Alaoui O, Mahmoudi A, Khattala K
… +1 more, Bouabdallah Y
Afr J Paediatr Surg
· 2024 Jul · PMID 38520234
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BACKGROUND: Hypospadias repair is a complicated surgery even in the best of hands. To date, there is a lack of consensus on which surgical technique offers more favourable post-operative outcomes. The present work was un...BACKGROUND: Hypospadias repair is a complicated surgery even in the best of hands. To date, there is a lack of consensus on which surgical technique offers more favourable post-operative outcomes. The present work was undertaken to evaluate and compare the outcomes and complications rates of two single-stage techniques widely used to repair primary anterior hypospadias, namely Thiersch-Duplay Tubularized Plate Urethroplasty and Koff Urethral Mobilisation and Advancement. MATERIALS AND METHODS: Data from the medical records of 120 patients operated on for primary anterior hypospadias were retrospectively analysed and compared. The patients were divided into two groups: 60 patients underwent Thiersch-Duplay procedure (Group A) and 60 patients underwent Koff procedure (Group B). They were compared using the Chi-squared or Fisher's exact test to assess the relationship between the adopted surgical technique and the complications' development with a P < 0.05. RESULTS: Neither intraoperative complications nor acute post-operative complications occurred, whereas 28.3% ( n = 34/120) cases have exhibited at least one late post-operative surgical complication, including 38.3% ( n = 23/60) in Group A and 18.3% ( n = 11/60) in Group B, revealing a better outcome of the Koff procedure despite the statistical insignificance ( P = 0.102). We did not objectify any other complication besides meatal stenosis (MS), urethro-cutaneous fistula (UCF) and wound dehiscence. CONCLUSION: Overall, our study could not demonstrate the superiority of one technique above another. At the same time, it established the versatility, satisfactory cosmetic and functional results, low MS and UCF rates of Koff urethral mobilization and advancement technique in primary anterior hypospadias repair.
Ibiyeye TT, Taiwo JO, Nasir AA
… +1 more, Popoola AA
Afr J Paediatr Surg
· 2024 Oct · PMID 38520233
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BACKGROUND: Circumcision of a male child is an integral part of some African cultures. An ideal technique of neonatal circumcision should be simple, safe and heal satisfactorily with good cosmetic appeal. The aim was to...BACKGROUND: Circumcision of a male child is an integral part of some African cultures. An ideal technique of neonatal circumcision should be simple, safe and heal satisfactorily with good cosmetic appeal. The aim was to compare conventional dissection (CD), Plastibell (PB) and Gomco (GM) techniques of circumcision in neonates in terms of wound healing, wound healing complications, cosmetic outcome and parental satisfaction. MATERIALS AND METHODS: A total of 144 male neonates were randomised into three study groups: CD, GM and PB groups. All procedures were performed under local anaesthesia as day case. Superficial wound healing was assessed on the 7 th post-operative day. The cosmetic outcome of the three techniques was assessed by a plastic surgeon and the parents using a 4-point Likert scale on the 4 th post-operative week. RESULTS: The three groups were comparable in terms of age ( P = 0.207) and weight ( P = 0.098) at circumcision. There was satisfactory wound healing in 48 (100%) patients in the GM group, compared to 47 (97.8%) in the CD group and 45 (93.8%) in the PB group ( P = 0.324). Wound healing complications were recorded in seven patients, 1 (2.1%) in the CD group with wound infection, 5 (10.4%) in the PB group with moderate pain despite the use of analgesia and 1 (2.1%) patient with skin bridge in the CD group. The plastic surgeon and the parents rated the cosmetic outcome of CD higher than the other two techniques. CONCLUSION: There is no significant difference in superficial wound healing amongst the three circumcision techniques. The cosmetic outcome of CD was significantly better than that of GM and PB circumcisions.
