Background: The standard procedure in the management of pouch colon is the staged procedure (SP), which has well-known disadvantages. We believe that staged procedure is unnecessary and single-stage procedure (SSP) can be done in the congenital pouch colon cases. Methods: Patients with pouch colon who underwent SSP (90 cases from 2008 to 2013) and SP (100 cases from 2003 to 2008), 65 and 55 of whom, respectively, were in regular follow-up for more than 3 years, were evaluated. Results: In SSP, male/female ratio was 87:3; in SP-94:6. Mean age of patient in SSP was 3.7 days and in SP 15 months. The distribution of cases into types I, II, III, and IV was 7,16,18, and 24 in SSP,and 6,14,15,and 20 in SP, respectively. The ratio of PSSP/SP for partial pouch colon (I and II) was 23:20 and for complete pouch colon (III and IV) was 42:35. The ratio of SSP/SP in terms of continence, mortality, and cost was 81:60, 17:53, and 1:6, respectively. Conclusions: Primary single-stage procedure gives better continence and cosmesis, with low morbidity and mortality at a low cost, and hence is recommended. Aggarwal S et al. Int Surg J. 2017 Apr;4(4):1158-1162 International Surgery Journal | April 2017 | Vol 4 | Issue 4 Page 1159 All the cases of pouch colon diagnosed clinically supported by radiological evidence (babygram, invertogram, cross-table prone lateral view, ultrasonogram) admitted at S.G.R.D. Hospital, Department of Paediatric Surgery, Amritsar, during the period 2003 to 2013 were included in the study. During this period, 100 cases were managed before 2008 with standard SP, and 90 cases were managed with SSP after 1997. Of these, 55 cases of SP and 65 cases of SSP who were in regular follow-up of more than 3 years were studied. All the patients were evaluated for associated congenital anomalies with X-ray abdomen, ultrasonography abdomen, micturating cystourethrogram, and echocardiogram whenever possible. After exploratory laparotomy with left lumbar hockeystick incision, the type of pouch colon was assessed according to the classification of Narasimharao et al, and decision was made accordingly. 1 In the follow-up period, all the cases were evaluated for continence with Kelly's scoring, mortality, and cost of treatment. Keywords METHODSThe SSP includes laparotomy, ligation of the fistula, followed by primary abdominoperineal pull-through/ abdomino-PSARP after pouch excision (partial/total pouch colon). Abdomino PSARP includes initial posterior sagittal approach and placement of tube stent, followed by change of posture for abdominal approach with dissection and division of fistula, followed by anoplasty with the pulled-down colon. The distribution of various operative procedures performed in both groups (SP and SSP) ( Table 1). RESULTSIn our study, pouch colon accounted for 30.64 % of all ARM (total ARM cases during the period 2003 -2013 was 620) and 44.1 % of all high ARMs (high ARM cases were 430). Male predominance was noted in our series (9:1).All the patients with congenital pouch colon had a high vari...

Background: Late-presenting congenital diaphragmatic hernia (CDH) is a rare subset of CDH, most of the information is derived from small series or case reports. The aim of this study is to document the varied presentations of late-presenting CDH in a tertiary hospital.Methods: Information about late-presenting CDH (diagnosed at later than 30 days of age) was identified from the data collected by a 5 year reterospective study and 1 year prospective study.Results: Twenty five cases were studied over a period of 6 years with 5 years of reterospective study and 1 year of prospective study. Three cases had a morgagni hernia (2 right-sided, 1 central, 2 males and 1 female). There were 16 males (64%) and 9 females (36%). Major associated anomalies were identified in 6 cases (24%). Cardiac anomalies included ventricular septal defect (n = 4), atrial septal defect (n = 2), gastroesophageal reflux was found in 3 cases, 1 of which required surgery. Presenting symptoms were respiratory in 8 (32%), gastrointestinal in 13 (52%), both in 4 (16%). The hernia was left-sided in 17 (68%), right-sided in 5 (20%), and central 3 (12%). Patients with gastrointestinal symptoms invariably had left-sided hernias (n = 10), whereas patients with respiratory symptoms                 (n = 8) seemed equally likely to have right- or left-sided lesions. A primary repair without patch was done in all cases with 100% survival.Conclusions: Presenting symptoms of late-onset CDH can be respiratory or gastrointestinal, but presentation with gastrointestinal problems was more common in left-sided hernias, whereas respiratory symptoms were seen with equal preponderance in left and right-sided lesions. The prognosis is excellent once the correct diagnosis is made.