Management strategy and outcomes of sacrococcygeal teratoma - an Egyptian multicenter experience.

OBJECTIVES: Nationwide criteria regarding patients with sacrococcygeal teratoma (SCT) are still lacking in Egypt. We aimed to present a multicenter study regarding the management and outcomes of this tumor to evaluate our national treatment strategy. METHODS: A retrospective analysis including all patients with SCT who were managed at four major Egyptian centers between 2013 and 2023. Clinical data, surgical approaches, and short- and long-term outcomes were discussed. RESULTS: The study included 95 patients (74 were females). Antenatal diagnosis was reported in 25% of patients. Seventy-one patients (74.7%) were classified as Altman type I/II. Surgery was performed via a perineal approach in 75 patients, whereas the remaining 20 underwent a combined abdominoperineal approach. Vertical elliptical incision with midline closure was conducted in 51.5% of patients, followed by classic or modified chevron incisions. Benign mature teratoma was detected in 82% of patients. At a median follow-up of 57 months, eight patients (8.5%) had relapsed. The 5-year overall survival (OS) and event-free survival (EFS) of all patients were 94% and 91%, respectively. In the after-care monitoring, 19 patients (20%) had urinary or bowel dysfunctions. Nine of them were managed using medications. Clean intermittent catheterization was practiced in another five patients. The remaining five underwent further surgical interventions. CONCLUSION: Favorable outcomes were achieved in our country during the last decade. Diverse perineal incisions were performed for resection, and vertical elliptical with midline closure was the commonest. During follow-up, 20% of patients developed urological or bowel dysfunctions that required medical and surgical treatment modalities to improve their quality of life.

Laparoscopic Suture Rectopexy for Persistent Rectal Prolapse in Children: Is It a Safe and Effective First-Line Intervention?

BACKGROUND: Several techniques have been described for the surgical correction of rectal prolapse without any clear advantage for one technique over the other. We evaluated the use of laparoscopic suture rectopexy (LSRP) as a modality of treatment for rectal prolapse in children. MATERIALS AND METHODS: Prospective data were collected for all children who presented to our center between 2011 and 2014 and required surgery for rectal prolapse. All children underwent LSRP with fixation of the mobilized rectum to the sacral promontory with multiple nonabsorbable sutures. The median follow-up period was 14 months (range, 6-29 months). The operative time, operative complications, length of hospital stay, and postoperative complications were recorded and analyzed. RESULTS: Seventy-four patients presented with rectal prolapse during this period. Twenty patients (27%) required LSRP. Their median age at surgery was 4.4 years (range, 2-11 years), median operative time was 77.5 minutes (range, 30-150 minutes), and the median length of hospital stay was 1 day (range, 1-4 days). Only 1 patient had full-thickness recurrence that required redo surgery, and another had mucosal prolapse, which spontaneously resolved. CONCLUSIONS: LSRP is a safe and effective technique for treating children with full-thickness rectal prolapse with the benefits of being minimally invasive, a short hospital stay, early recovery, and low recurrence rate.

Long-term functional evaluation of fecal continence after laparoscopic-assisted pull-through for high anorectal malformations.

BACKGROUND: The use of laparoscopy while performing an abdominal dissection for the mobilization of rectovesical fistula should have an impact on anorectal function, as compared to the original posterior sagittal anorectoplasty, where muscle complex was not cut and the rectum was pulled in a way similar to the old techniques for the abdominoperineal pull-through. This necessitates a functional reevaluation. MATERIALS AND METHODS: A prospective case study included 15 patients treated with a laparoscopic-assisted pull-through for high anorectal malformation. Laparoscopy was used for abdominal dissection and ligation of the fistula, with the pull-through completed by a small perineal incision centered over the external sphincter. Nine of them are now older than 3 years for fecal continence evaluation. After the approval of the Ethical Committee for Medical Research in the Department of Surgery at Ain Sams University (Cairo, Egypt) and obtaining an informed consent from the parents, they were subjected to a full clinical history and a checklist about motions and soiling to be filled in over 1 month, a barium enema to check for any dilatation, anorectal manometry to evaluate resting pressure, maximum squeezing pressure, and sphincter relaxation, and MRI (magnetic resonance imaging) to evaluate the central situation of the rectum within the sphincter and the degree of development of the sphincter. Their degree of continence was graded according to the Kelly score. RESULTS: Six of 9 patients are clean without any attacks of fecal soiling or incontinence, and they evacuate spontaneously but need the application of a rectal suppository for evacuation from time to time. The remaining 3 patients had variable degrees of fecal incontinence. One of them had mucosal prolapse and was excised with good cleanliness postoperatively. The remaining 2 patients are managed by medical control and they are clean with minimal soiling when stools are loose. MRI and barium enema showed a centrally placed rectum in the muscle complex without dilatation in all cases. Manometry showed a high resting pressure that decreased on straining in the 7 clean patients and low in 2. The resting pressure did not increase on squeezing and all showed weak rectoanal inhibitory reflex (RAIR). One patient developed dysurea and constipation 1 year after surgery, as diagnosed by VCUG (voiding cystourethrogram) to have a diverticulum at the site of excised fistula causing rectal and urethral obstruction treated by a transabdominal excision with a good functional result. CONCLUSION: The state of continence with the laparoscopic technique in high anorectal malformations in this study showed acceptable results but needs bigger series with longer follow-up for a proper evaluation of this technique.