Umbrella repair of giant omphalocele, A new technique.

Introduction: Although many techniques have been described for reconstruction of the giant omphalocele, we present a simple , effective and safe new technique.Materials and Methods: We have studied 11 neonates with giant omphalocele that were treated by a new technique, Umbrella repair, in Sarvar pediatric hospital of Mashhad, Iran. In this new technique we released the skin around the omphalocele membrane just near the junction and a purse string suture is placed at the edge of the skin with beads beneath each bite and graded tightening of the suture in order to pushing the omphalocele toward the abdominal cavity. Finally we compare the results.Results: Among total 11 patients, mean age and weight at the time of operation were 2.18 days and 2150 grams respectively. comparing the results between groups, we observed significant less operative time and number of surgeries in neonatal period among patients who managed by umbrella repair. Post-operative complications, morbidity and mortality in umbrella repair group were also less than coventional methods.Conclusion: Umbrella repair provide a rapid and safe method for management of giant omphalocele with acceptable results and low morbidity and mortality

Unilateral Cleft Lip and Nasal Repair: Techniques and Principles

The Mashhad University of Medical Sciences and the Sheikh Hospital in Mashhad sponsored a Cleft Lip and Palate Workshop 30 April – 1 May 2009. During the Workshop, 6 surgical cases were performed and televised live to the audience attending the conference. Two of those cases were unilateral cleft lip repairs. The surgical technique used to repair these patients by the primary author (JGM) is a hybrid technique. It has evolved over the last decade as a result of prior surgical literature as well as first hand observation of various surgical colleagues. The following manuscript describes the surgical technique used at the Cleft Workshop in a step-wise or atlas-like fashion. The technique portion of the paper describes the repair of the unilateral cleft lip and nasal deformity in roughly the order the first author typically performs the procedure. More importantly, the final section of the paper details the principles that form the foundation for the techniques described

Case report: Secretory breast cancer in an 11-year-old girl

AbstractA lack of consensus about the optimal treatment modalities for breast cancer in children is because of its absolutely rare prevalence. In this article, the medical history and treatment of a secretory breast carcinoma in an 11-year-old girl is reported. Modified radical mastectomy (MRM) was performed on April 6, 2013. Systemic chemotherapy was performed after surgery because metastatic lymph nodes were found in the dissected axillary tissue. Long term follow-up had to be done

Thoracoscopic Congenital Diaphragmatic Hernia repair in neonate: The First Experience of Iranian Group

Background: Congenital diaphragmatic hernia (CDH) occurs due to a failure in closing pleuroperitoneal membrane thus resulting in an incomplete diaphragm formation1, which allows passage of the abdominal viscera into the thorax.1,3 Until 1995, the standard method for treatment of CDH was performed by open surgery through the abdomen or thoracic cavity. Minimally invasive approach via thoracoscopy or laparoscopy is applicable for treatment of CDH since 1995.4 Now a day’s thoracoscopic repair of CDH (T’Scopy CDH) is performed in many centers. In this paper, we present our experience of T’Scopy CDH repair from Iran.Patients and Methods: From 2011 to 2015, 74 patients with CDH were admitted to Pediatric Surgery Department of Dr. Sheikh (Sarvar) Pediatric Hospital. Twenty one patients (28%) met our inclusion criteria and underwent T’Scopy CDH repair. The median age at the time of repair was 5 days (2-daysold to 4-years-old patients). Inclusion criteria were weight over 2 kg and stable hemodynamics and arterial blood gas. Fourteen cases were intubated before entering the operating room. The defect was in the left side except in two cases. In 8 cases, we used thoracic wall as part of repair. Also, mesh support was utilized in 8 cases even in cases were primary repair of diaphragm was possible in order to reinforcing the repair (5 cases). Of these 8 cases, in 3 patients, whole repair was accomplished by mesh due to presence of a large defect.Results: The mean time of operation was 80 minutes (40-230 minutes). Intraoperative mortality was zero. In hospital, mortality occurred in two cases due to septicemia in one and respiratory and cardiac failure in another. Conversion to open surgery was required in 6 cases. Late recurrence was observed in 2 cases. The mean time of follow up was 14.6 months (3-36 months).Conclusion: It seems that appropriate case selection and liberal use of thoracic wall and mesh as a part of repair may cause better results and decreased chance of early and late recurrence

P117 Surgical management of Ureteropelvic Junction Obstruction (UPJO) in Neonates amid COVID-19 pandemic; Review of Literature and a Cohort Study in Iran

