Five Years' Single-center Experience of a Modified Approach to Divided Sigmoid Colostomy for Anorectal Malformation.

BACKGROUND: In patients with anorectal malformation (ARM), a divided descending colostomy is associated with high complication rates, including wound infection, dehiscence, and prolapse, and it places a significant burden on caregivers. To decrease the chances of such complications, we modified our approach for colostomy fashioning by keeping an intact skin bridge between the colostomy and mucous fistula. The objective was to compare the rate of complications among patients diagnosed with ARM who underwent a modified divided descending colostomy and classical descending colostomy. METHODS: We included all the patients diagnosed with ARM who underwent a divided colostomy with modified (group A) or classical technique (group B) in the last 5 years. The type of approach used to fashion the stoma was based on the surgeon's preference than on patients' selection criteria. All patients were followed and monitored for postoperative complications. SPSS version 26 was used to analyze the data. RESULTS: A total of 62 patients with ARM underwent the colostomy creation; 27 in group A and 35 in group B. Males were more in both groups and other demographic variables were comparable. The most common associated anomalies were cardiac (58%). The mean duration of surgery was 72.2 ± 18.26 min in group A while 91.25 ± 21.43 min in group B (P = 0.000). The mean hospital stay was 4.28 ± 3.63 days in group A while 7.97 ± 6.12 days in group B (P = 0.007). The overall complication rate was 14.8% in group A and 34.2% in group B (P = 0.082). CONCLUSION: The modified approach to fashioning a divided colostomy is easily reproducible and carries a low risk of postoperative complications. LEVEL OF EVIDENCE: IV.

The Effect of Topical Agents on the Tensile Strength of Absorbable and Non-absorbable Suture Materials-An in Vitro Study.

INTRODUCTION: Topical agents are sometimes applied to surgical wounds after closure; these may include antiseptics or antibiotics. Minimal research has been undertaken to investigate the effect of topical regimens on the tensile strength of suture materials. AIM: To investigate the effect of four commonly used wound care regimens on the tensile strength of suture materials. METHODS: The failure load of 9 different suture materials was tested using the Instron Electroplus E3000 tensile testing machine (Instron Corporation, Norwood, Massachusetts). Tensile strength was represented as the failure load, measured in Newtons (N), and defined as the maximal load that could be applied across the suture prior to failure. Each suture was tested dry and after immersion in one of 4 products for 7 days and tested on day 7. The immersion agents tested were: sodium chloride 0.9%, MicroSafe® (Sonoma Pharmaceuticals, Petaluma, CA), Aqueous Povidone-iodine 10% solution (Betadine-Mundipharma), and Fucidin ointment. RESULTS: Sodium chloride 0.9%, MicroSafe®, Aqueous Povidone-iodine 10%, and Fucidin seem to increase the failure load of most absorbable and non-absorbable sutures. However, the failure load of Polyglactin 910 suture (Surgilactin, coated, violet-Ethicon) is reduced by long-term exposure to either sodium chloride 0.9% or MicroSafe®, while the failure load of the Polydioxanone suture (PDS Plus-Ethicon) is reduced by long-term exposure to MicroSafe® only. CONCLUSION: In our experiment, the commonly used wound care products have been shown to alter the tensile strength of suture materials. Further human studies are required to ascertain the clinical validity and applicability of our findings.

Erratum to: Emergency Separation of Extreme VLBW Omphalopagus Twins: Case Report.

[This corrects the article DOI: 10.1055/s-0042-1750134.].

Emergency Separation of Extreme VLBW Omphalopagus Twins: Case Report.

The classification of conjoint twins is based according to the site of attachment. The challenges in management of such anomalies span the entire continuum of care from delivery to resuscitation to separation and finally discharge. Scheduled separation is ideal, occasionally the caring team is faced with no option but to perform an emergent separation. Omphalopagus is a type of conjoined twinning characterized by union of the peritoneal cavities through an infraumbilical abdominal wall defect. In this report we describe our experience with a successful emergency separation of extremely preterm omphalopagus twins. This is the first case of conjoint twins in Kuwait, we highlight the challenges faced, stressing the importance of adhering to antenatal care as well as management by a multidisciplinary team.

