Biliary Tract Disease in Pediatric Surgery Department: 10 Years Experience in Khouzestan-IRAN

Introduction: Our aim was to evaluate clinical manifestation, and outcome of biliary tract disease in patients referred for treatment to two referral centers of pediatric surgery of Ahvaz.Materials and Methods: In this retrospective study, patients with biliary tract disease admitted in Imam Khomeini and Abuzar hospitals (two referral centers for pediatric surgery in Ahvaz) during a 10-year period starting from March 2000 were evaluated. Age, sex, clinical manifestation, type of surgery, imaging finding, laboratory finding, duration of hospital stay, blood product infusion, and mortality rates were recorded. Data was analyzed with SPSS Ver 13.0(Chicago, IL, USA). We used Chi-square and t-test for comparison.Results: Twenty cases (m=13, f=7) of biliary atresia were included in this study. Mean age at the time of diagnosis and operation was 82.11 days (30 days- 6.5 months). Jaundice (100%), acholic stool (55%), and dark brown urine (55%) were the most frequent clinical manifestation in patients with biliary atresia. Of all cases, 17 patients underwent surgery. Eighteen cases (m=11, f=7) of cholecystitis were included in this study. Abdominal pain (72%) was the most frequent sign. Eleven cases underwent surgery. Five cases of choledochal cyst (m=0, f=5) were included in this study. Abdominal pain and vomiting was the most common clinical manifestation in cases with choledocal cyst.Conclusion: Jaundice, acholic stool, and dark brown urine were the most frequent clinical manifestation in cases with biliary atresia. Mean age at the time of diagnosis and operation for biliary atresia was 82.11 days (30 days- 6.5 months). Abdominal pain was the most frequent sign of cholecystitis. Early referral and more experience are needed in order to increase survival of biliary atresia cases in our hospital

Compare the effectiveness of two inguinal hernia repair techniques, Kugel and Lichtenstein repair

زمینه و هدف: هدف از انجام این مطالعه مقایسه نتایج دو روش ترمیم لیختن اشتاین و کوگل در بیماران مبتلا به فتق مغبنی می باشد. روش بررسی: در این مطالعه نیمه تجربی 42 بیمار مبتلا به فتق مغبنی با میانگین سنی 11 ± 9/49 سال وارد مطالعه و به طور تصادفی به دو گروه ترمیم کوگل و لیختن اشتاین تقسیم شدند. بیماران در طی عمل جراحی از نظر طول برش جراحی، مدت زمان عمل، بروزهماتوم، سروما، عفونت، احتباس ادراری و اختلالات حسی ناحیه اینگوئینال بوسیله آزمون t مستقل و آزمون دقیق فیشر مورد مقایسه قرار گرفتند. یافته ها: نتایج نشان داد که طول برش و زمان عمل جراحی در روش کوگل به طور معنی داری کمتر از لیختن اشتاین بود 001/0 >pسایر متغیرها تفاوت آماری معنی داری نداشتند 05/0 <

Outcome of patients with anorectal malformations after posterior sagittal anorectoplasty: a study from Ahvaz, Iran

Aim and purpose The aim of this study was to evaluate the outcome of patients who underwent posterior sagittal anorectoplasty (PSARP) for the treatment of low or high anorectal malformation (ARM).Patients and methods All patients who underwent standard PSARP were included in this study. Patients with mental retardation were excluded from our study. Patients were classified according to the Rintala score into four categories: poor (6–9); fair (9–11); good (12–17); and normal (18–20). We used a questionnaire introduced by Rintala. The type of anomaly was divided into two categories. We used low and high ARM definitions according to the relationship of the terminal colon to the levator muscles of the pelvic floor. The Student t-test, the Pearson v2-test, one-way analysis of variance, and the Levine test were used for data analysis using SPSS ver. 13.0.Results Sixty patients aged 3–17 years (13.63 ± 3.27 years) were included. The mean of score in patients with low-type ARM was 14.5± 2.6 and that in patients with hightype ARM was 13.19± 3.75 (P = 0.28). The mean of scores was 13.34± 3.5 among male patients and 13.94± 2.9 among female patients. There was no statistically significant difference (P = 0.46). The score was significantly higher in patients with fistula (n= 51, 13.9 ± 3.1) than in patients without fistula (n= 9, 11.8± 3.3; P= 0.03). Excluding two cases with scrotal-type fistula and rectal atresia, there was no significant difference between the two groups (P= 0.06).Conclusion There was no significant difference in the outcome after PSARP between boys and girls. There was no significant difference between low-type and high-type ARM. The mean of score was significantly higher among patients with fistula than among patients without fistula.Keywords: anoplasty, anorectal malformation, constipation, fistula, scrotal,vesical, vestibula

Evaluation of Omphalocele Treatment Using New Surgical Technique

Introduction: The aim of this study was to evaluate a new technique for treatment of omphalocele using mesh fixation to skin with preserved omphalocele sac. Materials and Methods:&nbsp; Chart of patients who treated with mesh fixation were reviewed. Demographic features, mortality and morbidity following treatment were recorded. Results: in the current study 68 patients (f=32, m=36) were included. Of 68 csaes, 44(64.7%) had giant omphalocele. Among all cases, 20(29.4%) had isolated omphalocele. Mortality was 26.5%(18 of 68).&nbsp; Of survived cases, 21(42%) had detached mesh. Adhesion band was seen in 4(8.2%) of cases. Sepsis was seen in 11.8% of the cases. Conclusion: According to the result of the study, suggested technique is promising and had several benefits. Duration of hospital staying, duration of intubation was less than previous technique

