Pediatric Surgery

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ElFiky, M., M. Gad, M. Elbarbary, S. Kaddah, and G. Eltagy, "Implementation of a bowel management program in the treatment of incontinence in children for primary healthcare providers", Annals of Pediatric Surgery, vol. 13, issue 1, pp. 21-25, 2017. Abstract166976-article_text-430068-1-10-20180219.pdfWebsite

Objectives: Our surgical team has devised a bowel management program (BMP) as a basic approach for primary healthcare providers with the least use of resources.

Background: Soiling in children is a major problem that has a serious impact on the child’s social and psychological life. Causes vary from idiopathic constipation to postoperative or neuropathic causes as meningomyelocele.

Participants and methods: Seventy five children suffering from fecal incontinence were assessed and divided into true incontinence and pseudoincontinence groups. The BMP was applied to both categories in the form of proper diet control, enemas, drugs, and bowel habit alteration. The program was fashioned according to the age, type, severity, and response of each case. A fecal incontinence scoring system was used to assess the results.

Results: All cases with pseudoincontinence attained 50% or more improvement in incontinence score whereas the true incontinence cases attained excellent results except in post high anorectal malformation repairs and neurologic groups.

Conclusion: Most of the cases suffering from constipation with pseudoincontinence can be treated properly by BMPs, whereas the minority suffering from true incontinence need multidisciplinary work to achieve acceptable results.

ElFiky, M., "Establishing a multimodular Information Technology (IT) solution Pediatric Surgery units with modest resources", IPEG’s 25th Annual Congress for Endosurgery in Children, Fukuoka, Japan, 25 May , 2016. Abstractipeg2016_finalprogram_finalweblong.pdf

Objective: Every Pediatric Surgery unit needs an IT solution for saving patient medical records, researching & communicating with the World and its staff, which costs from thousands to millions of dollars. Our goal was to minimize the cost to the least for units with modest resources.

Description of the technology and method of its use or application: Cloud computing was used with a shared private secure server. The initial needed modules were for creating emails, setting up a welcoming website, integrating social media platforms & setting up other cloud modules. The first module was an electronic medical records software. The other was a clinical research data collection tool. Both modules were synchronized for specific research projects. More modules were added later to archive all surgery photos, sharing presentations & for online tutorials.

Results: The IT solution was created & implemented for our University Faculty of Medicine, the local Pediatric Surgery Association & was proposed for IPEG. The cost for the total setup was $100 annually with no running costs. Several research projects results have been published using the technology in other surgery meetings. Results have helped in auditing and improving our department surgery services.

Conclusion: Implementing a total IT solution for a modern Pediatric Surgery unit can be created using this low cost

Arafat, A. E. A., Laparoscopic versus Open Pyloromyotomy in cases of Infantile Hypertrophic Pyloric Stenosis, , Cairo, Cairo University, 2016. Abstract

Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of vomiting in infancy
The technique of laparoscopic pyloromyotomy was introduced as a way to improve the cosmetic appearance and wound related complications while benefiting from the minimally invasive advantages of laparoscopy. A prospective study of 50 patients with IHPS was done.

The study revealed that this technique has excellent cosmesis, operative time and complications rate comparable to open approach, so it can be considered as an alternative technique for treatment of IHPS.

Seoudi, M., Comparative study between Botulinum toxin injection and Myectomy in treatment of Idiopathic Constipation in Children, , Cairo, Cairo University, 2015. Abstract

Background: Neurotoxic protein produced by Clostridium botulinum has many therapeutic indications with few studies on its role in constipation. Treatment of intractable constipation surgically has been Internal Sphincter Myectomy.

Methods: Cases were selected with positive Rome III criteria for Chronic Idiopathic Constipation that failed medical treatment for at least 6 months. Cases with suspected other causes of constipation were excluded.
Randomization was performed and data collected using REDCap. All cases received colonic preparation. Half the cases (group A) underwent Internal Sphincter Myectomy at least 5 cm. The other half (group B) received intrasphincteric injection of Botulinum toxin type A.

Results: Twenty cases were selected. Mean Age was 4.4 years (A) & 6.34 (B). Male to Female ratio 2.3:1. Mean duration of illness 2.95 years (A) & 4.15 (B). No major complication in both groups. Soiling improved in both groups (p=0.051). Constipation relief based on Zero Rome III criteria was obtained in 80% (A) & 70% (B) on follow up to 6 months. Most cases achieved 1-3 motions per day 70% (A) & 50% (B).

Conclusion: Botulinum toxin injection is equally effective but less invasive than Myectomy. Larger sample and longer follow up are needed to full evaluate results.