Transjugular intrahepatic portosystemic shunt(TIPS)placement is a standard procedure for the treatment of portal hypertension complications.When this conventional approach is not feasible,alternative procedures for sy...Transjugular intrahepatic portosystemic shunt(TIPS)placement is a standard procedure for the treatment of portal hypertension complications.When this conventional approach is not feasible,alternative procedures for systemic diversion of portal blood have been proposed.A one-step interventional approach,combining minilaparotomy-assisted transmesenteric(MAT)antegrade portal recanalization and TIPS,is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma(PC).A 16-yearold girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC.A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed.In the case of failed portal recanalization,this approach,would also be useful for varice endovascular embolization.Postoperative recovery was uneventful.Treatment consisting of propanolol,enoxaparin and a proton pump inhibitor was prescribed after the procedure.One month post-op,contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts.No residual peritoneal fluid was detected nor opacification of the large varices.Endoscopy showed good improvement of the varices.Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches.Three months post-op,TIPS maintained its hourglass shape despite a slight expansion.Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization.MAT-TIPS is feasible and safe for the treatment of PC even in children.This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.展开更多
In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care spec...In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care specialist to fully understand the preoperative anatomy and the intraoperative details of these patients. This allows a timely and appropriate treatment of general and lesion-specific complications. In this article we provide a list of commonly-performed surgical procedures and possible associated problems to be anticipated in the early postoperative period. Then it follows a discussion about the diagnosis and management of these complications, based on their pathophysiological features.展开更多
AIM： To determine whether there was an association between inter-cellular adhesion molecule-1 （ICAM-1） gene polymorphism and biliary atresia （BA）, and to investigate the relationship between serum soluble ICAM-1 ...AIM： To determine whether there was an association between inter-cellular adhesion molecule-1 （ICAM-1） gene polymorphism and biliary atresia （BA）, and to investigate the relationship between serum soluble ICAM-1 （sICAM-1） and clinical outcome in BA patients after surgical treatment, METHODS： Eighty-three BA patients and 115 normal controls were genotyped. K469EICAM-1 polymorphism was analyzed using PCR assay. Serum sICAM-1 was determined using ELISA rnebhod from 72 BA patients. In order to evaluate the association between these variables and their clinical outcome, the patients were categorized into two groups： patients without jaundice and those with persistent jaundice. RESULTS： There were no significant differences between BA patients and controls in terms of gender, K469E ICAM-1 genotypes, and alleles. The proportion of patients having serum sICAM-1 ≥3 500 ng/mL in persistent jaundice group was significantly higher than that in the other group. In addition, there was no association between K469EICAM-1 polymorphism and the status of jaundice in BA patients after Kasai operation. CONCLUSION： ICAM-1 possibly plays an important and active role in the disease progression. However, the process is not associated with genetic variation of K469E ICAM-1 polymorphism.展开更多
Background-Purpose: The study aimed to see the outcome of Double Incomplete Pyloromyotomy as new technique for surgical management of infantile hypertrophic pyloric stenosis (IHPS). Methods: This study was conducted i...Background-Purpose: The study aimed to see the outcome of Double Incomplete Pyloromyotomy as new technique for surgical management of infantile hypertrophic pyloric stenosis (IHPS). Methods: This study was conducted in pediatric surgery unite, Zagazig University Hospital, Egypt. Fifteen patients were included in this study (11 male and 4 female) with IHPS from January 2012 to January 2013. Under general anesthesia, two longitudinal separated incisions at different planes as pyloromyotomy. Results: Postoperative vomiting and weight gain were recorded. Follow up period was 3 months. Vomiting improved within first 48 hours then stopped after that. Weight gain significantly increased after theoperation when compared preoperatively. Conclusion: Double Incomplete Pyloromyotomy is a new, safe and effective procedure for treatment of infantile hypertrophic pyloric stenosis.展开更多
