Surgical treatment of neonatal ovarian cysts.

Medical experts are still at issue over the most suitable management of simple neonatal ovarian cysts exceeding 40mm and complex cysts of any size. The authors present surgical treatment of these cysts by classical laparotomy and laparoscopy. The study included 13 newborn babies surgically treated for 6 simple and 7 complex ovarian cysts. The diameter of the cysts ranged from 29 to 102mm. The age of children was from 2 days to 10 months. The open classical laparotomic approach was performed in 8 babies. In the laparotomy group, cystectomy was done in 3 infants with simple cysts. The other 5, presented with ovarian torsion, required salpingo-oophorectomy. Video-assisted cystectomy was the procedure for 3 simplex and one complex cyst with torsion. Laparoscopic adnexectomy was applied in one case with auto-amputated cyst. Our small study demonstrates that laparoscopy is as safe and effective as classical laparotomy in managing neonatal ovarian cysts, but with better cosmetic results.

[Ultrasound-guided water enema for reduction of childhood intussusception].

INTRODUCTION: Intussusception is a common abdominal emergency in infants and children. Ultrasonography and barium enema are very useful in diagnosis and treatment of this condition. The aim of the study was to assess the accuracy of ultrasound-guided saline enema for intussusception and to determine if some factors may improve the outcome of this technique. MATERIAL AND METHODS: Intussusception was diagnosed in 63 patients at the Clinic of Pediatric Surgery in Novi Sad. The study period was divided into two 2-year phases: phase I, from 2001 through 2002, and phase II, from 2003 through 2004. During phase I, besides barium enema and fluoroscopy, we started using ultrasonography and ultrasound-guided hydrostatic saline enema in the diagnosis and reduction of intussusception. In phase II, this method of reduction was routinely used in all cases. Our technique of ultrasonic reduction was similar to the conventional hydrostatic barium reduction, except the reservoir was higher than that of barium, analgosedation of patients was performed and in case of difficult and prolonged reduction, gentle manual pressure to the abdomen at right lower quadrant was used. RESULTS: In phase I the diagnostic accuracy of ultrasonography in detecting intussusception was 53.8%, and 100% in phase II. The success rate of ultrasound-guided saline enema was 55.5% in phase I, and 83.8% in phase II. Only 6 patients (16.2%) underwent operative manual reduction of intussusception in phase II. There were no cases with boewl gangrene or perforations in both groups. CONCLUSIONS: Ultrasonography is a useful screening tool in the diagnosis of intussusception. Tme main advantage of hydrostatic reduction with ultrasound guidance is avoidance of ionizing radiation. The success rate of this method of reduction may be increased with an integrated team approach to the management and with modifications of the technique.

[Urogenital abnormalities and atresia of the gastrointestinal tract].

INTRODUCTION: The goal of the study was to ivestigate the frequency of urogenital congenital abnormalities among atresias of the digestive system and analyze fetal maldevelopment. The study also deals with gastrointestinal and urogenital embryology. MATERIAL AND METHODS: This retrospektive study analyzed the clinical status of 55 newborns admitted to the Pediatric Surgery Clinic in Novi Sad due to atresia of the gastrointestinal tract during 1995-2003. All atresias were classified at primordial gut levels (foregut, midgut and hindgut). The incidence of associated abnormalities, especially urogenital, was analyzed. Diagnostic procedures included standard methods: clinical investigation, ultrasound, native and contrast medium radiography, etc. RESULTS: Results showed that urogenital anomalies were present in 21 (38.18%) newborns with gastrointestinal atresia. Foregut atresia was diagnosed in 14 newborns and it was associated with urogenital congenital anomalies in 9 (64.28%) newborns. Midgut atresias were found in 15 patients and in 4 (22.22/%) they were associated with urogenital anomalies. Hindgut atresias were established in 23 and in 8 (34. 78%) cases they were associated with urogenital anomalies. DISCUSSION AND CONCLUSIONS: It was confirmed that foregut atresias ara commonly accompanied by associated abnormalities. That is why the fourth gestational week is important when both gastrointestinal and urogenital systems are developed. When midgut differentiates into its own derivates, the frequency of congenital anomalies decreases for a short period, and then increases again during foregut development (seventh and eighth gestational weeks). There were no information on environmental teratogenic factors in maternal history. These abnormalities may be explained by complex urorectal development and separation of two systems.

[Clinical evaluation of fecal continence after posterior sagittal anorectoplasty in anorectal abnormalities]. / Klinicka procena fekalne kontinencije nakon posteriorne sagitalne anorektoplastike kod anorektalnih anomalija.

INTRODUCTION: Posterior sagittal anorectoplasty (PSARP) was introduced in 1982, by Pena and de Vries, as a new surgical procedure for patients with anorectal malformations. It was supposed to provide better chance for normal fecal continence. MATERIAL AND METHODS: Between 1991 and 2000, 50 patients with anorectal abnormalities underwent PSARP. In 43 patients PSARP was primary operation and in 7 it was a secondary procedure. At the time of study patients were not younger than 3, and not older than 13 years. Patients and their parents were interviewed, and fecal continence was graded as follows: voluntary bowel contractions, soiling less than once a week, soiling more than once a week, daily soiling and constipation. RESULTS: Amongst patients who underwent primary surgical correction, 74% had voluntary bowel contractions. Babies with perineal fistula, rectal atresia and stenosis presented with best results in term of voluntary bowel contractions (100%), as with vestibular fistula, ten of eleven patients. Only 18% of patients (atresia without fistula, vestibular fistula and bulbourethral fistula) had soiling. Patients with perineal fistula and rectal atresia and stenosis 40% were totally continent (voluntary bowel movements without soiling). The most frequent sequel was constipation, which appeared in 48%, without coincidence with frequency of soiling. The problem of constipation was surprisingly more frequent in patients with expected better prognosis in fecal continence. CONCLUSION: Although PSARP offers a good esthetic result, only two third of patients have voluntary bowel movements and in about half there exists a problem with constipation, with necessary further treatment.