ABSTRACT
Introduction: The paper discusses the challenges in providing care for children from underserved rural areas, for complex surgical conditions. It highlights the need to empower selected secondary hospitals to handle paediatric cases that represent a significant burden of surgical admissions, such as Pediatric Colorectal Diseases (PCRD), and risk inappropriate treatment when seen at a peripheral health facility level, as financial or transportation difficulties constrain access to a specialist hub. Materials and Methods: The study examines the capacity acquired by a secondary health facility to provide surgical care for Anorectal Malformations (ARM) and Hirschsprung's Diseases (HSCR) in terms of diagnostic accuracy, appropriate management, reduced complications, and favourable outcomes. The hospital serves a large catchment area with approximately 10 million people, including 45% who are under the age of 15. Results: Among 966 paediatric surgical admissions during the study period, ninety-four were referred for colorectal disease (ARM and HSCR). The document details the types of surgeries performed, complications encountered, and outcomes achieved. Posterior Sagittal Anorectoplasty (PSARP) was performed in 28 out of 42 ARM cases observed (66%) at a mean age of three years, and four were scheduled for treatment in a short time. Forty-six out of 48 HSCR cases could be treated with a favourable outcome by abdominoperineal pull-through or posterior rectal sphincterotomy. Conclusion: Extending specialist surgical coverage for children through selected secondary facilities with upgraded local capacities can significantly improve the management of Pediatric Colorectal Diseases in underserved areas, making appropriate staged treatments and close postoperative follow-up more accessible.

ABSTRACT
Congenital arteriovenous fistula is an extremely rare vascular malformation. Its symptomatology is variable and depends on its size as well as its location. We report the case of a 12-year-old girl with no known medical or surgical history, who was referred for an ultrasound examination at the Abidjan Heart Institute. Doppler ultrasound of the upper limb revealed a high-flow brachio-brachial arteriovenous fistula. The patient was subsequently transferred to the vascular surgery department for management.

ABSTRACT
Background: Hirschsprung’s disease (HD) is the most common surgical condition in pediatrics posing challenges to pediatricians and pediatric surgeons mainly practicing in resource-limited countries. Clinical features of the disease are variable and the risk factors in our setting are not well studied. Objectives: This study aimed at describing the clinical characteristics and determining the risk factors for Hirschsprung’s disease among Hirschsprung’s disease patients at Muhimbili National Hospital. Method: A case-control study was carried out whereby patients with histologically confirmed Hirschsprung’s disease and their caretakers admitted to the ward or attending regular clinics were selected, and verbally interviewed using a structured questionnaire and their findings were compared with corresponding controls without HD. Results: The study enrolled 225 cases and 476 controls. The majority of participants were male accounting for 156(69.4%) and 286(63.4%) for both cases and controls respectively. The mean age of the participants was 58 months, mainly coming from the coastal region where the hospital (MNH) is located. The most common age at first clinical presentation was neonatal age but the most age at confirmatory diagnosis was 25-60 months. Chronic constipation was the most common clinical presentation accounting for 223(99.1%) of cases followed by abdominal distension 207(92.0%) and soiling. Failure to pass meconium within 24 hours was common in cases (37.6%) compared to control (8.6%). %). Prematurity, Down’s syndrome, history of HD, and congenital anomalies in the family were found to be associated risk factors for Hirschsprung’s disease. Conclusion: The most common clinical presentations were found to be chronic constipation, abdominal distension, failure to pass meconium within 24-48 hours of life, and male predominance. Prematurity, Down’s syndrome, history of HD, and congenital anomalies in the family were more likely to be associated with Hirschsprung’

ABSTRACT
Total knee replacement (TKR) is an established procedure for advanced knee osteoarthritis, primarily indicated when pain and functional limitation significantly impair quality of life and activities of daily living. Surgical outcomes depend greatly on intraoperative technical decisions, particularly tibial cut and polyethylene thickness selection. This study explored the surgical preferences, intraoperative methods, and decision-making factors guiding proximal tibial resection and polyethylene selection among Nigerian orthopedic surgeons performing TKR. A descriptive cross-sectional survey of orthopedic surgeons with TKR experience was conducted using a structured questionnaire across four domains. Data were analyzed with descriptive statistics in SPSS v26. A total of 52 male surgeons participated, with 48.1% aged 41–50 years and 38.5% aged 51–60 years. Most had <10 years of arthroplasty experience (77%) and performed <50 TKRs annually (71%). Tibial resection was commonly guided by a combination of stylus and angel wing (69.2%), while polyethylene thickness was mainly determined by intraoperative gap assessment (69.3%). Key decision factors included flexion–extension gap balance (37.9% for tibial cut; 45.2% for polyethylene thickness) and joint line preservation (26.7% and 30.8%). The majority preferred polyethylene thickness of 10–12 mm (88.5%), with overstuffing indicated by polyethylene popping out on flexion (34.6%) or difficulty with insertion (31.5%). Nigerian orthopedic surgeons predominantly rely on conventional gap-balancing techniques and mid-range polyethylene thickness during TKR. The limited adoption of advanced technologies highlights the need for region-specific guidelines, enhanced training, and access to modern instrumentation to optimize surgical decision-making and long-term outcomes.

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Introduction: The aim of this study was to document the factors associated with death in children with cancer in the haematology-oncology unit of the paediatric department at Donka National Hospital between 1 January 2018 and 31 june 2021. Methods: This was a retrospective-prospective analytical study : retrospective over a 3-year period from 1 January 2018 to 30 june 2021. Results: We identified 122 cases of cancer-related deaths, representing 52.81% of the total. Males accounted for the majority of cases, representing 52.45% of the total. The under-2 age group was the most represented, accounting for 28.68%, with an average age of 4.39 years (3.97 years) and extremes of 1 year and 18 years. 57.37% of patients resided outside Conakry. The most common cancer was Burkitt's lymphoma, accounting for 31.14%. The factors associated with death with a statistically significant p-value were age : p-value 0.018; distance from home to the unit : p-value 0.001; the family's socioeconomic status : p-value 0.04; and the type of chemotherapy used : p-value 0.018. Conclusion: Although rare, childhood cancer remains a significant cause of mortality in children. The high mortality rate of these cancers in Guinea demonstrates the importance of this study and highlights the need for an epidemiological surveillance programme to improve care.

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Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure and carries one of the highest risks of serious complications. The success and safety of ERCP are strongly influenced by both the experience of the endoscopist and the procedural volume of the centre. Evidence have shown that higher case volumes are associated with improved outcomes and lower complication rates. However, this does not imply that low-volume centres are incapable of performing safe and effective ERCPs. This study aims to evaluate the outcomes of ERCPs performed by a single operator at a district general hospital. The results are compared with recognized international standards to assess the safety and efficacy of ERCP in a lower-volume setting. This retrospective study reviewed ERCP procedures performed in the General Surgery Department of Hospital Pakar Sultanah Fatimah, Muar, between 1 January 2021 and 31 October 2023. Data analysis included patient demographics, cannulation success rates, and procedure-related complications. Patients with missing or incomplete source documentation were excluded. A total of 137 ERCP procedures were analysed, of which 102 were first-time ERCPs. Most patients were Malay females. The overall common bile duct (CBD) cannulation success rate was 93.4%. Stone-related indications accounted for 94 procedures, with successful stone clearance during the first ERCP achieved in 58 cases (59.6%). The incidence of post-ERCP pancreatitis was 10.2%. These findings highlight opportunities for improving the ERCP service. In response, targeted changes have already been implemented to enhance patient safety and procedural outcomes.