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Kumar R, Addagatla R, Jaglan SK, Divya G, Jaju R, Debnath PR, Sen A, Shah S. Sepsis Screening of Neonatal Abdominal Surgery and Its Outcomes. J Indian Assoc Pediatr Surg 2022; 27:677-683. [PMID: 36714487 PMCID: PMC9878506 DOI: 10.4103/jiaps.jiaps_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/19/2022] [Accepted: 06/18/2022] [Indexed: 11/12/2022] Open
Abstract
Aim The aim of this study was to evaluate the early indicators of sepsis (sepsis screening) and their statistical correlation with sepsis in neonatal abdominal surgery. Materials and Methods A prospective observational study was performed on thirty consecutive neonate cases aged between 0 and 28 days with surgical abdomen at the Paediatric Surgery Department, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi. The study duration was 18 months. Septic screening was done in all neonates on day 0, 1, 3, 7, and 14 days of surgery with serum procalcitonin, C-reactive protein, total leukocyte count, immature/total neutrophil ratio, and microerythrocyte sedimentation rate. A septic screening-positive patient (three or more positive parameters out of five) was correlated with sepsis and analysis was done. Results A total of 30 neonates of abdominal surgical cases were included consequently, out of which 56.7% (n = 17) were male and 43.3% (n = 13) were female. Maximum cases were of congenital diaphragmatic hernia 20% (n = 6) and then anorectal malformation 16.7% (n = 5). About 70% of neonates were sepsis screening positive. Fifty percentage of neonates were diagnosed to have sepsis on the clinical or laboratory findings, so sensitivity and specificity of sepsis screening were 93.33% and 40%, respectively. There was total 30% mortality in this study. Conclusion Sepsis screening is an early marker of sepsis, which can be used to help in early detection of neonatal surgical sepsis and timely intervention that can lead to decrease mortality and morbidity in neonatal surgery.
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Affiliation(s)
- Ritesh Kumar
- Department of General Surgery, ANIIMS and G. B. Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
- Department of Paediatric Surgery, ABVIMS and Dr. RML Hospital, New Delhi, India
| | | | | | - Gali Divya
- Department of Paediatric Surgery, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Rishabh Jaju
- Department of Anesthesiology, AIIMS, Deoghar, Jharkhand, India
| | | | - Amita Sen
- Department of Paediatric Surgery, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Shalu Shah
- Department of Paediatric Surgery, ABVIMS and Dr. RML Hospital, New Delhi, India
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Chawdhary S, Panigrahi PK, Sharma K, Yadav M, Ranjan R, Mishra A, Kumar D, Gaur SK, Ashish A, Sharma SP. Prognostic Role of Procalcitonin and C-reactive Protein in Surgical Neonates: A Single-Institution Experience. Cureus 2022; 14:e28319. [PMID: 36158418 PMCID: PMC9499833 DOI: 10.7759/cureus.28319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Neonatal sepsis is a dynamic process where the rigorous evaluation of clinical signs along with appropriately selected biomarkers guides the diagnosis of sepsis. Procalcitonin (PCT) and C-reactive protein (CRP) are the two most commonly used diagnostic biomarkers used in sepsis. Sepsis remains the most important cause of mortality and morbidity in surgical neonates. A cross-sectional study was conducted to assess the prognostic predictability of PCT and CRP in neonatal surgical sepsis. Methods All the neonates admitted to the neonatal surgical intensive care unit between January 2019 and December 2020 with features of sepsis were included in the study. Blood cultures, CRP, and PCT on Day one (PCT1) and Day three (PCT3) of suspicion of sepsis were evaluated. The receiver operating characteristics curve was studied to estimate the probability of two markers to predict the mortality in neonatal sepsis. Results Of 102 surgical neonates, 63 neonates had early-onset sepsis while 23 (22.5%) neonates died and 30 neonates reported positive blood culture. There was a decline in the overall PCT trend from PCT1 and PCT3, while a significant PCT rise was noted for the non-survival group (p= 0.003). At cut-off of 5 mg/dl for CRP and 2.5 ng/dl for PCT1 and PCT3, the sensitivity (36.0%, 25.8%, 100%), specificity (84.1%, 83.3%, 97.5%), positive predictive value (52.2%, 73.9%, 91.3%), and negative predictive values (73.4%, 38.0%, 100%) were observed. Conclusion PCT on Day three of suspected sepsis has higher sensitivity, specificity, and accuracy for prognostication of surgical neonatal sepsis at the cut-off value of 2.5 ng/ml. The rising trend of PCT levels is indicative of a poor prognosis.
