Urethral ratio on voiding cystourethrogram: a comparative method to assess success of posterior urethral valve ablation.

OBJECTIVE: To develop a simple, objective and reproducible quantitative measurement to assess success of posterior urethral valve ablation. METHOD: In 30 patients with posterior urethral valves the diagnosis was confirmed by voiding cystourethrogram (VCUG). Our protocol was to perform valve ablation, and repeat VCUG at 12 weeks postoperatively. Urethral ratio was calculated by dividing the posterior urethral diameter by the anterior urethral diameter. Thirty males undergoing VCUG for urinary tract infections were evaluated as normative controls. RESULTS: Median age of controls was 12 months (2 days-6 years) and of study group was 13 months (1 day-11 years). Mean urethral ratio in pre-fulguration group was 4.94 (+/-2.97) and in post-fulguration group was 2.134 (+/-1.19) (P<0.001). The mean urethral ratio in the control group of 1.73 (+/-0.577) was significantly different from the pre-fulguration group result (P<0.001), but not significantly different in comparison to the post-fulguration group (P=0.104). CONCLUSION: Calculation of urethral ratio on VCUG as a method of assessment of outcome of fulguration is objective, reproducible, and allows preoperative and postoperative VCUG from different facilities to be compared. A post-fulguration urethral ratio of 2.5-3 represents an acceptable result postoperatively.

Minimal access surgery in children: an initial experience of 28 months.

BACKGROUND: This study reports our 28 months experience with minimal access surgery (MAS) in children. MATERIALS AND METHODS: This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC) and King Edward the VII Memorial (KEM) Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibility of MAS in neonates, in the appropriate operative groups. RESULTS: A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years). One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH) repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. CONCLUSION: We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery.

Laparoscopy in management of abdominal pain in children.

The aim of our study was to evaluate the role of diagnostic and therapeutic laparoscopy for abdominal pain in children. Fifty-four children under the age of 12 years who presented with an acute abdomen with symptoms of duration of less than 72 hours (N = 21), and recurrent abdominal pain (RAP) with duration of symptoms ranging from 2 to 18 months (N = 33) were included in this study. Patients who presented with hemodynamic instability and signs of generalized peritonitis were excluded from this study. All patients were evaluated thoroughly, including a detailed history with relevant investigations and other specific tests, such as the Mantoux test, urinary porphobilinogen, video electroencephalograph, M. tuberculosis polymerase chain reaction, and so on, were taken to rule out rare causes of RAP. The results of the study were assessed, and it is concluded that diagnostic laparoscopy allows for establishing a prompt, accurate diagnosis in the acute abdomen without a therapeutic delay and unnecessary hospital observation. Laparoscopy early in the course of debilitating chronic abdominal pain in children provides economic benefit by eliminating many low-yield imaging studies and also minimizes lost time from school.