Chordee without hypospadias: operative classification and its management

Developing countries. To propose a operative classification of Chordee without hypospadias [CWH] with its management. Tertiary referral centre; Retrospective study from January 2000 to January 2011. Total 26 patients were classified peroperatively into sixtypes [A: Cutaneous chordee[rightwards arrow] Degloving skin and dartos [1/26]; B: Fibrous chordee[rightwards arrow] chordectomy [4/26];C: Corporocavernosalchordee[rightwards arrow] Corporoplasty +/- Urethral mobilization [4/26]; D: Urethral tethering with Hypoplastic urethra[rightwards arrow]Urethral mobilization +/- urethral reconstruction because of hypoplastic urethra [14/26]; E: Congenital short urethra[rightwards arrow] excision of urethra from the meatus and urethroplasty [2/26]; and F: Complex chordee[rightwards arrow] Degloving +/- Corporoplasty +/- urethroplasty [1/26 patients].The follow-up over 6 months to 9 years were analyzed. SPSS soft ware version 17.0 for Windows. The mean age of surgery was 5.33 +/- ?0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% [7/26] [including 7.7% [3/26] of associated metal stenosis]. The urethral stricture developed in 3.8% [1/26]. CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results

Long-term follow up of mesenchymal hamartoma of liver-single center study

Mesenchymal hamartoma of liver [MHL] is a rare liver tumor of childhood. About 200 cases have been reported till now. Most of the work on MHL is limited to case reports and there are not many long term follow-up studies. We present our 20 years of experience with this uncommon entity. This study aims to highlight clinical features, diagnosis and treatment of MHL. All patients with a diagnosis of MHL in last 20 years were included in this retrospective study. The patients were evaluated clinically, radiologically and pathologically. The total number of patients with a diagnosis of MHL was nine. Mean age of the patients was 19.89 +/- 2.75 months. Right lobe was involved in eight patients. The prominent clinical features were distension of abdomen and anorexia. Surgical options used were hepatic lobectomy, wedge resection and enucleation. Histopathology of the specimens showed cysts of variable size with normal hepatocytes, bile ducts and connective tissue stroma. Overall mortality was one [11.11%].: MHL is a benign tumor that can present with various clinical features. It should be differentiated carefully from other liver masses especially malignant ones. The diagnosis can be made with the help of radiology and histopathology. Adequate resection is curative in most of the cases and long-term follow up is satisfactory

Modified method of T-tube placement in cases of ruptured choledochal cyst having complete loss of anterior wall

Survival rates for infants and children who have choledochal cyst with or without spontaneous rupture have improved dramatically in the past decades. Despite excellent long-term survival for patients with choledochal cyst who undergo elective surgery, many significant complications can occur in the patients being operated in emergency for rupture of the cyst. Spontaneous rupture of the cyst is one such problem resulting in considerable morbidity and mortality in these patients. Majority of surgeons manage these cases with T-tube external drainage. The conventional methods of T-tube placement for long period has remained simple as described in choledochotomies where there is no deficit of the walls of common bile duct [CBD]. The present technique has been designed specially for the cases of ruptured choledochal cyst, where the wall of the CBD gets necrosed leaving behind a long gap between the two ends. In these cases, placement of T-tube with conventional method is not possible because there is no wall to suture together, and make the CBD water tight again to prevent leakage of bile. We found only two patients of spontaneous rupture of choledochal cyst with a long gap between two ends of CBD because of necrosed anterior wall. In both of these patients, it was not possible to put T-tube with traditional method and one would have to opt for primary definitive repair despite poor general condition of patients