Immediate and long term results of surgical management of low imperforate anus in girls

Imperforate anus occurs in one of 5000 live births. Imperforate anus is classified into high, intermediate and low according to the level at which arrest of rectal descent occurred. The surgical management of low imperforate anus in females continues to develop. Two common surgical procedures are applied cutback anoplasty and Potts transfer anoplasty. The purpose of the study was to characterize the nature of anorectal malformation to do the suitable surgical procedures. Then recording immediate and long term outcome in girls with low imperforate anus. This study reviews 23 girls with low imperforate anus operated upon by cutback anoplasty and Potts transfer anoplasty in Sohag University Hospital, department of surgery from May 1998 to May 2004. All patients had low anomalies and anal fistulae. Ten patients [43.5%] had anovestibular fistula, 8 [34.8%] had anoperineal fistula and 5 [21.7%] had anovulvar fistula. Cutback anoplasty was performed in 10 patients, 8 had anoperineal fistula and 2 had anovulvar fistula. Potts transfer anoplasty was performed in 13 patients [56.5%] 3 had anovulvar fistula and 10 had anovestibular fistula. Early post operative complications included wound infection in 10 patients and wound dehiscence in 6. Late complications included anal stenosis in 6 patients, constipation in 18 and recurrent fistula in 2 patients repaired again by Potts transfer anoplasty. Low imperforate anus in girls can be successfully treated by using surgical procedures without colostomy. Potts transfer anoplasty [anal transposition] is easy to perform, perfect safe and has less postoperative complications. It has good long term anal function and accepted rate of continence. Also no recurrence was recorded in Potts transfer anoplasty during period of follow up

Liehtenstein tension-free repair versus Bassini's repair in inguinal hernia

Groin herniorrhaphy is the most common operation performed by the general surgeon. Since the first true herniorrhaphy was performed by Bassini over a century ago, all modifications and surgical techniques have shared a common disadvantage: suture line tension. Current studies described that Lichtenstein tension-free repair is simple, less painful, effective, and eschews all suture line tension with low recurrence rate. This study aims at evaluation of Bassini's repair [as an open non-mesh repair] versus Liechtenstein's tension-free repair [with only mesh] for the surgical repair of primary inguinal hernia. The study was carried out on 80 randomly chosen male adult patients with primary groin hernia. These patients were admitted and treated at surgery department. Sohag university hospital and equally divided into two groups of similar number 40 patients in each. Group I: Bassini's repair. And group II: Lichtenstein repair. Both groups were compared as regard: The clinical data, operative data, postoperative data and recurrence rate. All patients were followed up postoperatively for 2 years. 60[75%] had indirect inguinal hernia while 20 cases [25%] were direct inguinal hernias. There is no statistically significant difference as regard operative time between both groups. There was no intraoperative complication in both groups. Postoperative pain was dramatically diminished in the group II than in the group I as reflected by the minimal analgesic requirement. Patients in the Lichtenstein's repair group had returned to normal activities and to work more quickly than in the Bassini's repair group. The Lichtenstein's repair is relatively more expensive than the open approach. Recurrence rate was relatively high in the Bassini's repair group [3] [7.5%] than in the Lichtenstein's repair group [no cases]. Lichtenstein mesh repair is a tension-free hernioplasty, simple and easily performed technique with no disturbance of normal anatomy and the sphincter and shutter mechanisms of the inguinal canal are preserved. It is applicable in all types of primary inguinal hernia with early satisfactory results. Being tension-free, it eliminates all postoperative pain and discomfort, and allows early ambulation of the patients with a low incidence of recurrence when compared with Bassini's repair. It is relatively more expensive

Transition from open to laparoscopic nissen fundoplication

We reviewed Nissen Fundoplication performed from January 2000 to January 2005, encompassing our transition from open to laparoscopic procedures. Records of 33 consecutive patients were reviewed. From year 2000 to 2005, all patients whom suffering from gastro esophageal reflux disease [GERD] and were in need for surgical interference were classified into two groups. First group operated upon by open fundoplication [n= 20]. Second group operated upon laparoscopically [n=13]. Mean operating time for laparoscopic cases was 143 +/- 20 minutes compared with 90 +/- 20 minutes for open cases [P<0.05]. Intraoperative complication rate was similar in both laparoscopic and open group [15%]. Length of hospitalization was shorter for patients who underwent laparoscopic surgery [2.2 days versus 7.2 for open procedures, P <0.05]. In follow-up, 80% of the laparoscopic group was asymptomatic compared with 70% of the open group. In patients who had the open procedure, 15% had wound complications. None of those treated laparoscopically had any complications at trocar insertion sites. Laparoscopic Nissen Fundoplication nowadys is the preferred approach and becomes the first surgical option in treating patients with GERD. It is effective as open fundoplication, safe, associated with a short hospital stay and early return to normal daily life activity

Management of penile fracture

This prospective study was carried out over a period of one year, and included 12 patients presented by penile fracture. Diagnosis was made clinically and there is no need to perform cavernosography in any case. The most common cause of fracture was trauma to the erect penis during intercourse. Mean age of cases was 29.5 +/- 8.96 years, while mean time of presentation was 15.5 +/- 8.04 hours. Sub-coronal circumferential degloving incision was done in all cases. Nine patients had been operated upon, while three patients refused surgery and treated conservatively. Repair consisted of evacuation of hematoma, repair of the tunical defect with absorbable sutures. The mean operative time was 33.9 +/- 28.2 minutes. Preoperative and postoperative antibiotics was used and all operated cases discharged on the second postoperative day. All operated caws were able to achieve full erection with straight penis, except one in whom mild curvature and pain during erection was observed. In conclusion, fracture penis is a true urologic emergency. It should be treated surgically as early as possible to ensure a better outcome