Hypospadias why complications! When redo surgery! The impact of relevant factors

Great advances have been made in surgery for the correction of hypospadias. Proximal hypospadias remains the greatest challenge, but despite many innovations and much progress, surgery can fail. The new generation of pediatric surgeon has high ambitions in managing patients with hypospadias. More than 200 reconstructive procedures have been described for hypospadias repair. Despite large number of operative techniques for hypospadias repair, the complication rate is very high. To evaluate the factors that may influence the results of surgery after hypospadias repair at The Maternity and Child Teaching Hospital, pediatric surgery unit, Al-Qadisiya/ Iraq. It was a retrospective observational study. Files of all patients who had Hypospadias repair were retrieved and analyzed with a view to identify the factors which may influence the results of surgery for Hypospadias. Patients with complete record available were included in the study, whereas those with incomplete data were excluded. Forty cases [out of 115 cases of hypospadias] of fistula, stricture, retrusive meatus, meatal stenosis, torsion, open distal urethra and urethral diverticula with combination of two or more, were managed by from the 1[st] of January 2005 to the end of December 2009. There were 40 patients, aged 1-12 [mean 3.8] years, with failed hypospadias repairs. All operated on by the same surgeon, with a minimum of 12 months of follow-up. Twenty-seven of 40 patients had 1 redo operation, 9 had 2 redo operations, 3 had 3 redo operations and 1 had 4 redo operations, for a total of 58 redo operations. Of these, 34 were TIP techniques [58.6%], 8 were Mathieu [13.7%], 8 were TIP repairs [13.7%], 4 were onlay island flaps [6.8%] and 4 were buccal mucosal grafts [6.8%]. Follow-up was 1-3 years [mean 1.5 yr]. Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatal stenoses, 1 urethral stricture and 3 dehiscences]. Surgical techniques for the repair of hypospadias are being developed continuously, implying that no single procedure is considered a panacea for hypospadias repair. Admittedly, it is difficult to follow patients for a long time, and it is even harder to predict who will have complications that will merit closer follow-up. Success in hypospadias surgery depends on good team work. All types of repair involve straightening the penis by removal of chordee. The pediatric surgeon selects the appropriate operative procedure and carries it out with meticulous techniques

Review of cholecystectomy for non hemolytic gallstone in single pediatric surgery unit

In the last years following the extensive use of ultrasound scanning an increasing number of children with cholelithiasis has been identified. Prevalence of cholelithiasis has been well reported, and frequency of cholecystectomy had been addressed by some investigators. The aim of our retrospective study was to evaluate the management of children with cholelithiasis observed at the Pediatric and Surgical unit linked to the Maternity and Child Teaching Hospital. The records of all patients below age of 14 years, undergoing cholecystectomy for cholelithiasis, at Maternity and Child Teaching Hospital in Al- Qadisiya governorate in Iraq, from January 2005 to December 2008 were reviewed. A total of 13 pediatric patients were included in this study. Participants had a mean age of 5.6 years [SD, 2.9 years; range, 2.5-13]. There were 9 female and 4 male patients. Diagnosis of cholelithiasis was performed in all patients by ultrasound exam. All patients underwent cholecystectomy and extensive evaluations for their abdominal pain. The cause for gallbladder disease was identified as personal and familial anamnesis in 4 patients [30.7%]. Intra- and post-surgery course was adequate in all patients, but 2 who had transient complications. In our experience, approach to patients with gallbladder stones was heterogeneous suggesting the need for a common protocol. However, our data show that etiology, sex incidence, diagnosis's modality and management of pediatric patients with gallbladder stones is comparable to previous reported casistics. Pediatricians and pediatric surgeons have to consider that cholelithiasis can occur in children. Common diagnostic, therapeutic and follow-up protocols are needed to improve our knowledge on this pediatric disease

Evaluation of different presentations of sacrococcygeal teratoma in single pediatric surgery unit: a case series

