Laparoscopic assisted appendectomy in children. Our experience of first 50 cases at tertiary care hospital Rawalpindi

Objective: To present an experience of the first 50 cases of appendectomy performed via laparoscopy assisted open technique

Study Design: Descriptive case series

Place and Duration of Study: This study was carried out at Pediatric Surgery department, Pak Emirates Military Hospital Rawalpindi, from Jan 2016 to Apr 2018

Material and Methods: Fifty patients [<12 years old] diagnosed as cases of acute appendicitis were enrolled after ethical committee approval. The procedure was performed via three ports [4 ports if required]. Appendix was brought out through the right iliac fossa port and appendectomy was performed by extracorporeal knotting technique. Operative time, position of appendix and postoperative complications were recorded. Data was expressed as means and frequency percentages

Results: Out of 50 patients, 31 were male and 19 were females. The mean age of the patients was 7.99 +/- 3.34 years. Forty one patients had acute appendicitis while 9 patients were diagnosed as appendicular mass. The mean operative time was 24.9 +/- 7.42 minutes. There were no cases of surgical site infection. Thirty eight patients were operated via three ports while 12 patients required four ports. Three patients required conversion to open appendicectomy due to extensive adhesions or abscess. Post-operatively drain was placed in only 6 patients

Conclusion: Laparoscopic assisted open appendectomy is a safe, quick and easy to learn technique in children which combines all the advantages of minimal access surgery with open appendectomy while reducing the number of complications associated with it. The technique has the added advantage of diagnostic laparoscopy over open surgery

Management of congenital talipes equinovarus by the ponseti method - short-term and intermediate effectiveness of the technique and factors affecting outcome

Objective: To evaluate the effectiveness of the Ponseti method of clubfoot management in neonates and infants and to see which factors affect outcome

Study Design: Retrospective study

Place and Duration of Study: Department of Paediatric surgery, Military Hospital, Rawalpindi, from October 2012 to September 2014

Material and Methods: The Ponseti method for the management of congenital talipes equinovarus was applied in children of 7 days to 6 months age. While those with complex neurological problems, pathological clubfeet, syndromic clubfeet and older than 6 months at the time of presentation were excluded from the study

Assessment was done at presentation, at the removal of the last plaster cast and after one-year use of the foot abduction splint

Results: A total of 124 clubfeet of 89 children, including 63 males [70.78%] and 26 females [43.82%] were treated as outdoor cases. Eighteen feet [14.51%] were of rigid [typical] type whilst 106 [85.5%] were of flexible [typical] type. Bilateral involvement was seen in 35[37.31%] children. The mean pretreatment Pirani score was 5.4 and the mean number of plaster casts required was 5.8

The mean Pirani score at 1-year follow-up was 0.5 with successful outcome in 82.3 % of all cases [96.9 % of neonates]. Poor compliance with the use of the foot abduction splint adversely affected outcomes

Conclusion: The Ponseti method of treatment of congenital clubfeet is safe and easy to learn with effective and reproducible results. Early start of treatment and compliance with the use of the foot abduction splint during the maintenance phase are crucial to successful outcome