High risk intestinal atresia: a comparative study of three different techniques

In the period between April 2000 and October 2002, 55 patients with intestinal atresia presented to Banha Children's Hospital, Ain-Shams University Hospital and Cairo University Hospital. Patients were classified into three groups. Group A included 27 patients who had primary intestinal anastomosis performed. Group B included 13 patients who had surgery in the form of Bishop-Koop technique. Group C included 15 patients to whom Santulli technique was carried out. Points of evaluation included age at presentation, mean weight at surgery, clinical picture, site and type of atresia, time needed to start oral feeding, methods of stoma closure [groups B, C] [spontaneous, surgical bed side closure under local anesthesia or surgical closure in the operating room under general anesthesia], duration of hospital stay, morbidity and mortality. The follow-up period ranged between 6 and 30 months. The results revealed that patients in the three groups of the study had comparable parameters and similar clinical picture. Smooth recovery was achieved in seven patients in group A [26%], seven patients in group B [45%] and eight in group C [59%]. Oral feeding was started early in groups B and C patients [mean 3.5-4 days] compared to group A [mean 11.5]. Mean hospital stay was 39 days for group A, 11.7 days for group B and 14.6 days for group C. Leakage and anastomotic dysfunction and eventual mortality occurred in 20 patients in group A [74%], six patients in group B [46%] and seven patients in group C [41%]. In conclusion, patients with intestinal atresia have variable prognosis depending on many factors including prematurity, site of atresia, disparity between proximal and distal bowel, associated anomalies, perforation and septicemia. In centers, where total parental nutrition is not freely available or associated with high incidence of complications, Bishop- Koop and Santulli techniques may help to improve survivals and reduce complications

Preservation of the urethral plate in repair of penile hypospadias with chordee

Over a period of one year, 17 boys with various forms of penile hypospadias with evident chordee were treated in our unit. Their age ranged from 2 to 8 years. All of them were primary cases, no redo. The position of the meatus was coronal in 6 boys, mid penile in 5, and proximal penile in 6 and all of them were non circumcised with evident chordee. The repair of hypospadias was done using various techniques with preservation of the urethral plate despite the presence of chordee, with a low incidence of complications. The preservation of the urethral plate in hypospadias repair is a principle with significant implications to an extended variety of hypospadias