African journal of paediatric surgery : AJPS最新文献

Background: Hypospadias is a wide-world congenital malformation that accounts for 1 of 300 live male births. Many procedures were considered for its management. As the tubularised incised plate (TIP) urethroplasty, the most prevalent technique, caused many complications, several modifications were applied to the original operation to improve the outcomes and alleviate complications. The aim of this study was to compare the outcome of the ordinary TIP urethroplasty with the technique modified without dissection of the glans penis.

Materials and methods: A total of 82 patients with a mean age of 18.8 (±14.8) months, were randomly assigned to undergo TIP with either complete glans wings mobilisation (Group A, n = 42 patients) or without glans dissection (Group B, n = 40 patients). To evaluate the effect of modified TIP urethroplasty without glanular dissection for treatment of distal hypospadias in contrast to classical TIP repair.

Results: Both techniques showed similar outcomes regarding functional repair, with good to excellent results between 88% and 90% after 6 months of follow-up. Most confronted post-operative complications were wound infection, oedema, urethrocutaneous fistulas and meatal stenosis. Less frequently haematoma, post-operative bleeding and glans dehiscence were encountered. The differences in complication rates between the two studied groups were statistically insignificant except for oedema (P = 0.04), and need for urethral dilatation (P = 0.002) that were more prevalent among patients who were treated with classic TIP repair with complete glans wings mobilisation.

Conclusion: From our point of view, it seems that TIP without glanular dissection technique does not outweigh TIP with complete glans wings mobilisation regarding functional outcomes and post-operative complications.

Background: It is still unclear to what extent fast-track (FT) surgery is applicable in paediatric surgery. The aim of the study was to compare the outcome between FT and conventional perioperative care protocols in paediatric intestinal stoma closure to assess the safety for future application.

Materials and methods: This study was a prospective randomised study. Twenty-six paediatric patients who underwent intestinal stoma closure from December 2019 to March 2021 were divided into two groups: group A, conventional methods and Group B FT protocol. The FT protocol included minimal pre-operative fasting, no pre-operative bowel preparation, no routine intraoperative use of nasogastric tube, drain tube, urinary catheter, early post-operative enteral feeding, early mobilisation, non-opioid analgesics and prophylactic use of anti-emetic. Total length of post-operative hospital stays and complications between these two groups were compared.

Results: No significant differences were found between the two groups regarding anastomotic leak (nil in both groups), wound infection (7.7% in Group A vs. 0% in Group B; P = 1.0) and wound dehiscence (7.7% in Group A vs. 0% in Group B; P = 1.0). No significant differences were found in post-operative length of stay (median 5, interquartile range [IQR] 4-9 in Group A and median 6, IQR 4-7 in Group B, P = 0.549) and time to appearance of bowel function (passage of stool) (median 2 days in both groups; P = 0.978).

Conclusions: FT surgery was comparable to the conventional method in terms of complication and thus can reduce unnecessary interventions.

Background: The Ponseti technique remains the preferred method for club foot treatment. Although measures of treatment outcomes have been well documented, there is no consensus on the determinants of those outcomes. This study aims to assess treatment outcomes and the factors which can influence treatment outcomes.

Materials and methods: This is a cross-sectional study. A total of 472 children representing 748 feet in total were recruited. Patient characteristics such as age at presentation, gender, tenotomy, walking with or without deformity, parental educational status and occupation were documented. Outcomes of care were assessed using indictors such as parents' satisfaction with the outcome of treatment and the patients' ambulation without deformity. The relationships between the determinant factors and these outcomes were explored using multivariable binary logistic regression.

Results: Most of the children (69.1%) were aged below 2 years. Brace compliance was very high (89.9%). The pre-treatment average Pirani scores were 3.9 ± 1.8 and 4.3 ± 1.8 for the right and left feet, respectively. Majority (88.3%) of the children achieved ambulation without deformity, whereas most (87%) of the parents were satisfied with the treatment outcomes. In total, parental satisfaction with child's treatment outcomes was lower in parents who were not formally educated odds ratio (OR) = 0.19 (95% confidence interval [CI] 0.08-0.43), but parental satisfaction was lower if the child had higher Pirani score OR = 0.77 (95% CI 0.62-0.96). Children who had more casts applied to the affected foot were more likely to walk without deformity OR = 1.24 (95% CI 1.01-1.52).

Conclusions: This study revealed that treatment outcomes in children with club foot can be determined by some sociodemographic and treatment-related factors.

Abstract: We present a case report of a 15-month-old baby with an isolated unilateral paramedian cleft palate. A cleft palate is usually seen in children born to their parents through consanguineous marriage. However, a paramedian cleft palate is a very rare finding and very few cases have been reported in the world and none have been published, hence our initiative to present this case report and a modified technique for closure of the same. Along with the conventional von Langenbeck technique, a modification using a rotational flap from the retromolar fossa was done to close the oral mucosal layer.

Abstract: Stomal prolapse is one of the most common complications of enterostoma. Stoma if persistent and significant often requires revision of stoma. The techniques described often require laparotomy with resection or internal fixation of the bowel. Such procedures may make further laparotomy more difficult. We herein describe the use of a relatively simple procedure for the correction of stomal prolapse.

