postoperative outcome. The present study was carried out to identify some of those prognostic factors that are associated with poor outcome of abdominal surgical procedures in elderly patients and to observe the various associated intra-op and postoperative complications. Material and Methods: The present retrospective and prospective descriptive observational study was conducted among 40 patients undergoing Major abdominal surgery. These patients were observed from the time of admission till discharge. During their stay in hospital, their clinical presentation, hematological and biochemical reports, anesthesia records, surgical procedures performed and outcomes post-surgery was documented. All the collected data was analyzed using SPSS-17. Association between variables was assessed using Chi-Square test and unpaired t-test and p value ≤ 0.05 was considered statistically significant. Results: Out of total 40 patients, 27 (67.5%) patients survived while mortality was observed in remaining 32.5%. Significantly poor outcome in elderly (Mortality: 41.9% vs 0%) was observed in patients with associated co-morbidities (p< 0.05). The multivariate analysis showed that significant predictors of poor outcome in elderly patients undergoing emergency major abdominal surgeries were ASA (above III), tachycardia, anaemia, high TLC count, raised serum billirubin and reduced serum albumin, high serum creatinine and increased duration of surgery. conclusion: Thus to conclude, surgical outcome of a major abdominal operation in the elderly will be dependent on the physical status of the patient preoperatively demonstrated by the ASA grade.
Wadia Journal of Women and Child Health
Wadia Journal of Women and Child Health
Inflammatory myofibroblastic tumor (IMFT) is a rare mesenchymal tumor predominantly seen in the l... more Inflammatory myofibroblastic tumor (IMFT) is a rare mesenchymal tumor predominantly seen in the lungs. Intestinal IMFT is extremely rare and may cause intussusception. Surgery is the mainstay of treatment as IMFTs are resistant to conventional chemoradiation. Long term follow up is required as there is high recurrence risk. About 50% of IMFTs have translocations involving the anaplastic lymphoma kinase (ALK) gene which has been therapeutically targeted using Crizotinib. We report a 1-year-old boy with ileo-ileal intussusception who was operated after a trial of conservative management. Laparotomy revealed an ileal mass that was resected and histopathology confirmed IMFT. Recovery was uneventful.
Wadia Journal of Women and Child Health
Wadia Journal of Women and Child Health
Objectives: A way of identifying significant works from a plethora of published material is by a ... more Objectives: A way of identifying significant works from a plethora of published material is by a bibliometric analysis. The citation count of a particular article indicates its influence within the readership. A survey of the top 10 articles (in terms of citations per year) in pediatric surgery from each of the three leading international journals (Journal of Pediatric Surgery [JPS], European Journal of Pediatric Surgery [EurJPS], and Pediatric Surgery International [PSI]) and the foremost Indian journal (Journal of Indian Association of Pediatric Surgeons [JIAPS]) should give an insight into the research that has been quoted the most in the last decade. Through an extensive literature search, this paper aims to identify, analyse and categorize the characteristics of the most cited papers in pediatric surgery in the last decade, worldwide and in India. Material and Methods: The number of citations of all articles from 4 journals (JPS, EurJPS, PSI, JIAPS) published between January 20...
Journal of Pediatric Surgery Case Reports
IP International Journal of Medical Paediatrics and Oncology, 2021
Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague s... more Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a c...
Journal of Pediatric Surgery, 2021
BACKGROUND Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis... more BACKGROUND Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis. However, in patients with complicated appendicitis (CA), the best approach is still unclear though laparoscopy is being increasingly preferred over open appendicectomy (OA) nowadays. AIM To comprehensively review the current literature and compare the associations of LA and OA concerning various postoperative outcomes in order to determine the best approach for children with CA. METHODS The PRISMA guidelines were adhered to and an electronic database search was extensively performed. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Methodological and statistical heterogeneity, as well as publication bias of the included studies, were assessed. RESULTS Four randomized controlled trials (266 LA versus 354 OA) and thirty-six case-controlled trials (2580 LA versus 3043 OA) were included in the analysis. Compared to OA, LA has a shorter length of stay, a lower rate of surgical site infection as well as a significantly lower overall complication rate. The rates of intraabdominal abscess formation, post-operative fever, pneumonia and ileus are similar in the two groups. So are the rates of readmissions and reoperations. LA was also shown to have a shorter time taken to oral intake and a lesser requirement of analgesics as well as intravenous antibiotics. Operative time for OA was found to be significantly shorter than that for LA. CONCLUSION This meta-analysis objectively demonstrates that laparoscopy has a better overall complication profile compared to OA and should be the procedure of choice in children with complicated appendicitis.
IP International Journal of Medical Paediatrics and Oncology, 2021
Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of ... more Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of lung hernia, secondary to congenital absence of ribs – A 4‐year‐old girl without any antecedent history of chronic cough or chest trauma presenting with a left lower lobe hernia secondary to an absent left 9th rib; a 7 month‐old girl with recurrent pneumonia presenting with severe respiratory distress, fever and severe malnourishment, found to have absent 6th-9th ribs on right side with associated liver and lung herniation. The older girl has been kept on observation without surgery but the infant expired within 48 hours of admission due to respiratory failure. The clinical scenario is a rarity and can be managed conservatively in most cases. Surgical treatment should be considered in symptomatic patients and in those with severe complications. Repair for cosmetic reasons is sometimes justified.
Wadia Journal of Women and Child Health