Buccal mucosal graft for crippled hypospadias [experience in 11 cases]

Hypospadias is defined as the incomplete virilization of the genital tubercle causing an incomplete development of the tissues forming the ventral urethra. Free buccal mucosal graft is an excellent option if the genital tissue is fibrous or deficient. We would like to present our small experience with buccal mucosa on-lay graft for the treatment of anterior urethral stricture and recurrent urethra-cutaneous fistula after hypospadias

repair in male children. Between October 2004 and March 2007 we operated upon nine male patients. Their age ranged from 3-12 years old. Free buccal mucosal on-lay grafts from the inner aspect of the lower lip were taken for three cases of complicated anterior urethral stricture and for six cases of recurrent urethra-cutaneous fistula after previous multiple penile hypospadias repairs. Nine on-lay free grafts were ventrally placed on the penile urethra. The grafts length ranged from 0.5 to 6 centimeters. All these operations were performed in one stage by a single surgeon and his team. The follow up period was from 2 to 5 years. The success was achieved in 8 out of 11[73%] patients. Urethral complications occurred in three cases which were evident by one month and three months postoperatively. The first one had severe proximal and distal urethral strictures which eventually required a proximal urethrostomy as a first stage. The second one had a mild stenosis which required two meatal dilitations and at last a meatoplasty. The third one had a small fistula which was simply closed later. One patient developed a hypertrophied scar at the harvest site which spontaneously resolved over a period of three months. Complex hypospadias surgery is challenging and should be done by an experienced pediatric surgeon. Utilizing the buccal mucosa in case of deficient genital skin is an efficient, practical, and safe technique of managing the crippled cases that need redo surgery

Efficacy of combined local anesthetic wound infiltration and paracetamol suppositories in relieving postoperative pain in children

To evaluate the efficacy of combined incisional infiltration with Bupivacine and Paracetamol suppositories with Paracetamol suppositories alone in relieving the postoperative pain associated with surgery of inguinal pathologies. Prospectively, on hundred and ten children whom underwent groin surgery at Prince Rashed Ben Al-Hassan hospital form April 1, 2008 to December 1, 2008 were included in the study. Their ages ranged from six months to 13 years. Surgery was performed under general anesthesia. Patients were randomized into two groups; group A [55 patients] received Paracetamol rectally 30 mg/kg immediately preoperatively, while group B [55 patients] had Paracetamol rectally 30mg/kg and incisional wound infiltration with Bupivacaine 1 mg/kg. Post operative pain was managed by giving Paracetamol. The duration of the postoperative analgesia was estimated based on the time when rescue analgesia was first given. Assessment of the quality of postoperative analgesia was based on the children's behavior. In our study, both parents and older children were willing to cooperate. None of the children in the study groups suffered from local anesthetic toxicity such as arrhythmias, seizures, allergy and hematoma or tissue edema. In group A, 15 children suffered pain in the recovery room and received further analgesia in the form of Paracetamol suppositories, 18 had pain and received analgesia at home within four to six hours after discharge. The remaining 22 suffered pain during the next five days after surgery. In group B, two patients had pain in the recovery room, eight had pain with early mobilization at home and had their first analgesic dose after five to eight hours. The other 45 children had no significant post-operative pain. Group B showed an increased duration of postoperative analgesia with early mobilization. Rescue mean time at which children had their first post-operative dose of analgesia was two to four hours in group A and it was five to eight hours in group B. No patient in group B needed analgesia after day three post-operatively. Wound infiltration with Bupivacaine 1mg.kg combined with rectal Paracetamol 20 mg/kg has a better and valuable efficacy compared to the rectal Paracetamol 30mg/kg alone with respect to providing pain relief following inguinal herniotomy, hydrocelectomy and orchidopexy in children, with a longer duration of pain relief and earlier mobilization

Percutaneous central venous catheterization in children, is it efficient?

To evaluate the frequent use of percutaneous central venous catheters [CVCs] in pediatric age group. Retrospectively we reviewed the records of all children that had percutaneous CVCs in the pediatric surgical ward and pediatric intensive care unit at King Hussein Medical Center between January 2007 and December 2007 [one year]. Patients were evaluated with respect to their age, gender, catheter type, indication for CVC insertion, site of CVC insertion. The duration of catheter use and eventual complications were also taken into consideration. A total of 120 percutaneous CVCs were inserted in 104 children. Patient age ranged from one day to 14 years. The average catheter insertion time was 12.5 days. We noted 66 [18.8%] CVC- related complications. Complications related to percutaneous CVCs insertion were malposition of catheter [5.4%] and pneumothorax [0.9%]. Occlusion of CVCs [4.3%], catheter related bloodstream infections [CRBI] [4.0%], dislodgment [3.7%] and catheter damage [0.6%] were complications associated with length of CVCs use. We conclude that percutaneous central venous catheterization is a safe and efficient procedure that can be done at bedside with minimal complications in pediatric age group