ABSTRACT
Chronic pancreatitis (CP) is a sequelae characterized by recurrent attacks of pancreatitis leading on to fibrosis and calcification of both ductal and parenchymal elements of the pancreas. Most of these, if left untreated at the right time, will lead on to burnt-out pancreas with complete atrophy of the parenchyma, leading on to endocrine/exocrine insufficiency. The pain in such patients is most likely due to ductal hypertension, parenchymal hypertension, and head mass causing perineural inflammation. Puestow procedure (longitudinal pancreaticojejunostomy) is the surgery of choice in selected patients with ductal hypertension where decompression of the duct provides symptomatic relief. Performance of such procedures in children by minimal access laparoscopic method is still evolving. We report a series of three patients (aged 10, 12, and 16 years) diagnosed with CP and successfully managed by laparoscopic Puestow procedure.
ABSTRACT
AIM: The aim of the study is to report the outcomes of different stenting techniques during laparoscopic pyeloplasty (LP). MATERIALS AND METHODS: This study was a retrospective audit of duration of stenting, complications encountered, and operative outcomes of LP in children older than 3 years. RESULTS: Retrograde cystoscopic prestenting took significantly longer time (17.2 min) and the presence of stent hindered in anastomosis. Antegrade stenting without guide wire took longer time (9.6 min), and in some, there was difficulty in negotiating distal ureter. Antegrade stenting over guide wire, through a 14-gauge intravenous cannula, took significantly less time (7.3 min) although the cannula got kinked and the stenting was difficult in some as the length of the cannula was short and it did not reach anastomotic site. "Stenting Antegrade Via Veress needle during laparoscopic pyeloplastY" ("SAVVY" technique) favored by authors has the least stenting duration (4.8 min) and minimum failures (P = 0.01, ANOVA). The needle is wide enough to pass a 4-Fr stent and long enough to reach the anastomotic site. CONCLUSION: SAVVY technique saves time during LP with least failures and is a useful stenting technique in children.
ABSTRACT
AIMS: To retrospectively analyse the results of laparoscopically-assisted anorectal pull-through (LAARP) for high anorectal malformation (ARM) in male children in our institution. MATERIALS AND METHODS: We analysed the hospital records of patients who had undergone LAARP from October 2010 to December 2015 in terms of age, operative time, length of hospital stay and post-operative complications. RESULTS: Of 17 cases, 13 (76%) were in 6-12 months age group, whereas rest of them were in 12-18 months age group. The recto-prostatic urethral fistula was encountered in 82% (n = 14) of patients and rectovesical type in two cases (12%). The mean operative time was 132 min with mean length of hospital stay being 4 days. Rectal mucosal prolapse was the most common complication noted. CONCLUSIONS: LAARP is a feasible approach to male children with high ARMs with less post-operative morbidity.
ABSTRACT
Necrotizing fasciitis is an uncommon infection mainly caused by Streptococcus pyogenes, which is also known as flesh-eating bacteria. It is often caused by bacteria, but can also be caused and complicated by fungus. We report a case of bacterial necrotizing fasciitis that was complicated by a fatal fungal infection, a rare clinical presentation affecting the upper limbs, head and neck, in a young diabetic female patient. It was an unsuspected case of fungal infection with mucormycosis, which proved to be fatal due to a delay in diagnosis and treatment.
