Posterior sagital anorectal myoectomy versus transanal myoectomy in the management of short-segment hirshsprung's disease

Unlike classic Hirshsprung's disease, short segment varieties of the disease are usually found to be latent arid milder and depends mainly on proper diagnosis and good selection of the cases. During the period from March 2001 to Jan. 2004, twenty sex infants and child proved to have short segment Hirshsprung's disease by proper history taking, radiological study and hitopathological study of the rectal biopsies [two or three biopsies at different level] were the material of this research. The patients were classified into0two groups randomly, the first group include 12 patients were subjected to transanal myectomy [TAM] and the second group which include 14 patients were subjected to posterior Sagital anal myectomy [PSAM]. By analysis of the results of the first procedure [TAM] it was noticed that good results occurred in 8 patients 67% with postoperative normal bowel habit and reliving of symptoms, but recurrence of symptoms occurred in three patient 25% and postoperative soiling was noticed in 4 patients [33%], which was gradually improved. Two patients from this group [16%] required reintervention by abdominal procedure to excise the involved segment and to restore the continuity of GIT by Soave procedure. Posterior Sagital anal myectomy was done in the second group and show more accepted results than the first group, where good results was noticed among 12 patients from 14 patients [86%] with postoperative normal bowel motion and reliving of all preoperative symptoms. Also recurrence of symptoms occurred only in one child but postoperative soiling was noticed only in 3 patient and one patients required second revision by abdominal procedure. In conclusion posterior Sagital anal myectomy gives good results in the management of short segment Hirshsprung's disease than the transanal myectomy, especially with good selection of cases after proper diagnosis

Correction of proximal hypospadias with a modification of skin covering

In this study, both the double faced onlay flap technique and the combined onlay and tubularized flap technique were used, where the urethral plate was proximally divided. Forty-eight patients with proximal hypospadius were subjected to these techniques from June 2000 to November 2002. Their ages ranged from 3 to 14 years [mean 4.8 years]. The urethral meatus was at midshaft in 8 patients, penoscrotal in 36 and perineal in 4 patients. Double faced onlay flap with an excision of the chordee beneath the urethral plate with or without dorsal plication were done to 32 patients. In the remaining 16 patients, combined onlay and tubularized flap was fashioned. Urethral fistulas occurred in 12 patients; 7 underwent double faced onlay flap and 5 underwent combined onlay and tubularized flap. All fistulas were minor. Meatal stricture occurred in eight patients, seven of them were combined with the urethral fistulas