A model of short bowel syndrome independent of total parenteral nutrition (experimental study in rats)

AMAÇ: Çocuk yaş grubunda önemli mortalite ve bir morbidite olan kısa barsak sendromu (KBS); geniş barsak rezeksiyonu sonrası, kısalan barsak geçiş zamanı, yetersiz sindirim ve emilimi kapsar. KBS'de oluşan pek çok komplikasyonun hemen her zaman total parenteral beslenmeye (TPB) bağlı oluştuğu düşünülmektedir. Ancak TPB'den bağımsız da KBS komplikasyonları ortaya çıkabilmektedir. Bu çalışma ile TPB'den bağımsız oluşturulan KBS modeli oluşturulması planlandı. GEREÇ ve YÖNTEM: Ağırlıkları 180-220 g arasında değişen 37 adet erkek Wistar Albino cinsi sıçan, sham (n=16) ve kısa barsak sendromu (n=21) gruplarına ayrıldı. Sham grubunda ileoçekal valvin 15 cm. proksimalinden ileum transekte edildi ve rezeksiyon yapılmaksızın uç-uca anastomoz yapıldı. KBS grubunda ise, Treitz bağının 5 cm distali ile ileoçekal valvin 10 cm proksimali arasındaki ince barsaklar, mezenterik damarları ayrılarak, rezeke edildi ve jejenum ve ileum uç-uca tek tek anastomoz edildi. Deneklere eş besleme yapılarak günlük ve daha sonra yedi haftalık ağırlık takibi yapıldı. BULGULAR: KBS grubundaki deneklerin, sham grubuna göre birinci haftadan itibaren istatistiksel olarak anlamlı ağırlık kaybı yaşadıkları, zaman içinde ağırlık kazancı olsa bile hiçbir zaman sham grubundakileri yakalayamadıkları ancak yaşamlarını sürdürdükleri görüldü (*p<0.05). SONUÇ: TPB'den bağımsız oluşturulan bu deneysel model ile sıçanlar yaşatılmakta ve TPB'nin etkileri olmadan karaciğer yetmezliği gibi KBS'nun fizyopatolojisi incelenebilecektir.OBJECTIVE: Short bowel syndrome (SBS) which causes significant morbidity and mortality in children includes short bowel transit time, inadequate digestion and absorption as a result of intensive intestine resections. Most of the complications in SBS ocur as a result of total parenteral nutrition (TPN). However there are some other complications independent of TPN, the aim is to compose a SBS model which is independent of TPN. MATERIAL and METHODS: Two groups of 37 male Wister Albino rats which have weights of 180-220 g were generated. Sham group contained 16 and SBS group contained 21 rats. In sham group, ileum was transected 15cm proximal to ileocecal valve and end-to-end anastomosis was performed without resection. In SBS group, small intestines between 5cm distal to Treitz ligament and 10cm proximal to ileocecal valve were resected after isolating mesenteric vessels, then end-to-end anastomosis was performed between jejunum and ileum. The rats were fed equally and their weight were followed daily for seven weeks. RESULTS: The rats in SBS group have statistically significant weight loss hence first week when compared to those in sham group. Although they had weight gain in time they couldn't catch up with those in sham group however they continued to survive (*p<0.05). CONCLUSION: The rats survived in this TPN independent experimental model and it provides evaluation of SBS physiopathology such as liver failure without the effects of TPN

Contrubition of Laparoscopic Level Determination on Hirschsprung Disease Diagnosis and Management

Aim:Laparoscopic-assisted transanal pull-through (LATP) is a procedure that has gained increasing popularity in the management of Hirschsprung’s disease. The purpose of this study was to compare outcomes of patients treated with LATP and transanal pull-through (TPT).Methods:Records of 45 patients with Hirschsprung’s disease who underwent surgery between 2006 and 2017 were retrospectively evaluated.Results:LATP was performed in 16 patients [13 male (81%), three female (19%)]. The median age of the patients was four months (7 days-84 months). Twenty nine patients [21 male (72.4%), eight female (27.6%)] underwent TPT. The median age of the patients was 11 months (10 days-90 months). The mean time to start feeding in LATP and TPT groups was two days (one-three days) and 2.6 days, respectively (p=0.074). The mean operative time was 2.6 hours in the LATP group (two-four hours) and 2.7 hours in the TPT group (p=0.971). The mean length of hospital stay in for LATP and TPT groups was 4.8 days (two-nine days) and six days (3-14 days), respectively (p=0.305).Conclusion:The advantages of LATP include multiple sample collection from several segments of the colonn at the same time as well as shorter time to frozen section diagnosis. In addition, the possibility of intraabdominal dissection allows transanal surgery to be faster and more effective

