Hemanshi Shah

Laparoscopic Partial Splenectomy for Splenic Epidermoid Cyst

The treatment strategy of the splenic cyst is controversial. Better understanding of the splenic segmental anatomy, need of splenic conservation, and advances in laparoscopic skills has made laparoscopic partial splenectomy a preferred treatment for splenic cysts. In this paper, we report a case of splenic epidermoid cyst managed successfully by laparoscopic partial splenectomy. Also, results of various treatment strategies were reviewed.

Experience with video-assisted thoracoscopic removal of pulmonary hydatid cysts in children.

Pulmonary hydatid disease is prevalent in many parts of world including India. In our small series of 5 pediatric patients, all patients were diagnosed with clinical and radiological findings on plain X-ray chest and CT (Computed Tomography) chest. All of them received oral albendazole 10 mg/kg/day soon after diagnosis except in one patient in which preoperative differential diagnosis was bronchogenic cyst and lung abscess (case 4). All underwent video assisted thoracoscopy. Simple endotracheal intubation was utilized in all cases along with CO(2) insufflation. Complete thoracoscopic removal was successful in 3 cases, while conversion to open thoracotomy was required in 2 cases. All of them showed rapid recovery except for one patient in whom prolonged intercostal drainage was present for 2 weeks. The average duration of procedure was 150 minutes and average length of hospital stay was 4.5 days except case 2, which was discharged on day 15 due to prolonged air leak. Histopathology in all cases was suggestive of hydatid cyst. At mean follow up of 6 months, all patients are asymptomatic and doing well.

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.

Congenital alveolar fusion.

Congenital fusion of the jaws is rare. It may be unilateral or bilateral and may involve only the soft tissues or both the hard and soft tissues. This anomaly may be seen separately or in association with other syndromes. Congenital alveolar fusion restricts mouth opening, causing problems with feeding, swallowing, and respiration. Case 1 had membranous bands between the alveoli that required tracheostomy for stabilization, followed by osteotomy for release. Postoperatively, both patients had adequate mouth opening.

Thoracoscopic excision of mediastinal cysts in children

Aim: Thoracoscopy offers great advantages when compared with open surgery in terms of postoperative pain and pulmonary complications. Considering the benign nature of most of the mediastinal cysts, thoracoscopy is safe and feasible with minimal morbidity. The purpose of this article is to review our experience with four cases of mediastinal cysts resected successfully within a period of one year by thoracoscopy. Materials and Methods: The cases of mediastinal cysts operated by thoracoscopic excision in K.E.M. Hospital, Mumbai from November 2005 to December 2006 were reviewed. The age varied from six months to 10 years. The patients presented with respiratory distress or recurrent lower respiratory tract infection. All patients underwent Chest X-ray and CT scan thorax to delineate the location of the cyst and its relationship with adjacent vital structures. Two patients had anterior and two had posterior mediastinal cyst. The ports were placed depending on the location of the cyst on the CT scan, following the principles of triangularization. The cysts were excised mainly by blunt dissection. Results: All the patients were successfully managed by thoracoscopic surgery. None of them had intraoperative complications. Dissection in patient with history of recurrent respiratory tract infection was difficult because of adhesions. Intercostal drain was removed within 48hrs and the patients were discharged on the fourth postoperative day. Conclusions: Thoracoscopy in mediastinal cysts is a safe and effective procedure with low morbidity and a shorter hospital stay.

Laparoscopic Deroofing of Congenital Solitary Liver Cyst in a Neonate Managed at Day 16 of Life

Congenital liver cysts are uncommon lesions, which are being recognized with the increasing use of antenatal ultrasound. In this paper, we report a case of an antenatally diagnosed solitary simple liver cyst managed by laparoscopic deroofing. Laparoscopy confirmed the diagnosis and gave information about the relation of the cyst with the liver and portal structures. Laparoscopic deroofing is a safe, effective means of management of the liver cyst in pediatric patients.

Uncrossed complete ureteral duplication with dysplastic lower moiety: A violation of the Weigert–Meyer law

We report a rare case of complete uncrossed ureteral duplication with dysplastic lower moiety. This case not only violates the Weigert-Meyer law but also fails to explain Mackie and Stephens theory of renal dysplasia in a complete duplication system.

Posterior urethral polyps and review of literature.

Urethral polyp is a rare finding in young children. Fibroepithelial polyps of the urethra are usually diagnosed during the first decade of life. They present with obstruction, voiding dysfunction and hematuria. They can be associated with other congenital urinary tract anomalies. They are usually benign fibroepithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy.

Membranous variety of rectal atresia - primary management in a neonate

Rectal atresia is a rare form of anorectal malformation, with reported incidence of 1 to 2% and membranous variety of rectal atresia is even rarer. Most reported cases have been dealt with a staged procedure which includes sigmoid colostomy. We diagnosed and classified the variety of rectal atresia by performing an X-Ray (invertogram along with the red rubber catheter in situ.). In lesser developed geographies where MRI is not readily available or not affordable, this simple test could be used to confirm the variety of rectal atresia. However, the usual fallacies of invertogram should be considered. Here we report a neonate with membranous variety of rectal atresia managed by transanal endoscopic fulguration using bugbee passed through the cystourethroscope, without a covering sigmoid stoma.

Ureteropelvic junction obstruction in both upper and lower moieties of a duplex system: A rare association

Ureteropelvic junction (UPJ) obstruction is a rare association with duplex system. It has been reported infrequently in lower and upper pole moieties. This is the first case of both upper and lower moieties UPJ obstruction to be reported in the literature. This case adds one more variant to the known wide spectrum of duplex systems.