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CONTEXT: Developing countries. AIMS: To propose a operative classification of Chordee without hypospadias (CWH) with its management. SETTINGS AND DESIGN: Tertiary referral centre; Retrospective study from January 2000 to January 2011. MATERIALS AND METHODS: Total 26 patients were classified peroperatively into sixtypes (A: Cutaneous chordeeâ Degloving skin and dartos (1/26); B: Fibrous chordeeâ chordectomy (4/26);C: Corporocavernosalchordeeâ Corporoplasty ± Urethral mobilization (4/26); D: Urethral tethering with Hypoplastic urethraâ Urethral mobilization ± urethral reconstruction because of hypoplastic urethra (14/26); E: Congenital short urethraâ excision of urethra from the meatus and urethroplasty (2/26); and F: Complex chordeeâ Degloving ± Corporoplasty ± urethroplasty (1/26 patients). The follow-up over 6 months to 9 years were analyzed. STATISTICAL ANALYSIS: SPSS soft ware version 17.0 for Windows. RESULTS: The mean age of surgery was 5.33 ± 0.11 years. The success rate defined on uroflowmetry and voiding cystourethrography was 65.6%. The coronal urethra-cutaneous fistula developed in 26.9% (7/26) {including 7.7% (3/26) of associated metal stenosis}. The urethral stricture developed in 3.8% (1/26). CONCLUSIONS: CWH needs stepwise surgical management. The operative classification may help in better understanding and management of this difficult entity. Meticulous tissue handling and urethroplasty is needed for good and promising results.
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BACKGROUND: Developing countries at tertiary referral centre. This study analysed the aetiology of colonic perforation (CP) in neonates and infants. MATERIALS AND METHODS: Retrospective analyses of 60 CP cases (presented from May 2005 to May 2011) were done. RESULTS: The mean age at presentation was 8.33 ± 0.11 days (range, 2-110 days). The aetiology were Hirschsprung's disease (HD), necrotising enterocolitis (NEC) and idiopathic perforation in 78.33% (47/60), 6.67% (4/60) and 15% (9/60), respectively. There were 210 patients with histopathologically proven HD; 22.38% (47/210) cases of HD had CP. Most common site of perforation was mid-transverse colon (74%, 35/47) in HD patients. All HD-associated mid-transverse colonic, caecal, appendicular and ascending colon perforations (except one caecal perforation) had aganglionic recto-sigmoid region and ganglionic perforation site. Features of enterocolitis were not found in any HD patients. Two patients (3.33%) died due to sepsis. CONCLUSIONS: There was a high rate of primary HD-associated colonic perforation in this study. Colonic perforation may the initial presenting condition in HD disease. We advocate colonic biopsy to rule out HD in any neonate presenting with primary colonic perforation.
Asunto(s)
Enfermedades del Colon/cirugía , Perforación Intestinal/cirugía , Enfermedades del Colon/etiología , Enterocolitis Necrotizante/complicaciones , Femenino , Enfermedad de Hirschsprung/complicaciones , Humanos , Lactante , Recién Nacido , Perforación Intestinal/etiología , Masculino , Estudios Retrospectivos , Enfermedades del Sigmoide/cirugíaRESUMEN
BACKGROUND: Developing countries at tertiary referral centre. The aim of this study was to share our experience of paediatric achalasia in Indian scenario. MATERIALS AND METHODS: This was a retrospective analysis of children <16 years, operated for achalasia at our centre, from December 1998 to December 2011. RESULTS: Total 40 patients (mean age 39 ± 4.29 months), including 1 patient of megaesophagus were operated over 13 years of period; 17 patients (associated congenital H-type tracheoesophageal fistula in one patient, non- responders/ lost follow-up for minimum of 3 years in 16 patients) were excluded from the study. The response rate of parents in follow-up was 60.0%. Mean symptoms duration was 27.88 ± 2 months. Most common symptoms were regurgitation and failure to thrive (78.2%). Mean symptom scoring in follow-up after 3 year was 1 ± 0.7 compared to 5 ± 0.51 at the time of admission (P < 0.012). One infant expired (mediastenitis), one developed adhesive intestinal obstruction and one needed posterior re-myotomy (for megaesophagus). There were no treatment failures in mean follow-up of 40.2 ± 5.07 months. CONCLUSIONS: Cardiomyotomy with partial fundoplication is the best modality of treatment for paediatric achalasia cardia, even from parents' perspective.