Introduction: The birth of conjoined twins is an event extremely rare that offers unique therapeutic challenges and circumstances. We must examine each situation with the many questions that arise and which sometimes ...Introduction: The birth of conjoined twins is an event extremely rare that offers unique therapeutic challenges and circumstances. We must examine each situation with the many questions that arise and which sometimes require a long reflection. We report a case of separation of pygopages conjoined twins as well as a review of the literature. Patients and Observations: a pair of conjoined twins aged 11 days, weighing 3080 g between them, was referred to the neonatology department from the Faranah prefecture, 300 km from Conakry, for care. The mother, a 30-year-old housewife, multipara, eight gestures and nine parities, had not followed any prenatal consultation. The delivery took place at home in a village with the death of the mother immediately postpartum. The clinical and paraclinical investigation had concluded with the diagnosis of Siamese type pygopage. After multidisciplinary consultation, the surgical treatment by separation of the twins was carried out at the age of 50 days with success and preservation of the physiological functions. Conclusion: The birth of conjoined twins is extremely rare. Each pair of Siamese is different and the surgical strategy must be adapted according to the shared organs. The perfect multidisciplinary work of the medical staff has been the main contributor to our success.展开更多
Introduction: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The intervention is required for the persistent rectal prolapse (PRP). Only sca...Introduction: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The intervention is required for the persistent rectal prolapse (PRP). Only scanty experience is available with laparoscopic rectopexy in children. There is no available work using both mesh and suture laparoscopic rectopexy in literature. This work is unique that it presents our clinical experience with both mesh and suture laparoscopic rectopexy in children. This is a prospective clinical study for the outcome of laparoscopic rectopexy (LRP) by both mesh and suture technique in children with persistent rectal prolapse (PRP). Materials and Methods: Fourteen cases of PRP were managed with LRP from February 2008 to August 2012. Results: Of the 14 children, 10 (71.42%) were males and 4 (28.57%) were females. Male to female ratio was 2:1. The mean age of presentation was 5 years (range 3 - 8 years). The presenting complaints were mass descending per rectum along with bleeding per rectum lasting from 1 to 3 years. All had rectal prolapse of 5 - 7 cm in length. 12 out of 14 children had recurrence even after sclerotherapy before referral to laparoscopic rectpexy. The mean duration of surgery was 30 minutes (range 20 - 60 minutes). No intraoperative complications were reported;only one case got constipation and was managed conservatively and no recurrence. Conclusion: LRP is safe, feasible in children and gives satisfactory results after failure of all conservative even sclerotherapy injection.展开更多
Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised ever...Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised everywhere, constituting an alternative approach to surgery in poor areas. Patients and Methods: This observational and descriptive study included newborn babies with gastroschisis who underwent gradual bedside reduction at the Paediatric Surgery Department of the Yaounde Central Hospital. Results: Our cohort was constituted by 32 newborn babies with a mean age of 18.12 hours on admission. The Lefort type 2 was the most frequent in 81.25% of cases. The mean time for oral feeding after complete reduction was 17.4 days and the duration of hospital stay was 24.91 days. Survival rates were at 40.63%, with a residual hernia after healing in 38.46% of cases. Conclusion: Despite the high rate of mortality, gradual reduction of gastroschisis at the bedside seems to be an opportunity for resource constrained areas and can be an alternative solution to surgery.展开更多
Background: The aim of this study is to evaluate the short-term results of surgical correction of Tetralogy of Fallot in adult patients. Methods: Between 1999 and 2007, surgical correction was performed in 16 adult pa...Background: The aim of this study is to evaluate the short-term results of surgical correction of Tetralogy of Fallot in adult patients. Methods: Between 1999 and 2007, surgical correction was performed in 16 adult patients (mean age: 34.6 years;range: 18 to 62). Five previous procedures had been performed in 4 patients. Thirteen patients were in NYHA functional classification III or IV (81%), and 12 were cyanotic. Echocardiography was performed in all patients and 14 of them were catheterized. The mean gradient in the right ventricular outflow tract was 82 mmHg. Four patients had bad anatomy, consisting in coronary fistulas (2) and small pulmonary artery branches (2). Results: Infundibular resection was performed in all patients, ventricular septal defect closure in 15, pulmonary valve commissurotomy in 8, right ventricular outflow tract patch enlargement in 9 and transannular patch placement in 4. Three patients died during the postoperative hospital stay, 2 of them with sepsis. All of them had bad anatomy and severe preoperative condition. No residual defects were found. The other 13 patients had a good recovery. Eleven had less than 24 hours of mechanical ventilation. Early hospital discharge was possible in all survivors. Conclusion: Surgical correction of Tetralogy of Fallot in adulthood is an infrequent procedure. The short-term results depend mostly on the anatomic substrate and the preoperative clinical condition of the patient.展开更多
