Cohen transtrigonal ureteric reimplantation without ureteric splint or cystostomy drains

To review our experience in the outcome of children undergoing Cohen transtrigonal ureteric reimplantation without cystostomy tube or ureteric splint, just to keep urethral drain [Foley's] for 48 hours. Between July 2001 and July 2008, 67 patients who underwent ureteric reimplantation at King Hussein Medical Center and Queen Alia Military Hospital were included in this study. Those patients who needed extensive dissection, ureteric tapering, or had thickened bladder wall or neuropathic bladder were excluded. Data recorded included the procedure, operative and post operative pain, hospital stay, post hospital discharge problem and operative success. 67 patients 46 females, and 21 males, with mean age of 7.8 years [range from 1 to 14 years] there were 25 bilateral and 42 unilateral reimplantations, only Foley's catheter left in and no uretral stent or cystostomy drains were placed which was removed on the second post operative day. Caudal anaesthetic, oral and rectal analgesia were used for pain relieve, and all patients were discharged home within 48 hours of surgery. Surgical repair of vesico-ureteric reflux can be successful with early bladder catheter removal and without ureteric splint or cystostomy drains and appears to be significant decrease in the hospital stay and discomfort after surgery

Laparoscopic gastrostomy in children

Pediatric gastric access for long term enteral feeding, may be performed via laparotomy, laparoscopy, or a percutaneous approach. The aim of this study was to report our experience with laparoscopic video-assisted gastrostomy in children and infants as a route for gastric access. From April 2005 to April 2009 we retrospectively reviewed 17 cases of laparoscopic assisted gastrostomy performed at New Children Hospital at West mead, Sydney - Australia and King Hussein Medical Center - Jordan, using two 5-mm working ports, one placed through an infra-umbilical incision for 5mm 0-degree scope and the other 5-mm port was placed over the stomach at the designated site for tube placement tube was placed. In 17 children, the procedure was successfully completed without conversions. The median patient age at the time of surgery was four years [range, 6 months to 14 years]. The mean operative time was 20 minutes [range, 15-35]. When a concurrent laparoscopic nissen fundoplication was performed [n= 4] the laparoscopic gastrostomy was placed after completion of nissen fundoplication. No intra-operative complication occurred, all buttons and tubes were successfully placed, feeds were instituted the following day and advanced to goal. Minor post operative complications, such as, granulation tissue, stoma irritation, tube dislodgement, leakage from the stoma site occurred and responded well to conservative management, revision has not been necessary. Based on our initial experience. Laparoscopic assisted gastrostomy is feasible, safe and effective procedure in children for feeding access as an alternate to an open gastrostomy. Technically, it is a simple method not only representing an alternative to PEG when this procedure is not suitable or after failure. But, can also be widely used for patients as a first choice

combination of tramal with bupivacine versus bupivacaine alone in wound infiltration and ilioinguinal blocks in herniotomy

To evaluate the analgesic efficacy and tolerability of tramadol with bupivacaine, in comparison with bupivacaine alone. This was a double-blind randomized study on 300 Paediatric patients undergoing inguinal hernia repair under general aneasethsia with local infiltration anesthesia and ilioinguinal blockade at Queen Rania Paediatric Hospital, Jordan. Post operative pain at 1,2,3,6, 12 and 24 hours and analgesic requirements [paracetamol and Ibuprofen] were assessed. Two hundred ninety patients were admitted for twenty four hours for evaluation, four patients were discharged because parents refuse admission. The median intra-operative VAS score was 10 [IR 15] in group I, receiving the combination of 2 drugs vs. 12 [IR 16] in group II, receiving bupivacaine alone, [P = 0.02]. There was no difference in pain scores or analgesic requirements at 12 hour post-operatively]. Distribution of intra-operative VAS scores showed a greater number [P<0.05] of patients having a VAS score > 30 post-operatively in patients receiving the combination of both drugs vs. bupivacaine alone. The use of combination of Tramal and Bupivacaine infiltration with ilioinguinal blocks is more effective than the bupivacaine group alone and can produce rapid onset of block and also stays for longer duration. We recommend this technique for groin hernia repair to reduce post-operative pain

Extra-ordinary sacrococcygeal teratoma. a case report and review of the literature

Sacrococcygeal teratoma is the most common congenital neoplasm in neonates. It is more common in females and is associated with a higher incidence of congenital anomalies. This tumour is often large, vascular, and carries malignant potentials. Management consists of complete tumour excision and removal of the coccyx. We report a one day old female newborn, part of twin born prematurely at 34 weeks of gestation as a product of caesarean section due to pre labor rupture of membranes at king Hussein Medical Center, presented with a very large soft, cystic, pendulous mass over the sacrococcygeal area, with a circumference of about 30 cm. No neurological deficit was elicited and radiography showed no involvement of the underlying bone. Surgery was performed three days after delivery. The tumour was completely excised enblock with coccyx and sent for histopathological examination. Post-operative period was uneventful and the child was discharged in a good health, and is followed up till now, 4 years after surgery and no any signs of recurrence

Choledochal cyst in children an experience at the royal medical services

To evaluate our experience in the management of choledochal cyst in children at the Royal Medical Services. Nine cases of choledochal cyst were treated by the pediatric surgical section of the Royal Medical Services over a 24 year period [1979-2003]. Case material for one child was lost, leaving eight cases to be analyzed. There were nine children [4 males] with age at presentation ranging from six weeks to 13 years. The clinical presentation included jaundice, abdominal mass, and recurrent abdominal pain. A variety of imaging modalities were used including; contrast meal intravenous cholangiogram [n=2]; abdominal ultrasonography; computed tomography scanning and percutaneous cholangiography [n = 6]. A number of different types of cysts were seen including Todanis Type I [n = 7] and Type IV [n = 1]. An associated biliary Atresia was found in one case. Cyst excision was carried out in all cases with a number of different forms of biliary reconstruction [hepaticoenterostomy with [n = 1]. There was one death at 10 post-operative day due to sepsis and one bile leak, which was treated conservatively. One child had recurrent cholangitis treated with antibiotics. Choledochal cyst is rare in Jordanian children and excision of the cyst with the reconstruction of biliary duct is the treatment of choice

Phreno-pyloric syndrome: a case report and a review of the literature

A phreno-pyloric syndrome is an association of hypertrophic pyloric stenosis and hiatal hernia; it is a rare condition and most of the cases diagnosed during surgery. We report a case of one month old male infant with history of recurrent vomiting since birth, barium meal show the stomach in the right side of the chest, diagnosed as a case of para- oesophageal hiatal hernia with suspicion of volvulus stomach. During surgery, we found the stomach in the chest with pyloric mass. He was diagnosed as phreno-pyloric syndrome