Right thoracotomy approach for patients with congenital tracheoesophageal fistula associated with right-sided aortic arch: a multicentric study

Background: A right-sided aortic arch (RAA) occurs in 5% of patients with esophageal atresia (EA). Its presence has significant surgical implications. Repair of the atresia has been considered difficult with the usual approach through the right chest. We hereby report our experience with cases of EA and RAA treated over the past 13 years in three pediatric surgical departments to determine the optimal surgical approach.Patients and methods: This is a retrospective study, which included all patients having EA with tracheoesophageal fistulas (TEFs) treated between January 2000 and September 2013 at four pediatric surgery departments (Zagazig University Hospital, Egypt; Assir Central Hospital, Kingdom of Saudi Arabia; MCH Najran, Kingdom of Saudi Arabia; Soba University Hospital, Sudan). The study compared a group of 22 patients who had EA with TEFs with RAA and no associated congenital disorder with another group of 22 patients who had the same condition but with normally situated left-sided aortic arch.Results: A total of 44 patients having EA with fistula were included into this study. They were divided into two groups on the basis of the side of aortic arch; 22 patients had leftsided aortic arch (group L), and the other 22 patients had RAA (group R). All patients were treated through right  thoracotomy. It was possible to achieve successful, although difficult management, in all patients with RAA through right thoracotomy. There was significant difference between the two groups of patients with regard to the operative time (104± 9.8 vs. 149 ±15.4 min). Twenty patients (45%) developed postoperative complications, with a morbidity rate of 41 and 50%, respectively, with no significant difference between the two groups. No mortality was recorded.Conclusion: Repair of congenital TEF associated with RAA can be performed through right thoracotomy safely but with some difficulty and longer time.Keywords: congenital tracheoesophageal fistula, right-sided aortic arch, right thoracotom

Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children

Background. Infantile hemangiomas (IHs) are the most common benign tumours of infancy. Propranolol has recently been reported to be a highly effective treatment for IHs. This study aimed to evaluate the efficacy and side effects of propranolol for treatment of complicated cases of IHs. Patients and Methods. This prospective clinical study included 30 children with huge or complicated IHs; their ages ranged from 2 months to 1 year. They were treated by oral propranolol. Treatment outcomes were clinically evaluated. Results. Superficial cutaneous hemangiomas began to respond to propranolol therapy within one to two weeks after the onset of treatment. The mean treatment period that was needed for the occurrence of complete resolution was 9.4 months. Treatment with propranolol was well tolerated and had few side effects. No rebound growth of the tumors was noted when propranolol dosing stopped except in one case. Conclusion. Propranolol is a promising treatment for IHs without obvious side effects. However, further studies with longer follow-up periods are needed

One or Two Stages Procedure for Repair of Rectovestibular Fistula: Which is Safer? (A Single Institution Experience)

Background: Rectovestibular fistula (RVF) is the most common type of anorectal malformations in females. The need for a diverting colostomy during correction of defect has ignited a heated debate. In this study, we reviewed the girls with RVF that had been treated by either one or two stage procedure in the past 10 years in our institution to define whether one stage or two stage procedures is safer and more beneficial for the patients. Materials and Methods: Seventy girls with RVF that had been operated from January 2005 to January 2015 were studied retrospectively. Data were obtained from medical hospital records. The cases were divided into two groups. Group A (46 patients): were operated by two stages technique (simultaneous sigmoid colostomy and anterior sagittal anorectoplasty [ASARP]). Group B (24 patients): were operated by one stage (ASARP without covering colostomy). The short-term outcome as regard wound infection, wound dehiscence, anal stenosis, anal retraction, recurrence of fistula as well as complications of colostomy was reported. The long-term outcome as regard soiling, constipation and voluntary bowel movement was evaluated. Results: The age of patients at the time of surgery ranged from 3 months to 2 years (mean; 9.5 months). In Group A, seven patients (15.2%) developed wound infection, two patients developed wound disruption. One patient developed anterior anal retraction and required redo-operation, anal stenosis was noticed in five (10.9%) patients. Complications from colostomy had occurred in nine patients (19.5%). In Group B, wound infection occurred in ten patients (41.7%). Seven patients (29.2%) developed wound disruption. Anal stenosis occurred in eight patients (33.3%). Five patients required redo-operation because of anal retraction in three patients and recurrence of fistula in the other two patients. Constipation recorded in 15 patients (32.6%) of Group A and in ten patients (41.3%) of Group B. Soiling was reported in six girls (13.04%) of Group A and five girls (20.8%) of Group B. Conclusion: The avoidance of colostomy is not outweighed achieving sound operation and continent child. Two stages correction of RVF is safer and more beneficial than one stage procedure, especially in our locality and for our paediatric surgeons during their learning curve