Treatment and postoperative complication of 420 patients with congenital megacolon

Hirschprung's disease is still one of the most important problems of pediatric surgery and its treatment has its own different complications and difficulties. Therefore, pediatric surgeons use different methods in each case. The objective of this study was to review the advantages and disadvantages of the Swenson's procedure over the past 20-years. In this survey, we reported 420 patients who in a 20-year interval [from 1981-2000] with the net diagnosis of Hirschprung's disease, were admitted to the pediatric surgery ward of Taleghani Medical Center, Tehran, Iran and operated on by Swenson's procedure. This survey has been carried out in 2 parts with descriptional method using patients' files and analytical method by using patients' observation and questionnaires. In the first step, they were 420 patients and in second step 216 patients were studied and the results of the first 10 years [190 cases] and the results of the second 10 years [230 cases] were analyzed alone and compared with each. The results revealed wound infection in 17 cases in the first 10 years [14.2%], with18 cases in the second [7.9%] giving a mean of 10.7%. Anastomosis leakage was 6.8% in the first and 2.2% in the second 10 years with a mean of 4.2%. Septicemia was 3.6% in the first and 0.9% in the second period with a mean of 4%. Intestinal obstruction was 4.2% in the first and 2.1% in the second 10 years with a mean of 3%. There was no mortality during the surgery and for one month after. The results of late complications are: rectal anastomosis stricture, 13% in the first and 3% in the second 10 years with a mean of 7.6%; inguinal hernia of 1.6% in the first and 0.4% in the second period with a mean of 1% and finally, the death rate due to enterocolitis was 1.6% in the first and 0.9% in the second 10 years. Altogether, 87% of patients and their parents were satisfied with bowel habits after operation; 10% were relatively satisfied and 3% were not satisfied at all. Age distribution at the time of diagnosis: 50% of 0-1 months; 23% of 1-12 months and 27% were above one-year-old. Three hundred and eleven patients [74%] were male and 109 [26%] were female. The youngest patient was 3-days-old and the oldest was a 14-year and 3-month-old boy. The most common denerved part of the intestine was sigmoid colon with 54.4% prevalence. Our results show that Swenson's method is a successful procedure in the treatment of Hirschprung's disease

Primary extrarenal wilms' tumor in the retroperitoneum

Extrarenal Wilms' tumor is extremely rare. Approximately 54 cases have been reported in the world literature through 1993. Only eight extrarenal Wilms' tumors were enrolled in the National Wilms' Tumor Study [NWTS] between 1980 and 1986. These cases constituted a fraction of 1% of all Wilms' tumors reported to the N.W.T.S during this period. The authors report a case of retroperitoneal Wilms' tumor [Stage III] presenting as a lower abdominal mass in a previously healthy 6-year-old girl who was operated and staged according to the current N.W.T.S III criteria

treatment and post-operative complications of congenital megacolon: a nine year follow-up of abdominal-perineal pull-through operation

During a 10 year period, from 1980 until 1989, 74 patients with congenital megacolon were treated by abdomino-perineal resection [Swenson's operation] at Taleghani Medical Center Pediatric Surgery Unit, Shahid Beheshti University of Medical Sciences. Fifty of the patients were last interviewed and examined more than 5 years after resection. There were 2 post-operative deaths and 3 late deaths from enterocolitis. Both early and late complications were infrequent and are discussed in detail. Almost 90% of the patients reported that they gained normal bowel habits. None of the patients developed urinary incontinence, although 4 reported permanent fecal soiling. This is the first large group of patients in this country treated for congenital megacolon and followed for at least 5 years. Low incidence of post-operative complication indicates that Swenson's operation is a safe, effective method of treatment for congenital megacolon