Repair of low anorectal anomalies in female patients: risk factors for wound dehiscence

Background/purpose: Wound dehiscence after rectoperineal/vestibular fistulae repair may have adverse effects on the continence mechanism with delayed functional sequels. We report the incidence of wound complications following the sagittal anorectoplasty in a group of female patients, in addition to studying the effect of some possible risk factors.Patients and methods: This is a prospective cohort study conducted on female patients with rectoperineal or rectovestibular fistula operated during the period from January 2011 to December 2015. Patients were divided into three groups: group A (no dehiscence); group B (minor dehiscence); and group C (major dehiscence). Patients were compared regarding their age at the time of repair, the type of anorectal anomaly, the degree of dilation of the colon, and the prevalence of covering colostomy.Results: The study included 63 female patients. Group A included 34 patients (those with no dehiscence, 52.4%), group B included 17 patients (minor wound dehiscence, 26.98%), and group C included 13 patients (major wound dehiscence, 20.6%). There was no statistically significant difference between the three groups regarding the studied risk factors.Conclusion: With regard to the wound complications following the repair of rectoperineal/vestibular fistulae in the female patients, none of the studied risk factors appear to have a significant effect on the outcome.Keywords: anterior sagittal anorectoplasty, colostomy, posterior sagittal anorectoplasty, rectoperineal fistula, rectovestibular fistula, wound dehiscenc

Surgical management of congenital chylous ascites

Objective: The objective of this study was to present our experience regarding the diagnosis and therapeutic approach in cases of congenital chylous ascites that were surgically managed in our department in a 10-year period.Background: Congenital chylous ascites is a rare condition that constitutes a challenge for physicians. This condition is often refractory to therapy, and it is responsible for serious malnutrition and immunological deficiency because of losses of proteins and lymphocytes.Patients and methods: From 2007 to 2017, four cases of congenital chylous ascites were managed at our center. All cases were treated surgically after failure of medical treatment.Results: The first patient had no definite lymphatic leaks rather than presence of a moderate amount of milky ascitic fluid with dilated lymphatics at the root of the mesentery and at the intestinal wall and enlarged regional lymph nodes. The second one had leaking chylolymphatic cyst in the greater omentum that was excised. The third patient had no definite lymphatic leaks rather than thickened greater omentum, and thus, subtotal omentectomy was done. The fourth baby had no definite lymphatic leaks and developed reaccumulation of the ascitic fluid 1 month after surgery; insertion of a peritoneovenous shunt was indicated that succeeded to resolve the ascites. All children are growing up normally with no recurrence of the ascites on long-term follow-up.Keywords: chylolymphatic cyst, chylous ascites, lymphatic leak, peritonealvenous shun