<strong>Background: </strong>Acute intestinal invagination or intussusception is the most common abdominal surgical emergency in infants, but it can occur at any age. Performing an ultrasound scan at the s...<strong>Background: </strong>Acute intestinal invagination or intussusception is the most common abdominal surgical emergency in infants, but it can occur at any age. Performing an ultrasound scan at the slightest clinical suspicion contributes to early diagnosis and therapeutic management. <strong>Objective:</strong> To show the relevance of ultrasound in the therapeutic management of the child’s intussusception through a correlation between the ultrasound diagnosis and the clinical and/or per operative diagnosis. <strong>Patients and Methods:</strong> It was a retrospective study of 24 cases from July 2017 to September 2020 (30 months) in the Medical Imaging and Paediatric Surgery departments of Teaching Hospital of Bouaké. We included only patients from 0 to 15 years old who had digestive symptoms, an abdominal ultrasound scan. These patients were eligible for surgery. Data analysis was performed with Epi info 7 software. <strong>Results:</strong> Median age was 17.2 months [02 - 120]. Male gender predominated (83.3%). Clinico-biological data were dominated by abdominal pain (79.2%), vomiting (75%) and rectorragies (33.3%), with Ombredanne’s triad in 33.3% and hyperleukocytosis (70.8%). Ultrasonography showed invaginated coves (95.8%) sitting in the right angl iliac fossa, peri-umbilical and right flank in 73.9%. Cockade image coupled with the sandwich image accounted for 95.6%. Superficial adenopathies (45.8%) and peri-lesional fluid effusion (20.8%) were associated with it. An occlusive syndrome complicating intussusception was observed in 41.67% associated with intra-peritoneal effusion of fluid (25%). There was a significant diagnostic agreement between the clinic, ultrasound and surgery according to the Fisher’s exact test (p = 0.002). That between ultrasound and surgery was calculated at 95.4%. <strong>Conclusion:</strong> This study allowed us to show a good clinical-echo-surgical concordance. Ultrasound is therefore an undeniable diagnostic, prognostic and therapeutic tool in the exploration of intussusception, hence the interest of its prescription in the shortest possible time by the clinician.展开更多
Background/Purpose: In the pediatric population the failure rate of sclerotherapy for the treatment of varicocele has been reported to be up to 35%. Therefore, the aim of our study was to evaluate the efficacy of retr...Background/Purpose: In the pediatric population the failure rate of sclerotherapy for the treatment of varicocele has been reported to be up to 35%. Therefore, the aim of our study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in children and adolescents. Methods: A total of 97 patients were operated on for left-sided varicocele using the retroperitoneoscopic approach between January 1999 and July 2003. Median age was 12.3 years (range,6-16 years). A 10-mm subcostal retroperitoneoscopic port was used. The operation was performed through an operative laparoscope according to Palomo’s technique,with the mass division of spermatic vessels after bipolar coagulation below the renal vein. Elective conversion to laparoscopic transperitoneal varicocelectomy was performed in cases of difficulties in identifying the vessels. The postoperative follow-up included clinical and ultrasound assessment (range, 6-48 months). Results: A total of 17 (17.6%) patients needed elective conversion to laparoscopic transperitoneal varicocelectomy. In RV, the mean operative time was 28 minutes (range, 15-55 minutes), the mean hospital stay was 2 days, persistence rate was 11.2%, and hydrocele occurrence was 6.2%. Conclusions: Our results indicate that the RV is an acceptable technique to achieve the high division of the spermatic vessels. The advantage of this anatomic approach is its very low invasiveness.展开更多
It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart di...It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic?arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough?pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain “balanced” autonomously, until the “second” stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there’s no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.展开更多