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BÜYÜKFIRAT E, DEMİR A, DÖRTERLER ME, GÜNENDİ T. Etiology and Mortality Investigation in Neonates that Underwent Surgery. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1024822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mohta A, Mishra A, Khan NA, Jajoo M, Neogi S, Sengar M, Gupta CR. Evaluation of Risk Factors Affecting Outcome in Outborn Surgical Neonates. J Indian Assoc Pediatr Surg 2021; 26:307-310. [PMID: 34728915 PMCID: PMC8515518 DOI: 10.4103/jiaps.jiaps_149_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/22/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Mortality in surgical neonates contributes to neonatal mortality rates. The study was conceptualized to study clinical and nonclinical factors affecting mortality in surgical neonates so that timely intervention could result in improved survival of the neonates. Materials and Methods: The study was initiated after approval from the institutional ethics committee and included 120 surgical neonates over a period of 18 months after obtaining consent from the parents/caregivers. Predesigned pro forma was used to record the details of antenatal care received, place of birth, travel history, maternal education and gestational age, and clinical condition at the time of admission. Values of biochemical tests such as serum electrolytes, serum creatinine, and arterial blood gasses were recorded. The need of inotrope support, blood or blood product transfusion, and postoperative ventilator support and intensive care unit (ICU) care was recorded. The results of the two groups, i.e., survivals and mortality, were compared. Outcome was recorded as mortality at 30 days or earlier. Results: Irrespective of the surgical condition, the survival rate was significantly better in those babies who weighed more than 2.5 kg at the time of admission, had capillary refill time of <3 s, had serum ionized calcium levels more than 1 mmol/L, and did not require inotropes, blood or blood product transfusion, and postoperative ICU care and ventilator support. The place of birth, educational status of the mother, gestational age, and distance traveled for care had no statistically significant effect on survival. Conclusion: There is a statistically significant correlation between the survival of the babies who weighed more than 2.5 kg and are more physiologically preserved at the time of admission. Mortality rates can be decreased by timely interventions to reduce the need of inotropes, blood or blood products, and ICU care and ventilator support during their postoperative recovery.
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Affiliation(s)
- Anup Mohta
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Ashwani Mishra
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Niyaz A Khan
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Mamta Jajoo
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Sujoy Neogi
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Mamta Sengar
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Chhabi Ranu Gupta
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
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Risk factors of early mortality after neonatal surgery in Tunisia. J Pediatr Surg 2020; 55:2233-2237. [PMID: 32654833 DOI: 10.1016/j.jpedsurg.2020.05.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Research concerning factors of death after neonatal surgery is scarce. Insight into mortality might improve perioperative care. This study aimed to identify predictive factors of mortality after neonatal surgery in a low income country (LIC). METHODS Charts of all newborn patients who underwent surgical procedures under general anesthesia during the neonatal period in our department of pediatric surgery between January 2010 and December 2017 were reviewed. We used univariate and multivariate analysis to evaluate perioperative variables potentially predictive of early postoperative mortality. RESULTS One hundred eighty-two cases were included in the study: 41 newborns (28.6%) were premature (<37 weeks of gestation) and 52 (22.5%) weighed less than 2.5 kg. The most commonly diagnosed conditions were esophageal atresia (24%) and bowel obstruction (19%). Forty-four patients (24%) died during hospitalization. The highest rate of mortality was observed for congenital diaphragmatic hernia. Univariate analysis showed that perinatal predictive variables of mortality were prematurity, low birth weight, the necessity of preoperative intubation, and duration of surgery more than 2 h. Logistic regression showed three independent risk factors, which are the duration of surgery, low birth weight and the necessity of preoperative intubation. CONCLUSION The overall mortality in infants undergoing neonatal surgery is still high in LICs. Knowledge of independent risk factors of early mortality may help clinicians to more adequately manage the high-risk population. TYPE OF THE STUDY Clinical research paper. LEVEL OF EVIDENCE III.
