Objective: Aim of current study is to determine the success of right thoracotomy versus exploratory laparotomy in right sided congenital diaphragmatic hernia in neonates. Study Design: Retrospective study Place and duration: The Children’s Hospital PIMS Islamabad. Jan 2021 to Dec 2021 Methods: Total 74 neonates had right sided congenital diaphragmatic hernia were included. All the neonates were admitted to hospital for surgery. Neonates were equally divided in two groups. Thirty seven patients in group I received thoracotomy and 37 patients in group II underwent for exploratory laparotomy. Post-surgery success rate among both groups were compared. Results: There were majority 41 (55.4%) males and 33 (44.6%) females. Mean age of the neonates was 13.7±4.19 days. Pre-operative tracheal intubation and cardiac malformation was found in 67 (90.4%) and 14 (18.9%) cases. Compared to thoracotomies, exploratory laparotomies were associated with shorter hospital stays, shorter durations of postoperative mechanical ventilation, and shorter times to optimum feeding. We found that recurrence rate in thoracotomy group was higher as compared to laparotomy group with p value <0.004. There were no any significant differences in postoperative complications between the two groups. In both groups, 3 (8.1%) and 1 (2.7%) patients were died. Conclusion: We concluded in this study that the exploratory laparotomy among patients of right sided congenital diaphragmatic hernia was effective and useful in terms of shorter hospital stay, short mechanical ventilation and less time to optimum feeding as compared to right thoracotomy. No any significant difference was found in terms of post-surgery complication among both groups. Keywords: Congenital Diaphragmatic Hernia (CDH), Exploratory laparotomy, Thoracotomy

Objective: Aim was to compare the outcome of conservative management versus open appendicectomy in early presentation of Acute Appendicitis in children during Covid-19 pandemic. Study Design: Retrospective study Place and Duration: The Children’s Hospital PIMS. March 2020 to Sep 2020 Methods: This research comprised 80 children of both sexes who were diagnosed with acute appendicitis during the Covid-19 epidemic. Following the collection of written informed consent, complete demographic data, including age, sex, and sickness severity, was collected from all recruited patients. There were two sets of patients, and both were treated similarly. Forty individuals in Group I underwent for open appendicectomy, whereas the same number in Group II underwent conservative treatment (intravenously injection Tanzo, Flagyl, Amikacin). Complications after therapy and antibiotic resistance were analysed and compared between the two groups. All of the data was analyzed using SPSS 22.0. Results: There were majority males 47 (58.8%) and 33 (41.2%) females in this study. Mean age of the patients was 9.09±5.29 years. Disease severity was found in 67 (83.8%) cases. Although there was no statistically significant difference between the groups, the more conservatively treated group had a higher risk of complications. Between the two groups, there was no discernible difference in the average length of hospitalization. Surgery patients had significantly higher white cell counts (WCCs) and Alvarado scores (p=0.010 and p=0.018, respectively) at arrival. We found higher readmission and reoperation during Covid-19 pandemic among both groups. Conclusion: We concluded in this study that severity of acute appendicectomy was higher during pandemic wave of coronavirus. Both conservative and open appendicectomy was effective in terms of minimum complications and decrease hospital say while readmission and reoperation was higher among both groups because of pandemic disease Covid-19. Keywords: Acute Appendicitis, Conservative Management, Open Appendicectomy, Complications, Hospital Stay

Objective: The goal of this research is to evaluate the efficacy of bleomycin sclerotherapy against hypertonic saline (at 15%) in treating cystic hygroma in children. Study Design: Comparative study Place and Duration: Children Hospital, Pakistan Institute of Medical Sciences PIMS Islamabad. July 2021-Feb 2022. Methods: There were 52 children of both genders with cystic hygroma were included in this study. Included children had age 2 months to 12 years. After taking informed written consent from the parents of children detailed demographics age, sex, weight and place of living were recorded. Patients were equally categorized in two groups. 26 patients in group I received sclerotherapy with bleomycin and in group II 26 children received 15% hypertonic saline. Post-treat outcomes among both groups were assessed and compared. SPSS 22.0 was used to analyze all data. Results: Among 52 children, there were 32 (61.5%) males and 20 (38.5%) females. Mean weight of the children was 14.7±5.37 kg and mean age was 6.9±9.54 years. Majority of the cases 34 (65.4%) were from rural areas and 18 (34.6%) were had urban residency. Most common site of lymphangioma was neck and axilla. In group I 18 (69.2%) children received four sessions of bleomycin. We found higher number of effectiveness in patients of group I 25 (96.2%) as compared to group II in 22 (84.6%) cases with p value <0.009. Frequency of wound infection and recurrence rate was also higher in group II. Conclusion: We concluded in this study that the use of sclerotherapy with bleomycin was an effective and useful in the treatment cystic hygroma children in terms of higher number of excellent results as compared to 15% hypertonic saline. Except this recurrence rate and complications were also not seen in sclerotherapy with bleomycin group. Keywords: Bleomycin, Sclerotherapy, Cystic Hygroma, Recurrence, Wound Infection, 15% Hypertonic Saline

Objective:The purpose of this study is to compare the outcomes of laparotomy versuslaparostomy tube in neonates presented with pneumoperitoneum.

Objective: The purpose of this study is to compare the Bishop-Koop procedure (BK) to the divided stoma in newborns with meconium ileus (MI) and congenital intestinal atresia. Study Design: Retrospective study Place and Duration: Children Hospital PIMS.Dec-2021-Jun 2022 Methods: There were seventy six neonates were presented in this study. Included neonates had meconium ileus (MI) and congenital intestinal atresia (CIA) and admitted to Hospital for surgery. Pateints were equally divided in two groups. Group I received divided stoma (DS) among 38 neonates and group II received Bishop-Koop procedure (BK) in 38 cases. Outcomes among both groups were compared in terms of surgery time, complications, and hospital stay. Mean standard deviation was used for data presentation. Results: There were 42 males (21 in each group) and 34 female (17 in each group) neonates among all cases. Mean age of the neonates in group I was 8.5 ± 4.16 days. Meconium ileus was found in 21(55.3%) in group I and 20 (52.6%) in group II and the rest of the neonates among both groups had congenital intestinal atresia. Mean operative time in group I was higher 180.7 ±9. 34 minutes as compared to group II 110.3 ± 7.26 minutes. We found that hospitalization in group II was lower 3.11 ±5. 40 days as compared to group I 10.2± 9.17 days. Frequency of complications in group I was higher found in 8 (21.5%) cases as compared to group II in 4 (10.5%) cases. Conclusion: In comparison to DS ostomies, we came to the conclusion that the BK approach is a safe, dependable, and acceptable technique for newborn surgery with a low risk of complications and shorter operating time and duration of hospital stay after ostomy closure. Keywords: Divided Stoma, Bishop-Koop, Meconium ileus , Congenital Intestinal Atresia, Complications