RESUMEN
BACKGROUND: Surgical correction of severe proximal hypospadias represents a significant surgical challenge and single-stage corrections are often associated with complications and reoperations. Bracka two-stage repair is an attractive alternative surgical procedure with superior, reliable, and reproducible results. PURPOSE: To study the feasibility and applicability of Bracka two-stage repair for the severe proximal hypospadias and to analyze the outcomes and complications of this surgical technique. MATERIALS AND METHODS: This prospective study was conducted from January 2011 to December 2013. Bracka two-stage repair was performed using inner preputial skin as a free graft in subjects with proximal hypospadias in whom severe degree of chordee and/or poor urethral plate was present. Only primary cases were included in this study. All subjects received three doses of intra-muscular testosterone 3 weeks apart before first stage. Second stage was performed 6 months after the first stage. Follow-up ranged from 6 months to 24 months. RESULTS: A total of 43 patients operated for Bracka repair, out of which 30 patients completed two-stage repair. Mean age of the patients was 4 years and 8 months. We achieved 100% graft uptake and no revision was required. Three patients developed fistula, while two had metal stenosis. Glans dehiscence, urethral stricture and the residual chordee were not found during follow-up and satisfactory cosmetic results with good urinary stream were achieved in all cases. CONCLUSION: The Bracka two-stage repair is a safe and reliable approach in select patients in whom it is impractical to maintain the axial integrity of the urethral plate, and, therefore, a full circumference urethral reconstruction become necessary. This gives good results both in terms of restoration of normal function with minimal complication.
RESUMEN
AIMS AND OBJECTIVES: The aim of this study was to assess and present the outcome (initial experience and lessons learnt) of minimally invasive surgery for various indications in neonates and small infants (< 5 kg) at a single medical centre. MATERIALS AND METHODS: A retrospective analysis was performed on 65 patients (age day 2 to 10 months) managed with minimal access surgery (MAS) for various indications, between 2005 and 2010. We analyzed demographic information, procedures, complications, outcomes, and follow-up and overall feasibility of the procedure. RESULTS: No serious complications except one death in congenital diaphragmatic hernia (CDH) (due to other comorbidities) occurred. Intra operative hypercarbia and hypoxia were observed more frequently in thoracoscopic procedures. Intra operative hypothermia was not common and was well tolerated. Conversion to open procedure (n = 5), post operative ileus (n = 3), port site infection (n = 5) were other complications. CONCLUSION: MAS in neonates and small infants is a technically demanding but a feasible choice available. Some prior experience in older children is required for safe and effective outcome. Good quality optics, video equipments and instruments are required for safe and effective procedure. Intra operative measurement of oxygen saturation and temperature, and diligent post operative ICU care are mandatory for safe and successful outcome.
RESUMEN
AIM: The aim of this study was to study the effects of laparoscopic inguinal hernia repair on testicular perfusion and size. MATERIALS AND METHODS: A prospective study concerning laparoscopic inguinal hernia repair was performed for an 18-month period to evaluate testicular perfusion and size in the preoperative, early postoperative (within 48 hours of surgery), and late postoperative periods (6 months after surgery) using Doppler ultrasound (DUS) (both duplex and power Doppler mode). Laparoscopic closure of the deep inguinal ring was accomplished with a purse string suture (Nylon 3-0) using standard 3-port technique. The testis units were divided in 2 groups: group 1 comprising testis units in which a resistive index (RI) could be calculated and group 2 with instances in which an RI could not be calculated but showed blood flow consistently on DUS. RESULTS: A total of 112 boys underwent laparoscopic inguinal hernia repair with 100 available for complete follow-up and data analysis. One hundred twenty-five inguinal (25 bilateral) hernia repairs were performed. Group 1 had 80 testis units. There was no significant difference in values of RI between preoperative, early postoperative, and late postoperative periods. Group 2 had 45 testis units. Resistive index could not be calculated. Seventy-five percent showed only systolic blood flow on spectral analysis; hence, RI, 1; and the rest showed the presence of blood flow on power Doppler scan. All testis units consistently showed blood flow in the early and late postoperative period. No testicular atrophy was found at 6-month follow-up examination on DUS. CONCLUSION: Laparoscopic repair of inguinal hernia in children does not affect testicular perfusion or growth.