Results of surgical repair of primary obstructive megaureter.

Surgical treatment of primary obstructive megaureter is generally recommended when ureteral dilatation is likely to contribute to symptoms such as pyelonephritis or calculi. The authors' objective for this study was to present the surgical results performing ureteral reimplantation, combined with modified Lich-Gregoir antireflux procedure (using anchoring stitch) over a 10 year period. The average operative time for ureteral reimplantation was 259.64 minutes. The authors' success rate was 92% and all patients had no postoperative ureteral obstruction from intussusception of reimplanted ureter Follow-up postoperative renal sonography at 22 weeks showed a decrease in hydronephrosis in 92%. The authors concluded that the surgical results were comparable with surgical results of other techniques and an anchoring stitch should be considered to prevent postoperative ureteral obstruction from ureteral intussusception.

Surgical treatment for congenital duodenal obstruction.

Thirty-four congenital duodenal obstructions (19 duodenal atresia, 7 duodenal web, 7 annular pancreas and one duodenal stenosis) were surgically treated in Siriraj Hospital between 1990 and 1999. Eleven per cent of duodenal atresia had no bile-stained vomiting. Duodenal web which received web excision and duodenoplasty in 43 per cent of cases, also presented with bile-stained vomiting. Duodeno-duodenostomy, duodeno-jejunostomy and web excision with duodenoplasty were performed in 29, 2 and 3 patients respectively. Duodeno-duodenostomy and web excision with duodenoplasty had no difference in the feeding capability. There was no statistically significant difference in duration of TPN, ability to be early fed, post-operative onset of full feeding and hospital stay between diamond-shaped (n = 18) and side-to-side (n = 11) duodeno-duodenostomy. Although transanastomotic feeding tube (n = 4) decreased a percentage of TPN requirement and made early feeding possible, the onset of full feeding, duration of TPN and hospital stay were not different from those who had no transanastomotic tube (n = 30).