Igwe AO, Kannachamkandy L, Agwu EL
… +7 more, Lawal TA, Nwankpele TO, Mosanya AO, Dzagnidze N, Olugbemi AJ, Abidoye I, Danyltsiv A
Afr J Paediatr Surg
· 2024 Apr · PMID 38520230
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Management of oesophageal atresia (OA) with tracheoesophageal fistula (TOF) in Nigeria and the West African subregion has no doubt been a very demanding task for paediatric surgeons, not necessarily due to lack of skills...Management of oesophageal atresia (OA) with tracheoesophageal fistula (TOF) in Nigeria and the West African subregion has no doubt been a very demanding task for paediatric surgeons, not necessarily due to lack of skills, but due to the significant demand on neonatal intensive care, which in our region, is often fitted with the poor infrastructure needed to make this a success. Furthermore, the use of open thoracotomy has increased this demand resulting in a significant number having severe morbidities and significant mortality rates. Hence, in our subregion, there is still a slow progression to meet up with the evolving trend of the management of this complex condition in the developed world. Following the first documented successful thoracoscopic repair of OA with TOF since 2000, there has been a progressive evolution and refinement of this technique, such that thoracoscopic repair is fast becoming the gold standard for the repair of all types of OAs, including long-gap anomalies. This article reports our experience with the first two cases of thoracoscopic repair of OA with TOF in the West African subregion.
Machino K, Mimori K, Ogata S
… +4 more, Minami Y, Shimizu H, Yamashita M, Tanaka H
Afr J Paediatr Surg
· 2024 Oct · PMID 38426534
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BACKGROUND: To predict native liver survival (NLS) after Kasai portoenterostomy (KP) for biliary atresia (BA) using pre-operative clinical data. MATERIALS AND METHODS: Pre-operative data were collected from 29 patients w...BACKGROUND: To predict native liver survival (NLS) after Kasai portoenterostomy (KP) for biliary atresia (BA) using pre-operative clinical data. MATERIALS AND METHODS: Pre-operative data were collected from 29 patients with BA who underwent KP at our department between 1989 and 2017 and were analysed including serum albumin, bilirubin, prothrombin time-international normalised ratio, body height, body weight, age at KP, paediatric end-stage liver disease score calculated using the pre-operative data and the period of NLS. RESULTS: The 10-year NLS rate of all patients was 51%. A multivariate analysis revealed that among all factors, the pre-KP serum albumin level was the only independent predictor of NLS ( P = 0.04, hazard ratio = 0.269, 95% confidence interval = 0.077-0.934). The area under the receiver operating characteristic curve for NLS, determined using pre-KP serum albumin was 0.760 and 3.75 mg/dl was selected as the cut-off value. There was a significant difference in NLS between patients with high (≥3.8 mg/dl) and low (≤3.7 mg/dl) pre-KP serum albumin (90.0% vs. 31.5%, P < 0.01). CONCLUSIONS: Decreased pre-KP serum albumin may reflect not only functional impairment of the liver, but also the inflammatory process, which is hypothesized to occur during its advancement. The pre-KP serum albumin level may be a good prognostic factor for NLS in post-KP BA patients.
Afr J Paediatr Surg
· 2024 Jan · PMID 38259028
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Gastrointestinal (GI) haemangiomatosis is a very rare cause of GI bleeding in children. Due to this fact, making the diagnosis sometimes is delayed. In this case report, two different patients with multiple GI haemangiom...Gastrointestinal (GI) haemangiomatosis is a very rare cause of GI bleeding in children. Due to this fact, making the diagnosis sometimes is delayed. In this case report, two different patients with multiple GI haemangiomatosis are presented. Of note is an 8 year old male with a previous history of a vascular malformation of the face presented with features of bowel obstruction (intussusception) and a history of recurrent blood in stool. At laparotomy, multiple haemangiomatosis were seen on the small bowel, right colon, liver, diaphragm and on the body of the gallbladder. Surgical management with excision of the enteric lesions and stapled anastomosis was done.
