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

Supersonic shear waves quantitative elastography and kinetic magnetic resonance dynamic curve in discriminating BI-RADS 4 breast masses: A comparative study

AbstractPurposeThe purpose of this study was to evaluate the usefulness of shear wave elastography (SWE) versus MRI dynamic curve in discriminating BI-RADS 4 breast masses to detect which modality is more sensitive and specific.Patients and methodsSixty-three patients presented by breast masses and categorized as BI-RADS 4 by mammography and ultrasound over the study period for 1 year were included. We analyzed and compared the quantitative dynamic MRI curve types with E-maximum (E-Max) shear wave (SW) velocity values.ResultsHistopathological evaluation revealed 41.3% of the cases had benign lesions and 58.7% had a malignant lesion. The mean E-max SW value of each pathology and its corresponding dynamic MRI curve were analyzed.At a cutoff value 45.3kPa±41.1 for benign lesions and 146.6kPa±40.05 for malignant lesions, the recorded sensitivity, specificity and accuracy of quantitative SWE in differentiating between the benign and malignant BI-RADS 4 breast lesions were 89.5%, 88%, and 88.9%, respectively and those for DC-MRI curve were 100%, 92.3%, and 96.8%, respectively.ConclusionQuantitative measurements are more vulnerable in detecting and differentiating BI-RADS 4 lesions. Type of the dynamic MRI curve is more sensitive, specific and accurate than SWE