Background:Abnormalities involving the skin coverage of the penis are diffi cult to defi ne,but they can significantly alter penile appearance,and be a cause of parental concern.Data sources:The present review was bas...Background:Abnormalities involving the skin coverage of the penis are diffi cult to defi ne,but they can significantly alter penile appearance,and be a cause of parental concern.Data sources:The present review was based on a non-systematic search of the English language medical literature using a combination of key words including"penile skin anomalies"and the specific names of the different conditions.Results:Conditions were addressed in the following order,those mainly affecting the prepuce(phimosis,balanitis xerotica obliterans,balanitis,paraphimosis),those which alter penile configuration(inconspicuous penis and penile torsion),and lastly focal lesions(cysts,nevi and vascular lesions).Most of these anomalies are congenital,have no or minimal influence on urinary function,and can be detected on clinical examination.Spontaneous improvement is possible.In the majority of cases undergoing surgery,the potential psychological implications of genital malformation on patient development are the main reason for treatment,and the age generally recommended for surgery is after 12 months of age.Conclusion:This review provides the pediatrician with a handy tool to identify the most common penile skin anomalies,counsel parents adequately,make sensible and evidence based choices for management,and recognize complications or untoward outcomes in patients undergoing surgery.展开更多
Background:Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies(peptic or caustic inge...Background:Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies(peptic or caustic ingestion).The purpose of our work was to describe the experience of gastric transposition in three Italian centers.Methods:This is a retrospective study.The data were extrapolated from a prospective database.We included all patients who had undergone gastric transposition in the last 15 years.Results:In the 15-year period,eight infants and children(3 males and 5 females)underwent gastric transposition for esophageal replacement.Six patients had long-gap esophageal atresia,and two had caustic esophageal stenosis.There were no deaths in the series.Three patients had an early postoperative complication:two had a self-limited salivary fistula at three weeks,and one(a patient with jejunostomy)had a jejunal perforation treated surgically.One late complication,anastomotic stricture,was recorded that required two endoscopic dilatations.The median follow-up was 60 months(range:18–144 months).At final clinical follow-up,six patients had no eating problems,and two patients had some difficulties with eating(jejunostomy in situ),but they underwent logopedic therapy with improved outcomes.All patients had an increase in body weight and height postoperatively.Conclusion:Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results,both in terms of surgical technique(simplicity,reproducibility,complication rate)and clinical follow-up(good oral feeding of young patients,normal social life and regular growth curves).展开更多
Surgical resection and chemotherapy are the mainstay of the treatment for undifferentiated embryonal sarcoma of the liver.Whether neoadjuvant chemotherapy should be systematically performed is a matter of debate;perio...Surgical resection and chemotherapy are the mainstay of the treatment for undifferentiated embryonal sarcoma of the liver.Whether neoadjuvant chemotherapy should be systematically performed is a matter of debate;perioperative morbidity and mortality should be carefully weighed against chemotherapy-associated complications.In order to manage undifferentiated embryonal sarcoma of the liver and to allow for accurate outcome analysis,there is a clear need for standardization of disease extent as well as for a risk stratification system,including the PRETEXT grouping system,patient age,and tumor size.展开更多
Progressively,as chemotherapy has become more effective,more children with liver malignancies are amenable to liver transplantation,and indications have expanded from a limited range of cases(mostly hepatoblastoma)to ...Progressively,as chemotherapy has become more effective,more children with liver malignancies are amenable to liver transplantation,and indications have expanded from a limited range of cases(mostly hepatoblastoma)to a range of other unresectable malignant liver tumors;as a result,more children with hepatocellular carcinoma are also now proposed to transplantation,even and often outside the Milan criteria,for a cure.Recent series have highlighted that patient and graft survivals after transplantation for hepatoblastoma and hepatocellular carcinoma have improved in the last decade.Although consensus has not yet been reached about transplantation as a possible cure for other tumor types than hepatoblastoma and hepatocellular carcinoma,liver transplantation,generally speaking,has become an important pillar in the management of pediatric liver malignancies.Remaining limitations and inquiries relate to patient selection(in term of selection criteria considering the risk of recurrence),the role and usefulness of chemotherapy after transplantation,or the best immunosuppression strategy to both protect renal function and improve outcome.Although some prospective studies are on the way regarding these aspects,more studies are needed to explore this rapidly changing aspect of care.展开更多
