RESUMO
BACKGROUND: Meconium ileus is a common cause of neonatal intestinal obstruction. Various surgical procedures are in practice for uncomplicated meconium ileus. Bishop Koop ileostomy allows distal passage of gut content and uses the distal absorptive area. T tube ileostomy avoids the need for gut resection and formal closure of stoma. The aim of this prospective interventional study was to compare the outcome of T-tube ileostomy and Bishop Koop ileostomy for the treatment of uncomplicated meconium ileus. MATERIALS AND METHODS: It was a prospective interventional study from January 2015 to December 2016. Patients were randomly assigned to the T-tube ileostomy group (group A) and Bishop Koop ileostomy group (group B). The patients were followed up for 6 weeks post-operatively. Surgical outcomes between the two groups were compared. RESULTS: The age range of the patients was 1 to 7 days; majority of the patients were males. Mean operation time of group A (60.76±5.81 minutes) and group B (87.05±6.49 minutes) showed significant difference (p =0.0001). After operation, mean time to start bowel movements in group A (4.90±1.41days) and group B (6.53±2.58 days) showed significant difference (p= 0.020). Times to establish oral feeding, irrigation tube removal and postoperative complications showed no significant difference. All patients that survived in the group B required formal stoma closure, while in the group A stomas closed spontaneously. One patient in the group A had intraperitoneal leakage leading to mortality after second operation. Four patients had leakage in the group B; 2 of them died. CONCLUSIONS: T-tube ileostomy was found as an effective and safe procedure for the management of uncomplicated meconium ileus.
RESUMO
UNLABELLED: Repair of anterior palate after repairing the cleft lip in complete cleft lip and palate patient is sometimes very difficult. It needs wide, extensive and difficult dissection, and has later chances of wound infection, wound dehiscence, complete wound disruption, recurrent oronasal fistula formation and also maxillary hypoplasia. In this study, we compare the outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). METHODS: A prospective study was carried out in 43 patients with UCLP. In Group A, 23 patients underwent cleft lip and cleft hard palate repair with vomer flaps simultaneously, and only cleft lip repair was done in another 20 patients in Group B at the first sitting. After 3 months in both groups, repair of the cleft soft palate and cleft entire palate was done. The gaps of the cleft alveolus and posterior border of the cleft hard palate were measured during the first and second operation, and duration of operations, postoperative complications and requirement of blood transfusion during the operation were also recorded. RESULTS: The procedure of simultaneous repair of cleft lip and closure of cleft hard palate with a vomer flap is easy to perform. Cleft alveolar and gap of the posterior border of the cleft hard palate were reduced remarkably. No fistula formation occurred and no blood transfusion was needed, but the procedure took some extra operating time. These were compared with simple cleft lip repair. CONCLUSION: Repairs of cleft lip and simultaneous closure of cleft hard palate with vomer flaps are safe in patients with UCLP, and it makes easy the closure of the soft palate later on and decreases the chance of oronasal fistula.
