Postoperative functional outcome of intradural extramedullary spinal tumors through posterior approach

Objective: To determine functional outcome of intradural extramedullary spinal tumors in patients undergoing excision through the posterior approach alone

Study Design: Interventional study

Place and Duration of Study: Neurosurgery Department, JPMC, Karachi, from March 2011 to February 2014

Methodology: Patients with intradural extramedullary spinal tumors [IDEM], confirmed on MRI, were admitted through Outpatient Department. Those with bleeding disorders, diabetes mellitus, previously operated and with no histopathological evidence of tumor on biopsy, were excluded. Clinical signs, symptoms and location of the tumor were noted. These patients then underwent laminectomy and excision of tumor through the posterior approach, regardless of the location or type of tumor. Transpedicular screw was placed where the tumor was so large, as to cause posterior instability. The functional outcome was evaluated by assessment of Medical Research Council [MRC] Scale for Muscle Strength preoperatively and at 6 months follow-up postoperatively. Good outcome was labelled when there was improvement from previous grade before surgery to higher grade, as assessed by muscle strength on follow-up at 6 months after surgery

Results: The mean age of the 38 patients was 42.6 +/- 10 years. Majority were females [68.42%]. Meningioma was the commonest tumor [63.15%]. The commonest location was thoracic spine [73.68%]. Backache was present in all [100%] patients, motor weakness in 30 [78.92%] patients, sensory disturbance in 5 [13.5%] patients, sphincter disturbance in 7 [18.42%] patients, and shortness of breath in 1 [2.63%] patient. Preoperatively, there were 10 patients [26.31%] in grade 3, 9 [23.68%] patients in grade 0, 8 [21.05%] in grade 1, 7 [18.42%] patients in grade 2. After 6 postoperative months, there were 23 [60.52%] patients in grade 5, 5 [13.15%] patients in grade 3, 5 [13.15%] patients in grade 2 and 2 [5.26%] patients in grade 1. Postoperative complications were CSF leak, respiratory distress, wound infection and incontinence

Conclusion: Functional outcome of intradural extramedullary spinal tumors was found to be good

Short term outcome of single stage anterior sagittal anorectoplasty in the management of rectovestibular fistula in female children

Objective: The objective of the study was to assess the short term outcome of single stage anterior sagittal anorectoplasty for the management of rectovestibular fistula in female children

Study Design: Descriptive, Case Series study

Place and Duration of Study: This study was conducted in the Department of Neonatal and Pediatric Surgery, Bahawal Victoria Hospital, Bahawalpur from November 2010 to November 2013

Materials and Methods: Total 151 female children from 1 month to 13 years with the diagnosis of recto vestibular fistula undergoing primary ASARP were selected. No covering colostomy was done in any case. All the patients who were previously operated for RVF, or colostomy done for RVF, and those with septicemia were excluded. All the cases were managed in the ward and short term outcome was assessed in terms of post-operative wound infection [noted at 72 hours after surgery], vaginal tear[assessed during surgery], hospital stay and operative time. Results: There were a total of 151 female patients with mean age of 17.53 +/- 27.12 months. Mean operative time in our study was 85.76 +/- 16.49 minutes and mean hospital stay was 5.31 +/- 2.33 days. All the patients were examined regularly till discharge from ward and looked for any wound infection and vaginal tear. Wound infection was seen in 24 [15.89%] and vaginal tear in 21 [13.91%] patients. Wound infection was managed by daily wound wash with normal saline and povidone iodine solution. Vaginal tear managed during surgery by repair with vicryl 5/0

Conclusions: This study concluded that the short term outcome in terms of mean operative time, hospital stay, wound infection and vaginal tear after single stage anterior sagittal anorectoplasty is satisfactory in recto vestibular fistula treatment in female children

Differential immune cell densities in ductal carcinoma In-Situ and invasive breast cancer: possible role of leukocytes in early stages of carcinogenesis