Congenital duodenal obstruction(CDO)is a relatively common neonatal anomaly with a reported incidence of 1 in 2500-10000 live births.12 Diagnosis can be made prenatally with ultrasound(US)during antenatal care or duri...Congenital duodenal obstruction(CDO)is a relatively common neonatal anomaly with a reported incidence of 1 in 2500-10000 live births.12 Diagnosis can be made prenatally with ultrasound(US)during antenatal care or during the postnatal period commonly as bilious vomiting and feeding intolerance.Patients with a partial stenosis can survive to present in a much-delayed fashion.展开更多
文摘Transjugular intrahepatic portosystemic shunt(TIPS)placement is a standard procedure for the treatment of portal hypertension complications.When this conventional approach is not feasible,alternative procedures for systemic diversion of portal blood have been proposed.A one-step interventional approach,combining minilaparotomy-assisted transmesenteric(MAT)antegrade portal recanalization and TIPS,is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma(PC).A 16-yearold girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC.A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed.In the case of failed portal recanalization,this approach,would also be useful for varice endovascular embolization.Postoperative recovery was uneventful.Treatment consisting of propanolol,enoxaparin and a proton pump inhibitor was prescribed after the procedure.One month post-op,contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts.No residual peritoneal fluid was detected nor opacification of the large varices.Endoscopy showed good improvement of the varices.Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches.Three months post-op,TIPS maintained its hourglass shape despite a slight expansion.Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization.MAT-TIPS is feasible and safe for the treatment of PC even in children.This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.
文摘In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care specialist to fully understand the preoperative anatomy and the intraoperative details of these patients. This allows a timely and appropriate treatment of general and lesion-specific complications. In this article we provide a list of commonly-performed surgical procedures and possible associated problems to be anticipated in the early postoperative period. Then it follows a discussion about the diagnosis and management of these complications, based on their pathophysiological features.
文摘AIM： To determine whether there was an association between inter-cellular adhesion molecule-1 （ICAM-1） gene polymorphism and biliary atresia （BA）, and to investigate the relationship between serum soluble ICAM-1 （sICAM-1） and clinical outcome in BA patients after surgical treatment, METHODS： Eighty-three BA patients and 115 normal controls were genotyped. K469EICAM-1 polymorphism was analyzed using PCR assay. Serum sICAM-1 was determined using ELISA rnebhod from 72 BA patients. In order to evaluate the association between these variables and their clinical outcome, the patients were categorized into two groups： patients without jaundice and those with persistent jaundice. RESULTS： There were no significant differences between BA patients and controls in terms of gender, K469E ICAM-1 genotypes, and alleles. The proportion of patients having serum sICAM-1 ≥3 500 ng/mL in persistent jaundice group was significantly higher than that in the other group. In addition, there was no association between K469EICAM-1 polymorphism and the status of jaundice in BA patients after Kasai operation. CONCLUSION： ICAM-1 possibly plays an important and active role in the disease progression. However, the process is not associated with genetic variation of K469E ICAM-1 polymorphism.
文摘Background-Purpose: The study aimed to see the outcome of Double Incomplete Pyloromyotomy as new technique for surgical management of infantile hypertrophic pyloric stenosis (IHPS). Methods: This study was conducted in pediatric surgery unite, Zagazig University Hospital, Egypt. Fifteen patients were included in this study (11 male and 4 female) with IHPS from January 2012 to January 2013. Under general anesthesia, two longitudinal separated incisions at different planes as pyloromyotomy. Results: Postoperative vomiting and weight gain were recorded. Follow up period was 3 months. Vomiting improved within first 48 hours then stopped after that. Weight gain significantly increased after theoperation when compared preoperatively. Conclusion: Double Incomplete Pyloromyotomy is a new, safe and effective procedure for treatment of infantile hypertrophic pyloric stenosis.
