ABSTRACT
Objectives: The purpose of this study was to determine the predictors of the clinical outcome after Kasai portoenterostomy done for cases with biliary atresia [BA]
Study design: a prospective clinical study involving twenty patients with billay atresia that underwent Kasai operation. All patients underwent a detailed history taking, clinical examination and were investigated for liver function tests. US abdomen was also done in addition to preoperative liver biopsy and intra-operative cholangiogram. Patients were followed up for a period of 6 months post operatively and complications such as cholangitis, progress to liver failure and cirrhosis was noted. The schedule and indications for liver transplantation were also followed
Results: There were no mortalities within the 6 months of follow up, 11 patients showed gradual reduction of serum bilirubin [<2mg/dI] as well as liver enzymes [Non-icteric] and 9 patients' maintained high levels of serum bilirubin [>2mg/d1] and liver enzymes [Icteric].There was statistically significant difference between the two groups regarding age at operation, presence of preoperative ascites, hepatomegaly and patients' child-Pugh score. Preoperative total serum bilirubin and its direct fraction, preoperative liver enzymes [AST-ALT-GGT-alkaline phosphatase], preoperative serum albumin and total proteins, advanced pathological changes in preoperative liver biopsy showed statistically significant difference between the two groups. However; sex, splenomegaly, associated anomalies, bleeding profile, presence of preoperative TC sign and operative duration didn't show statistically significant difference between the two groups
Conclusion: Kasai portoenterostomy showed better results with short term follow up if done at an early age. Presence of ascites, hepatomegaly and advanced Child-Pugh score adversely affect the clinical outcome, Better outcome is predicted also by lower preoperative serum bilirubin with its direct fraction, lower levels of liver function tests and higher levels of plasma proteins and serum albumin. Advanced liver fibrosis and pathological changes in preoperative liver biopsy are predictors of bad outcome after Kasai portoenterostomy
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Biliary Atresia/surgery , Treatment Outcome , Prospective StudiesABSTRACT
The aim of this study is to compare between the transanal pull-through and the open Soave technique in the surgical correction of neonatal Hirschsprung's disease as regards the results, feasibility, operative and immediate postoperative details. A prospective analysis of twenty neonates with Hirschsprung's disease admitted to the Pediatric Surgery Unit, Alexandria University from August 2002, till August 2003, was carried out. The twenty cases were classified randomly into two groups, ten in each. Group A underwent transanal pull-through, while group B underwent open Soave operation. The results showed that, in-group A, the mean operative time was 40 minutes [30-60], compared to 80 minutes in-group B. The mean length of hospital of stay was three days [2-5] in-group A, while in-group B it was 9 days [8-11]. Babies in-group A started oral feeding after a mean period of 1.5 day [1-2 days], whereas in-group B, it was 4 days [3-5]. Both groups recorded no bowel motion disturbance. Two cases required anal dilatation in-group B, in comparison to only one case in-group A. Neither major complications, nor mortality was observed
Conclusion: in selected cases, one stage pull-through operation can be safely done in neonatal Hirschsprung's disease. Transanal technique is superior to open Soave due to its simplicity, cost effectiveness, and less surgical morbidity
ABSTRACT
Undescended testis is a common congenital abnormality in children that contributes to impaired fertility in adulthood. The pathogenesis of the reduced fertility seen in cryptorchidism has not been fully clarified. This work aimed at evaluating the role of germ cell apoptosis as well as serum inhibin B as prognostic markers of fertility potential. The study was carried on 32 children with unilateral undescended testis, divided into three age groups: group 1 [< 6 months], group 2 [6-12 months] and group 3 [12-24 months]. Control group included 22 age-matched children admitted for herniotomy. Histological assessment of apoptosis using semithin sections and immunohistochemical staining for Fas were done for testicular biopsy of cryptorchid patients. Hormonal assay of serum inhibin B, FSH, LH and testosterone of patients and controls were done. Blunted gonadotrophins surge was observed in cryptorchid infants [group 1], which was accompanied by defective transformation of gonocytes to adult spermatogonia. In groups 2 and 3, inhibin B was significantly lower in cryptorchid than their age- matched controls [P=0.014, P=0.01 respectively], while in these two groups testosterone level was very low in both patients and controls with no significant difference detected. Reduced inhibin B was parallel with high Fas expression and accelerated rate of germ cell apoptosis mostly in group two. In group 3, evidence of testicular atrophy was depicted. From the previous results, it could be concluded that the longer duration of maldescent carries more risk of impaired fertility potential, mainly through delayed germ cell maturation and enhanced apoptosis
ABSTRACT
Aim: Assessment of: 1. Functional patterns in patients with refractory idiopathic constipation and its impact on treatment strategies. 2. Role of anorectal myectomy in outlet obstruction
Methods: Forty patients with refractory constipation were subjected to full clinical assessment, perineometry, standard proctography, measurement of the anorectal angle, assessment of colon motility, colon transit time, and anal manometry, assessment of rectal sensation, recto anal inhibitory reflex, electromyography, and rectal biopsy. Anorectal myectomy was performed as a therapeutic and diagnostic procedure
Results: Patients with normal CTT included 56.25% of children and 43.75% of adults. A significant difference was present in perineal descent between patients with delayed CTT and the control group. After anorectal myectomy, there was an overall significantfall in maximum resting anal pressure. The RAIR was present in 66.67% after anorectal myectomy. Rectal biopsy and histopathological examination revealed aganglionosis and diagnosis of ultrashort-segment Hirschsprungs disease in 31.25% with normal CIT and 16.7% with delayed CTT. 75% of patients with delayed CTT and without aganglionosis were initially improved by anorectal myectomy. Patients with ultrashort-segment were cured after anorectal myectomy
