Aim: The aim is to evaluate the outcome of right subumbilical transverse incision approach for the management of complicated appendicitis in paediatric age group. Materials and Methods: This is a retrospective multi-institutional study which was conducted in the Department of Paediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India and the Department of Paediatric Surgery, Rajiv Gandhi Super Speciality Hospital/Raichur Institute of Medical Sciences, Raichur, Karnataka, India. In this study, a review of 77 paediatric patients operated for complicated appendicitis using a right subumbilical transverse incision approach was done for a period of 3 years (from December 2017 to December 2020). All patients had proven complicated appendicular pathology like appendicular perforation, appendicular abscess or complicated appendicular lumps on ultrasonography or computed tomography scan, which mandated exploration. Results: There was no mortality. Average operative time was 1 h 48 min (ranging from 58 min to 3 h 12 min). Average length of hospital stay was 9 days (ranging from 5 days to 13 days). There was no incidence of fecal fistula. Seventeen (22%) patients developed superficial surgical site infection which subsided with regular dressings. There was no incidence of wound dehiscence or burst abdomen. Five (6.5%) patients required the incision to be extended beyond the midline to the left side to deal with the pathology and to access the entire peritoneal cavity. Nine (11.6%) patients required loop ileostomies, which was fashioned on the lateral aspect of the transverse incision. Only one patient had a doubtful caecal injury which was repaired and loop ileostomy was done. Six patients (7.7%) had adhesive intestinal obstruction postoperatively, of which three required re-exploration. There was no incidence of incisional hernia or any stoma-related complications. Conclusion: Complicated appendicitis is a condition which lacks standardisation of approach for management, and is inherently associated with complications. However, with a more logical incision and intra-operative approach we can keep the complications to minimum and improve outcomes to great extent in those patients requiring surgical intervention. We have been using the subumbilical transverse incision in all sizes of patients ranging from small children to adolescents with excellent results, and we believe that the same approach can be applied even in adult patients in similar clinical scenarios.

Background: The laparoscopic procedure has many added advantages of being less time consuming, early discharge from the hospital, less tissue damage, and better visualization of the pelvic structures. Objective: to study the complications and outcomes in ARM patients following LAARP. Methods: This study was conducted on 55 ARM patients in the Raichur Institute of Medical Sciences RIMS/ RGSSH (OPEC) Raichur Karnataka. The study period is from Dec 2016 to Dec 2020. Results: All the  fifty five patients who are operated for anorectal malformation, they underwent first surgery (high sigmoid loop colostomy) within the second and third day of neonatal period, and second surgery  the LAARP  within the six weeks to three months of the first surgery, a Demographics, type of ARM, and age at pull-through. All LAARP surgery was done by single surgeon, there were no anaesthetic complications. Conclusion: This study emphasizes the emerging laparoscopic technique for management of anorectal malformations. Using this approach it is possible to achieve better continence rates as the extent of perineal dissection is minimal, hence inflicting minimal neural and sphincter injury.