文摘Introduction: The birth of conjoined twins is an event extremely rare that offers unique therapeutic challenges and circumstances. We must examine each situation with the many questions that arise and which sometimes require a long reflection. We report a case of separation of pygopages conjoined twins as well as a review of the literature. Patients and Observations: a pair of conjoined twins aged 11 days, weighing 3080 g between them, was referred to the neonatology department from the Faranah prefecture, 300 km from Conakry, for care. The mother, a 30-year-old housewife, multipara, eight gestures and nine parities, had not followed any prenatal consultation. The delivery took place at home in a village with the death of the mother immediately postpartum. The clinical and paraclinical investigation had concluded with the diagnosis of Siamese type pygopage. After multidisciplinary consultation, the surgical treatment by separation of the twins was carried out at the age of 50 days with success and preservation of the physiological functions. Conclusion: The birth of conjoined twins is extremely rare. Each pair of Siamese is different and the surgical strategy must be adapted according to the shared organs. The perfect multidisciplinary work of the medical staff has been the main contributor to our success.
文摘Introduction: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The intervention is required for the persistent rectal prolapse (PRP). Only scanty experience is available with laparoscopic rectopexy in children. There is no available work using both mesh and suture laparoscopic rectopexy in literature. This work is unique that it presents our clinical experience with both mesh and suture laparoscopic rectopexy in children. This is a prospective clinical study for the outcome of laparoscopic rectopexy (LRP) by both mesh and suture technique in children with persistent rectal prolapse (PRP). Materials and Methods: Fourteen cases of PRP were managed with LRP from February 2008 to August 2012. Results: Of the 14 children, 10 (71.42%) were males and 4 (28.57%) were females. Male to female ratio was 2:1. The mean age of presentation was 5 years (range 3 - 8 years). The presenting complaints were mass descending per rectum along with bleeding per rectum lasting from 1 to 3 years. All had rectal prolapse of 5 - 7 cm in length. 12 out of 14 children had recurrence even after sclerotherapy before referral to laparoscopic rectpexy. The mean duration of surgery was 30 minutes (range 20 - 60 minutes). No intraoperative complications were reported;only one case got constipation and was managed conservatively and no recurrence. Conclusion: LRP is safe, feasible in children and gives satisfactory results after failure of all conservative even sclerotherapy injection.
文摘Introduction: Gastroschisis is one of the neonatal pathologies with bad prognosis in developing countries due to a lack of equipment. We aim to report one way of managing this malformation that could be practised everywhere, constituting an alternative approach to surgery in poor areas. Patients and Methods: This observational and descriptive study included newborn babies with gastroschisis who underwent gradual bedside reduction at the Paediatric Surgery Department of the Yaounde Central Hospital. Results: Our cohort was constituted by 32 newborn babies with a mean age of 18.12 hours on admission. The Lefort type 2 was the most frequent in 81.25% of cases. The mean time for oral feeding after complete reduction was 17.4 days and the duration of hospital stay was 24.91 days. Survival rates were at 40.63%, with a residual hernia after healing in 38.46% of cases. Conclusion: Despite the high rate of mortality, gradual reduction of gastroschisis at the bedside seems to be an opportunity for resource constrained areas and can be an alternative solution to surgery.