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Siddharth V, Gupta SK, Agarwala S, Satpathy S, Goel P. Outcome of Care Provided in Neonatal Surgery Intensive Care Unit of a Public Sector Tertiary Care Teaching Hospital of India. J Indian Assoc Pediatr Surg 2019; 24:257-263. [PMID: 31571756 PMCID: PMC6752072 DOI: 10.4103/jiaps.jiaps_177_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: There is limited literature on the outcome of care in intensive care units (ICUs), especially when it comes to neonatal surgical units. Hence, this study was aimed to observe the outcome of care provided in the neonatal surgery ICU (NSICU) at an apex tertiary care teaching institute of North India. Methods: A descriptive, observational study was carried out through retrospective medical record analysis of all the patients admitted in NSICU from January to June 2011. Results: In NSICU, from January to June 2011, 85 patients were admitted. More than two-third (69.9%) patients were admitted through the emergency department. Of the total admitted patients, 69.9% were male. Mean and median age of the admitted patients were 6.31 and 2 days (range 0–153 days), respectively. The most common diagnosis was esophageal atresia with tracheoesophageal fistula (36.1%). Within a day of admission at NSICU, 88% patients underwent surgical intervention. Of the total admitted patients, 56.6% required mechanical ventilation with 3.57 days (range 0–31 days) of mean duration of mechanical ventilation. Reintubation rate (within 48 h of extubation) was observed to be 15.7%, and 27.7% (23) of the patients required vasopressor support during their NSICU stay. Patients who developed postoperative complications were 34.25%, with the most common being wound infection/discharge/dehiscence. Two patients were readmitted within 72 h of their discharge/transfer out from the NSICU. Conclusion: NSICU survival rate was 85.5% and net death rate was observed to be 14.5%. Sepsis was the major reason for mortality in NSICU.
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Affiliation(s)
- Vijaydeep Siddharth
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Shakti Kumar Gupta
- Dr. RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Satpathy
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Puri A, Lal B, Nangia S. A Pilot Study on Neonatal Surgical Mortality: A Multivariable Analysis of Predictors of Mortality in a Resource-Limited Setting. J Indian Assoc Pediatr Surg 2019; 24:36-44. [PMID: 30686886 PMCID: PMC6322181 DOI: 10.4103/jiaps.jiaps_30_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: The aim of this research is to study the predictors of neonatal surgical mortality (NSM)-defined as in-hospital death or death within 30 days of neonatal surgery. Materials and Methods: All neonates operated over the study period of 18 months were included to evaluate NSM. The evaluated preoperative and intraoperative variables were birth weight, gestation age, age at presentation, associated anomalies, site and duration of surgery, intraoperative blood loss, and temperature after surgery. Assessed postoperative variables included the need for vasopressors, postoperative ventilation, sepsis, reoperations, and time taken to achieve full enteral nutrition. Univariate and multivariate logistic regression was applied to find the predictors of mortality. Results: Based on patient's final outcome, patients were divided into two groups (Group 1-survival, n = 100 and Group 2-mortality, n = 50). Incidence of NSM in this series was 33.33%. Factors identified as predictors of NSM were duration of surgery >120 min (P = 0.007, odds ratio [OR]: 9.76), need for prolonged ventilation (P = 0.037, OR: 5.77), requirement of high dose of vasopressors (P = 0.003, OR: 25.65) and reoperations (P = 0.031, OR: 7.16 (1.20–42.81). Conclusion: NSM was largely dependent on intraoperative stress factors and postoperative care. Neonatal surgery has a negligible margin of error and warrants expertize to minimize the duration of surgery and complications requiring reoperations. Based on our observations, we suggest a risk stratification score for neonatal surgery.
