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.

Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material & Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.

Background: Imperforate anus with recto-vestibular fistula is one of the most common anorectal malformations in females. Wound infection and disruption after recto-vestibular fistula repair may affect the fecal continence and functional outcome. Fecal incontinence may cause long term social, economical and psychological problems in children. Although a protective colostomy reduces the infectious complications and dehiscence, it is also associated with many problems. Aim: To compare the safety, feasibility, post operative complications and functional outcomes of limited posterior sagittal anorectoplasty with or without colostomy. Study design: Prospective descriptive study. Place and duration of sudy: Department of Pediatric Surgery, Sahiwal Teaching Hospital Sahiwal, from 1st January 2019 to 31st December 2021. Methodology: Forty-one patients with congenital recto-vestibular fistula were managed by two techniques. Patients were divided into two groups. Group A (19 patients): were operated by single stage limited posterior sagittal anorectoplasty without covering colostomy. Group B (22 patients): were operated by two stage technique. Limited posterior sagittal anorectoplasty and covering colostomy in first stage and stoma closure was done in second stage. The patients in both groups were evaluated for hospital stay, operation time, postoperative complications, fecal continence, constipation, bowel function. Results: The age of patients ranged from 11-56 months (mean 26.93 months) in Group A and 9-60 months (mean 27.03 months) in Group B. The total length of hospital stay in Group A ranged from 7-11 days (mean 9.20 days); however, in Group B, it ranged from 4-6 days (mean 5.01 days) for first stage procedure and 8-11 days (mean 9.27 days) for second stage colostomy closure procedure. In Group A, complications were, wound infection 03 (15.78%), anal stenosis 02 (10.52%), mucosal prolapse 01 (5.26%), constipation 04 (21.05%), soiling 04 (21.05%), perineal excoriation 03 (15.78%) and recurrent H-type recto-vestibular fistula 01 (5.26%). In Group B, during the first stage of repair, one patient (4.54%) developed wound infection. Mucosal prolapse was observed in one patient (4.54%). Constipation was reported in 03 (13.63%) and soiling in 01 (4.54%). Peri stoma skin excoriation was seen in five patients (22.72%). Stomal prolapse was observed in two patients (9.09%). Two patients (9.09%) developed wound infection after colostomy closure. Conclusion: Single stage repair of congenital recto-vestibular fistula increases the risk of postoperative complications. Two stage approach is associated with less postoperative complications. However it is associated with lengthy hospital stay, long operation time and complications related to stoma formation and closure. Keywords: Recto-vestibular fistula, Limited posterior sagittal anorectoplasty, Single stage technique, Two stage technique.

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.

Background: Inguinal hernia in children is a very common surgical condition. Various techniques are being done for hernia repair in children. Single port needlescopic assisted hernia repair in girls is a time honoured technique with minimum complications and excellent Aim: To determine the outcome of single port needle assisted hernia repair in girls. Study design: Descriptive case series Place and duration of study: Department of Paediatric Surgery Sahiwal Teaching Hospital and Sahiwal Medical College Sahiwal between March 2021 and February 2022. Methodology: Twenty eight female patients from 3-13 years old with inguinal hernia underwent single port needlescopic assisted hernia repair. Follow up was done for three months to evaluate outcome with respect to recurrence, stitch abscess and cosmetic appearance. Results: Maximum patients between 7-10 years 12(42.85%). Fifty percent were right sided inguinal hernias. Four (14.28%) girls were developed complications. Two (7.14%) developed retroperitoneal intraoperative hematoma, 1(3.57%) stitch abscess and 1(3.57%) recurrence respectively. One patient with intraoperative hematoma was converted to open herniotomy. Stitch abscess was managed conservatively and recurrent hernia was repaired by open herniotomy. Conclusion: Single port laparoscopic needlescopic assisted hernia repair in girls is a simple and safe procedure with minimum complications and excellent cosmetic results. Keywords: Hernia, Inguinal, Girls, Single port, Needlescopic