Objectives: Hypospadias, one of the most common genital anomalies, is characterized by an abnormal meatal opening on the ventral aspect of penis. Anterior hypospadias are the most common. Most of the surgical techniques involves the construction of neourethra with significant risk of urethrocutaneous fistula. Limited urethral mobilization technique involves the advancement of native urethra. Study Design: The objective of this study was to evaluate the outcome of Limited Urethral Mobilization Urethroplasty for Anterior Hypospadias. Setting: The study was conducted in the Department of Paediatric Surgery, DHQ teaching Hospital Sahiwal. Period: From January 2016 to December 2018. Material & Methods: A total number of 187 patients were included in this study. Limited urethral mobilization technique was used in all patients. Minimum age was 2.5 Years and maximum age was 12 years. Cosmetic appearance, functional outcome and complication rate were assessed. Results: Wound infection developed in 3.20 %( n=6) patients. Complete glanular disruption was seen in 2.13 %( n=4) patients. Partial disruption of glans with meatal retraction was observed in 1.60 %( n=3) patients. Post-operative haematoma was seen in 1.60 %( n=3) patients. Meatal stenosis in 1.06 %( n=2) patients. Post-operative bleeding and diverticula was observed in 0.5 %( n=1) patients each. Vertical oriented, slit like meatus at the tip of glans was achieved in 95.72 %( n=179) patients. Conclusion: Limited urethral mobilization urethroplasty is a technique with proven benefits and effectiveness in the terms of cosmesis and functional outcome with a minimal number of complications because of the usage of native elastic urethra.
Objectives: This study is aimed at determing the pattern and treatment outcome of neonatal gastrointestinal surgical emergencies. Study Design: Prospective Descriptive study. Setting: DHQ Teaching Hospital Sahiwal. Period: January 2018 to December 2019. Material & Methods: All neonates (<28 days old) who underwent surgery for acute gastrointestinal emergency during the study period were included. Newborns more than 28 days and diseases such as esophageal atresia, esophageal atresia with trachea-esophageal fistula, diaphragmatic hernia, omphalocele, gastroschisis and infantile hypertophic pyloric stenosis were not included in the study. Results: A total of 104 cases of neonatal gastrointestinal surgical emergency were included in the study. The most common cause was anorectal malformation 37(35.57%), followed by intestinal atresia 26(25.0%), Hirschsprung disease 13(12.50%), necrotizing enterocolitis 9(8.65%), intestinal malrotation 8(7.69%), meconium ileus 7(6.73%) and others 4(3.84%). Males were 59(56.73%), females 45(43.26%) and male to female ratio 1.3:1. Mean weight was 2.62kg, ranging from 1.5 to 4.4kg. Post-operative complications were septicemia 26(25.0%), wound infection 17(16.34%), respiratory problems 19(18.26%). Mortality rate in necrotizing enterocolitis was 55.55%, meconium ileus 42.85% and intestinal atresia 38.46%. Mortality rate in premature neonates was 48.0% and mature 12.65%. Overall mortality rate was 21.15%. Conclusions: Anorectal malformation is the commonest cause of neonatal gastrointestinal surgical emergency. Necrotizing enterocolitis, intestinal atresia and meconium ileus are the neonatal surgical diseases with high mortality rate. Surgical outcome depends on the complexity of the disease. Sepsis, late presentation, prematurity and low birth weight are significant contributory factors for high morbidity and mortality.
Objectives: This study is aimed to compare the results of limited urethral mobilization and tubularized incised plate urethroplasty in the management of anterior hypospadias, in terms of cosmetic and functional outcomes, complication rate, operative time, and hospital stay. Study Design: Prospective Randomized Controlled study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2020. Material and Methods: A total of 89 patients with anterior hypospadias were included. Patients were divided randomly into two groups. In group A, limited urethral mobilization was performed and in group B, tubularized incised plate urethroplasty was carried out. A self-structured performa was used to collect the data of all patients. Both groups were compared in terms of the operation time, hospital stay, postoperative complications, cosmetic appearance, and functional outcomes. Results: Forty-five patients were included in group A, age ranged from 2.5 to 12 years (mean 4.83years). Forty-four patients were included in group B and their ages ranged from 3.5 to 11years (mean 4.76 years). The operation time was significantly less for group A than for group B. In group A, it ranged from 54 to 69 min with an average time of 60.51 min and in group B from 70 to 88 min, with an average of 79.34 min. The mean hospital stay period in group A was 7.37 days, ranged from 7 to 9 days, and in group B was 11.04 days, ranging from 10 to 13 days. The mean follow-up period in both groups was 7.45 months, ranging from 3 months to 12 months. Meatal stenosis was the most common complication in group A, which developed in 6.66% (n=3) patients. Urethrocutaneous fistula was the most common complication in group B, which developed in 6.81% (n=3) patients. Cosmetic appearance and functional outcome were good and comparable in both groups. Conclusion: Although both techniques, tubularized incised plate and limited urethral mobilization urethroplasty are acceptable modalities for the management of anterior hypospadias. But limited urethral mobilization urethroplasty seems to be a good option due to its simplicity, short hospital stay, significant shorter operative time, low fistula formation rate, and good cosmetic and functional outcomes.
Objectives: Purpose of the study is to identify the characteristics and burden of pediatric trauma in a hospital with limited resources and to compare the results with published literature and to formulate the effective injury prevention strategies. Study Design: Prospective, Descriptive, Cross-sectional study. Setting: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2019. Material & Methods: A total of 871 patients aged 12 years and below with a history of trauma were included. The patients were categorized into four age groups, 0-2 years, 3-5 years, 6-8 years, and 9-12 years. Data collected included, age, gender, area (rural/urban), type of injury, mechanism of injury, regional pattern of injury, any intervention required and final outcome. The data were compared in different age groups and both sexes. Results: Out of total 2609 admissions, 871(33.38%) patients were of trauma and burn. 699(80.3%) trauma patients and 172(19.7%) burn patients. The males were 595(67.9%) and females comprised 276(32.1%). Age ranged from 05 days to 12 years (mean5.07years). By age groups, distribution of patients was, 0-2years 201(23.1%), 3-5years 340(39.0%), 6-8years 213(24.5%), and 9-12years 117(13.4%). Blunt trauma was most common type of injury 688(95.56%) and penetrating trauma was 31(4.43%). Most common mechanisms of injury were, vehicle related incidents 380(54.4%) and fall 238(34.0%). The majority of injuries 432(61.8%), were seen in head, neck and face region. Scald was most common type of burn and seen in 125(14.4%) patients. Conclusion: This study clearly shows that pediatric injuries and burn contribute a substantial proportion of all pediatric surgical admissions. Pediatric trauma including burn is a significant burden on health care system. Vehicle related incidents, fall injuries and scald burns are most common type of injuries.
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