Esophageal atresia: our experiences in a university hospital

Introduction and aim Esophageal atresia is a relatively common congenital malformation occurring one in 2500–3000 live births. The aim of this study was to determine the frequency, type of anomaly, and mortality and to detect the associated anomaly in patients with esophageal atresia.Patients and methods All neonates with diagnosis of esophageal atresia who were referred to pediatric surgery ward of Imam Khomeini Hospital were included in this study. Duration of this study was 10 years from 20 March 1997 to 20 March 2006. For comparison, duration of the study was divided into two periods (1997–2001 and 2002–2006). Sex, mortality rate, associated anomalies, type of atresia, mortality, performing thoracostomy or gastrostomy, and packed cell infusion were studied. Gross classification was used for typing of anomaly. Analysis was performed using the Pearson v2-test and analysis of variance using SPSS.Results In this study, 198 (male = 100, female = 98) neonates were included. The most frequent type of atresia was type C (93.4%). Overall mortality rate was 50%. Mortality during the first period was 54.43% and during the second period was 47.05% (P = 0.384). The mean age at the second surgery was significantly higher in type D patients compared with others. The rate of gastrostomy was significantly higher during the first period (89.87%) compared with the second period of study (79.27%) (P = 0.002). The rate of cervical esophagostomy was decreased from 8.86 to 4.23% (P = 0.228).Conclusion Mortality rate has decreased in our hospitals. The rate of gastrostomy decreased during the second period of study. The age at the first surgery was significantly higher in type D classification patients.Keywords: esophageal atresia, gastrostomy, morbidity, mortality, thoracostomy, tracheoesophageal fistula, VACTERL syndrom

EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA Avaliação dos fatores de risco que afetam deiscência de anastomose após reparação de atresia esofágica

ABSTRACT -Background: Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion: Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage. RESUMO

Omphalocele, Gastroschisis: Epidemiology, Survival, and Mortality in Imam Khomeini Hospital, Ahvaz-Iran

Gastroschisis and omphalocele are the most common malformation of the anterior abdominal wall.The aim of the study was to determine the abdominal wall defect frequencies, survival, and mortalities in Ahvaz, Khuzestan province of Iran.Materiał and methods. All cases born with omphalocele or gastroschisis whom born in Imam Khomeini hospital, were included in this study. Duration of study was 3 years from April 2005. All patients treated at Imam Khomeini hospital in Ahwaz, Iran.Results. Among 15321 consecutive births, 42 patients had abdominal wall deformity. Overall incidence was 27.41 per 10,000 live births. Of all cases, 18 (42.9%) of cases were male and 24 (57.1%) were female. Of all cases, 21.7% of patients with omphalocele and 10% patients with gastroschisis had other anomalies. Of all cases, 71.8% of patients with omphalocele and 60% with gastroschisis underwent surgery. The type of anomaly (omphalocele and gastroschisis) had correlation with post operation prognosis significantly (p<0.001). Of 66.7% of patients under went surgery, 46.4% with mesh and 53.6% without mesh performed. 80% of patients with omphalocele and 20% with gastroschisis were lived.Conclusions: In our study, mortality was significantly higher in cases with gastroschisis than cases with omphalocel

Comparison Outcomes of Divided End Loop Versus Separate Double Barrel Colostomy in Neonates with Imperforate Anus: Divided End Loop Versus Separate Double Barrel Colostomy in Imperforate Anus

Introduction: the aim of current is to compare clinical outcomes between the divided end loop and separate double barrel colostomy in neonates with imperforate anus. Materials and Methods: This is a retrospective study to review 184 patients who presented with imperforate anus and were managed with a divided end loop or separate double barrel colostomy between 2017 and 2020. Complications were compared in the two groups. Results: There was more skin excoriation in separate double barrel colostomy compared to divided end loop colostomy (p=0.001).&nbsp; The mean of scar size in patients of divided end loop colostomy group was lower than that of separate double barrel colostomy significantly (p&lt;0.0001). Conclusion: Our results suggest that divided end loop colostomy may be more acceptable than separate double barrel colostomy for neonates with imperforate anus

Skin Bridge versus Rod Colostomy in Children – Comparison between Complications

Due to economic problems, sigmoid loop colostomy using glass rod may cause problems for our patients for finding glass rod and several visits. The aim of the study was to compare rod versus skin bridge colostomy. Material and methods. In this study, 42 cases who are candidate for colostomy were included. Cases were randomly placed in skin bridge and rod colostomy group. Independent sample t-test and Chi-square were used for comparison. SPSS version 16.0 (SPSS Inc, Chicago, IL, USA) was used for analysis. Results. Of 42 cases, 20 were male and 22 were female. Hirschsprung’s disease was the indication of colostomy in 33 cases. In nine cases, imperforate anus was the indication of colostomy. Mean time of surgery was 79.4 and 82.5 minute for the rod and skin bridge group respectively (P>0.05). Retraction was seen in 2 case of rod group, and no case of skin bridge group. Prolapse was seen in 2 (9.5%) case of rod group and 1(4.7%) case in skin bridge. There were no reports of necrosis, stenosis, and hernia in both groups. Conclusion. In the skin bridge group the rates of complications were lower but the groups are too small for statistical analysis. Colostomy with a skin bridge method may decrease number of revision and expenses and may be appropriate option. Sigmoid loop colostomy using skin bridge flap may be appropriate choice in developing country. Another study with more samples is recommended to better comparison of Skin Bridge versus rod colostomy