To investigate immune cell densities in pre-neoplastic [DCIS], cancer [IDC] and control breast tissues. A total of four preneoplastic, 104 cancer and 104 control samples were analyzed. Morphological classification and prognostic scoring along with quantification of immune cells/mm[2] was performed. Data were entered and analyzed using SPSS version 16. Correlation of immune cell densities with various tumour sub-types was investigated using paired t-test and ANOVA. A p-value of <0.05 was considered as significant. Our data show increased infiltration of lymphocytes [mean lymphocytes = 287.6 cells/mm[2]] as well as myelocytes [mean lymphocytes = 117.1 cells/mm[2]] in pre-neoplastic tissues. This infiltration was significantly high compared to cancer [p-value<0.001] as well as control tissues [p-value <0.001]. Moreover, we report increased infiltration of lymphocytes in cancer tissues compared to controls [p-value<0.001]. There was no difference in lymphocyte densities within various tumour sub-types [all p-values >0.05]. Leukocytes may play a role in early stages of breast carcinogenesis

Use of corticosteroids in the management of idiopathic pulmonary haemosiderosis: do we have enough evidence

Idiopathic Pulmonary Haemosiderosis [IPH] is a rare disease commonly affecting the paediatric population with approximately 500 globally reported cases in the literature. The disease usually presentswith a symptom triad consisting of ferropenic anaemia, cough with haemoptysis and diffuse bilateral alveolar infiltrates. Therapeutic options for this disorder are not only limited but also not fully effective. Moreover, corticosteroids remain the mainstay of IPH treatment. This communication reviews the available evidence in support of corticosteriod usage in the treatment of IPH. We conclude that the use of corticosteroid in IPH treatment is unfathomed and demands further investigation

Thrombocytopenia-an indicator for severe plasmodium vivax infection?

To see the effect of thrombocytopenia in plasmodium vivax infection. Prospective study. This study was conducted at Trauma and General Hospital, Karachi from June 2013 to October 2014. Ninety seven patients were included in the study with low platelets and positive malarial parasite [MP] or immunochromatographic test [ICT] malaria. Patients that were presenting with other causes of thrombocytopenia were excluded from the study including plasmodium falciparum or dengue fever. Total 97 patients were included in the study. Among them 63 [64.9%] were males. Mean age was33.15 +/- 8.513 years. In our study none of the patient develops bleeding or required platelet transfusion. Thrombocytopenia is now commonly seen in plasmodium vivax infection, but usually do not lead tobleeding like dengue fever or plasmodium falciparum infections

Evaluation of predictors for severity of dengue fever at the beginning of the disease

To evaluate the predictors of severity of dengue at the beginning of the disease. Prospective and Observational study. This study was conducted at Shan General Hospital and Trauma and General Hospital from July 2010 to 1[st] October 2011. The study was conducted on all patients who were admitted and confirmed to have dengue fever after positive serology on day VI. There was pre-assigned protocol and every predictive marker was given one point. Patients who had > 4 points at the time of presentation had more severe illness and developed more severe complications rather than those who had

Cytogenetic and molecular analyses of philadelphia chromosome variants in CML [chronic myeloid leukemia] patients from Sindh using karyotyping and RT-PCR

To determine the frequency of Philadelphia chromosome [Ph] and its variants in chronic myeloid leukemia [CML] cases at a tertiary care hospital of Sindh. The study was conducted at the Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro and Isra University Hospital, Hyderabad during May-to-September 2014. Bone marrow and peripheral blood samples from a total of 145 diagnosed cases of CML were collected. Cytogenetic analyses were performed using karyotyping as per the International System for Human Cytogenetic Nomenclature guidelines. All karyotypic images were analyzed using the Cytovision software. In order to identify BCR-ABL transcripts, RT-PCR was performed. Statistical analysis of the data was done using SPSS-version-21.0. Of the 145 samples, a total of 133 [91.7%] were positive for the Ph [Ph+] while 12 [8.3%] were negative for the Ph [Ph-]. Of the 133 Ph+ samples, standard karyotypes were noted in 121 [91%], simple variants in 9 [6.7%] and complex variants in 3 [2.3%] of the samples. All the Ph+ samples [n=133] showed BCR-ABL positivity. Of the 12 Ph- samples, a total of 7 [58.3%] were BCR-ABL-positive and 5 [41.6%] were BCR-ABL-negative. Frequency of the Ph was found to be of 90.9% in CML patients using a highly sensitive technique, the RT-PCR. Cytogenetic abnormalities were at a lower frequency. Cytogenetic and molecular studies must be conducted for better management of CML cases. These findings could be very useful in guiding the appropriate therapeutic options for CML patients

Effect of povidone-iodine irrigation on post appendectomy wound infection: randomized control trial