Abstract: Iatrogenic bladder rupture in children during a retrograde cystourethrography is very uncommon. We present a case of iatrogenic intraperitoneal bladder rupture in a 9-month child during the retrograde cystourethrography performed by a radiologist. The child presented in a paediatric emergency after 6 h with an acute abdomen indicating urinary peritonitis. An urgent laparotomy was performed and the perforation was repaired in two layers. The follow-up was unremarkable. This report emphasises the importance of respecting the criteria of the proper retrograde cystourethrography imaging procedure.

Background: Trauma is a leading cause of morbidity and mortality in children worldwide. There is a need for development and provision of efficient paediatric trauma services based on adequate information and funding which are lacking in low- and middle-income countries.

Aims: This study was carried out to assess the scale of the problem, identify the most common causes of trauma in Pan African Paediatric Surgical Association (PAPSA) zone and to define the limiting factors for provision of the necessary services required to reduce the potential mortality and disability.

Materials and methods: Data were collected through an electronic form sent out in PAPSA platform. Members were requested to provide prospective data on all paediatric major trauma admitted to or seen at their health facilities between the beginning of April 2019 and the end of June 2020. Hospital location, child's age, gender, type of injury, mechanism of injury, severity, initial management, method of transport, time to arrive to hospital, availability of surgical specialities, length of hospital stay and injury outcome were analysed.

Results: There were 531 entries. The mean age was 3.53 years and median age 1.34 years. Male-to-female ratio was 2:1. The leading causes for injuries were falls 194 (36.53%) and motor vehicle crashes (MVCs) 176 (33.15%) followed by obstetrical 42 (7.9%), thermal 27 (5.1%) and domestic injuries 22 (4.1%). The most common injuries were limb fractures 181 (34.1%) and traumatic brain injury 111 (20.9%). Public and private transport were used in 313 (58.9%), while ambulance service was used in only 54 (10.1%). Distances to a health facility varied between 1 and 157 km. 70.2% of cases did not receive any primary care, while definitive care was received in 95.5% of the cases. Outcome was full recovery in 90.6% of patients, morbidity in 8.1% and a mortality rate of 1.3%.

Conclusions: Most of the injuries were in the under 5-year age group. The two main causes of trauma in children in this study were the falls from height and MVCs. Long distance travels to reach health-care facilities were noticeable in this study, together with substantial lack of adequate ambulance facilities and shortage in necessary subspecialty services such as neurosurgical, orthopaedics and rehabilitation. Implementing proposed recommendations can reduce the burden.

Background: This study aimed to use anthropometric measurements taken pre- and post-operation to evaluate quantitative assessment of modified Millard technique compared with Tennison-Randall technique in unilateral cleft lip (UCL) repair.

Materials and methods: Prospective randomised controlled study recruited infants scheduled for UCL repair. Infants aged 2-6 months, either complete or incomplete deformity. A total of 68 patients were randomised in 1:1 ratio to undergo either modified Millard technique (Group I) or Tennison-Randall technique (Group II).

Results: Group I had significantly longer operative time than Group II (85.7 ± 7.4 vs. 68.7 ± 8.8 min, respectively; P < 0.001). Group I has less post-operative wound infection, wound dehiscence and wound scarring than Group II, but Group II has less post-operative lip notch. In Group I, greater increases in post-operative horizontal lip length and vertical lip height were observed, compared to Group II, without statistically significant difference. Group I showed a greater reduction in nasal width and total nasal width than Group II, without statistically significance. Group II had a greater increase in philtral height. However, only post-operative Cupid's-bow width was significantly different between two groups (P = 0.041).

Conclusion: Overall results demonstrate no significant differences between modified Millard technique and Tennison-Randall technique.

Background: The two most commonly performed methods of biliary-enteric reconstruction following choledochal cyst resection are Roux-en-Y hepaticojejunostomy (HJ) and hepaticoduodenostomy (HD). There is a lack of consensus regarding the better technique between them. This study aimed to evaluate the outcomes, efficacy and early complications of HD as a mode of biliary reconstruction after surgical resection of a choledochal cyst.

Materials and methods: This was a multi-institutional prospective study carried out in high-volume tertiary care teaching institutes from January 2010 to December 2022. All children managed with HD following choledochal cyst resection were analysed for their early complications and outcomes.

Results: A total of 74 patients were included in this study. There were 59 (79.73%) females and 15 (20.27%) males. Thirty-nine (52.70%) patients had jaundice at the time of presentation. Magnetic resonance cholangiopancreatography was performed in 57 (77.03%) patients following ultrasonography. Intraoperatively, malrotation was present in 2 (2.70%) patients. In our study, operating time ranged from 60 to 195 min (mean: 118 min). Hospital stays ranged from 8 to 17 days (mean: 11.5 days). The post-operative biliary leak was seen in 7 (9.50%) patients, out of which 6 (8.11%) minor leaks were managed conservatively. Roux-en-Y HJ was performed on 1 (1.35%) patient with a major leak. In our series, 4 (5.40%) patients developed cholangitis; post-operative haemorrhagic nasogastric aspirate 5 (6.76%), post-operative pancreatitis 3 (4.05%) and wound infection 4 (5.40%) were observed and managed conservatively. None of the patients in our study developed an anastomotic stricture, bile gastritis and adhesive small bowel obstruction.

Conclusion: Resection of choledochal cyst with HD reconstruction is safe and feasible with short operative time. HD is a viable option for operative management of choledochal cyst with low complication rates and faster recovery.