文摘Background: The aim of this study is to evaluate the short-term results of surgical correction of Tetralogy of Fallot in adult patients. Methods: Between 1999 and 2007, surgical correction was performed in 16 adult patients (mean age: 34.6 years;range: 18 to 62). Five previous procedures had been performed in 4 patients. Thirteen patients were in NYHA functional classification III or IV (81%), and 12 were cyanotic. Echocardiography was performed in all patients and 14 of them were catheterized. The mean gradient in the right ventricular outflow tract was 82 mmHg. Four patients had bad anatomy, consisting in coronary fistulas (2) and small pulmonary artery branches (2). Results: Infundibular resection was performed in all patients, ventricular septal defect closure in 15, pulmonary valve commissurotomy in 8, right ventricular outflow tract patch enlargement in 9 and transannular patch placement in 4. Three patients died during the postoperative hospital stay, 2 of them with sepsis. All of them had bad anatomy and severe preoperative condition. No residual defects were found. The other 13 patients had a good recovery. Eleven had less than 24 hours of mechanical ventilation. Early hospital discharge was possible in all survivors. Conclusion: Surgical correction of Tetralogy of Fallot in adulthood is an infrequent procedure. The short-term results depend mostly on the anatomic substrate and the preoperative clinical condition of the patient.
文摘<strong>Background: </strong>Acute intestinal invagination or intussusception is the most common abdominal surgical emergency in infants, but it can occur at any age. Performing an ultrasound scan at the slightest clinical suspicion contributes to early diagnosis and therapeutic management. <strong>Objective:</strong> To show the relevance of ultrasound in the therapeutic management of the child’s intussusception through a correlation between the ultrasound diagnosis and the clinical and/or per operative diagnosis. <strong>Patients and Methods:</strong> It was a retrospective study of 24 cases from July 2017 to September 2020 (30 months) in the Medical Imaging and Paediatric Surgery departments of Teaching Hospital of Bouaké. We included only patients from 0 to 15 years old who had digestive symptoms, an abdominal ultrasound scan. These patients were eligible for surgery. Data analysis was performed with Epi info 7 software. <strong>Results:</strong> Median age was 17.2 months [02 - 120]. Male gender predominated (83.3%). Clinico-biological data were dominated by abdominal pain (79.2%), vomiting (75%) and rectorragies (33.3%), with Ombredanne’s triad in 33.3% and hyperleukocytosis (70.8%). Ultrasonography showed invaginated coves (95.8%) sitting in the right angl iliac fossa, peri-umbilical and right flank in 73.9%. Cockade image coupled with the sandwich image accounted for 95.6%. Superficial adenopathies (45.8%) and peri-lesional fluid effusion (20.8%) were associated with it. An occlusive syndrome complicating intussusception was observed in 41.67% associated with intra-peritoneal effusion of fluid (25%). There was a significant diagnostic agreement between the clinic, ultrasound and surgery according to the Fisher’s exact test (p = 0.002). That between ultrasound and surgery was calculated at 95.4%. <strong>Conclusion:</strong> This study allowed us to show a good clinical-echo-surgical concordance. Ultrasound is therefore an undeniable diagnostic, prognostic and therapeutic tool in the exploration of intussusception, hence the interest of its prescription in the shortest possible time by the clinician.
文摘Background/Purpose: In the pediatric population the failure rate of sclerotherapy for the treatment of varicocele has been reported to be up to 35%. Therefore, the aim of our study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in children and adolescents. Methods: A total of 97 patients were operated on for left-sided varicocele using the retroperitoneoscopic approach between January 1999 and July 2003. Median age was 12.3 years (range,6-16 years). A 10-mm subcostal retroperitoneoscopic port was used. The operation was performed through an operative laparoscope according to Palomo’s technique,with the mass division of spermatic vessels after bipolar coagulation below the renal vein. Elective conversion to laparoscopic transperitoneal varicocelectomy was performed in cases of difficulties in identifying the vessels. The postoperative follow-up included clinical and ultrasound assessment (range, 6-48 months). Results: A total of 17 (17.6%) patients needed elective conversion to laparoscopic transperitoneal varicocelectomy. In RV, the mean operative time was 28 minutes (range, 15-55 minutes), the mean hospital stay was 2 days, persistence rate was 11.2%, and hydrocele occurrence was 6.2%. Conclusions: Our results indicate that the RV is an acceptable technique to achieve the high division of the spermatic vessels. The advantage of this anatomic approach is its very low invasiveness.
文摘It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic?arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough?pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain “balanced” autonomously, until the “second” stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there’s no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.
