Outcome Of Laparoscopic Percutaneous Extra Peritoneal Closure Versus Open Repair For Paediatric Inguinal Hernia.

BACKGROUND: Laparoscopic inguinal hernia repair (LIHR) has many benefits like less frequency of metachronous contralateral hernias, minimum complications, comparatively less duration of operation and better cosmetic outcome as compared to the open technique. Objective of the study was to compare the outcome of laparoscopic percutaneous extra-peritoneal closure (LPEC) and open repair for paediatric inguinal hernia in terms of contralateral metachronous hernia, operative time and recurrence. METHODS: A randomized controlled trial was conducted at the Department of Paediatric Surgery, Children Hospital Lahore. Non-probability purposive sampling was used, and 296 cases were divided into group-1(managed with conventional open repair) and group-2 (managed with laparoscopic Percutaneous Extra-peritoneal closure). After taking informed consent, data was collected, and cases were studied for operative time, contralateral metachronous hernia and recurrence till 6 months postoperatively. Data analysis was done through SPSS 22.0. Chi-square and independent sample t-test was used for comparison. p-value ≤0.05 was taken as significant. RESULTS: The mean operative time was statistically less in the LPEC group (24.79±3.44 minutes) when compared to the open repair group (28.71±4.54 minutes), p-value <0.001. In the Open repair group, there were 19 (12.8%) cases that had contralateral metachronous hernia, while in the LEPC group, 2 (1.4%) cases had contralateral metachronous hernia p-value <0.001. In the Open repair group, 4(2.7%) cases had a recurrence, while in LPEC group 1 (0.7%) cases had a recurrence, with statistically same recurrence rate, p-value >0.05. CONCLUSIONS: The LPEC technique is better than conventional open repair in terms of CMIH, operative time, and recurrence rate.

Perforated Meckel's diverticulum in neonates: a report of six cases and systematic review of the literature.

Background: Perforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms "Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum." All reports of perforated MD in the English literature were identified. Details of our 6 cases were analyzed in similar fashion. Results: A total of 3027 manuscripts were screened and 59 cases including 6 of our own were identified. The vast majority (78%) were female. Fifty patients (84.7%) presented in the newborn period. Half of the cases (52.5%) had associated anomalies and 13 neonates (22%) required oxygen supplementation including CPAP or ventilatory support before surgery. In 73% of the cases, a resection of gut was undertaken. Histopathological assessment in 44 cases (74.6%) revealed no ectopic gastric mucosa. Three cases demised prior to treatment. The outcome in the vast majority was excellent with 84.7% surviving and discharged well. Conclusion: Perforated MD is an unusual cause of a pneumoperitoneum in the newborns. Diagnosis is established at laparotomy and it rare to find ectopic mucosa histopathologically. The overall outcome is excellent.

Correction to: 14 Years' experience of esophageal replacement surgeries.

The quality of the images published in the original version was not satisfactory. The better version images are provided below.

14 Years' experience of esophageal replacement surgeries.

BACKGROUND: Esophageal replacement is a challenge to the therapeutic skills of surgeons and a technically demanding operation in the pediatric age group. Various conduits and routes have been described in the literature, each with their specific advantages and disadvantages. We carried out this retrospective study to share our experience of esophageal replacement. METHODOLOGY: This study was conducted at the department of pediatric surgery The Children's Hospital and The Institute of Child Health, Lahore. The records of patients treated for esophageal replacement were reviewed. The patients under follow-up were called for clinical evaluation and assessed of long terms complications if any. RESULTS: A total of 93 patients with esophageal replacement were included in the study. Esophageal replacement was done with gastric transposition in 84 cases (90%), colon interposition in 7 cases (7.5%) including one case of redo colonic interposition, and jejunal interposition in 2 cases (2%). Routes of esophageal replacement were trans-hiatal in 71 (76%), retrosternal in 13 (14%), and trans-hiatal with thoracotomy in 9 (10%) patients. Postoperatively, all of the conduits maintained viability. Wound infection was seen in 10 (11%), wound dehiscence in 5 (5%), anastomotic leak in 9 (10%), anastomotic stenosis in 12 (13%), fistula formation in 4 (4%), aortic injury 1 (1%), dumping syndrome 8 (9%), reflux 18 (19%), dysphagia 15 (16%) and death occurred in 12 patients (13%). CONCLUSION: There are problems with esophageal replacement in developing countries. In this context, gastric conduit appeared as the best conduit for esophageal replacement, using the trans-hiatal route for replacement, in the authors' experience.