Hipospadiyas Cerrahisinde Askı Dikişine Bağlı Gelişen Komplikasyon

Proksimal ve distal hipospadiyas onarımlarında cerrahın deneyimi ve kullanılan tekniklerdeki gelişmeye karşın komplikasyon oranı hala %1-90 arasında değişmektedir. Literatüre bakıldığında; glans penis ile ilgili meatal darlık, prolapsus ve retraksiyonu içeren az sayıda komplikasyondan söz edilmiştir. Yapılan taramada; hipospadiyas cerrahisi sonrasında tanımlanmış glansın dorsal kısmı ile ilgili herhangi bir yayına rastlanmadı. Glansda askı, stentin tesbitlenmesi ya da her ikisinin kullanımı nedeni ile glansdan geçilen rekraksiyon dikişine bağlı gelişen ameliyat sonrası skar bu komplikasyonlara eklebilir. Bu çalışmanın amacı; hipospadiyas cerrahisi sırasında kullanılan askı dikişine bağlı glansda skar gelişen dört hastanın sunulmasıdır.The complication rates are still 1-90% both in proximal and distal hypospadias regardless of the surgeon’s experience and the usage of most developed techniques. The literature survey revealed few complications of glans penis including meatal stenosis, prolapsus and retraction. Despite our literature survey, we could not find any article concerning the permanent scar tissue at the dorsal part of glans following hypospadias surgeries. A new complication can be added to these, concerning glans which is the formation of postoperative scar tissue as a reaction to suture material used in traction, stent anchoring or both. The aim of this paper is to demonstrate four cases which had glanular scar due to traction suture following the surgical proce- dures for hypospadias repair

Megameatus intact prepuce and associated anomalies

Objective: Megameatus intact prepuce is described as subset of megalourethra or distal hypospadias by several authors. Despite suggested different operative techniques, some authors prefer not to operate this variant of penile anomaly. We aimed to evaluate 31 patients operated due to megameatus intact prepuce and associated anomalies . Material and methods: Thirtyone patients operated between 2008-2018 for MIP were evaluated retrospectively. All data were collected from hospital records. Patient age, application reasons, raphe anomalies, associated genitourinary and extragenitourinary pathologies, operative techniques, and postoperative complications were analyzed. Results: Mean age was 50 months (8-128 months). Ten of the patients had raphe anomalies. Genital raphe hyperpigmentation was seen in 1 patient, raphe deviation and bifurcated raphe was seen in6 and 3 patients respectively. Genitourinary anomalies were detected in 7 patients, bilateral undescended testes in 1 patient, penile chordee in 2 patients, ureteropelvic junction obstruction in 2 patients, penoscrotal web in 1 patient, nocturnal enuresis in one patient. Tubularized incised plate urethroplasty (TIPU) (n=5), tubularized urethral plate urethroplasty (TUPU)(n=16) and meatoplasty (n=10) were the operative techniques. Conclusion: . Co-occuring raphe anomalies should arise awareness of MIP among the clinicians who are engaged with the children’s medical conditions and also the possible anomalies especially in the societies which circumcision is not traditionally required. Further studies with large number series needed for better understanding of this pathology

Laparoscopy is the Gold Standard in Ovarian Pathologies in Childhood: Clinical Evaluation and Literature Review

OBJECTIVE:Ovarian cysts and related torsions are the most common adnexial pathologies in childhood. Diagnostic laparoscopy is the gold standard approach for differential diagnosis. It is aimed to evaluate the data of patients who had surgery for ovarian pathology. STUDY DESIGN: Fifty-three girls of ten years are included the study. Demographic data, medical history, physical examination, laboratory and radiologic investigations, surgical procedure, histopathology, complications and follow up periods are recorded. RESULTS: The median age of children was 13. Excluding the patients who were diagnosed in intrauterine period (n=4), all of the patients had abdominal pain (92%). Laparoscopic cystectomy (56.7%), detorsion and cystectomy (16.9%) and oopherectomy (16.9%) were performed in patients with cysts. Diagnostic laparoscopy (3,8%) and laparoscopic detorsion (5.7%) were performed in patients without cyst. Dermoid cysts were found in three children and teratomas in two. Patients were discharged in postoperative second day. CONCLUSION: Diagnostic laparoscopy is the gold standard approach for differential diagnosis. Laparoscopic approach should be chosen because of shorter hospital stay, shorter healing period, and better cosmetic results. Besides, less pelvic adhesions compared to laparotomy in laparoscopy is important for further fertility

The effect of azygos vein preservation on postoperative complications after esophageal atresia repair: Results from the Turkish Esophageal Atresia Registry

Aim: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. Methods: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fis-tula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. Results: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the re-quirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) Conclusion: The data in the TEAR demonstrated that preserving the AV during EA repair led to no sig-nificant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory com-plications. (c) 2020 Elsevier Inc. All rights reserved