Adumah CC, Akpaette IC, Oni O
… +7 more, Obasi IA, Ogundele IO, Adesunkanmi A, Oyinloye OA, Talabi AO, Sowande OA, Adejuyigbe O
Afr J Paediatr Surg
· 2024 Jan · PMID 38259027
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Penile agenesis is complete absence of the penis in an otherwise normal phenotypic and genotypic male at birth that results from failure of development of the genital tubercle. It is an extremely rare anomaly that may be...Penile agenesis is complete absence of the penis in an otherwise normal phenotypic and genotypic male at birth that results from failure of development of the genital tubercle. It is an extremely rare anomaly that may be associated with anomalies in other organ systems, the extent and severity of which may affect the prognosis. The management is challenging and may have far reaching implications for the individual and family. While gender reassignment with bilateral orchidectomy and feminising genitoplasty has been carried out for most patients, significant psychosexual and social issues related to the male identity may occur due to foetal or postnatal sex steroid imprinting. We report a neonate with penile agenesis with bilateral renal agenesis and anorectal malformation.
Afr J Paediatr Surg
· 2024 Jan · PMID 38259026
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Male congenital urethrocutaneous fistula is an extremely rare anomaly that is commonly associated with chordee or anorectal malformations. It is characterised by an abnormal urethral opening on the ventral aspect of the...Male congenital urethrocutaneous fistula is an extremely rare anomaly that is commonly associated with chordee or anorectal malformations. It is characterised by an abnormal urethral opening on the ventral aspect of the penis with well-formed distal urethra and meatus at the tip of the glans. The treatment is individualised according to the site of the fistula, associated anomalies and condition of the distal urethra. The principles of hypospadias surgery should be strictly followed.
Dudhani S, Sinha AK, Kumar B
… +2 more, Kumar A, Anant M
Afr J Paediatr Surg
· 2024 Jan · PMID 38259025
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Primary vaginal calculi are uncommon in children. Urethral duplication in females is seen to occur in association with complex congenital malformations. We report the case of perianal persistent urogenital sinus with a h...Primary vaginal calculi are uncommon in children. Urethral duplication in females is seen to occur in association with complex congenital malformations. We report the case of perianal persistent urogenital sinus with a hypertrophied clitoris with phallic urethra, scrotum-like pouch, uterus didelphys with obstructed hemivagina, and giant colpolithiasis in 46XX female. A 16-year-old presented with pain abdomen and cyclic passage of blood clots per rectum. She had a tender lump in left iliac region, a phallus like protrusion and a ruggous sac below it. Vaginal opening was absent. Computed tomography showed two uterine horns with a separate cervix and distended non-communicating hemivaginas with a large calcified oval mass in the left hemivagina. On exploration, calculus was extracted from the left hemivagina. The large calculus found in the left hemivagina appears to be the cause of all presenting symptoms. It obstructed the left hemivagina, filling the left uterine horn with menstrual blood causing its gradual enlargement and secondary infection. The early diagnosis and prompt referral of such an anomaly can only be ensured in institutional deliveries. For a significant proportion of newborns in the developing world, the ability to afford or even be referred to institutes which deal with such cases is a luxurious affair. We hope to bridge bridging the knowledge, attitude and practice gap that exists in our health-care system with this report.
Dudhani S, Jana S, Singh R
… +2 more, Sinha AK, Kumar B
Afr J Paediatr Surg
· 2024 Jan · PMID 38259024
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Inguinal hernias are more common in preterm and neonates and incidence of incarceration are reported to be more in the first 6 months of life. Strangulation follows incarceration and various incarcerated and strangulated...Inguinal hernias are more common in preterm and neonates and incidence of incarceration are reported to be more in the first 6 months of life. Strangulation follows incarceration and various incarcerated and strangulated contents having been reported in the sac. The fistulation of the herniated content through the scrotal skin is quite rare with only a few reported cases. We present the case of entero-scrotal fistula in a neonate managed with staged repair along with a brief review of the literature. A 27-days-old, full-term male presented with faecal discharge from the right scrotum. He had no tell-tale signs of obstructed hernia. A faecal fistulous opening was located in the right hemi-scrotum. The terminal ileum was seen as the content with an antimesenteric perforation, divided ileostomy and scrotal debridement was done and later ileo-ascending anastomosis was performed electively. Neonatal hernias should be considered an urgency and we advocate early surgery. The resource-limited setting and poor post-natal surveillance may have added to the worries. In our case, swelling and fistulation occurred in a very brief period of 36 h. We managed the child with a diversion stoma followed by ileo-ascending anastomosis later.
