Pattern of Neonatal Surgery at a Teaching Hospital in Nigeria: A Review of 101 Cases.

Background: Neonatal surgeries are a particularly challenging aspect of paediatric surgery following the peculiar physiologic and metabolic demands of neonates. Surgery in the neonates therefore will require specific anaesthesia, analgesia, intraoperative and postoperative  monitoring. There are a wide range of surgical conditions requiring surgery in the neonates.Methods: The study was a retrospective study of neonates who underwent various surgeries from 2010-2012.The study was carried out at the University of Benin Teaching Hospital, Benin City, Nigeria. A total of 101 neonates had various surgeries during this period.Results: A total of 53 males and 48 females were seen with a male to female ratio of 1.1:1. The ages at presentation of the neonates ranged between few hours to 28 days. A wide range of clinical conditions involving various systems of the body were seen requiring surgery. These varied from neurosurgical plastic to gastrointestinal conditions. Most of the cases were congenital anomalies involving the gastrointestinal system (87.1%). Adequate analgesia was achieved with use of intravenous paracetamol in our patients. This does not require monitoring unlike in the case of opiods. Active postoperative monitoring is crucial to achieving good outcome in neonatal surgery.Key words: Neonatal, Congenital, Surger

Colostomy for anorectal malformation in a tertiary center in Nigeria

Background: Anorectal malformations constitute a wide spectrum of congenital anorectal abnormalities ranging from absent anus to anal membranes and fistulae. It is one major indication for the creation of colostomy in early neonatal life. This study was aimed at o describe and highlight the place of colostomy in the management of anorectal malformations. This article also reviews the issues relating to the choice of colostomy in anorectal malformation and common complications.Methods: The study was a prospective study carried put at a tertiary medical centre in Nigeria. It involved patients with a anaorectal malformation requiring the creation of colostomy.Results: A total of 19 neonates with anorectal malformation was seen over the period. The male to female ratio was approximately 1:2 with a female preponderance. Rectovestibular fistula was the commonest indication in females while recto-urethral fistula was commonest indication in males. Elective colostomy accounted for 78.9%.Conclusion: Anorectal malformation is the commonest indication for the creation of colostomy; this is closely followed by hircshsprungs disease. It is usually a part of the staged repair of anorectal malformation.The use of colostomy is acceptable as important in the initial management of patients with anorectal malformation. This affords the neonates the ability to feed and evacuate from the stoma. Complications are common and not life-threatening.Keywords: Colostomy, congenital, anorecta

Management of Congenital Tracheosophageal Atrasia and Fistula: A preliminary Bi-Cenre Study in Nigeria

Background: Esophageal atresia and tracheosophageal fistula are congenital abnormalities of the esophagus. The incidence is about 1 in 2,400 to 4,500.It can occur in association with conditions of the VACTERL group. The diagnosis is confirmed by the failure of a nasogastric tube to get to the stomach. Surgery is the mainstay of treatment. There has been remarkable improvement in the outcome following surgery in developed countries. This cannot be said of low resource and developing countries where significant morbidities and mortalities are recorded. This paperhighlights the early postoperative complications seen from two centers in Nigeria. It also raises questions that stimulate further researchMethods: This was a retrospective study done in two tertiary teaching hospitals in Nigeria over a one year period (2012). It was a preliminary work to evaluate the differences in management of neonates with tracheosophageal fistula (TEF) from the two centers over the same period.Results: Two centres were compared.Centre A managed 4 patients and Center B managed 5 patients.Staged repair was done in centre A and primary repair in Centre B.Conclusion: The outcome of management using primary repair and staged repair were comparably the same.Keywords: Atresia, Fistula, Tracheoesophageal, Congenita

Modified transanal repair of congenital H-type rectovestibular fistula: A technique to avoid recurrence

Congenital H-type rectovestibular fistulas are rare in the spectrum of anorectal malformations. Repair is associated with recurrence rates of up to 30%, using perineal repair, vestibuloanal pull-through or anterior anorectoplasty. The rarity of the malformation has limited experience with the surgical approach; hence, the rate of wound breakdown. We describe the use of a modification of the transanal approach for the repair in a 7-month-old female patient