Laparoscopic splenectomy advantages over open surgery

In recent years, laparoscopy has become a popular surgical method. Laparoscopy is a minimally invasive surgery, which results in minor traumas in comparison with conventional open surgeries. There are several risk factors associated with laparoscopy based on the involved organ and the patient's general situations. Due to the improvements of clinical approaches, laparoscopic splenectomy has been known as a gold standard method for spleen removal as a result of various diseases, such as ITP. The human spleen plays a key immunologic role in defense against a number of organisms, particularly encapsulated bacteria. The spleen can cause significant morbidity and/or hematologic disturbance if it becomes hyperfunction [hypersplenism] or hypertrophied [splenomegaly]. Laparoscopic surgery for cancer is also an appropriate procedure if good tissue handling techniques are maintained. In this study, we attempted to review the results obtained from recent articles about the beneficial features of the laparoscopic splenotectomy in comparison with conventional open surgery

[ investigation of diagnostic accuracy of intraoperative frozen sections in Hirschsprung's disease]

Widespread use of one-stage pull-through technique for Hirschsprung's disease and its excellent results are dependent on the accuracy of intraoperative frozen sections [IOFS]. The purpose of the present study is to determine the incidence and sources of probable errors during this process. This cross-sectional study included all patients who were admitted from 2000 to 2010 in Dr Sheikh Children Hospital and had undergone IOFS for diagnosis of Hirschsprung's disease. This cross-sectional study included all patients who were admitted from 2000 to 2010 in Dr Sheikh Children Hospital and had undergone IOFS for diagnosis of Hirschsprung's disease. Frozen section can be a reliable method for evaluation of suspected Hirschsprung's patients with consideration that the favorable outcome is totally dependent on quality and number of prepared frozen sections for careful evaluation by pathologist

Monosymptomatic and non-monosymptomatic nocturnal enuresis: a clinical evaluation

Nocturnal enuresis is divided into monosymptomatic nocturnal enuresis [MNE] and non-monosymptomatic nocturnal enuresis [NMNE]. This study reviews clinical and ultrasonography [US] findings in enuretic children, and compares the organic and functional pathologies of the lower urinary tract [[UT] in children with MNE to those who have NMNE. We enrolled 111 neurologically normal children with chief complaints of enuresis in this study. Participants included 60 boys and 51 girls, aged 5-17 years. There were 43 [38.8%] patients diagnosed with MINE and 68 [61.2%] with NMNE. Urine analysis, urine culture and kidney-bladder US were performed for patients. Some patients underwent a voiding cystoureterography [VCUG], urodynamic study [UDS], or both. Patients were divided into three groups: i] MNE, ii] NMNE without daytime incontinence [NMNE - daytime incontinence], and iii] NMNE plus daytime incontinence [NMNE + daytime incontinence]. Constipation [P= 0.011], encopresis [P= 0.003] and urge incontinence [P = 0.001] were significantly more frequent in patients with NMNE + daytime incontinence. Bladder wall thickness [BWT] was the most common US finding. One patient with MNE and 9 with NMNE + daytime incontinence had vesicoureteral reflux [VUR; P 0.016]. Posterior urethral valve [PUV] was reported in one patient with NMNE. Evidence of bladder dysfunction was noted in about half of the patients who underwent UDS, with a higher prevalence in cases that had NMNE + daytime incontinence [P = 0.297]. Bowel symptoms and VUR were significantly more prevalent in cases with NMNE + daytime incontinence. We recommend VCUG in enuretic children who have daytime incontinence. In addition our study has revealed that symptoms suggestive of an overactive bladder [OAB] are not good indicators for bladder dysfunction

8-year experience of esophageal atresia repair in Sarvar children hospital [Mashhad- IRAN]

Esophageal atresia [EA] is a congenital anomaly treated by surgical reconstruction. Some early postoperative complications may be encountered we assessed complications following EA repair in a large series of neonates with EA / TEF and in hospital mortality among a large series of our cases. 243 patients with EA / TEF that were treated operatively in Sarvar Children's Hospital from 2002 to 2010 were studied. Early post-operative complications in the ICU and surgery ward until hospital discharge were assessed. Mean age was 3.4 +/- 2.76 days. Primary repair was performed in 83.5% Mean hospital stay was 12.5 +/- 12.81 days. Respiratory problems and food intolerance were the most common early complications. In-hospital mortality rate decreased significantly during the last 8 years [from 17.6% to 4.7%]. Acceptable results and a growing survival rate were observed in this series of patients and we anticipate better results with improvements in minimally invasive methods

[Outcomes of rectopexy of rectal prolapse through anus by sub mucosal injection of 5% dextrose]