Disc Battery - An Unusual Vaginal Foreign Body in a Child.

Disc battery ingestion and esophageal injury is well-known in children. Insertion of a disc/lithium battery into body's natural orifices is rarely reported. We present a case of self-insertion of a lithium battery into the vagina by a 2 ½ year old female. Vaginoscopy was performed and the battery was retrieved which had corroded and caused vaginal ulceration. Post-operative outcome was favorable. Treating physicians must be aware of the hazardous effects of insertion of lithium batteries as it may cause significant damage in a short period.

Hypertrophic Pyloric Stenosis developing In a Patient Operated for Patent Urachus - A Case Report.

A neonate with patent urachus (PU) who later developed hypertrophic pyloric stenosis (HPS) is being reported. The newborn was first operated for PU; post-operatively he developed persistent vomiting and radiological workup confirmed HPS. Pyloromyotomy was performed with an uneventful recovery.

The influence of nutrients, biliary-pancreatic secretions, and systemic trophic hormones on intestinal adaptation in a Roux-en-Y bypass model.

PURPOSE: The signals that govern the upregulation of nutrient absorption (adaptation) after intestinal resection are not well understood. A Gastric Roux-en-Y bypass (GRYB) model was used to isolate the relative contributions of direct mucosal stimulation by nutrients, biliary-pancreatic secretions, and systemic enteric hormones on intestinal adaptation in short bowel syndrome. METHODS: Male rats (350-400 g; n = 8/group) underwent sham or GRYB with pair feeding and were observed for 14 days. Weight and serum hormonal levels (glucagon-like peptide-2 [GLP-2], PYY) were quantified. Adaptation was assessed by intestinal morphology and crypt cell kinetics in each intestinal limb of the bypass and the equivalent points in the sham intestine. Mucosal growth factors and expression of transporter proteins were measured in each limb of the model. RESULTS: The GRYB animals lost weight compared to controls and exhibited significant adaptive changes with increased bowel width, villus height, crypt depth, and proliferation indices in the alimentary and common intestinal limbs. Although the biliary limb did not adapt at the mucosa, it did show an increased bowel width and crypt cell proliferation rate. The bypass animals had elevated levels of systemic PYY and GLP-2. At the mucosal level, insulin-like growth factor-1 (IGF-1) and basic fibroblast growth factor (bFGF) increased in all limbs of the bypass animals, whereas keratinocyte growth factor (KGF) and epidermal growth factor (EGF) had variable responses. The expression of the passive transporter of glucose, GLUT-2, expression was increased, whereas GLUT-5 was unchanged in all limbs of the bypass groups. Expression of the active mucosal transporter of glucose, SGLT-1 was decreased in the alimentary limb. CONCLUSIONS: Adaptation occurred maximally in intestinal segments stimulated by nutrients. Partial adaptation in the biliary limb may reflect the effects of systemic hormones. Mucosal content of IGF-1, bFGF, and EGF appear to be stimulated by systemic hormones, potentially GLP-2, whereas KGF may be locally regulated. Further studies to examine the relationships between the factors controlling nutrient-induced adaptation are suggested. Direct contact with nutrients appears to be the most potent factor in inducing mucosal adaptation.