Sacrococcygeal teratoma [SCT] is a well-known tumor of the newborn which carries an excellent prognosis provided adequate surgical treatment. The aim of this study were to the study the age distribution at presentation, the sex ratio, variation of the morphological presentations, and the incidence of postoperative complications, recurrence rate and the malignancy at the time of diagnosis. Retrospective analysis of clinical and epidemiological data of seven cases of Sacrococcygeal teratomas operated in Pediatric Surgery Unit at the Maternity and Child Teaching Hospital / Al-Qadisiya -Iraq from the period 1[st] of January 2005 to 31[st] of December 2008 the data used being extracted of the surgical protocols and histopathological exams. Of 7 patients, 6 [86%] were female. Sacrococcygeal teratoma contained only cystic component in four patients [57%], both cystic and solid components in one patient [14%] and predominantly solid components in two patients [29%]. Four patients [57%] were delivered by caesarean section. The follow up ranges between 3 months and 2 years in only 5 patients. Follow-up sonogram and magnetic resonance imaging MRI was done for all patients. Five patients [71%] were diagnosed and treated before the age of two months. One patient [14%] died postoperatively and one [14%] developed a recurrence. We suggest a national survey for large group of patients with Sacrococcygeal teratoma in other centers for reliable identification of different presentation and risk factors. Whenever histopathological examination of the resected specimen shows mature teratoma, a careful search for areas of malignancy in the specimen should be performed especially in delayed presentation [later than the age of 2 months]

Study in two different procedures for repair of hypospadias

Repair of hypospadias remains one of the challenging problems for pediatric surgeons. The aim of this paper is to compare two commonly used procedures in repairing proximal hypospadias; the perimeatal based flap [Mathieu] procedure, and the tabularized incised plate [Snodgrass] urethroplasty procedure. 64 patients had undergone hypospadias repair for distal hypospadias coronal, subcoronal and anterior shaft over a three-year period from January 2005 to December 2007 in pediatric surgery unit / The Maternity and Child Teaching Hospital Al-Qadisiya-Iraq were reviewed. Patients were assigned into two groups to undergo either Snodgrss or Mathieu surgical repair by a single surgeon. The majority of patients aged 3 to 5 years. A perimeatal skin flap [Mathieu repair] was performed in 42 [65.6%] patients and tubularized incised plate [TIP] urethroplasty [Snodgrass procedure] in 22 [34.3%] patients. Cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus. Combining the Mathieu procedure with plate incision can be a promising simple technique to achieve a normally shaped meatus and to reduce the rate of meatal-related complications

Congenital gastro-intestinal obstruction in the maternity and child teaching hospital of Al-Qadisiya

Gastro-intestinal obstruction is probably the most common reason for emergency operation in neonates, infants and children. From July 2004 to the end of June 2007 200; 138 male [69%] and 62 female [31%] cases of gastro-intestinal obstruction needed surgical treatment at The Maternity and Child Teaching Hospital, Al-QadisiyaAl-Diwaniya. Male: Female ratio 2.2: 1 [138:62] Vomiting was the leading sign and symptom in 133 of cases [66.4%], failure to pass meconium in 98 of cases [49%]. The radiological study was the usual diagnostic aid whether conventional plain radiography used in 163 of cases [81.5%] or a contrast study. Ano-rectal obstruction caused by imperforated anus was found in 89 of cases [44.5%]. 31 [15.5%] had a gastric outlet obstruction, 26 [13%] had jejunoileal atresia, 18 [9%] had a Hirschsprung' s disease, while duodenal obstruction was found in 9 cases [4.5%.] The surgical procedures were enterostomies in 97 of cases [48.5%], intestinal anastomosis [18.7], pyloromyotomies, 30 [15%], posteriolateral thoracotomy and esophageal anastomosis in 6 [3%] and explorative laparotomy, 5 [2.5%]. Ano-rectal obstruction was the commonest cause of congenital gastro-intestinal obstruction in this series. Enterostomies were the most commonly performed operations