Posterior sagittal anorectoplasty versus anterior sagittal anorectoplasty for repair of low imperforate anus in females

In the surgical correction of low imperforate anus in females, many surgical procedures were tried mostly cutback or anal transposition. These procedures have many disadvantages with unaccepted results. Pena in 1982 and Okada in 1992, described the posterior sagittal and anterior sagittal anorectoplasty respectively for correction of such anomalies. Twenty cases of low imperforate anus in females were classified into 2 groups, 10 patients for each First group [I]: Limited pesterior sagittal anorectoplasty was used for the repair. Second group; [II]: Anterior Sagittal anorectoplasty was used for the repair. Second group [II]: Anterior sagittal anorectoplasty was used for the repair. In this study, the functional and cosmetic outcomes were compared in the two procedures. From this study we concluded that the results of both procedures are satisfactory

Primary pull-through for Hirschsprung's disease: abdominal vs transanal

In the last few years, one stage pull-through operation for Hirschsprung's disease has replaced the previous gold standard of 2 or 3-stage procedures. One stage procedure can be done abdominally, by laparoscope, or completely trans-anally. In this research, we compared trans-anal with abdominal approach for one-stage pull-through for Hirschsprung's disease. The study was done in Zagazig University Hospitals and included 24 patients with biopsy proven Hirschsprung's disease. The patients were selected according to standard inclusion and exclusion criteria, and were prospectively randomized into group A with trans-anal and group B with abdominal approach. Assessment included patients data, operative and early post-operative courses. Also, late operative sequelae [within 6 months] were evaluated according to unified system. There was significant increase in operative blood loss and hospital stay in-group B. No significant difference was evident between the two approaches concerning early and late postoperative sequelae. Avoidance of laparotomy in trans-anal route is attractive, but more studies are needed to confirm its safety and to stratify indications and contraindications of its use

Early versus delayed laparoscopic cholecystectomy for the treatment of acute cholecystitis

Patients with a preoperative diagnosis of acute cholecystitis were prospectively allocated to treatment with early laparoscopic cholecystectomy within 24 hs of randomization or initial conservative treatment followed by delayed laparoscopic cholecystectomy 6-8 weeks later. There were 31 patients in the early group and 27 in the delayed group. There were no significant difference in conversion rate[early 19.4 percent versus delayed 22 percent], postoperative analgesic requirement [2 versus 1 dose]. Intra and postoperative complications. However, the early group has significantly longer operating time [112.5 versus 96.4 min, P=0.03] and shorter total hospital stay [3.7 versus 2.2 days, P<0.001]. The incidence of bacterial complications being markedly low, especially in the early group.These results indicate early laparoscopic cholecystectomy is safe and feasible for acute cholecystitis with the additional benefit of shorter total hospital stay and avoid the problems of failed conservative treatment and delayed surgery

saftey of laparoscopic cholecystectomy for cholelithiasis in sickle cell disease

As surgery in sickle cell patients is associated with high morbidity, this study aimed to establish the safety of minimally invasive surgery in this high-risk group. The study included 41 sickle cell patients underwent laparoscopic cholecystectomy [LC] for cholelithiasis, three patients had asymptomatic gallstones and preoperative gastroscopy and endoscopic retrograde cholangiography were performed in nine and eight patients, respectively. Twenty-six patients were given simple transfusions, while three received partial exchange transfusions. The mean operative time was 10 minutes and the conversion rate was 4.8%. There were 14.6% postoperative complications, the majority of which were respiratory and wound related and the median hospital stay was 2.5 days. Laparoscopic cholecystectomy is safe in patients with sickle cell hemoglobinopathy who are particularly at risk of developing pigmented gallstones. Therefore, the use of minimally invasive surgery is encouraged in any sickle cell patient undergoing operative intervention with the advantages of short postoperative analgesia requirement, shorter hospitalization and remarkable reductions in perioperative morbidity