Single stage Anterior Sagittal Anorectoplasty (ASARP) for Anorectal Malformations with Vestibular Fistula and Perineal Ectopic Anus in Females: A New Approach.

Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 – 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided.

Handling Overdispersion in Mortality Data in Time-Series Epidemiologic Research Using SAS Software

Analysis of count event data such as mortality cases, were often modelled using Poisson regression model. Maximum likelihood procedures were used by using SAS software to estimate the model parameters of a Poisson regression model. However, the Negative Binomial distribution has been widely suggested as the alternative to the Poisson when there is proof of overdispersion phenomenon. We modelled the mortality cases as the dependent variable using Poisson and Negative Binomial regression and compare both of the models. The procedures were done in SAS by using the function PROC GENMOD. The results showed that the mortality data in Poisson regression exhibit large ratio values between deviance to degree of freedom which indicate model misspecification or overdispersion. This large ratio was found to be reduced in Negative Binomial regression. The Normal probability plot of Pearson residual confirmed that the Negative Binomial regression is a better model than Poisson regression in modelling the mortality data. The objective of this study is to compare the goodness of fit of Poisson regression model and Negative Binomial regression model in the application of air pollution epidemiologic time series study by using SAS software.

Laparoscopic vagotomy in treatment of chronic duodenal ulcer [Posterior truncal vagotomy associated with anterior highly selective vagotomy]

To evaluate the safety of laparoscopic vagotomy this study included 20 patients with chronic duodenal ulcer, admitted in Al-Zahraa university hospital in the period between 1994-1997. Preoperatively, full history, clinical examination upper gastrointestinal endoscopy, abdominal ultrasonography and barium meal were done to all patients. Laparoscopic posterior truncal vagotomy associated with anterior highly selective vagotomy was done to all patients and any operative or postoperative complications were recorded. Postoperatively clinical evaluation and endoscopy were repeated to compare with the preoperative data and to assess ulcer healing. 90 to 180 minutes [mean 135 mm.]. Intraoperatively there was minimal bleeding in 2 cases and was controlled by diathermy and clips, two cases of arrthymia and one case of hypercapnoea improved spontaneously after temporal desufflation of co2. Postoperatively scapular pain, diffuse abdominal pain and mild fever were noticed in 6,2 and 2 patients respectively. Postoperative stay in the hospital was ranged from one to 5 days [mean 3 days]. Two patients were still complaining of dyspepsia and were improved by medical treatment. Six months follow up by endoscopy revealed that 19 cases were completely free and one case still had an ulcer which also was improved by medical treatment. One patient developed a very small hernia at the site of laparoscopic port above the umbilicus. However laparoscopic vagotomy is a new promising, minimally invasive technique. Its simplicity, safety, efficacy, minimal scarring and early mobilization support its wider use, but it will be necessary to validate this initial experience with a large number of patients and adequate long term follow up. So we concluded that laparoscopic vagotomy should not be developed so as to avoid or be contrary to the established principles of open surgery, but rather it should be designed as a continuation of classical surgery with new and different techniques