Considering the vast methods of rectal prolapsed, a very common condition in children, either surgical [by abdominal or perineal approach] or non-surgical [sclerozing agents' injection], the authors evaluated the therapeutic effects of injecting dextrose 50% through perineal rectopexy. All those referred patients with rectal prolaps to Dr. sheikh children hospital were included in this study. All were sub-mucusally injected 5 cc of dextrose 50% solution and the therapeutic results [recurrence and complications] were evaluated. During this study 46 patients were injected about 5 cc of dextrose 50% solution. All went through the operation without any complications and during a 6 month following up none of the complications such as fistulae, abscess formation, urinary retention, and mucosal necrosis were detected. Nine patients were re-injected due to the prolapsed recurrence however no complications occurred in the second operation. The described procedure is a simple, inexpensive, and repeatable one. Deflux has been suggested as the best sclorizing agent in articles but it is expensive. Sub-mucusally injection of dextrose 50% is a simple, inexpensive, and repeatable procedure with a 100% positive therapeutic results, therefore could be, suggested as a substitution procedure in treating children's rectal prolapsed

Unilateral cleft lip and nasal repair: techniques and principles

The Mashhad University of Medical Sciences and the Sheikh Hospital in Mashhad sponsored a Cleft Lip and Palate Workshop 30 April - 1 May 2009. During the Workshop, 6 surgical cases were performed and televised live to the audience attending the conference. Two of those cases were unilateral cleft lip repairs. The surgical technique used to repair these patients by the primary author [JGM] is a hybrid technique. It has evolved over the last decade as a result of prior surgical literature as well as first hand observation of various surgical colleagues. The following manuscript describes the surgical technique used at the Cleft Workshop in a step-wise or atlas-like fashion. The technique portion of the paper describes the repair of the unilateral cleft lip and nasal deformity in roughly the order the first author typically performs the procedure. More importantly, the final section of the paper details the principles that form the foundation for the techniques described

[ outcome of transanal anorectal myectomy in the patients with ultrashort_segment hirschsprung's disease]

Anorectal myectomy and anal dilation under anesthesia could be an effective way in the treatment of patients with ultrashort_segment Hirschprung.In this article we studied the outcomes of anorectal myectomy. Our study group was 61 patients with the disease who had reffered to SHEIKH hospital from the second half of 1386 to the first half of 1388. Barium enema and anorectal myectomy was performed in all patient. Follow up after myectomy was in the second week after surgery and then monthly. For the complications and results, patients were also divided in to 3 groups based on the presence or absence of ganglion cell in the muscular resectal region,and the results were compared in each group. Bleeding, infection of the operation zone, sepsis, entrocolitis, and anal stenosis was not observed in any patient after surgery. 4 patients had gas incontinence and 3 had fecal incontinence after surgery which was cured in 3-6 months with bio-feedback orders. 40 patients [87.5%] had complete remission after surgery and 2[4.17%] had partial remission and 4[8.33%] had no remission at all. Based on these results, there is no relation between gender, complications of surgery and the results of surgery. Anorectal myectomy could be an effective treatment strategy for patients with following situations: absence of anatomical abnormalities-chronic constipation in spite of medical treatment-absence of transitional zone in barium enema-failure of anorectal reflex relaxation with rectal distention in anorectal manometry

[Results of one stage transanal resection of large bowel in hirschsprung's disease]

Hirschspnmg's disease is a developmental disorder of the enteric nervous system, characterized by functional obstruction. Absence of ganglion cells in the distal colon resulting in a functional obstruction. The aim of this study was to evaluate the results and complications of one-stage transanal endorectal pull-through [OTEPT] in the management of patients with Hirschsprung's disease. A total of 40 children [31 boys and 9 girls] aged 3 days to 60 months underwent OTEPT procedure over a period of two-years at Dr. Sheikh pediatric Hospital. This study was approved by the local committee of Medical Ethics. Median follow up period was 9.10 months [range, 3 to 33 months]. Mean operation time recorded 101.60 mins [range, 25 to 270 minutes]. Hirschsprung's disease developed conventional in 55% [short segment in 30%], Ultra-short in 32.5% and long segment in 12.5%. Mean length of resected bowel measured 17.31 cm, 2 patients underwent laparatomy because of extension of aganglionic segment beyond the sigmoid colon. Mean NPO time and need to rectal tube after the operation were 4.35 and 4.41 days, respectively. 8 patients required urinary catheters after the operation with the mean remaining time of 3.30 days, 20% needed ICU care after surgery and mean hospital stay was 5.76 days. Post-operative complications included entrocolitis [n=2] and abdominal distension [n=1]. One patient expired due to non surgical reason [heart failure]. OTEPT procedure is a safe method with low incidence of postoperative complications. In Hirschsprung's disease confined to the rectosigmoid region, the hazard and morbidities associated with laparatomy and colostomy are avoided with this technique

Fibrous hamartoma of infancy, report of two cases

Fibrous hamartoma of infancy [FHI] is a rare, benign soft tissue tumor that typically occurs within the first two years of life. It has a specific histologic appearance comprising of three different mesenchymal tissues with variable proportions in an organoid fashion. The clinical course is typically benign with excellent prognosis. We report two cases of this rare lesion and review its cilinicopathologic characteristics The first case was a 15-month-old girl who had a subcutaneous mass in the right axillary region and the other one was an 18-month-old boy with a mass on the medial surface of his right ankle. The masses were successfully excised. After 6 and 30 months follow up no recurrence occurred. Although the clinical and imaging findings of FHI are quite similar to those of malignant soft tissue tumor, histologic characteristics of this tumor will guide to the definite diagnosis that will prevent aggressive and mutilating procedures