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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

The objective of this study is to compare Bianchi supra umbilical curvilinear incision with a right upper transverse incision in patients presenting with infantile hypertrophic pyloric stenosis (IHPS) in terms of level of difficulty faced during the procedure, operative time, postoperative cosmesis, wound infection and wound dehiscence. A prospective comparative study was conducted at the Department of Paediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad. The total duration of the study was 1 year from 1st March, 2020 to 28th February, 2021. The anticipated sample was minimum of 20 cases in Group A (Bianchi) and 20 cases in Group B (right upper quadrant incision), i.e. total 40 cases of IHPS. All infants up to 12 weeks admitted with the diagnosis of IHPS were added in the study. The study outcome was determined in terms of duration of surgery, wound infection and cosmetic effect after intervention with Bianchi and right upper transverse incision. Age and gender distribution was found equal when compared between study groups with male preponderance. The mean duration of surgery was 47.0 min in Group A, as compared with 32.5 min in Group B. Similarly, hospital stay was found slightly longer in Group A than Group B (5.3 versus 4.8 days, respectively). The level of difficulty while performing the surgery was slightly greater in Group A. The scar was detectable in all 20 (100.0%) patients in Group B compared with only 2 (10.0%) in Group A. Wound dehiscence was found in one (5.0%) patient in Group A, whereas none (0.0%) in Group B had it. The management of IHPS can be safely and successfully done with both Bianchi technique and right upper quadrant incision. The duration of surgery, level of difficulty while performing surgery and postoperative complications like wound infections and dehiscence were slightly more prevalent in Group A, whereas scar was significantly associated with Group B (100.0 versus 10.0%).

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