One-stage transanal Swenson procedure for rectosigmoid Hirschsprung’s disease in infants and children

Objective: This study aimed to present the outcome of transanal one-stage Swenson pull-through procedure in the management of rectosigmoid Hirschsprung’s disease (HD).Background: HD is a common cause of intestinal obstruction in pediatric age. Several pull-through procedures have been used to treat this pathology.Patients and methods: Between June 2008 and June 2015, 84 children with biopsy-proven HD underwent transanal one-stage Swenson pull-through procedure. Intraoperative details, postoperative complications, and bowel habits were recorded. Follow-up period ranged from 6 to 42 months.Results: The age at the time of surgery ranged from 3 months to 2 years. The length of the resected aganglionic segment ranged from 12 to 34 cm. The operating time ranged from 72 to 180 min. Postoperative hospital stay ranged from 3 to 6 days. There were no anastomotic leaks, no perianal infection, or postoperative bowel obstruction. Twelve patients (14.28%) developed postoperative enterocolitis. Six patients (7.14%) required a posterior internal sphincter myectomy despite repeated dilatations. All patients had less than four times bowel motions per  day, 3 months after surgery. No voiding disturbances were encountered at the end of the follow-up period and none of the patients complained of recurrent constipation. Six patients developed perianal dermatitis, which was treated conservatively within 3 months after surgery. Anastomotic circumference could not be felt at digital examination in 78 patients 3 months after surgery.Conclusion: One-stage transanal Swenson pull-through procedure is a safe alternative and simpler procedure for rectosigmoid HD with low morbidities and accepted outcome as regards postoperative bowel habits.Keywords: Hirschsprung’s disease, rectosigmoid Hirschsprung’s, Swenson procedure, transanal pull-throug

Using the renal pelvis flap to replace the whole hypoplastic ureter: a preliminary report

Background Hypoplastic ureter is a rare condition usually associated with hypoplastic kidney, and it ends with nephrectomy in most of the cases. Many techniques have been described as ureteric substitutes in the literature. Here, we describe a new technique using the renal pelvis flap to replace the whole hypoplastic ureter in two cases. Objective The aim of this study was to describe a new surgical technique in the management of ureteric hypoplasia.Patients and methods Of the two boys diagnosed antenatally, unilateral hydronephrosis was detected in one boy and a huge renal cyst was present in the other, with evidence of postnatal progressive obstruction necessitating surgical intervention. On exploration, hypoplastic ureter throughout its entire length was an accidental intraoperative finding. The renal pelvis flap was taken and tubularized to replace the entire ureter, and reimplanted into the urinary bladder. This technique was the primary procedure in one case, whereas it was the secondary procedure in the other case after failure of initial trial of pyeloplasty.Results The postoperative period was uneventful with adequate drainage of the renal pelvis in the short-term follow-up (6 and 3 months consecutively).Conclusion The renal pelvis flap is a new feasible alternative procedure for ureteric replacement in a hypoplastic ureter when there is preserved renal parenchyma.Keywords: renal pelvis flap, ureteral hypoplasia, ureteric replacemen

Application of contact stabilization activated sludge for enhancing biological phosphorus removal (EBPR) in domestic wastewater

The experiment has been performed in order to investigate the effect of using contact stabilization activated sludge as an application of enhancing biological phosphorous removal (EBPR) by using contact tank as a phosphorus uptake zone and using thickening tank as a phosphorus release zone. The study involved the construction of a pilot plant which was setup in Quhafa waste water treatment plant (WWTP) that included contact, final sedimentation, stabilization and thickening tanks, respectively with two returns sludge in this system one of them to contact tank and another to stabilization tank. Then observation of the uptake and release of total phosphorus by achievement through two batch test using sludge samples from thickener and final sedimentations. Results showed the removal efficiencies of COD, BOD and TP for this pilot plant with the range of 94%, 85.44% and 80.54%, respectively. On the other hand the results of batch tests showed that the reason of high ability of phosphorus removal for this pilot plant related to the high performance of microorganisms for phosphorus accumulating. Finally the mechanism of this pilot plant depends on the removal of the phosphorus from the domestic waste water as a concentrated TP solution from the supernatant above the thickening zone not through waste sludge like traditional systems