Foura S, Fouraiji K, Aballa N
… +2 more, Kamili EOEA, Saiad MO
Afr J Paediatr Surg
· 2024 Jan · PMID 38259023
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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...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.
Jayakumar TK, Saxena R, Yadav T
… +2 more, Mathur NS, Sinha A
Afr J Paediatr Surg
· 2024 Jan · PMID 38259022
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The routine schedule of antenatal ultrasound scans has led to an increased frequency of detection of foetal ovarian cysts. Although most of them regress spontaneously, some may grow into large cysts and undergo torsion f...The routine schedule of antenatal ultrasound scans has led to an increased frequency of detection of foetal ovarian cysts. Although most of them regress spontaneously, some may grow into large cysts and undergo torsion followed by auto-amputation. However, pre- and post-natal scans may fail to identify this event. We report a case of a prenatally diagnosed ovarian cyst that failed to resolve conservatively and was increasing in size in post-natal ultrasounds. Pre-operative ultrasound and magnetic resonance imaging failed to detect the auto-amputation. The diagnosis was confirmed on laparoscopy which offers a safe and effective method for the removal of ovarian cysts in neonates and infants.
Marimallappa TR, Pal S, Rao K
… +1 more, Sreelakshmi MS
Afr J Paediatr Surg
· 2024 Jan · PMID 38259021
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BACKGROUND: Reduction and stabilisation of fractures at the earliest is valuable in the paediatric age groups. This novel technique focuses on stabilisation of the fracture fragments using vicryl, which has an added adva...BACKGROUND: Reduction and stabilisation of fractures at the earliest is valuable in the paediatric age groups. This novel technique focuses on stabilisation of the fracture fragments using vicryl, which has an added advantage to conventional plating and wiring. This study aimed on a novel cost-effective technique of stabilising the paediatric mandibular fracture using 2-0 resorbable polyglactin 910 suture with minimal trauma to tooth buds and bone and adequate stability. TECHNIQUE: After raising a full-thickness mucoperiosteal flap, the fracture segments are identified and reduced. 1.6mm drill bit is used to make holes through the buccal cortex on either side of the fractured segment in an anteroposterior direction. The patency of holes is checked by passing a long 26-gauge wire. The proximal end of the wire is bent into a loop, a 2-0 resorbable polyglactin suture (vicryl) is passed through this loop and the loop is pressed in place to lock the suture. The wire with the attached suture is pulled through the distal end. Once the suture is secure in place, the 26G wire is cut, and the two ends of sutures are knotted and stabilised. The mucoperiosteal flap is then closed. CONCLUSION: A novel method of stabilisation of paediatric fracture without hampering the tooth and jaw growth, especially in the financially unstable population. 2-0 polyglactin 910 suture is cost-effective, $2 US, compared to resorbable plates costing about $150 US, and easily available. Polyglactin 910 takes 40-60 days for resorption, and half-life tensile strength is 2 weeks; thus, it gives adequate stability and time for callus formation and does not damage the tooth buds or bone by cutting through them.
Afr J Paediatr Surg
· 2024 Jan · PMID 38259020
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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 f...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.
Chigblo PS, Tidjani F, Lawson É
… +6 more, Noukpozounkou B, Amossou F, Padonou A, Goukodadja O, Akué AH, Fiogbe M
Afr J Paediatr Surg
· 2024 Jan · PMID 38259019
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BACKGROUND: Childhood fractures are frequent. The aim of this study was to evaluate their epidemiological and clinical peculiarities in our context. MATERIALS AND METHODS: This was a retrospective study that focused on t...BACKGROUND: Childhood fractures are frequent. The aim of this study was to evaluate their epidemiological and clinical peculiarities in our context. MATERIALS AND METHODS: This was a retrospective study that focused on the files of children with a fracture. They were aged 0-15 years and received between January 2011 and December 2015 at the Emergency Department of the National Teaching Hospital of Cotonou. RESULTS: Two hundred and eighty fractures were recorded in 257 children. The average age was 8.24 years (7 days-15 years). Older children (6-10 years) were the most affected with 33.8% of cases. The predominance was male (sex ratio = 2.3:1). The aetiologies were dominated by road traffic accidents (45.1%) followed by domestic accidents (42.7%). Fractures were predominant in the lower limbs (52.1%). The most affected segments were the leg (25.4%) and the femur (23.6%). The fracture was open in 13.9% of cases. CONCLUSION: Childhood fractures interest preferentially the older boys. Then, road traffic accidents are the most frequent circumstances of occurrence in our context. Measures to prevent the main causes of these fractures must be taken, in order to reduce their frequency and ensure the development of children.