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Affiliation(s)
- Archana Puri
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Brahmanand Lal
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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Yagi M, Kohno M, Asagiri K, Ikeda T, Okada T, Kanada S, Kawashima S, Goto Y, Takano S, Yasufuku M, Wada M. Twenty-year trends in neonatal surgery based on a nationwide Japanese surveillance program. Pediatr Surg Int 2015; 31:955-62. [PMID: 26319695 DOI: 10.1007/s00383-015-3775-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
AIM To discuss the chronological changes observed in a national survey of neonatal surgery in Japan performed every 5 years by the Committee in the Japanese Society of Pediatric Surgeons. METHODS We analyzed the data obtained for 20 years from 1993 to 2013 and herein report the chronological changes. RESULTS The number of summarized cases was least in 1993, with 2806 cases, and subsequently increased to 3753 cases in 2013. The mortality rate among the patients with maternal transport linearly decreased (p = 0.0386). Although the proportion of extremely low birth weight infants linearly increased (p = 0.0014), with an annual rate of +0.39 %, the mortality rate linearly decreased (p = 0.0010), with an annual rate of -1.68 %. Moreover, the overall mortality rate linearly decreased (p = 0.0002), with an annual rate of -0.26 %. Most diseases were observed to exhibit a decline in the mortality rate with the same trend as overall mortality. The decline in the mortality rate was most robust with respect to congenital diaphragmatic hernia (CDH). The mortality rates, except for that of CDH, omphalocele, esophageal atresia, and intestinal perforation, declined to 5 % or lower by 2013. CONCLUSIONS The present findings may be the result of remarkable progress in perinatal management.
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Affiliation(s)
- M Yagi
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan. .,Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahimachi, Kururme-City, Fukuoka, 830-0011, Japan.
| | - M Kohno
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - K Asagiri
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - T Ikeda
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - T Okada
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - S Kanada
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - S Kawashima
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - Y Goto
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - S Takano
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - M Yasufuku
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | - M Wada
- Committee of Academic Survey and Advanced Medical Science, Japanese Society of Pediatric Surgeons, Tokyo, Japan
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Catre D, Lopes MF, Madrigal A, Oliveiros B, Viana JS, Cabrita AS. Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 16:943-52. [PMID: 24896599 DOI: 10.1590/s1415-790x2013000400014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 06/05/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Anesthetic and operative interventions in neonates remain hazardous procedures, given the vulnerability of the patients in this pediatric population. The aim was to determine the preoperative and intraoperative factors associated with 30-day post-operative mortality and describe mortality outcomes following neonatal surgery under general anesthesia in our center. METHODS Infants less than 28 days of age who underwent general anesthesia for surgery during an 11-year period (2000 - 2010) in our tertiary care pediatric center were retrospectively identified using the pediatric intensive care unit database. Multiple logistic regression was used to identify independent preoperative and intraoperative factors associated with 30-day post-operative mortality. RESULTS Of the 437 infants in the study (median gestational age at birth 37 weeks, median birth weight 2,760 grams), 28 (6.4%) patients died before hospital discharge. Of these, 22 patients died within the first post-operative month. Logistic regression analysis showed increased odds of 30-day post-operative mortality among patients who presented American Society of Anesthesiologists physical status (ASA) score 3 or above (odds ratio 19.268; 95%CI 2.523 - 147.132) and surgery for necrotizing enterocolitis/gastrointestinal perforation (OR 5.291; 95%CI 1.962 - 14.266), compared to those who did not. CONCLUSION The overall in-hospital mortality of 6.4% is within the prevalence reported for developed countries. Establishing ASA score 3 or above and necrotizing enterocolitis/gastrointestinal perforation as independent risk factors for early mortality in neonatal surgery may help clinicians to more adequately manage this high risk population.
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Affiliation(s)
- Dora Catre
- Universitario de Coimbra, Coimbra, Portugal
| | | | - Angel Madrigal
- Centro Hospitalar, Universitario de Coimbra, Coimbra, Portugal
| | | | - Joaquim Silva Viana
- School of Health Sciences, Universidade da Beira Interior, Covilha, Portugal
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Ekwunife OH, Okpata A, Ugwu JO, Osuigwe AN. Outcome of neonatal surgeries in Nnewi, Nigeria. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000462927.37972.ff] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kandpal DK, Siddharth S, Balan S, Chowdhary SK. Intestinal obstruction in a premature baby: Endoscopic diagnosis and management by minimal access surgery. J Indian Assoc Pediatr Surg 2013; 18:118-20. [PMID: 24019644 PMCID: PMC3760311 DOI: 10.4103/0971-9261.116046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neonatal intestinal obstruction is the most common surgical emergency in a newborn. Although, large numbers of newborns are operated in our country, limited published literature is available on advances in diagnosis, and management of this problem with outcome analysis in newborns. We report a premature (32 weeks) newborn who developed acute onset symptoms of small bowel obstruction in 3rdweek of life, and discuss the approach to diagnosis and management with the minimal access surgery and successful outcome.
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Affiliation(s)
- Deepak K Kandpal
- Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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