Objective: despite the use of prophylactic antibiotics and sterilization techniques, rate of post appendicectomy wound infection is high. The usefulness of povidone-iodine on intact skin is well-established but its use as prophylactic irrigation solution on open surgical wounds is limitedly addressed. This study compare the frequency of superficial surgical site infection after appendicectomy, with and without peroperative irrigation of subcutaneous tissue with 1% povidone-iodine solution

Methods: a Total of 166 patients operated for acute appendicitis with open appendicectomy at Civil Hospital Karachi were included in the study. They were randomly allocated into two groups. In the treatment group, the subcutaneous tissue was irrigated with 1% diluted povidone-iodine solution before skin closure while no irrigation was done in the control group. All patients were followed for surgical site infection according to Southampton wound grading system for 30 days after surgery

Results: the mean age of patients was 25.96 +/- 9.9 years with a male to female ratio of 2:1. Wound healed normally with no signs of inflammation in 107 [64.5%] out of 166 patients. Mild bruising was present in 34[20.5%], erythema with tenderness or heat in 11[6.6%] and serous/ haemoserous discharge in 6[3.6%] patients with no significant difference between the groups. Purulent discharge was significantly reduced in the treatment group [p-value<0.05]. The overall infection rate was 10.8% and 19.3% in the treatment and control group respectively [p=0.129]

Conclusion: the irrigation of the subcutaneous tissue with 1% diluted povidone-iodine solution after appendicectomy, though not affect the overall infection rate but significantly reduced the formation of pus within the infected wound cavity

Various presentation of abdominal tuberculosis in surgical patients

To see the various presentation of abdominal tuberculois in surgical patients. prospective study. This study was carried out in the Surgical Department at civil Hospital Karachi, from Oct 2011 to 31[st] May 2012. Study consisted of twenty six patients. Base line and specific investigations were done in all patients, especially mantoux test, sputum examination x-ray abdomen and ultrasound of abdomen. Inclusion criteria were that all patients diagnosed as case of tuberculosis on the basis of history, clinical examination and investigations. Exclusion criteria included unfit patients for general anesthesia, pregnant ladies due to risk of foetal loss, patients with carcinoma of colon. Data was analyzed through SPSS software. 26 cases of abdominal tuberculosis. 12 males [46.15%] and 14 females [53.84%]. Male to female ratio was 1:1.16. Age ranged from fifteen to seventy years with mean age of patients were 42.1 years. Twelve Patients [46.15%] presented in subacute intestinal obstruction, four patients [15.38%] with acute intestinal obstruction, six [23.07%] with signs of peritonism and four [15.38%] with mass in abdomen. Erythrocyte sedimentation was 2 patients [7.70%] had ESR 20 mm/hr, eight patients [30.77%] between 20 to 40 mm/hr, eleven patients [42.1%] between 40 to 60 mm/hr and five patients [19.23%] between 60 to 100 mm/hr. Liver Function Test was within normal range in all of them. Mantoux Test was found positive in fourteen [53.84%]. Plain x-ray abdomen erect and supine position showed sixteen patients [61.54%] significant findings were observed. Barium meal and Follow through examination was performed in four patients [15.38%]. Three patients [75%] showed narrowing of ileum and irregularities in the caecum and one' patient [25%] had dilated small bowel loops with narrowing of terminal part of ileum while caecum was normal. In one patient [3.84%] small bowel enema revealed delayed emptying of small bowel with dilatation of jejunum, Barium enema was performed in three cases, which revealed, filling defect in caecum and narrowing at ileocecal junction. We conclude that. The clinical features of this disease are usually non-specific, vague and diverse therefore the accurate diagnosis is some times difficult

Treatment of old supracondylar fractures of humerus In children

To study the outcome of open reduction and fixation with K wires of supracondylar fractures of humerus in children presenting between 2-14 days after injury. Case series. Department of Orthopaedics, B.V.Hospital Bahawalpur, from April 2009 to March 2010. This study included patients with displaced extension type supracondylar fracture of the humerus [Gartland type III] who presented between 2-14 days post injury. Open reduction and internal fixation[ORIF] with crossed K-wire was done. The results were assessed by the criteria described by Flynn et al and Mark et al. The average age of patients was 4.5 year. The average hospital stay was 2 days [range 1-3 day]. The average duration of follow-up was 15 months [range: 12-24 months]. Forty patients were managed during the study period. Eighteen [45%] patients had excellent results with less than 5 degree loss of range of motion and minimal loss of carrying angle; thirteen [32.5%] had good results out of which seven had less than 10 degree loss of carrying angle and six had less than 20 degree loss of motion. Six [15%] had fair results due to transient nerve lesions. One of the six patients had 30 degree loss of motion. The remaining three [7.5%] had poor results due to varus deformity that needed corrective surgery. Delayed presentation of displaced supracondylar humerus fractures in children did not increase complication rates or unsatisfactory results following an open reduction and internal fixation with K wires. It is a safe and effective method of treatment even with delayed presentation of supracondylar fractures of humerus in children

