Esophagocoloplasty for caustic stricture of the esophagus: changing concepts

A review of 540 patients with caustic esophageal stricture who underwent esophageal replacement over a 20 years period is presented. Their age at the time of esophagocoloplasty varied from 9 months to 18 years [mean 3.4 years]. Simple colon bypass of the strictured esophagus was performed in 455 patients utilizing the retrosternal route. Trans-hiatal esophagectomy with colon interposition was performed in the successive 85 patients. The overall mortality rate was 4.25%. 296 patients were available for periods between 1 and 20 years for evaluation. The isoperistaltic left colon is the best substitute for strictured esophagus in the experience. Prereconstruction feeding catheter gastrostomy is of utmost importance in most of the patients. Over the years, changes in technical measures to reduce colonic graft redundancy, esophagocolic anastomotic leak and stenosis, fear of malignant potentials and complications of left strictured esophagus have been learnt and are the subjects of this review

Antenatal detection of obstructive uropathy: postnatal management

The widespread use of maternal ultrasonography has resulted in an increasing number of newborns diagnosed with obstructive uropathy [O.U]. Over the past 4 years, 39 neonates had been referred for evaluation of their prenatally detected O.U. thirty-four were males. Mean time of prenatal ultrasound examination was 32 +/- 2 weeks of gestation. Postnatal evaluation consisted of ultrasonography, voiding cystourethrography, excretory urography and radionuclide renal scan to assess the differental function and document the severity of obstruction. One infant died at 2 days of age. In the remaining 38 patients, surgery was needed in 34 of them. The excellent postoperative clinical and radiological status of these patients further advocates early intervention when feasible

Augmentation cystoplasty: a report of eleven cases

Since 1988, eleven children underwent augmentation cystoplasty for bladder exstrophy/epispadias complex 6, myelomeningocoele 2, sacral agenesis 1 and non-compliant bladders associated with posterior urethral valves 2. the augmentation was performed by the use of sigmoid colon in 6 patients, ileum in 3, cecum in 1, and lyophilized human dura in 1. eight patients underwent additional procedures, including transtrigonal ureteric remplantation in 6 cases [11 ureters], young-Dees leadbetter procedure in 5, nephroureterectomy in 2, and mitrofanoff procedure with bladder neck closure in 1. the main complications included contracture and disruption of the dura cystoplasty in one patient [underwent continent diversion ultimately]; formation of large calculi in 2 patients; transient urinary leak in 2 and small bowell obstruction in 1. in the remaining 10 patients, 7 are dry with intermittent self catheterization and 3 are voiding and continent with crede maneuver. Augmentation cystoplasty using bowell segments proved to be a successful adjunct to reconstruction of the lower urinary Tract in selected patients with small capacity bladders