Background. Hydronephrosis is the most common urinary tract pathology detected on antenatal screening by Ultrasound. The detection of fetal hydronephrosis by ultrasound pres­ents a treatment dilemma to the treating surgeon and parental anxiety. Objective. This study aims to examine the role of serial ultrasounds in antenatally detected fetal hydronephrosis to know the disease progression, and to assess indications and timing of surgery in these patients to preserve renal function. Methods. This is an observational study of 30 cases of foetal hydronephrosis conducted at a tertiary care paediatric surgery centre. A foetal renal pelvic Antero-posterior diameter (APD) >7 mm at 32 weeks of gestation is considered to indicate Foetal hydronephrosis. These patients are followed up for a period of two years from 2018 to 2020. Progression of disease and need for surgical intervention is noted. Results. The study comprised 30 cases of antenatal foetal hydronephrosis (42 renal units). Of 26 renal units with mild hydronephrosis, all are resolved in the post-natal period. Of 10 renal units with moderate hydronephrosis, 3 (30%) resolved and 7 (70%) worsened and required surgical intervention. Of 6 renal units with severe hydronephrosis, all required surgical intervention and underwent surgery between 12 to 18 months of age. Conclusions. These results suggest a grading system with antero-posterior diameter of renal pelvis distinguishes those cases with moderate and severe degrees of hydronephrosis that are at higher risk of surgery.

Background. Fetal supra renal mass revealed incidentally by routine antenatal ultrasound is a great challenge for diagnosis and management by a surgeon. This is a matter of parental anxiety and diagnostic dilemma to a physician. Indeed, such masses turn out to be complicated by an intra-tumor hemorrhage in neuroblastoma or antenatally diagnosed adrenal hemorrhage. The first one needs intensive management and the latter needs watchful observation. Objective. A case of bilateral fetal adrenal mass revealed by routine fetal ultrasound examination at 28th week of gestation which turned out to be adrenal hemorrhage is presented. This is aimed to make awareness to ensure that clinicians always keep benign etiologies first and thoroughly investigate in case of incidentally detected fetal adrenal mass. Methods. The study is a single case report of incidentally revealed supra renal mass. This case report encompasses differentiating features between the two and investigations that aid the surgeon to avoid unnecessary intervention in a benign hemorrhage. Results. The baby was kept on follow up with serial ultrasound scans in the postnatal period and by the second scan in a month, the hemorrhage had resolved completely. Conclusion. In cases of benign looking masses like adrenal hemorrhage or spontaneously resolving neuroblastoma, appropriate antenatal assessment and close monitoring with serial ultrasound scans can avoid surgery.

Background. Nonthyroidal neck swellings are common and cause diagnostic challenges. This study highlights various diagnosis associated with non-thyroidal neck swellings and their management challenges. Objective. This pilot study highlights the various diagnosis associated with nonthyroidal neck swellings and their management challenges. The clinical spectrum of two most common aetiology of nonthyroidal neck swelling: tubercular cervical lymphadenopathy and lymphomas, are also compared. Methods. This prospective study was conducted in a tertiary care teaching hospital from 01 Jun 2018 to 31 Dec 2019. The first 100 nonthyroidal neck swellings presented to the surgical outpatient department were included and assessed clinically, radiologically and histopathologically. Comparison was carried out between the first two common diagnosis of tubercular cervical lymphadenitis and lymphoma. Continuous variables were analysed using Student’s t-test and categorical data were analysed using the Chi square test. A statistical p value <0.05 was taken as significant. Results. There were 73 lymph node swellings and 27 non-lymph node swellings in the study. The most common diagnosis was tubercular cervical lymphadenitis (n=38) and lymphoma (n=17). The mean volume of lymph nodes in the lymphoma group (38.72±22.12 cm3) was significantly bigger than in the tuberculosis group (9.44±5.99 cm3) P=0.00001. The mean age (33.81±11.8 years) of tubercular patients was significantly less than the lymphoma (52.38±25.3 years) with P=0.000167. The clinical diagnosis was nearly accurate in 85% of cases. However, in 15 cases clinical diagnosis was changed after fine needle aspiration cytology. Conclusions. Ultrasonography and fine needle aspiration cytology are very useful adjunct in arriving at a definite diagnosis of a lymph node swelling in neck. Tubercular cervical lymphadenopathy and lymphoma were two major diagnosis. Tubercular cervical lymphadenopathy is significantly different from lymphomas in terms of early age of presentation and smaller size at the time of presentation.

Background. Laparoscopic cholecystectomy has become the choice of treatment for symptomatic cholelithiasis and has replaced open cholecystectomy. Numerous studies and scoring system have been develo­ped over the past 2–3 decades which predict the rate of conversion of laparoscopic to open cholecystectomy. Recently, few scoring systems have been developed which incorporates various intraoperative findings to predict this conversion. No studies are available in literature to assess gender-specific and body weight complications in laparoscopic cholecystectomy. The purpose of this study was to compare the outcome of laparoscopic cholecyst­ectomy between male and female patients in terms of preoperative factors, intraoperative difficulties and rate of conversion to open cholecystectomy and common postoperative complications. Materials and methods. This non-randomized, prospective, observational study was conducted at a tertiary care hospital in Northern India from June 2019 to May 2021. Various preoperative data was collected from the patients like age, the American Society of Anesthesiologists (ASA) class, comorbidity, indication for surgery, preoperative ultrasonography findings and any previous surgery. Surgeries in all patients were started with laparoscopic cholecystectomy under general anae­sthesia. The outcomes were measured in terms of time taken to complete surgery, whether laparoscopic cholecystectomy was converted to open cholecystectomy, common bile duct/cystic duct injury during surgery, common postoperative complications and average length of hospital stay in days. Results. A total of 300 patients were included in the study: 222 females and 78 males. Mean age of presentation in women was (46.45 ± 11.55) years ranging from 21 to 71 years and in men (51.78 ± 11.49) years ranging from 36 years to 76 years. This difference was statistically significant (p = 0.001). The other significant preoperative differences between males and females were comorbidity (p = 0.001) and previous surgeries (p = 0.001). However, the ASA class under which the patients were operated was not significant (p = 0.998). The various indications for surgery to include chronic cholecystitis, resolved acute cholecystitis, gallstone-induced pancreatitis and common bile duct stone had no statistical diffe­rence between men and women (p = 0.072). Conclusions. This study concludes that intraoperative difficulties were more often in male patients as compared to females. The average operating time, conversion of laparoscopic to open cholecystectomy and postoperative hospital stay were significantly higher in men than in women.

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