Single incision Trans scrotal versus standard inguino-scrotal orchidopexy in children with palpable undescended testis: our experience from April 2007 to April 2010

To compare the efficacy and complications of single incision trans scrotal versus standard inguinal orchidopexy in children with palpable undescended testes. This randomized controlled trial was conducted at the Paediatric Surgery Department Bahawal Victoria Hospital Bahawalpur from April 2007 to April 2010. Children aged 9 months to 12 years, diagnosed as cases of palpable undescended testes were randomized into two groups. In group A orchidopexy was performed through single scrotal incision and in group B by standard two incision inguinal approach. The groups were compared for operative time, hospital stay, scrotal hematoma, wound infection, and secondary ascent. Each group had 134 cases. Mean operative time and hospital stay in group A and B were 28.32 +/- 0.92 minutes and 47.83 +/- 0.76 minutes [p value 0.0001] and 1.027 +/- 0.205 days and 3.023 +/- 0.203 days [p value 0.0001] respectively. There was no significant difference in the formation of scrotal haematoma, wound infection and secondary ascent of testis between the two groups. The conversion rate of surgery in group A was 7.46%.Trans scrotal orchidopexy is the simple, effective and less invasive technique as compared to the standard two incision inguinal approach.

Early laparoscopic cholecystectomy for acute calculous cholecystitis: what is the optimal timing?

To assess the outcome of optimal timing of early laparoscopic cholecystectomy in cases of acute calculous cholecystitis. Descriptive case series. Shaukat Omer Memorial [Fauji Foundation] Hospital and Hill-Park General Hospital Karachi, from April 2010 to November 2011. Clinical records of 164 patients who underwent early laparoscopic cholecystectomy in acute calculous cholecystitis were retrieved and categorized into two groups according to the timing of surgery from the onset of symptoms [A, who had laparoscopic cholecystectomy within 72 hours; B, who had laparoscopic cholecystectomy after 72 hours]. Outcome of interests were conversion to open procedure, postoperative complications and length of hospital stay. The SPSS version 11 was utilized for data analyses. Chi-square test was used to assess qualitative and unpaired Student t test was employed for quantitative data. A value of p < 0.05 was considered statistically significant. The mean [+SD] age was 40.42 +12.42 year. There were 21 [12.8%] males and 143 [87.2%] females with male to female ratio being 1:6.8. Comparing the two groups, the conversion rates [2.9% versus 13.6%, p=0.012], postoperative complications [1.9% versus 10.2%, p=0.026], and length of hospital stay [2.34 versus 3.93 days, p<0.001] were significantly reduced in group A. The early laparoscopic cholecystectomy within 72 hours minimizes the conversion rates and postoperative complications, and shortens the length of hospital stay in cases of acute calculous cholecystitis

Pakistani journals and the impact factor: where are we standing right now

To summarizes the performance of Pakistani journals in terms of their Impact Factor. Pakistani journals were analyzed for their impact factor [IF], citations and publications from 2000-2009. Journal Citation Reports [JCR] published by Thomson Reuter was used to retrieve the data electronically. All tables and graphical presentations were generated by using either Minitab version-10 or MS-Excel for Macintosh. Total seven journals have their IF in the year 2009. Only two Pakistani Bio-medical journals have an international impact factor listed by JCR. The highest impact factor of any Pakistani journal is 0.825 in 2009 of Pakistan Journal of Pharmaceutical Sciences. In the year 2009, Journal of College of Physicians and Surgeons Pakistan [JCPSP] and Pakistan Journal of Medical Sciences [PJMS] were included in the list of IF journals for the very first time after 13 and 26 years of their first publication respectively. The IF of JCPSP is 0.554 and PJMS is 0.203 for the year of 2009. There is a very small contribution by Pakistani journals in terms of ISI indexation. Basic sciences journal continues to overshadow in term of ISI indexation with highest impact factor of 0.825 by Pakistan Journal of Pharmaceutical Sciences