Introduction The current study presents a systematic review of literature on surgical management of ureteropelvic junction obstruction (UPJO) alongside an ongoing cohort study of neonates presenting with high grades of hydronephrosis due to UPJO requiring urgent treatment in a developing country amid the COVID-19 pandemic. The aim of this study is to investigate the efficacy and cost effectiveness of laparoscopic-assisted pyeloplasty. Methods Patients’ demographics, clinical presentations and treatment outcomes are recorded. The cohort is classified into 3 groups based on type of surgical treatment offered including open, laparoscopic and laparoscopic-assisted pyeloplasty. All patients admitted with grade 3-4 hydronephrosis due to UPJO are included. Patients with UPJO as part of a complex multisystemic syndrome are excluded. Literature review was conducted from 2000/1/1 to 2020/1/1 to include all original research papers on surgical management of UPJO. The age group was limited to neonates (under 1 year-old). Results 32 articles were included in the review. 20 papers (62.5%) recommended open pyeloplasty, 10 papers (31.3%) recommended laparoscopic pyeloplasty and 2 papers (6.25%) recommended laparoscopic-assisted pyeloplasty. The cohort study is currently recruiting patients treated by the 3 surgical approaches. Conclusion The majority of studies are focusing on open pyeloplasty. However, as more surgeons are going through the learning curve of laparoscopic pyeloplasty, the trend is towards more laparoscopic management in the future. It is important to discover the advantages of laparoscopic-assisted approach as a new technique to improve the outcome and shorten the hospital stay amid the COVID-19 pandemic

Laparoscopic splenectomy advantages over open surgery

In recent years, laparoscopy has become a popular surgical method. Laparoscopy is a minimally invasive surgery, which results in minor traumas in comparison with conventional open surgeries. There are several risk factors associated with laparoscopy based on the involved organ and the patient’s general situations. Due to the improvements of clinical approaches, laparoscopic splenectomy has been known as a gold standard method for spleen removal as a result of various diseases, such as ITP. The human spleen plays a key immunologic role in defense against a number of organisms, particularly encapsulated bacteria. The spleen can cause significant morbidity and/or hematologic disturbance if it becomes hyperfunction (hypersplenism) or hypertrophied (splenomegaly). Laparoscopic surgery for cancer is also an appropriate procedure if good tissue handling techniques are maintained. In this study, we attempted to review the results obtained from recent articles about the beneficial features of the laparoscopic splenotectomy in comparison with conventional open surgery

Intrathoracic Testicular Ectopia in Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a defect in the diaphragm through which intra-abdominal and retroperitoneal organs may pass. However, the presence of the testis in the thoracic cavity is rare. Here, we describe a case of left-sided Bochdalek CDH with herniation of the left testis through the defect into the thorax, which was managed successfully by primary orchiopexy

Urethral Advancement and Glanuloplasty with V Flap of the Glans in the Repair of Anterior Hypospadias

Hypospadias is a common urethral anomaly in boys. More than 65% of hypospadias cases are anterior (glanular, coronal and distal penile shaft). More than 200 original techniques have been applied to correct hypospadias. Each of these techniques has some complications, the most common of which are fistula and meatal stenosis. Methods: A total of 74 boys with anterior hypospadias underwent the procedure of urethral advancement and glanuloplasty (UAGP) with V flap of the glans in our medical centres between March 1994 and March 2000. The procedure included degloving, correction of chordee, urethral mobilization and glans plasty. Results: Cosmetic results were excellent in most patients. There was no fistula, and meatal stenosis was also not observed after applying V flap of the glans. In a 1-6-year follow-up (mean ± SD, 3.15 ± 1.79 years), the results, functionally and cosmetically, were satisfactory in all cases, with no long-term complication or chordee. Conclusion: Our findings suggest that UAGP is an excellent technique for repairing anterior hypospadias with satisfactory results and low complication rate

Fibrous hamartoma of infancy, Report of Two Cases

Objective: Fibrous hamartoma of infancy (FHI) is a rare, benign soft tissue tumor that typically occurs within the first two years of life. It has a specific histologic appearance comprising of three different mesenchymal tissues with variable proportions in an organoid fashion. The clinical course is typically benign with excellent prognosis. We report two cases of this rare lesion and review its cilinicopathologic characteristics. Case Presentation: The first case was a 15-month-old girl who had a subcutaneous mass in the right axillary region and the other one was an 18-month-old boy with a mass on the medial surface of his right ankle. The masses were successfully excised. After 6 and 30 months follow up no recurrence occurred. Conclusion: Although the clinical and imaging findings of FHI are quite similar to those of malignant soft tissue tumor, histologic characteristics of this tumor will guide to the definite diagnosis that will prevent aggressive and mutilating procedures