文摘Background:Abnormalities involving the skin coverage of the penis are diffi cult to defi ne,but they can significantly alter penile appearance,and be a cause of parental concern.Data sources:The present review was based on a non-systematic search of the English language medical literature using a combination of key words including"penile skin anomalies"and the specific names of the different conditions.Results:Conditions were addressed in the following order,those mainly affecting the prepuce(phimosis,balanitis xerotica obliterans,balanitis,paraphimosis),those which alter penile configuration(inconspicuous penis and penile torsion),and lastly focal lesions(cysts,nevi and vascular lesions).Most of these anomalies are congenital,have no or minimal influence on urinary function,and can be detected on clinical examination.Spontaneous improvement is possible.In the majority of cases undergoing surgery,the potential psychological implications of genital malformation on patient development are the main reason for treatment,and the age generally recommended for surgery is after 12 months of age.Conclusion:This review provides the pediatrician with a handy tool to identify the most common penile skin anomalies,counsel parents adequately,make sensible and evidence based choices for management,and recognize complications or untoward outcomes in patients undergoing surgery.
文摘Background:Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies(peptic or caustic ingestion).The purpose of our work was to describe the experience of gastric transposition in three Italian centers.Methods:This is a retrospective study.The data were extrapolated from a prospective database.We included all patients who had undergone gastric transposition in the last 15 years.Results:In the 15-year period,eight infants and children(3 males and 5 females)underwent gastric transposition for esophageal replacement.Six patients had long-gap esophageal atresia,and two had caustic esophageal stenosis.There were no deaths in the series.Three patients had an early postoperative complication:two had a self-limited salivary fistula at three weeks,and one(a patient with jejunostomy)had a jejunal perforation treated surgically.One late complication,anastomotic stricture,was recorded that required two endoscopic dilatations.The median follow-up was 60 months(range:18–144 months).At final clinical follow-up,six patients had no eating problems,and two patients had some difficulties with eating(jejunostomy in situ),but they underwent logopedic therapy with improved outcomes.All patients had an increase in body weight and height postoperatively.Conclusion:Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results,both in terms of surgical technique(simplicity,reproducibility,complication rate)and clinical follow-up(good oral feeding of young patients,normal social life and regular growth curves).
文摘Surgical resection and chemotherapy are the mainstay of the treatment for undifferentiated embryonal sarcoma of the liver.Whether neoadjuvant chemotherapy should be systematically performed is a matter of debate;perioperative morbidity and mortality should be carefully weighed against chemotherapy-associated complications.In order to manage undifferentiated embryonal sarcoma of the liver and to allow for accurate outcome analysis,there is a clear need for standardization of disease extent as well as for a risk stratification system,including the PRETEXT grouping system,patient age,and tumor size.
文摘Progressively,as chemotherapy has become more effective,more children with liver malignancies are amenable to liver transplantation,and indications have expanded from a limited range of cases(mostly hepatoblastoma)to a range of other unresectable malignant liver tumors;as a result,more children with hepatocellular carcinoma are also now proposed to transplantation,even and often outside the Milan criteria,for a cure.Recent series have highlighted that patient and graft survivals after transplantation for hepatoblastoma and hepatocellular carcinoma have improved in the last decade.Although consensus has not yet been reached about transplantation as a possible cure for other tumor types than hepatoblastoma and hepatocellular carcinoma,liver transplantation,generally speaking,has become an important pillar in the management of pediatric liver malignancies.Remaining limitations and inquiries relate to patient selection(in term of selection criteria considering the risk of recurrence),the role and usefulness of chemotherapy after transplantation,or the best immunosuppression strategy to both protect renal function and improve outcome.Although some prospective studies are on the way regarding these aspects,more studies are needed to explore this rapidly changing aspect of care.
文摘Congenital duodenal obstruction(CDO)is a relatively common neonatal anomaly with a reported incidence of 1 in 2500-10000 live births.12 Diagnosis can be made prenatally with ultrasound(US)during antenatal care or during the postnatal period commonly as bilious vomiting and feeding intolerance.Patients with a partial stenosis can survive to present in a much-delayed fashion.