Empyema thoracis; possible factors for predicting this complication in children with community acquired bacterial pneumonia

Empyema as a complication of community acquired pneumonia [CAP] is relatively common occurrence in developing countries. Prospective study. 4 year Jan 2001- Dec 2004. Department of Pediatric surgery the Children's hospital Lahore. A total of 114 cases of empyema thoracic secondary to CAP were dealt with during this period, while in the same duration a total of 1768 cases of pneumonia were treated at the Children's hospital Lahore. Majority of the patients with CAP [59.61%] were below one year of age whereas the patients who developed empyema, were mainly [45.67%] between 2 to 5 years of age. Patients above 5 years of age having CAP [31.70%] and having repeated attacks of respiratory tract infection were most susceptible to develop empyema. Staphylococcus aureus was the most common organism found [40.35%] in this series. Vaccination, poverty and gender did not significant affected the development of empyema among the patients of CAP. Antibiotic resistance had no role in the development of empyema. Ibuprofen may be a risk factor. All the patients were initially managed with tube thoracostomy and antibiotics. Forty-eight patients [42.10%] needed subsequently operative management. Three patients [2.63%] had fatal course in this series same as seen in patients of CAP [2%]. Immunization against causative organism and modification of out patient treatment may affect the incidence of empyema in children and should be studied prospectively

Daily progress notes by surgical interns: an assessment of quality

To evaluate the quality of daily progress notes documented by surgical interns in a tertiary care teaching hospital. Daily progress notes documented by interns during two months period from February to March 2008 were assessed according to the guidelines developed by the Unit. During each working day progress notes were evaluated in a specially designed proforma about documentation, which included subjective, objective, assessement and plan. Data was analysed by SPSS version 10 and Chi square test was applied between categorial data. Two hundred fifty patient's record were assessed for daily progress notes. Out of them 44 [17.6%] daily notes were not found, so a total of 206 morning follow up notes were analyzed. These included 63 [30.6%] preoparative and 143 [69.4%] postoperative patient notes. Most common documented variable was Blood Pressure reading in 194 [94.2%] notes followed by pulse rate in 193 [93.7%]. The leaset documented variable was assessement of patient's current condition in 111 [53.9%] patients' notes. There was statistical significant difference between quality of notes in preoperative patients as compared to postoperative patients. Overall no significant difference was noted while comparing elective vs emergency surgery patient's notes and hepatits positive vs negative notes. Our results showed that our documentation as regards daily progress notes was overall fair. Systematic audit of this type can lead to the development of improved documentation supporting the clinical process within a busy general surgical department with benefits for patient care, clinical governance and inter-specialty communication

Microcephaly: tracing the evolutionary lineage of ASPM gene

Microcephaly, in the form of congenital autosomal recessive disorder [MCPH], is characterized by the reduced occipital frontal head circumference >3 standard deviation of otherwise normal population of matching age and sex. The disease is primarily associated with mild to severe mental retardation. Earlier studies have unravelled that among Pakistani population, mutations in ASPM gene is strongly associated in MCPH. In the present study, we have explored the ancestral root of this disease and the process involved in its evolution using tools of bioinformatics. Experimental Methods: cDNA gene and protein sequences of ASPM gene were retrieved from NCBI database and subjected to the non-redundant BLAST. Consensus phylogenetic tree was developed after multiple sequence alignment and bootstrapping of the protein sequences of ASPM gene from different mammals using Neighbour Joining method, selecting non mammals as an out group. Comparisons of the gene synteny and exon and intron patterns of ASPM gene were also undertaken to investigate chromosomal changes during the course of human evolution. Different statistical evolutionary models namely, Codon Based Z test and Maximum Composite Likelihood Estimate were used in order to estimate the nature of nucleotide substitution and the type of selection pressure the gene has undergone. Phylogenetic tree based on ASPM gene clearly segregated all non mammalian members as an out group. Mammalian in group holds the established evolutionary lineage, based on morpho-genetic attributes of mammalian evolution, segregating monotremes at the beginning followed by the members of rodentia and finally radiation of the primates including humans. Orientation of the ASPM gene remains conserved between human and chimpanzee, however, it was found reversed along with two flanking genes, a zinc finger binding domain 41 and coagulation factor XIII, which suggest relatively recent event of gene inversion. Some earlier and, in comparison, more intricate chromosomal changes have also been detected among the lower order of mammals. Aligning ASPM gene exons with the primates and lower order mammals indicates transitional bias of mutation over transversion [R value= 1.563]. Holistically, codon based Z test revealed positive selection pressure on of ASPM gene from rodentia to primates. Briefly, the studies highlights the evolutionary events of ASPM gene in mammals especially primates including humans. Further studies in connection to correlating the cranial cavity size and ancestral gene sequences and in depth sequence comparison would be more insightful in this regard and studies in this connection are ongoing and will be reported shortly

