Role of vascularized pedicled sternomastoid muscle flap in esophageal anastomosis: an experimental simulator of congenital esophageal atresia

This study was done at Al-Azhar University Hospitals in the period from April 1996 to July 2001. A total of 30 male new Zealand rabbits 4-6 months old weighting about 2.5 Kg were the materials of this work. In this work, 3 cm segment was resected from the cervical oesophagus and the oesophagus was anastomosed to create some sort of tension similar to that is present in congenital oesophageal atresia. Pedicled sternomoistoid muscle flap was used to reinforce the anastomsis in 15 rabbit [group B]. while in the other 15 rabbits [group A] no flaps were used, Five rabbits in-group [A] and one in-group [B] developed leakage and died in the first 2 weeks postoperatively. Three rabbits from each group were sacrificed 3 weeks postoperatively and the remaining alive rabbits are 11 in-group [B] and 7 in-group [A], were sacrificed 8 weeks postoperatively. All rabbits underwent clinical examination gastrograffin swallow, postmortem macroscopical examination and histopathological study using 4 types of dyes. The aim was to study the effect of muscle flap on the incidence of leakage and stricture and the mechanism of its action. The results of the study revealed that, the muscle flaps decreases remarkably the incidence of leakage, gives an extra blood supply to the anastomotic area and decreases the fibrosis in the anastomolic area, The mucosa was healed by regeneration and not by fibrous tissue excluding its role in incidence of stricture, The muscle flap itself was gradually infiltrated by increasing fibrous tissue by time

High peri-anal fistula, is there a place for seton in their management?

Thirty patients with high perianal fistulae were selected [22 males and 8 females with an average age ranging from 13 to 65 years] for this study. The main presenting symptoms were discharge [100%], pruritis ani [60%], pain [23.3%], swelling [16.6%], diarrhea [6.6%], constipation [6.6%] and fever [3.3%]. Fistulogram was accurate to demarcate the fistulous tract in 23 patients [76.6%] and most of the patients were managed under spinal or caudal block anesthesia. Fifteen patients were treated by fistulectomy operation [group I] and the other 15 patients were treated by cutting seton [group II]. In spite of the slight increase in pain amplitude and the increased discharge in seton group, the period of hospital stay was less [three days with seton versus seven days for fistulectomy] and the mean time needed for healing was also reduced [1.5 months for seton versus 3 months for fistulectomy]. Moreover, recurrence was encountered in only two cases after seton versus three cases after fistulectomy. However, the incidence of mild loss of sphincteric control was more after seton group [eight cases versus six cases after fistulectomy]. Most of them were slightly incontinence to flatus