Comparison of the effects of Roux-en-Y gastric bypass and ileal transposition surgeries on food intake, body weight, and circulating peptide YY concentrations in rats.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is one of the most effective treatments for obesity producing long-term weight loss. The anorexia and weight loss from RYGB could be due to gastric restriction, malabsorption, enhanced lower gut stimulation, increased energy expenditure, and/or other metabolic adaptations. In ileal transposition (IT) surgery, a segment of the ileum is transposed to the upper jejunum with no gastric restriction or malabsorption. Our objective is to compare the effects of RYGB and IT surgeries on food intake, body weight, and plasma concentrations of the anorexigenic lower gut hormone Peptide YY (PYY) in rats. METHODS: Adult male Sprague-Dawley rats were subjected to either RYGB (n = 9), IT (n = 9) or sham surgeries (n = 16). A subset of sham animals were either pair-fed to RYGB (n = 9) or ad lib fed (n = 7) on a highly palatable mixed nutrient liquid food (Ensure). Food intake, body weight and plasma PYY concentrations were measured. RESULTS: The data demonstrate that (1) RYGB produces a sustained reduction in food intake and weight gain, (2) the anorexic effects of IT are relatively transient lasting for 5 weeks, (3) the reduction in weight gain resulting from IT is similar to that of animals pair-fed to RYGB, and (4) RYGB and IT surgeries are associated with elevated postprandial plasma PYY concentrations. CONCLUSIONS: We demonstrate in our rat models that RYGB surgery produces a greater reduction in food intake and weight gain than IT surgery, and that both surgeries are associated with enhanced plasma concentrations of Peptide YY.

Outcome of laparoscopic appendectomy for perforated appendicitis in children.

BACKGROUND: The aim of this study was to evaluate the outcome of laparoscopic (LA) vs open appendectomy (OA) in patients with perforated appendicitis in our center. METHODS: Retrospective review from July 2002 to April 2007 (institutional review board-approved), evaluating 281 patients with perforated appendicitis based on surgical approach. We compared demographics, mean operative time, length of stay (LOS), infectious complications, and follow-up in patients with OA (n = 213) and LA (n = 68). RESULTS: Laparoscopic appendectomy patients were significantly older (12 vs 9.4 years), heavier (51.8 vs 36.6 kg) and more frequently girls (47.8% vs 34.3%). Mean operative time was longer in LA (72.6 vs 50.2 minutes). Median LOS was 5 days in LA and 6 days in OA. Few patients in each group required a drainage procedure for a persistent abscess (LA 4.4%, OA 4.7%; P = 1.000). Laparoscopic appendectomy patients had fewer wound infections (1.5% vs 9.5%; P = .034), and less follow-up visits were needed (>2 clinic visits 4.5% vs 16.4%; P = .013). CONCLUSION: Laparoscopic appendectomy has a shorter median LOS, a trend toward less postoperative infectious complications, and fewer clinic visits than OA, which makes it a safe and effective procedure for patients with perforated appendicitis.

Evaluation of surgical approaches to pyloromyotomy: a single-center experience.

BACKGROUND: This study was conducted to evaluate the outcome of various approaches to pyloromyotomy: supraumbilical (SU), right upper quadrant (RUQ), and laparoscopic (LP). METHODS: Single-center retrospective review from 1998 to 2005 with institutional review board approval, evaluating 192 pyloromyotomies based on surgical approach: RUQ (119), SU (64), and LP (9). Patient demographics, acid-base/electrolyte status on presentation, mean operative time, postoperative length of stay, and complications were evaluated. RESULTS: Patient demographics, acid-base/electrolyte status, and mean operative time were not significantly different. The median length of stay was 34, 29, and 24.5 hours for SU, RUQ, and LP, respectively (P = .479). The frequency of duodenal/gastric perforations in the SU, RUQ, and LP groups were 1, 4, and 1, respectively. The LP perforation was not recognized intraoperatively, resulting in sepsis and multiorgan failure. One patient in the SU group had a late adhesive bowel obstruction requiring laparotomy and bowel resection. Wound infection rates did not differ significantly between groups (SU, 4; RUQ, 2; LP, 1; P = .113). CONCLUSION: Pyloromyotomy is associated with a low complication rate. Cosmetically, SU is superior to the RUQ approach. The added benefits of being able to examine the integrity of the duodenal mucosa intraoperatively and its short learning curve may make SU a safer alternative to LP for surgeons who are still practicing the RUQ approach.