Propofol in an emulsion of long chain triglyceride and medium-long chain triglyceride: the effect on pain during injection

Pain on injection is major disadvantage of standard propofol formulated with long chain triglycerides [LCT] during induction of anesthesia and sedation in critically ill patients. It is found that concentration of free propofol in aqueous phase of emulsion is responsible for pain on injection and that reducing amount of free propofol would also reduced frequency and intensity of pain on injection. The study was design to investigate whether pain on injection can be reduced by new formulation of propofol which consist of medium chain and long chain triglycerides [MCT/LCT] which is now available in market, and claimed reduced concentration of free propofol in aqueous phase. We devised a prospective, analytical; double blind randomized study to compare the pain on injection of two formulation of propofol for induction of general anesthesia. The present study included 200, non premeditated ASA I, II - adult patients scheduled for elective surgery under general anesthesia at Abbasi shaheed hospital. Patients were allocated randomly in two groups to receive either propofol - MCT/LCT [group I] or propofol - LCT [group II]. The study solution injected at speed of 1ml/sec in a dose of 2.5 mg /kg for induction of general anesthesia and patients graded any associated pain on injection using four point scale: 0= no pain, 1= mild pain, 2= moderate pain, 3= severe pain. There was a significantly less incidence and intensity of injection pain in group-I compared with group-II. The author concluded that propofol MCT/LCT significantly reduced the incidence and severity of pain on injection

Total contact cast for neuropathic diabetic foot ulcers

To determine the outcome of diabetic neuropathic foot ulcers treated with Total Contact Cast [TCC] in terms of percentage of ulcers healed and time to heal. Department of Orthopaedic Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, from April 2005 to March 2007. The study included diabetic patients with non-ischemic neuropathic foot ulcers of upto grade 2 of Wagner's classification. Ulcers were debrided off necrotic tissues and Total Contact Cast [TCC] was applied. TCC was renewed every 2 weeks till healing. Cases were labeled as cast failure when there was no reduction in wound size in 4 consecutive weeks or worsening to a higher grade. Main outcome measures were the percentage of ulcers healed and time to heal in the cast. Thirty four [87.17%] patients were males and 5[12.82%] were females. The mean age was 62 +/- 13.05 years. All patients had NIDDM. Out of the 52 ulcers, 41[78.84%] healed with TCC in an average 2 casts duration [mean 32 days]. There were 11[21.15%] cast failure. Majority [63.63%] of cast failure ulcers were located on pressure bearing area of heel. Most [90%] of the ulcers on forefoot and midsole region healed with TCC [p<0.001]. Longer ulcer duration [mean 57.45 +/- 29.64 days] significantly reduced ulcer healing [p<0.001]. Total contact cast was an effective treatment modality for neuropathic diabetic foot ulcers of Wagner's grade 2, located on forefoot and midsole region

Omphalocele: various treatment modalities and their outcome: a study of 53 cases at the department of paediatric surgery B .V. hospital, Bahawalpur

To evaluate the out come of the different treatment modalities for omphalocele. Descriptive. At the department of paediatric surgery Bahawal Victoria hospital Bahawalpur from January 2004 to August 2007. Fifty three patients have been studied, 33 patients with a major defect, 20 patients with a minor defect and male to female ratio of 1:3. All the patients with minor defect were managed with primary closure while same was done in only 4 [12.12%] patients with major defect. Rest of the patients with major defect, 11 [33.33%], were managed conservatively followed by delayed primary closure, silo formation was done in 6 [18.18%] patients and ventral hernia was formed in 5 [15.15%] patients. 100% survival rate was found in patients who were managed conservatively with delayed primary closure. Overall mortality was found in 12 [22.6%] patients. Primary closure is the treatment of choice in exomphalos minor. Delayed primary closure after application of escharating agent is the Management of choice in patients with exomphalos major. Silo formation is considered in exomphalos major with ruptured membrane