Aim:To investigate the correlation between the status of interstitial cells of Cajal (ICC) in ureteropelvic junction (UPJ) and the resected ureteric margin and the postoperative outcome of Anderson-Hynes pyeloplasty in UPJ obstruction (UPJO) and to compare the ICC in the UPJ and the resected margin of the normal ureter.Materials and Methods:An observational study was conducted over a period of 2 years at the Department of Pediatric Surgery at Niloufer Institute of Women and Child Health. Children with intrinsic UPJO who underwent Anderson-Hynes dismembered pyeloplasty were included in the study. Six months postoperatively, the patients were divided into two groups based on diuretic isotopic renogram using technetium-99m-labeled diethylene triaminepentaacetic acid. Group 1 comprised patients with good surgical outcome. Group 2 comprised patients with a poor outcome. The histologic specimens were evaluated for ICC, and the immunohistochemical findings were correlated with the outcome.Results:Twenty-five patients were included in this study (19 male and 6 female). Seventy-six percent of patients were under the age of 1 year. Group 1 had 23 cases and Group 2 had 2 cases. Out of the two patients with a poor outcome, one had negative grading at the UPJ and one had positive grading. Both these patients had a negative grading at the lower resected margins. More number of patients (24%) had +++ grading at the lower resected margin when compared to the UPJ (8%).Conclusion:This is the first study which correlates the status of ICC in UPJ with the outcome of pyeloplasty in pediatric patients. Both the cases with bad outcome had no ICC at the lower margin of the resected specimen and one case had no ICC at the UPJ. There is a statistically significant difference (P = 0.001) in the number of ICC at the UPJ and the resected margin.

Background: Pelviureteric junction obstruction (PUJO) is the most common cause of pediatric hydronephrosis. The gold standard treatment for PUJO is Anderson hynes (AH) dismembered pyeloplasty. The parameters to assess the post-operative outcomes of pyeloplasty include reduction in the AP diameter of the pelvis and increase in parenchymal thickness. The aim of the study was to find out the long-term outcomes following pyeloplasty for Ureteropelvic junction obstruction (UPJO) in paediatric patients.Methods: A prospective study was done from September, 2014 to January, 2019. All children above the age of 2 months who presented with unilateral PUJO were included in the study. All patients underwent ultrasound of the kidneys and diuretic renogram. All patients underwent AH dismembered pyeloplasty. Success was defined as both symptomatic relief and radiographic resolution of obstruction at the last follow-up visit.Results: 60 patients with unilateral intrinsic PUJO were included in this study. Post-operatively split renal function (SRF) improved in 42 patients, remained stable in 13, and deteriorated in 5 cases. Post-operative renal drainage improved in 40 patients, remained stable in 15 and deteriorated in 5.  The degree of hydronephrosis deteriorated in 5 cases but improved or was preserved in 55 cases. The renal parenchyma deteriorated in 7 cases. Overall success rate of AH dismembered pyeloplasty was 92%.Conclusions: Dismembered pyeloplasty is a safe and effective treatment of PUJO in the pediatric population. Majority of the patients had an improved split renal function, renal drainage, cortical thickness, and decreased degree of hydronephrosis.

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Ovarian lesions are a rare condition in children but are extremely important since they can cause multiple complications and often need emergency management. This case series highlights the different types of ovarian lesions in children and varied management for each of the cases. All pediatric patients who presented with ovarian lesions to the Department of Pediatric Surgery at KIMS Hospital, Secunderabad between August 2018 and August 2021 were included in the study. All patients were evaluated with imaging (ultrasound or computed tomography) and blood tests. Blood tests included alpha fetoprotein and beta HCG. The patients were treated as per standard guidelines. Nine children were included in the study out of which 7 had ovarian cysts and 2 had mature teratoma of the ovary. Ovarian cyst was managed conservatively in 2 patients. 4 patients underwent oophorectomy out of which 2 patients had teratoma and the others had simple cyst torsion of the ovary. 3 patients underwent excision of the ovarian cyst. Ovarian lesions in children may be cystic or solid. Neonatal ovarian cysts affect approximately 1:2500 pregnancies. Commonest presenting complaint of pediatric ovarian lesion is abdominal or pelvic mass. Ultrasound is accurate in distinguishing between cystic and solid lesions. Complications are usually seen in lesions over 4 – 5 cm. Ovarian tumors may be benign or malignant. Surgery is indicated when there is an enlargement of the cyst, if complications arise, and cysts of 4-5 cm persisting over 6 months. Preferred surgical management involves ovarian sparing techniques.

Introduction Cystic lesions involving the gastrointestinal tract are rare in infants and children. Clinical presentations include asymptomatic lesions, pain abdomen, mass per abdomen and vomiting. The aim of the present study is to study the acute presentation of cystic lesions of the gastrointestinal tract in pediatric patients. Methods All patients below the age of 12 years with acute abdomen in the setting of a gastrointestinal cyst were included in the study. The patients underwent ultrasound of the abdomen or CECT or both. All patients underwent laparotomy. Either resection and anastomosis or excision of cyst was done for all patients. Results 16 patients were included in the study. The age of the patients ranged from 1 day to 12 years. The most common presenting symptoms were abdominal pain, distension and vomiting. Most common signs were abdominal lump, distension and tenderness. Ultrasound was done in 14 cases, CECT was done in 10 patients. Resection and end to end anastomosis was done in 11 cases and excision of the cyst was done in 5 cases. Conclusion Cystic lesions of the gastrointestinal tract can present in children of both sexes at any age. Due to the improvement in antenatal scans some of these cystic lesions can be diagnosed antenatally. Nearly two thirds of the cystic lesions of the abdomen present with an acute abdomen. All these patients require immediate surgical management. The cysts which are in proximity with the bowel are more prone for complications. The management may involve resection and anastomosis of involved or excision of cyst.