ABSTRACT
Background: Hirschsprung's disease [HSCR] is the most common congenital malformation of the enteric nervous system. Duhamel's Operation [DO] is among the accepted procedures for the treatment of Hirschsprung's disease. One stage pull-through without colostomy has been reported. The procedure is currently performed using circular staplers, which afford equally good results
Objective: To evaluate efficacy and feasability of one-stage Duhamel's procedure using circular stapler for treatment Hirschsprung's disease
Patients and methods: Over a period or 2 years, 22 child patients have been treated by one stage Duhamel's operation using circular stapler after good preparation of the colon. Clinical presentation, other anomalies, operative time, intraoperative complications, bowel habits, continence scoring, postoperative complications and mean of body weight were reported within 2-ycars follow-up period
Results: The mean or age was 2.6 years [range: 1-4 years]. There was post-operative wound infection in one case, no infection at the anastomotic site, or pelvic collection. Motion was passed within 24 to 48 hours and the patients discharge from the hospital within 7 to 14 days postoperative. There were no intraoperative complications. All postoperative complications were mild to moderate in severity and improved after medical treatment. Bowel function was significantly improved after surgery. There was a significant increase in the modified Kelly's continence scoring after operation [p-value <0.001]
Conclusion: One-stage Duhamel's operation with circular stapler has a great satisfactory results in infancy and early childhood
ABSTRACT
In the last year 1999, multi disciplinary projects were done between surgical, dermatological and pediatric departments aiming to re-explore the histological and morphological changes in cryptorchid testis and its relation to age. Twenty four male patients were divided into 4 main groups; group A included 6 infants under the age of 2 years, group B included 4 patients from 2-9 years [prepubertal], group C included 6 patients from 9 to 14 years [pubertal] and group D included patients from 14 to 21 years [postpubertal]. Orchidopexy was done for all patients in one stage and bilateral testicular biopsy was taken and fixed immediately in Baun's solution and then stained by H and E for histopathological preparations. The results showed that for boys under the age of 2 years, there was no change from the normal spermatogonia and sertoli cells with no thickening of their basement membrane. For prepubertal children, changes were evident by the age of 7 and 8 years in the form of decreased number of spermatogonia, delayed maturation of sertoli cells, widening of interstitial spaces and increased number of fibroblasts in the interstitium. In pubertal patients, the spermatogonia became rare and sertoli cells were immature. Biopsy specimens from post-pubertal patients showed marked reduction of spermatogonia and arrest of spermatogenesis at primary spermatocyte stage