Comparison of divided versus loop sigmoid colostomy in the management of anorectal malformation

Introduction: Anorectal malformation (ARM) is a birth defect of the digestive tract in which the anus and rectum are not normally developed. Surgical procedure such as colostomy (loop or divided) is suggested as the initial treatment for high variety ARM. Our objective was to compare frequency of stoma related complications of loop sigmoid colostomy versus divided sigmoid colostomy for high variety anorectal malformations.Materials and Methods: A randomized controlled trial was carried out at children’s hospital and the institute of child health Lahore. A total of 180 patients were divided into two groups randomly using lottery method loop sigmoid colostomy (group-A) and divided sigmoid colostomy (group-B). After surgeries patients were followed weekly up till 4 weeks. Stoma related complications were noted.Results: The mean age in group A and group B were 3.22 ± 1.26 days and 3.36 ± 0.97 days respectively. In group A there were 77 male & 13 were female, in group B there were 67 male & 23 female patients. In group A 24.5% patients had complications: 3.4% patients had retraction, 11.1% had prolapse, 2.2% had Obstruction, parastomal hernia was seen in 5.6%, stoma necrosis were seen in 2.2%. In group B 20% patients had different complications: 2.2% patients had retraction, 2.2% had prolapse, 5.6% had obstruction, parastomal hernia were seen in 2.2% and stoma necrosis were seen in 7.8%. The complications in group A were higher when compared to group B but were not significant, p-value > 0.05.Conclusion: Divided sigmoid colostomy can be adopted to avoid stoma related complications in future

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Outcome of urethral mobilization and advancement after anterior hypospadias surgery

Abstract Background In hypospadias surgery, despite continued refinement of various surgical procedures, there is no completely satisfactory technique in terms of complications and cosmesis. In recent literature, urethral mobilization and advancement (UMA) is gaining popularity in the management of distal penile hypospadias with no or very low complication rate as compared to all other techniques. The aim of this study is to share our results by using UMA in the management of anterior hypospadias with or without chordae. Results A total of 60 patients of anterior hypospadias having the mean age 57.15 ± 38.73 months were included. The mean length of hospital stay was 2.83 ± 1.33 days. The only peroperative complication was urethral injury during urethral mobilization seen in one patient. The most common postoperative complication was hematoma seen in five (8.3%) cases. Two patients (3.3%) had retraction of urethra. One patient had wound infection. Stenosis was labeled in four (6.6%). At 3 months follow-up, 93.3% patients had slit-like meatus and good urinary stream. Conclusion We found that UMA technique had good functional as well as excellent cosmetic outcome, so the technique can be adopted for anterior hypospadias correction. </jats:sec

Comparison of Duhamel’s Pull-Through Procedure Versus Soave’s Pull Through Procedure for The Management of Hirschsprung’s Disease

The Hirschsprung’s disease is managed via surgical procedures. Mostly two different procedures are common called Soave’s and Duhamel’s. we compared the procedure safety and output benefits and complications rate of these two studies. Objectives: To find the efficacy of Soave’s and Duhamel’s pull-through procedure that which method is more safe and efficient for the children with Hirschsprung’s disease. Methods: Randomized clinical trials were conducted.  The sample included was consists of 60 children of less than 1 year of age up to 3 years. Sample size was calculated by world health sample size calculator for randomized control trials. With the confidence interval of 95%. Purposive sampling technique was used to collect the data.  The study used paired t-test to compare the outcomes of two surgical procedures. 30 patients got Soave’s procedure and 30 underwent Duhamel’s procedure. Overall 54 boys and 6 girls were under study. Paired t-test were used to analyze the data. Results: In Soave’s pull-through the 26 patients recovered without any serious complications. If we compared this to the Duhamel’s procedure output the complications rate was a little high 23 patients recovered uneventfully while complications reported in 7 patients. The results of this study prove the significant findings in terms of efficiency and associated complications. Conclusion: In the light of above mentioned clinical trials the Soave’s procedure covers less frequency of complications and cost-efficient in comparison to Duhamel’s pull-through procedure in which the complications rate was significantly higher and a costly procedure.</jats:p