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Aims: To evaluate the utility of umbilical pyloromyotomy for infantile hypertrophic pyloric stenosis [IHPS] compared to published series promoting laparoscopy
Methods: Forty five babies with IHPS had pyloromyotomy using an umbilical skin fold incision. Operating times, post-operative hospital stay and cosmetic appearance of the umbilical wound were studied. Data extracted from recent series promoting laparoscopy were unified using a MEDLINE search strategy and used for comparative analysis
Results: Mean operating time for umbilical pyloromyotomy was 30 +/- 5 min [range 25-40 min]. All patients went home at an average period of 62.5 +/- 12 h [range 48-72 h] following surgery. The mean age at presentation was 22.7 +/- 7 days [range 74-40], and the time for starting oral diet was 23 +/- 4 h [range 15-30]. The umbilical scar was barely visible in the post-operative period. Laparoscopic pyloromyotomy operating times ranging from 78-41 min [mean overall 30 min] are recorded in the literature. Post-operative stay following laparoscopy has been variable [23-91 h] where reported. In contrast with umbilical pyloromyotomy, pox marks observed following port insertions for laparoscopy can give an unsightly scat
Conclusions: This study has found that umbilical pyloromyotomy can be performed with minimal mohidity and equivalent operating times to laparoscopy. The shorter hospital stay reported in some series promoting laparoscopy must be balanced against local practice influencing hospital stay, the financial implications of offering a laparoscopic service, the skills needed for laparoscopy, and the short learning curve required by pediatric surgical trainees to become proficient at umbilical pyloromyotomy. The cosmesis of the umbilical incision is excellent. These findings suggest fhat umbilical pyloromyotomy is a reliable alternative to laparoscopy
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We have included in this study 100 patients, who have undergone different therapeutic laparoscopic operations. All these patients proved not to have liver cirrhosis, preoperatively, according to the results of preoperative laboratory tests and imaging studies done for these patients but had a risk factor for development of liver cirrhosis. Laparoscopic appearance of the liver was evaluated and laparoscopic guided liver biopsies were taken from all patients and sent for histopathological examination. 46 patients of our studied patients have proved to have liver cirrhosis and/or fibrosis, and we did not have any intraoperative or postoperative complications from the sites of biopsy. This reflects the important role of laparoscopic guided liver biopsy as a very safe procedure to detect early pathological changes of the liver not detectable by routine preoperative investigations, and it is better to be done for all patients who are going to be operated by laparoscopy, and having a risk factor for developing liver cirrhosis
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Background: In the 20th century, congenital megacolon Hirschsprung's disease was defined clinically, pathologically as well as the treatment has developed greatly from open Swenson pull-through to transanal one-stage Soave's pull-through
Aim of the work: The aim of this study is to assess the feasibility and efficacy of the trans-anal one stage endorectal pull-through Soave's procedure in treatment of infants and children with Hirschsprung's disease
Patients and Methods: This study comprised 20 children with Hirschsprung's disease, 19 males [M] and 1 female [F]. All patients were diagnosed clinically, and had positive punch rectal biopsy. The mean age was 12 +/- 9.7 months [range 2-28]. All patients were underwent one stage trans-anal endorectal pull-through
Results: The mean operative time was 90 +/- 10.5 minute. The mean length of the resected segments was 24.5 +/- 6 cm. The mean blood loss was 87.5 +/- 35.5 ml of blood. Mean hospital stay was 6.5 +/- 2 days. Six patients [6/20, 30%] had napkins dermatitis and diarrhea and improved within three months later on medical treatment. One patient [1/20,5%] had mild entero-colitis and improved rapidly post-operatively. Two patients [2/20, 10%] required post-operative dilatation due to stenosis for few sets. Two patients [2/20.10%] had partial retraction of the pulled down colon and healing by auto anastomosis had occurred. No mortality in this series
Conclusion: Transanal endorectal pull-through is feasible operation, it avoid lapamtomy and its complication, and no need for blood transfusion. Hospital stay is shorter than the open technique
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This study included 70 patients with peptic ulcer disease. 58 patients of our studied patients have proved to have been infected with H. pylori in the biopsy specimens of the peptic ulcer site. The other 12 patients did not have H. pylori in their biopsies from ulcer sites. The infected patients with H. pylori has been divided into 2 equal groups: Group [I]: patients received triple therapy in the form of omeprazole, ampicillin and metronidazole. Group [2]: Patients received only omeprazole. The 12 non-infected patients constituted group [3], and received also omeprazole only. Follow up endoscopy for all patients has shown much better rate of healing for peptic ulcer patients in group 1 than in group 2. Healing rate in group [3] was also still better than healing in group [2]. We can conclude from our study that H. pylori plays a definite role in pathogenesis of peptic ulcer patients and the best healing of peptic ulcer patients infected with H. pylori can be achieved by the triple therapy used in our study
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Background: Endoscopic retrograde cholangiopancreatography [ERCP] with stone extraction is the gold standard for the management of common bile duct [CBD] stones. Many scoring systems had developed aiming at prediction of CBD stones prior to cholecystectomy to avoid unnecessary ERCP. On the other hand Magnetic Resonance Cholangiopancreatography [MRCP] had proved efficiency in diagnosis of CBD stones and was replacing ERCP in some centers but with additional cost for therapeutic ERCP in case of CBD stones
Aim of the work: the aim of this study was to evaluate the validity of the scoring system, predicting CBD stones, in selecting patients with suspected CBD stones for ERCP or MRCP prior to cholecystectomy
Patients and methods: One hundred twenty consecutive patients with cholelithiasis and suspected CBD stones were enrolled in this study between July 2001 and Dec. 2004. They were randomized into three groups, group 1 for ERCP, group 2 for MRCP followed by ERCP if there was stone and group 3, according to the scoring system, for either MRCP if the score is < 4 or ERCP if the score is >/= 4
Results: CBD stones were found in 67 out of 120 patients [56%]. The success rate for diagnostic ERCP was 100%, and successful therapeutic ERCP was 98.5%. The incidence of unnecessary ERCP was reduced significantly from 40% [Group 1] to 5.9% [Group 3A] [P< 0.001]. Also additional ERCP after +ve MRCP was reduced significantly from 55% [Group 2] to 21.7% [Group 3A] [P <0.05]
Conclusion: This study confirms the validity of this new scoring system, predicting CBD stones, in selecting patients for ERCP or MRCP prior to cholecystectomy to avoid unnecessary ERCP
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In this study, we have included 80 patients who had symptomatic chronic anal fissure, proved to have low anal sphincter pressure. Half of these patients [group 1] have been treated by local advancement flap, the other half [group 2], has been treated by lateral internal sphincterotomy. In group 1 patients satisfactory healing of the fissure with continent anal sphincter has occurred, while in group 2 patients, significant complications in the form of anal incontinence and persistent fissure symptoms, have occurred. The results in this study have given rise to the recommendation for sphincter assessment before traditional surgery through measurement of anal sphincter pressured by manometry. The patients with sphincter pressure [hypotonic] is better to be treated by sphincter saving operation as the island advancement flap as the treatment of choice for patients suffering from chronic anal fissure with low anal sphincter pressure