Short-term outcome of posterior anorectal myectomy for treatment of children with intractable idiopathic constipation

Purpose: Many children with idiopathic constipation (IC) fail to improve with bowel management program. The role of surgical treatment in this subset of patients with intractable IC is still controversial. The aim of this study was to assess the outcome of anorectal myectomy in treatment of intractable IC.Patients and methods: Twenty-five patients with intractable IC were included in this study after failure of bowel management program for at least 1 year. Work-up was made to exclude all other causes of chronic constipation. All patients were selected for internal sphincter myectomy. Patients were followed for at least 6 months postoperatively. Clinical improvement was evaluated by number of bowel motions per week, weaning of laxatives, soiling, child’s own feedback, and overall parent satisfaction.Results: Study included 25 children with a mean age of 6.3 ±1.6 years, suffering from constipation for a mean of 32.9 ± 8.5 months, with failed trails of bowel management program for at least 12 months. All children were subjected to anorectal myectomy with a mean follow-up of 12.4 months. Children’s feedback showed a mean of 79.1% improvement. Postoperative parent satisfaction had a mean of 75.9%.Conclusion: Anorectal myectomy is an effective and technically simple procedure in selected patients with intractable IC.Keywords: anorectal myectomy, children, idiopathic constipatio

Urethral advancement procedure in the treatment of primary distal hypospadias: a series of 20 cases

Introduction: Distal hypospadias is the most common genital anomaly, occurring in almost 65% of all hypospadias cases. Although there are several surgical techniques for the treatment of distal hypospadias, it is clear that none can be used to correct all forms of hypospadias. The aim of the study was to evaluate urethral advancement in the repair of primary distal penile hypospadias with regard to feasibility, complication rates and the final cosmetic outcome.Patients and methods: Between October 2014 and June 2015, the urethral mobilization technique was used in 20 patients who presented at the Pediatric Surgery Unit, Tanta University Hospital, with primary distal hypospadias. A submeatal crescent-like incision was performed a few millimeters proximal to the meatus with two vertical incisions from the lateral ends of the submeatal incisions. The urethra within the corpus spongiosum was dissected from the skin of the ventral surface and from the glans and corpora cavernosa for a distance of ~ 4 : 1. The urethra was advanced till the urethral meatus reached its normal position without any tension. Spongioplsty can be performed, and covering Buck’s or Dartos’ layers can be used. The follow-up was conducted on a weekly basis in the outpatient clinic in the first month, and then every month for 6 months.Results: The age of the patient at the time of operation ranged from 6 to 24 months, with a mean age of 10.5 months. The operative time ranged from 60 to 90 min, with a mean time of 73.5 min. Intraoperative urethral injury occurred only in one patient. In all patients, the catheter was removed immediately postoperatively except for one patient who had operative urethral injury. Deep wound infection was noticed in only one patient, followed by partial glanular disruption. Only one patient had urethrocutaneous fistula and two patients had meatal retraction.Conclusion: Urethral advancement can be used safely in the mobilization of the distal urethra with wide glanular dissection and wide lateral mobilization of glanular wings. However, it should be stressed that in the presence of hypoplastic distal urethra and/or persistent ventral curvature, another technique should be adopted. The majority of our patients had very good cosmetic results and minimal complication. However, the technique requires further studies with a larger number of patients and longer follow-up periods to draw more precise and final conclusions.Keywords: distal hypospidaus, primary, urethral advancemen

Bipolar sealing devices versus endoscopic vascular staplers during laparoscopic splenectomy in children with benign hematological diseases

Background: Splenectomy, whether open or laparoscopic, is considered a step of management in many children with benign hematological diseases such as immune thrombocytopenia, thalassemia, autoimmune hemolytic anemia, and spherocytosis. The major challenge during laparoscopic splenectomy (LS) is the rich blood supply of the spleen. Many techniques were considered to control the vascular supply of the spleen. Staplers, clips, either titanium or hemoclips, a bipolar sealing device (BSD), or ultrasonic shears were all used to complete LS. We aimed to compare the results of using BSD versus endoscopic staplers for vascular control of the pedicle during LS.Patients and methods: The study was carried out on 30 children with benign hematological diseases who presented to the Pediatric Surgical Unit. They were grouped randomly into two groups: group A and group B. Group A included 15 patients who were subjected to LS in which BSD was used for vascular control, whereas group B included 15 patients subjected to LS in which endoscopic staplers were used for vascular control of the pedicle.Results: The mean age of the children in group A was 9.60 years, whereas the mean age of the children in group B was 10.40 years. In group A, the mean estimated amount of blood loss was 72.27 ml. However, this was 80.67ml in group B. In group A, the mean operative time required was 39.00 min, whereas it was 56.27 min in group B. The indications for splenectomy were thalassemia in 15 cases (seven for group A and eight for group B), idiopathic thrombocytopenic purpura in 13 cases (seven for group A and six for group B), and spherocytosis in two cases (one for each group). The mean splenic size in group A was 10.43 cm, whereas it was 11.73 cm in group B.Conclusion: LS has evolved over the last decade because of the advancements of BSDs and endoscopic staplers. According to our data the use of LigaSure reduces the overall operative time, operative blood loss, and associated complications compared with the use of staplers.Keywords: children, laparoscopic, splenectom