Bilateral empyema thoracis treated simultaneously with video-assisted thoracic surgery and open decortication: A case report and review of the literature

Empyema thoracis is a complication and a late sequel of untreated  pneumonia in children. The reviews published on bilateral empyema are very few. We present a case that was managed bilaterally simultaneously with good results, and we also present a review of the current trend of management of this entity.Keywords: bilateral empyema, children, pneumonia, simultaneous managemen

Incise, dissect, excise and suture technique of laparoscopic repair of paediatric male inguinal hernia

Background: Authors report incise, dissect, excise and suture (IDES) technique of laparoscopic repair of paediatric male inguinal hernia (LRPMIH). This series retrospectively evaluates a consecutive personal series of children undergoing laparoscopic hernia repair by this new technique. Materials and Methods: It is a retrospective review of the LRPMIH done by single surgeon from January 2001 to December 2007. All male patients who were referred to the first author for management of inguinal hernia were given the option of laparoscopic repair. Parents who gave consent for their child to undergo LRPMIH were retrospectively reviewed. Results: A total of 155 patients were operated. Age group was 2 months to 13 years (average-5 years). Follow-up period ranges from 1 to 7 years. Average operating time was 29 min for unilateral and 40 min for bilateral inguinal hernia. Maximum time required was 50 min which was for bilateral inguinal hernia. Bilateral inguinal hernia was present in 10 (6.4%) patients. There were no intraoperative complications. Contralateral processus vaginalis was patent in 25 (16.12%) patients. In the immediate post-operative period 8 patients had port site surgical emphysema which resolved on its own. There are no recurrences so far. One patient developed port site hernia, which was repaired with the standard surgery. There is no incidence of clinical testicular atrophy. Conclusion: LRPMIH can be done as routine procedure and also has fewer complications. It has advantage of diagnosing and repairing contra lateral patent processus vaginalis. However a double-blind controlled study is required to establish the results

Video assisted thoracic surgery in children

Thoracoscopic surgery, i.e., video assisted thoracic surgery (VATS) has been in use in children for last 98 years. Its use initially was restricted to the diagnostic purposes. However, with the improvement in the optics, better understanding of the physiology with CO2 insufflation, better capabilities in achieving the single lung ventilation and newer vessel sealing devices have rapidly expanded the spectrum of the indication of VATS. At present many complex lung resections, excision of mediastinal tumors are performed by VATS in the experienced centre. The VATS has become the standard of care in empyema, lung biopsy, Mediastinal Lymphnode biopsy, repair of diaphragmatic hernia, etc. The article discusses the indications of VATS, techniques to achieve the selective ventilation and surgical steps in the different surgical conditions in children

Modified tubularized incised plate urethroplasty

Aim: To share our experience of doing tubularized incised plate urethroplasty with modifications. Materials and Methods: This is a single surgeon personal series from 2004 to 2009. One hundred patients of distal hypospadias were subjected for Snodgrass urethroplasty with preputioplasty. The age range was 1 to 5 year with mean age of 2.7 years. Selection criteria were good urethral plate, without chordee and torsion needing complete degloving. Main technical modification from original Snodgrass procedure was spongioplasty, preputioplasty, and dorsal slit when inability to retract prepuce during surgery. Results: Average follow-up period is 23 months. Seven (7%) patients developed fistula and one patient had complete preputial dehiscence. Phimosis developed in three (3%) patients and required circumcision. Dorsal slit was required in seven patients. One patient developed meatal stenosis in postoperative period. All other patients are passing single urinary stream and have cosmesis that is acceptable. Conclusions: Modified tubularized incised plate urethroplasty with preputioplasty effectively gives cosmetically normal looking penis with low complications

Biliary atresia associated with choledochal cyst

Choledochal cyst and biliary atresia are rare but important causes of neonatal jaundice. Both present with jaundice and acholic stool in neonatal period. Treatment and prognosis of both entities are very different. We are presenting a case in which choledochal cyst co-existed with biliary atresia; the antenatal diagnosis was that of choledochal cyst. Patient had cyst excision with hepatojejnostomy, but ultimately required portoenterostomy because of associated biliary atresia. We conclude that choledochal cyst and biliary atresia are two entities with similar antenatal and postnatal presentation; they should be differentiated as management and prognosis are different

Video assisted thoracic surgery in children

Thoracoscopic surgery, i.e., video assisted thoracic surgery (VATS) has been in use in children for last 98 years. Its use initially was restricted to the diagnostic purposes. However, with the improvement in the optics, better understanding of the physiology with CO2 insufflation, better capabilities in achieving the single lung ventilation and newer vessel sealing devices have rapidly expanded the spectrum of the indication of VATS. At present many complex lung resections, excision of mediastinal tumors are performed by VATS in the experienced centre. The VATS has become the standard of care in empyema, lung biopsy, Mediastinal Lymphnode biopsy, repair of diaphragmatic hernia, etc. The article discusses the indications of VATS, techniques to achieve the selective ventilation and surgical steps in the different surgical conditions in children

Use of the processus vaginalis: A new technique for reinforcing the neourethra in hypospadias associated with undescended testis

Incidence of the undescended testis (UDT) along with hypospadias varies from 6 to 31%. The repair of UDT and hypospadias is rarely done simultaneously. Here we present a novel technique that uses processus vaginalis as vascular cover for neourethra in hyposapdias patients with UDT. We have done urethroplasty and orchiopexy simultaneously. This is the first report of processus vaginalis being used to reinforce the urethra

Use of the processes vaginalis: A new technique for reinforcing the neourethra in hypospadias associated with undescended testis

Context: The incidence of undescended testis (UDT) along with hypospadias varies from 6 to 31%. The simultaneous repair of UDT and hypospadias is rarely done. Herein, we present a novel technique to use processes vaginalis as a vascular cover for neourethra in a hypospadias patient with UDT. We have done urethroplasty and orchiopexy simultaneously. This is the first report concerning the use of processes vaginalis to reinforce the urethra. Aims: Simultaneous repair of hypospadias and undescended testis. Results: Both the patients withstood the procedure well. Postoperative period was uneventful. Patients passed urine in single stream without any fistula. Conclusions: In patients of undescended testis with hypospadias, simultaneous repair with the processes vaginalis flap is an ideal technique with good results. Processes vaginalis is good vascular cover for neourethra

Hypospadias with dorsal chordee: Case report of a novel approach for correction

We report a novel surgical technique for correction of dorsal chordee with coronal hypospadias. The bulbar elongation and anastomotic meatoplasty procedure gave an excellent cosmetic and functional outcome

Giant appendicolith mimicking as foreign body: A case report

Acute appendicitis is one of the most common surgical emergencies. However, atypical clinical presentation and imaging can cause diagnostic confusion. We report a case of a 3 yr old girl with doubtful history of foreign body ingestion and presenting to us with features of sub acute intestinal obstruction. Serial Computerized Tomography scans (CT) were suggestive of single foreign body (FB) in distal illeum with high attenuation. But the nature of FB could not be determined on history or imaging. However on exploration there was acute appendicitis with a giant appendicolith at the base of the appendix. Appendectomy with retrieval of the appendicolith was done. Post operatively patient had complete relief of symptoms