Afr J Paediatr Surg
· 2024 Jan · PMID 38259018
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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 consensu...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.
Afr J Paediatr Surg
· 2024 Jan · PMID 38259017
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BACKGROUND: The authors report their experience of the transanal endorectal pull through technique as described by De la Torre Mondragon in the treatment of Hirschsprung's disease (HD). MATERIALS AND METHODS: It was a re...BACKGROUND: The authors report their experience of the transanal endorectal pull through technique as described by De la Torre Mondragon in the treatment of Hirschsprung's disease (HD). MATERIALS AND METHODS: It was a retro prospective, observational and descriptive hospital based study involving all proven cases of HD managed within a time frame of 8 years. RESULTS: Fifty two patients with a mean age of 18 months at the time of surgery. The male pre dominance was remarkable. The mean duration of the surgery was 2 h and a half hours. The surgical indication was based on the history, clinical findings and on the contrast enema (transition zone) with a 24 h film (prolonged contrast evacuation) and calculation of the rectosigmoid index (<1). With a mean follow up of 16 months, the morbidity was dominated by soiling, anastomotic strictures and enterocolitis. The mortality in one case was related to a post operative enterocolitis that was not amenable to resuscitation. CONCLUSION: Soiling, anastomotic strictures and enterocolitis are the main post operative complications of TEPT in the treatment of HD in our practice.
Gad M, Dessouky MN, Abdullateef KS
… +4 more, Abdelazim O, Fares AE, Kaddah SN, Ragab M
Afr J Paediatr Surg
· 2024 Jan · PMID 38259016
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BACKGROUND: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The primary treatment of rectal prolapse is non-operative. Surgical intervention is...BACKGROUND: Rectal prolapse is a relatively common, usually self-limiting illness in children. Peak incidence is between 1 and 3 years. The primary treatment of rectal prolapse is non-operative. Surgical intervention is needed in long-standing intractable cases of rectal prolapse, rectal pain/bleeding/ulceration and prolapse that needs frequent manual or difficult reduction. The aim of this study was to compare the efficacy and outcome of laparoscopic ventral mesh rectopexy versus laparoscopic suture rectopexy in the management of persistent rectal prolapse in children not responding to conservative management and/or recurrent after sclerotherapy or anal encirclement. MATERIALS AND METHODS: Twenty-four cases were randomised into two groups at the ratio of 1:1, Group 1 patients were managed by laparoscopic ventral mesh rectopexy, whereas Group 2 cases were managed by laparoscopic suture rectopexy. Patients with primary surgical conditions such as anorectal malformations, Hirschsprung's disease, rectal polyps or masses and Ectopia Vesicae were excluded from the study. Inclusion criteria were complete rectal prolapse cases with failed medical treatment for at least 6 months and/or recurrent after injection sclerotherapy or anal encirclement. RESULTS: In the mesh rectopexy group, one case had recurrence in the form of partial prolapse 3 weeks postoperatively which improved 2 months postoperatively with conservative management, one case had bleeding per rectum 2 months postoperatively, stool analysis was done revealing parasitic infestation which was treated medically. In the suture rectopexy group, one case had one attack of bleeding per rectum on the 2nd day postoperatively which resolved spontaneously and one case was readmitted on the 5th day postoperatively for non-bilious vomiting which improved by medical treatment. No recurrent cases of complete rectal prolapse were reported in both groups. CONCLUSION: Laparoscopic rectopexy can be an effective modality for the treatment of refractory complete rectal prolapse in children. It is effective, safe and easy. Although the current study has shown that laparoscopic suture rectopexy and mesh rectopexy have nearly the same results, a larger number of patients are needed to compare more deeply between the two groups.