Partial versus total splenectomy in the management of hemolytic disorders in children, a randomized controlled trial

The risk of septicemia in postsplenectomy pediatric patients is approximately 2%. This risk is twice as great for children less than 4 years of age. In the first year of life this risk can be 30% or higher. Partial splenectomy is an alternative to preserve the immune function of the spleen. This study aims to compare Partial versus Total Splenectomy in the management of hereditary hemolytic blood disorders in children. The study was conducted at the Cairo University Children Hospital [CUPH], department of pediatric surgery. Seventy eight patients were assigned randomly to undergo either partial or total splenectomy in the period between 2000 and 2004. Thirty eight patients underwent partial splenectomy [PS] and 40 were assigned to the total splenectomy [TS] group. The data collected included age, gender, type of hemolytic disorder, ultrasonography, and hematologic values [HB concentration, Hematocrit and reticulocytic count], levels of IgM and lgG, description of surgical procedure and early- and late-occurring complications. From 2001 to 2004, 78 children from 3 years, 9 months to 7 years of age suffering various forms of hereditary hemolytic anemias [Thalassemia Major and Spherocytosis] underwent either TS or PS. Indications were hypersplenism and severe anemia. The average age at the time of the operation was 4 years, 5 months. There was a reduction in the need for transfusion after PS and was comparable to the results of the total splenectomy group. There was confirmed preservation of the immunologic phagocytic function of the residual splenic tissue. There was no increase in the rate of complications in the PS group compared to the TS group. Subtotal splenectomy [80-90%] seems to preserve the immunologic role of the spleen and reduce the need for blood transfusion. PS is associated with a regrowth of the splenic remnant. Thus, a second operation to perform a total splenectomy can be necessary. However preserving the immunologic function of the spleen and reduction of the risk of overwhelming sepsis warrants the procedure

Comparative study between the tubularized incised plate urethroplasty and single faced onlay preputial island flap in the management of mid-penile hypospadias

The tubularized incised plate [TIP] and the single faced Onlay preputial island flap procedures are two popular procedures used for the repair of mid-penile hypospadias deformity. This study was designed to compare these two techniques objectively. Forty five boys with similar mid-penile hypospadias deformities were selected for this study at Cairo University Children Hospital. All were 2 years or more at the time of operation. They were assigned randomly to either a TIP [n=24] or an Onlay procedure [n=21]. Operative details for each patient were recorded and the patients were followed up for a minimum of one year post operatively. Results were compared for three groups of variables: cosmetic outcome, occurrence of complications and function results which was assessed by uroflowmetry studies. Results were compiled and compared statistically. There were no differences between the two techniques as regard incidence of complications and function. On the other hand there was a significant statistical difference regarding cosmetic outcome in favor for the TIP procedure. Due to its easier technique and superior cosmetic results, the authors believe it is indicated whenever suitable urethral plate is present. Both the TIP and Onlay procedures proved to be effective techniques in the management of mid penile hypospadias. However, due to a significantly better cosmetic results and easier technicality of TIP the authors believes it is indicated whenever the suitable urethral plate is available