Sameh Shehata

Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy.

During laparoscopy for impalpable testes (IT), if the vas and vessels are found exiting the deep ring, many surgeons proceed to inguinal exploration as a routine, regardless of the adequacy of the vessels or the presence or absence of the processus vaginalis (PV). We tried to find out whether this was necessary in cases with hypoplastic vessels. This was a retrospective study of cases of IT where during laparoscopy, the vas deferens and the gonadal vessels were seen passing through the deep inguinal ring. Cases were divided into four groups, according to the condition of the PV: present (whether patent or closed) or absent and the adequacy of the vessels. Findings at inguinal exploration and histopathologic examination were compared. Over a period of 4 years, 27 children had laparoscopy for 36 IT. Twenty-three cases (64%) had the vas and vessels passing through the deep ring. Eleven cases (48%) had hypoplastic vessels: 5 (22%) with PV, and on inguinal exploration, 3 (60%) had atrophic testes, and 2 small "nubbins," and 6 (26%) with no PV; 3 with blind ended vas and vessels and 3 with small "nubbins." No case in the last group showed testicular tissue on histopathology. In cases with hypoplastic vessels exiting the deep inguinal ring, it is the presence or absence of PV that should determine the next step. If it is present, inguinal exploration should follow. If it is absent, exploration is unnecessary.

Introduction: Different procedures are applicable for Hirschsprung’s disease and some cases may be complicated with recurrence with symptoms of partial or complete obstruction due to colorectal anastomotic stricture or missing of aganglionic tissues.
Materials  and patients:  15 cases, aged from 2 to 11 years had Hirschsprung’s disease, managed before with other different procedures of pull-through and presented with obstruction, abdominal distension, constipation and obstipation, treated with a modified Duhamel’s procedure using circular and linear staplers.
Results: Twelve cases had colostomy done and 3 cases managed without colostomy, all cases are followed for 6 months to 2 years without major complication.
The procedure, data and results of these cases will be discussed and presented

A high proportion of children with bladder exstrophy will continue to suffer from urinary incontinence and a miserable life even after a well-performed staged reconstruction in specialized centers. Most of those children usually have a normal anal sphincter allowing construction of a neobladder from the rectum, so they are continent without an abdominal stoma, and do not require frequent catheterization, which greatly contribute to a favorable body image. In this study a modified Duhamel's rectal pouch done for 19 children, with implication of suitable stapler adopted to construct a rectal bladder with a non-refluxing urterorectostomy, there is a theoretical advantage in our procedure of avoiding a mix of urine and feces. All patients were followed for up to 6 years (2-8 years) for efficacy, safety, subsequent renal complications, and surveillance for any rectal neoplastic changes in this new diversion. Assessment of electrolytes, acid base balance, and renal function were carried out regularly and all data were analyzed using the SPSS 9.0.1 statistical package and compared using a paired t test; data were considered significant if p < 0.05. Proctoscopy was performed 6 monthly in the first year then annually thereafter, and at any time if there was any rectal bleeding. In this group of patients, follow-up revealed no neoplastic changes in the rectal bladder, deterioration in renal function, or major electrolytes disturbance. They can hold up to 400 mL (350-550 mL) of urine and all are continent during the daytime with an emptying frequency of 3-5 h; three patients had infrequent (4 episodes/month) nocturnal enuresis; and four cases developed pyelonephritis controlled with medical treatment. The continent rectal bladder created by using the principles of the Duhamel pull-through is feasible, easy to perform, successful in the immediate short term with low complications after 6 years of follow-up and appropriately accepted by the children and their families with marked improvement in quality of life regarding continence; longer-term follow-up is requested to rule out rectal neoplastic changes. A comparative review of the complications, patient's acceptance, and longer-term follow-up with other well-known procedures, such as Mainz II, is required.