Short-term Effects of Mitomycin C Infiltration for Caustic Oesophageal Strictures in Children.

OBJECTIVES: The aim of this study was to investigate the efficacy and safety of endoscopic local infiltration of mitomycin C (MMC) after oesophageal dilation for children suffering from refractory postcorrosive oesophageal stricture (OS). METHODS: Children referred to Cairo University Specialized Paediatric Hospital with refractory postcorrosive OS during the period from March 2016 to August 2017 were included in this study. MMC was infiltrated endoscopically at the stricture site by the end of the dilation session. The measured outcomes were dysphagia score (DS) and periodic dilation index (PDI). RESULTS: During the inclusion period of the presented study, 17 children met the inclusion criteria. There were 7 boys and 10 girls. During the follow-up period, an average of 3.8 dilation sessions with MMC infiltration per case were performed, using a total dose of 1 mg each session. The median follow-up period was 9.5 months. The median DS improved from DS 3 before application of MMC to DS 0 at the last follow-up (P < 0.001). Additionally, the median PDI declined from 1 to 0.75 after MMC application (P = 0.052). Sixteen cases (94%) became dysphagia free after 6 months. Seven patients experienced postdilation minor bleeding that was spontaneously resolved, not triggering blood transfusion. There were no infiltration-related complications in the included series. CONCLUSION: Stricture-site MMC endoscopic infiltration by the end of a dilation session proved to be safe and effective in improving the DS and PDI.

Unsatisfactory testicular position after inguinal orchidopexy: Is there a role for upfront laparoscopy?

Objectives: To examine the role of laparoscopy in managing unsatisfactory testicular position after an open inguinal orchidopexy. We hypothesised that testes that were originally peeping, where short vessels represented a difficulty and testes that only reached a high scrotal position under tension, especially after an initial surgery performed with the appropriate expertise, are candidates for initial laparoscopic dissection. Patients and methods: Nineteen boys with an initial open inguinal orchidopexy, with a mean age of 31 months, were considered. Twelve were then treated by a laparoscopic-assisted orchidopexy technique. Standard laparoscopy was established and utilised to mobilise the spermatic cord from above, then completed by an open inguinal mobilisation. Results: The mean age at surgery was 26 months. The laparoscopic redo surgery took place at a mean interval of 11.9 months after the initial operation. The mean operative time was 72 min. A good position and size of the testis were achieved in all cases, evidenced by ultrasonography at 6 months postoperatively and clinically thereafter. Conclusion: An upfront combined laparoscopic and inguinal approach to redo orchidopexy for recurrent palpable undescended testes is suitable in selected patients. This study identifies the selection criteria and outlines the operative considerations. This laparoscopic-assisted approach is a safe and feasible way to correct unsatisfactory position of the testis, with diminished risk of injury to the vas and vessels, while gaining the maximum possible length by high retroperitoneal dissection. Abbreviation: UDT: undescended testis/testes.