Conclusions: Anarectal myectomy is successful in outlet obstruction constipation and is perfect in detection and cure of ultrashort-segment Hirschsprungs disease presenting as refractory constipation
ABSTRACT
Background: Low-sited presacral intrapelvic malignant tumors represent one of the challenging situations for surgeons. Laparotomy alone often does not provide adequate exposure for complete excision of a midline intrapelvic tumor
Objective: To evaluate, describe and discuss the use of PMA in the treatment of intrapelvic malignant tumors which are too high to be approached through the perineum and too low to be excised by laparotomy alone
Patients: A prospective study of eighteen patients suffering from documented malignant Iow-sited intrapelvic tumors. Methods: All patients were subjected to tumor excision through the posterior midsagittal approach. After excision, the rectum was placed in the normal position. The pelvic floor muscles were reconstructed in the midline
Results: The size of the completely resected tumors ranged from 2.5 x 4 cm to 7 x 11.5 cm. Complete excision was amenable in 15 patients [83.33%], while in three patients only partial tumor excision could be done. Histopathological results of resected tumors showed the predominance of prostatic rhabdomyosarcoma in male patients and mature teratoma in female patients. Postoperatively, no complications were recorded. In all the nine patients above 4 years-old, fecal continence was not affected. The function of the bladder remained undisturbed in all patients. Postoperative follow up of patients revealed that patients with complete tumor excision [83.33%] were disease-free during the whole follow-up period, [mean of 24.5 +/- 5.33 months]. Conclusion: Based on the results of this study, it can be concluded that PMA is a safe effective procedure for the radical excision of Intrapelvic malignant tumors which are too low to be approached through the perineum and too high to be reached by laparotomy alone
ABSTRACT
Background: PSARP procedure is claimed to have a better chance of enabling normal continence in later years. Questions have arisen regarding whether PSARP is superior to other repair methods
Objective: This study was designed to analyze quantitatively the clinical, manometric and functional results of PSARP and to compare the results of one stage PSARP with the multistage PSARP
Patients: A prospective study of eighty patients with high anorectal malformation who were selected out of 193 cases admitted in the period from June 1997 to March 2000 to the Main Alexandria University Hospital
Methods: Twenty patients were selected at random for the one-stage PSARP [Group I]. Multistage PSARP were carried out for the remaining sixty patients [Group II]. All patients were assessed by electrostimulation, MRI, manometry, and FCS. Prospective follow up recorded the efficacy of PSARP, the clinical and the functional outcome together with complications. All patients were followed up for a period that ranged from three years to six years with a mean of 4.52 t 0.63 years
Results: Electrostimulation revealed that in only 49 patients [61.25%], the new anal site was found to be central within the muscle complex. 43.75% were continent with good PCS. 28.75% were intermittently continent. 27.5% had involuntary passage of stools at least once a day. One stage operation resulted in a much more superior PCS than the multistage procedure with highly significant difference in the good PCS and poor PCS cases. RAP was < 40 cm H20 in patients complaining of soiling. All continent patients showed MSP > 135 cm H20. There was no clear correlation between RV and sailing, but patients with severe soiling had an RV > 150 mL. 76.25% showed a rectal sensation urge to go. 36.25% showed a normal RAIR
Results: MRI correlated well with PCS and electrostimulation. Eleven patients had postoperative complications
Conclusion: PSARP allows preservation of the anatomy of pelvic floor muscles and limits affection of fecal continence. One stage PSARP is a safe effective procedure which gives the superior results in treatment of patients with high Anorectal malformations. It minimizes postoperative complications, colostomy drawbacks, costs, hospital stay and psychological problems
ABSTRACT
The aim of this work was to study cases of spontaneous reduction of intussusception and their implication on the management and outcome. We routinely use ultrasound for diagnosis and hydrostatic reduction of intussusception with saline enema. The study included 16 patients who were admitted to the Pediatric Surgical Center, Faculty of Medicine, University of Alexandria during the period between January 1996 and October 2000 with the diagnosis of intussusception. They fulfilled the study criteria of spontaneous reduction. Details of the clinical picture were compared with the standard cases of intussusception together with correlation with ultrasound features before and after reduction. All cases were examined on admission and diagnosis of intussusception was confirmed by finding the characteristic target sign on ultrasound. During the period of preparation for hydrostatic reduction or during transport from another center, 12 cases showed evidence of spontaneous reduction, which was confirmed by ultrasound and observation. Hydrostatic reduction was attempted in 4 cases. Four cases showed faint target sign on ultrasound after trial of reduction and were considered questionable. Surgical exploration was performed and showed a reduced intussusception. Spontaneous reduction of intussusception is a possible though rare fate of childhood intussusception. It must be borne in mind to avoid unnecessary surgery in this peculiar subset of patients. The pseudotarget sign on ultrasound can be present for a short period after successful reduction of intussusception and is probably due to residual edema. Awareness, short period of observation and repeating sonography examination after 2 hours will avoid confusion in these cases