sherif kaddah

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

Abstract Purpose: Retroperitoneal laparoscopy that provides a direct access to the retroperitoneal cavity is an interesting approach to adrenal gland surgery. We report our initial experience with retroperitoneal laparoscopic adrenalectomy to determine its efficacy for children with adrenal tumors. Materials and Methods: Between July 2015 and March 2017, we have performed seven adrenalectomies by extraperitoneal laparoscopy in three girls and four boys with unilateral adrenal tumor <5?cm who were 3 to 7 years old (mean age 5.6 years). Preoperative diagnosis was virilizing tumor in three, feminizing tumor in one, Cushing syndrome in two, and masculinizing adrenal tumor in one patient. The operations were performed with the patients placed in prone position and three trocars were positioned. The retroperitoneal space was created bluntly by the index finger through a 10?mm skin incision, and the retroperitoneal space was insufflated with carbon dioxide at pressure of 15 to 20?mm Hg. Dissection of the adrenal gland and adrenal vein was performed using Ligasure. The completely freed adrenal gland was enclosed in a bag and extracted through the middle trocar and the wounds were closed. Results: We removed six right and one left adrenal glands effectively. Average tumor size was 34?mm (range 24?52). Average hospital stay was 2.1 days (range 1?3). Blood loss was minimal. There was no intraoperative complication. Postoperative analgesic requirements were moderate. Conversion to open surgery was not necessary. The morbidity rate was low, with no mortality. Conclusions: Retroperitoneal adrenalectomy is associated with excellent clinical results. It is a reliable, safe, and effective technique. At our institution, retroperitoneal laparoscopy is becoming the standard adrenal surgery approach for tumors <5?cm. No competing financial interests exist. Runtime of video: 7?mins 55?secsAbstract Purpose: Retroperitoneal laparoscopy that provides a direct access to the retroperitoneal cavity is an interesting approach to adrenal gland surgery. We report our initial experience with retroperitoneal laparoscopic adrenalectomy to determine its efficacy for children with adrenal tumors. Materials and Methods: Between July 2015 and March 2017, we have performed seven adrenalectomies by extraperitoneal laparoscopy in three girls and four boys with unilateral adrenal tumor <5?cm who were 3 to 7 years old (mean age 5.6 years). Preoperative diagnosis was virilizing tumor in three, feminizing tumor in one, Cushing syndrome in two, and masculinizing adrenal tumor in one patient. The operations were performed with the patients placed in prone position and three trocars were positioned. The retroperitoneal space was created bluntly by the index finger through a 10?mm skin incision, and the retroperitoneal space was insufflated with carbon dioxide at pressure of 15 to 20?mm Hg. Dissection of the adrenal gland and adrenal vein was performed using Ligasure. The completely freed adrenal gland was enclosed in a bag and extracted through the middle trocar and the wounds were closed. Results: We removed six right and one left adrenal glands effectively. Average tumor size was 34?mm (range 24?52). Average hospital stay was 2.1 days (range 1?3). Blood loss was minimal. There was no intraoperative complication. Postoperative analgesic requirements were moderate. Conversion to open surgery was not necessary. The morbidity rate was low, with no mortality. Conclusions: Retroperitoneal adrenalectomy is associated with excellent clinical results. It is a reliable, safe, and effective technique. At our institution, retroperitoneal laparoscopy is becoming the standard adrenal surgery approach for tumors <5?cm. No competing financial interests exist. Runtime of video: 7?mins 55?secs

Abstract Introduction: Surgical management of the high urogenital sinus (UGS) is challenging. Presence of a short urethra is a contraindication for UGS mobilization as this is likely to affect urinary continence. In addition, vaginal reconstruction of the high suprasphincteric confluence is complex and prone to complications and failure. Methods: This study included 7 girls who underwent a laparoscopically assisted vaginal pull-through in the past 2 years. All cases included were diagnosed with congenital adrenal hyperplasia (CAH), with a high UGS, and a short urethra of ≤15 mm above the confluence. Patients were preoperatively assessed by genitography. Mobilization of the vagina was pursued until the confluence became visible and the vaginal caliber tapered off at its junction with the urethra. The connection was sutured or clipped and divided. Uterine round ligaments were divided to allow delivering the vagina to the perineum with minimum tension. The tract for the pull-through was created and the vagina was pulled outside and sutured to the perineal skin. Good vaginal mobilization allowed a direct perineal anastomosis without skin flap augmentation of the vaginal wall. Clitoroplasty and labiaplasty were deferred. Results: Mobilization of the vagina was possible in all cases attempted, without injuries to the adjacent pelvic structures. Calibration and dilatation started 2 weeks postoperatively. At 12-month follow-up, all the patients had a patent vagina with good caliber, and were able to retain urine without dribbling. Conclusion: The laparoscopically assisted vaginal pull-through approach provides optimal exposure, facilitates vaginal dissection, separation from the urethra, and avoids injuries to the urinary structures. This allows vaginal reconstruction without tension.

Abstract Background: Traditionally, Billroth I procedure or bypass gastrojejunostomy were the recommended approaches for management of postcorrosive complete gastric outlet obstruction (GOO), whereas Heineke Mickulicz pyloroplasty was recommended for moderate mucosal injury with partial cicatrization. In this study, laparoscopic diamond antroduodenostomy was carried out as an alternative minimally invasive approach for cases with pyloric cicatricial obstruction. Patients and Methods: Between January and December 2017, children who were referred to Pediatric Surgery Department, Cairo University Hospital, with GOO as a consequence of caustic liquid ingestions were included in this study. Laparoscopic diamond antroduodenostomy was performed for the presented cases. Results: Through the year 2017, 5 cases were approached with laparoscopic diamond antroduodenostomy. Isolated pyloric cicatrization was evident in 4 cases, whereas synchronous insult to thoracic esophagus and pylorus was manifest in the fifth case. Laparoscopic feeding jejunostomy completed the procedure for the case with esophageal stricture. Contrast study—24 hour postoperatively—assured no radiological leaks in the presented cases, where enteral feeding was gradually commenced, and patients discharged home a day later. After a mean follow-up of 13.5 months, neither recurrence of obstructive symptoms nor dumping was displayed. Cosmetic outlook inherent to the minimally invasive approach was appreciated by the parents. Conclusion: Laparoscopic diamond antroduodenostomy is a feasible approach for management of postcorrosive pyloric obstruction. It allowed early enteral feeding, with no dumping symptoms, in addition to the fundamental advantages of minimally invasive surgery. A bigger series and longer follow-up is recommended to verify the reported results.