Outcome analysis of single-stage transanal endorectal pull through in selected patients with hirschsprung disease.

BACKGROUND: Hirschsprung disease is a notable cause of neonatal intestinal obstruction and constipation in older children. Transanal endorectal pull through (TEPT) is a newer technique of definitive management as against staged procedures. The aim of our study is to evaluate the feasibility and outcome of the procedure in selected children with Hirschsprung disease managed by this technique with review of the literature. MATERIALS AND METHODS: Medical records of 12 children who underwent single-stage TEPT in a tertiary care centre over a period of 3 years from 2015 to 2018 were reviewed and retrospectively analysed on the basis of age, investigations, intraoperative parameters, complications, functional outcome and hospital stay. RESULTS: The median age at surgery was 9 months. Nine patients were boys. The median weight of patients was 7.5 kg. The transition zone was observed at the level of the rectosigmoid in eight patients (66.6%) and sigmoid colon in four patients (33.3%). The mean length of muscle cuff was 3 cm, the mean length of resected bowel was 25 cm, the median operative time was 105 min and the mean hospital stay was 8 days. Perianal excoriation (n = 2) and enterocolitis (n = 1) were complications encountered postoperatively; however, no patient had cuff abscess, anastomotic leak or stricture. Stool frequency initially at 2 weeks was average of six to ten times a day, which gradually reduced to two to three times a day by 3 months postoperatively. None of the patients had faecal soiling or constipation on follow-up. CONCLUSION: Single-stage transanal endorectal pull through is an effective technique in the management of Hirschsprung disease with minimal complications.

Efficacy of fibrin sealant as waterproof cover in improving outcome in hypospadias surgery.

BACKGROUND: This prospective comparative study aims to assess the efficacy of fibrin sealant to improve outcomes in paediatric patients operated for hypospadias. MATERIALS AND METHODS: Forty consecutive patients with hypospadias were randomised into two groups of twenty patients each. The first group underwent hypospadias repair, technique depending on the type of hypospadias, whereas in the second group, fibrin sealant was used to reinforce the urethroplasty. Assessment was done with respect to the type of hypospadias, type of repair done, operative time, immediate post-operative complications (early ooze and skin flap-related complications), intermediate complications (urethra-cutaneous fistula) and delayed post-operative complications (penile torsion and poor cosmetic outcome) at follow-up. We also compared the overall improvement in outcome among the two groups. RESULTS: First Group: The mean operative time was 1 h and 45 min. Complications were seen in nine patients: Early ooze (n = 2); skin flap-related complications (n = 3); fistula (n = 7); poor cosmetic outcome (n = 7) and penile torsion (n = 4). Second Group (Fibrin Sealant): The mean operative time was 1 h and 30 min. Post-operative complications were observed in five patients: Coronal fistula (n = 3) and poor cosmetic outcome (n = 3). On comparing, the differences in outcomes of ooze, skin flap-related complications and torsion were found to be statistically significant with P < 0.05. The differences in the urethra-cutaneous fistula and cosmetic appearance were not found to be statistically significant. The difference in overall improvement in complications was found to be statistically significant. CONCLUSION: Fibrin sealant, when applied over the urethroplasty suture line as a waterproof cover, may help to improve the outcome in patients with hypospadias.

Outcome of topical steroid application in children with non-retractile prepuce.

True phimosis is overdiagnosed due to the failure to distinguish it from physiological phimosis, which is a normal developmental non retractability of the foreskin. The non-retractile prepuce in children is a cause of parental anxiety and concern. This leads to the majority of the children undergoing surgical procedures. Pathological phimosis needs to be differentiated from physiologic phimosis to avoid unnecessary circumcision. In recent years, topical steroid application use in cases of non-retractile prepuce has shown a good success rate and is well accepted by the parents. It has low risks, is cost effective and avoids anaesthetic and surgical complications. This is an observational study of 100 children with non-retractile foreskin who were managed by local application of topical steroid cream (0.1% Mometasone) over a period of 6 weeks. The non-retractibility was classified according to Kikiro's classification. These patients were analyzed on the basis of age at presentation, complaints at the first presentation, grade of phimosis at first presentation (as per Kikiro's classification), results of the topical steroid application as assessed at 6 weeks after starting application and after stopping of the steroid administered for 6 weeks. The results were analyzed on the basis of the resolution of symptoms and the decrease in Kikiro's grade. Those patients in whom there was no response to treatment or who developed recurrence after stopping steroid treatment underwent circumcision. A total of 19 patients required surgical intervention in the form of circumcision. The use of topical steroids yields satisfactory results in patients with a non-retractile prepuce. It could be a first-line treatment for management in such cases and is an effective alternative designed to avoid unnecessary circumcision.

Transurethral incision of ureteroceles in paediatric age group.

OBJECTIVE: Ureteroceles are a great clinical challenge because of variations in anatomy and clinical presentations. We present our experience with primary transurethral incision of ureteroceles in children. MATERIAL AND METHODS: Data of thirteen children managed for ureterocele from 2009 to 2016 was retrospectively analyzed with respect to age, sex, clinical presentation and symptomatology, type and localization of ureterocele, investigations, surgical management and follow-up. RESULTS: A total of 13 patients with ureteroceles were managed. There were 7 males and 6 females. Six were neonates with antenatal diagnosis of ureteroceles. Five patients presented with urinary tract infection and two were diagnosed during ultrasound for abdominal pain. The ureteroceles were on the right side in 7 patients and left in 6 patients. Six patients had a duplex system-five on right side and bilateral in one. Two patients had ureteroceles in solitary kidney. Four patients had associated hydronephrosis and hydroureter and two had only hydronephrosis alone. One patient had bilateral grade III reflux in the bilateral lower moieties of the patient with bilateral duplex system. Two patients had poorly functioning kidney on radionuclide scan. All patients underwent cystoscopic incision of the ureteroceles. Eleven had intravesical ureteroceles and two had large caeco-ureteroceles. Two patients required ureteric reimplantation during follow-up. CONCLUSION: Though the approach of managing a patient with ureterocele should be individualized, transurethral incision remains valuable as a primary intervention with regular follow up. It may even prove to be the only intervention required in most of the patients.

Management of Liver Abscess in Children: Our Experience.

INTRODUCTION: Liver abscess is common in pediatric population in India. Children have unique set of predisposing factors and clinical features. Liver abscesses are infectious, space-occupying lesions in the liver; the two most common abscesses being pyogenic and amebic. Its severity depends on the source of the infection and the underlying condition of the patient. MATERIALS AND METHODS: A total of 34 patients less than 12 years were assessed in a retrospective study from January 2012 to 2016. Patients were assessed in terms of age of presentation, etiology, bacteriology, diagnosis, and modality of treatment. RESULTS: The mean age of presentation was 6.3 years. Average volume of abscess was 164 cc. Nine patients (26.4%) underwent percutaneous needle aspiration under ultrasound guidance with wide bore needle (18 G disposable needle). Three patients required more than two sittings of aspiration. Patients with volume more than 80 cc were treated with catheter drainage. Twenty patients (58.8%) underwent ultrasound-guided percutaneous catheter drainage. Two patients required catheter drainage for large abscess and needle aspiration for the smaller abscess. CONCLUSION: Antimicrobial therapy along with percutaneous drainage constitutes the mainstay of treatment, whereas open surgical drainage should be reserved for selected cases.How to cite this article: Waghmare M, Shah H, Tiwari C, Khedkar K, Gandhi S. Management of Liver Abscess in Children: Our Experience. Euroasian J Hepato-Gastroenterol 2017;7(1):23-26.