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Objective To compare the outcome and complication rate of the platelet‐rich plasma applied as a coverage layer and dartos flap layer during primary repair of distal hypospadias. Methods A prospective randomized study was carried out comprising 180 boys (age range 12–65 months) from October 2011 to December 2016 at Al‐Azhar University Hospitals, Cairo, Egypt. A single surgeon carried out all urethroplasty. Patients were randomly divided into two groups: group A (tubularized incised plate urethroplasty with platelet‐rich plasma coverage layer) and group B (ventral dartos flap). Complication rates were compared between two groups. Results There was a significant difference in the occurrence of complications between the two groups. A total of 36 (20%) complications were recorded in 26 patients, just 12 (13.3%) reported in group A, but 24 (26.7%) complications were reported in group B. Urethrocutaneous fistula was observed in nine patients (10%) in group A, and 12 (13.3%) in group B. Partial glans dehiscence occurred in one patient in group A, and four patients in group B. No patient in group A had a superficial wound infection, compared with six patients in group B. One case of meatal stenosis and urethral stricture was recorded in each group, all of which were managed conservatively. The resultant urinary stream was single and good in 154 patients of both groups. Conclusions Platelet‐rich plasma sheet might be considered as an alternative coverage layer for distal hypospadias repair, especially in the absence of a healthy layer.

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Purpose. To compare laparoscopic mesh rectopexy with laparoscopic suture rectopexy. Patients and Methods. The prospective study was conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between Feb 2010 and Jan 2015. Seventy-eight children with persistent complete rectal prolapse were subjected to laparoscopic rectopexy. Fourteen parents refused to participate. All patients received initial conservative treatment for more than one year. The remaining 64 patients were randomized divided into two equal groups. Group A; 32 patients underwent laparoscopic mesh rectopexy and group B, 32 underwent laparoscopic suture rectopexy. The operative time, recurrence rate, post-operative constipation, and effect on fecal incontinence, were reported and evaluated for each group. Results. Sixty-four cases presented with persistent complete rectal prolapse were the material of this study. They were 40 males and 24 females. Mean age at operation was 8 (5–12) years. All cases were completed laparoscopically. Mean operative time in laparoscopic suture rectopexy was shorter than laparoscopic mesh rectopexy group. No early post-operative complications were encountered. No cases of recurrence with mesh rectopexy group while in suture rectopexy group it was 4 cases (14.2%). Post-operative constipation occurred in one case (3.57%) in suture rectopexy group and occurred in one case (3.3%) in mesh rectopexy group. Fecal incontinence improved in 26/28 cases (92.8%) in suture rectopexy while in mesh rectopexy it was improved in 30/30 cases (100%) of cases. Conclusion. Both laparoscopic mesh and suture rectopexy are feasible and reliable methods for the treatment of complete rectal prolapse in children. However, no recurrence, low incidence of constipation and high improvement of incontinence at follow up more than 36 months with mesh rectopexy accordingly, we considered mesh rectopexy to be the procedure of choice in treatment of complete rectal prolapse.

Background. Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett’s procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett’s procedure. Results. No significant difference was identified as regards demographic data. The follow-up period ranged from 20 to 66 months (mean of 28 months after DFPF and 31 months after Duckett’s repair), and the complication rate was 20.1% (29 of 144 children). There were statistically significant differences between the two groups as regards the urethral stricture, penile rotation, and total complication rate. HOSE score was adopted for assessment of surgical outcomes, urine stream, and cosmetic results. Conclusions. The DFPF technique is feasible and reliable for one-stage repair of penoscrotal hypospadias with chordee and can be considered as a good option as it ensures better surgical and cosmetic outcomes with lower incidence of complications.

Background:The most prevalent upper gastroesophageal disorder in Western populations is GERD. A number of techniques were recommended for this problem's prevention. Aim of the study: to compare the Nissen fundoplication with partial anterior fundoplication. Patients and Methods:The present comparative study comprised thirty patients with symptoms of GERD admitted in the pediatric surgery department, Al-Azhar University hospitals, and all patients submitted to preoperative clinical evaluation and investigations. Laparoscopic Nissen fundoplication (group I) or partial anterior fundoplication (group II) was randomly assigned to the patients. A consent form was signed by each participant in our study. Results: Between the two groups, there has been no significant difference in intraoperative complications or length of hospital stay. But, there was a significant difference in surgical time between the two groups in favor of the partial anterior procedure. Regarding heartburn and regurgitation after 1, 3, and 6 months, there is no significant difference between the two groups. After 3 months, there had been a highly significant difference in post-operative dysphagia favoring partial anterior fundoplication between the two groups, since dysphagia was significantly less common after partial anterior fundoplication. Gas bloating was less frequent after 1, 3, and 6 months with partial anterior fundoplication but without significant differences between both groups. Conclusion: Partial anterior fundoplication appears to be as safe and effective as Nissen fundoplication in treating GERD symptoms, even in patients with severe disease forms. Its technique is easier and requires less time to conduct.

Background: Laparoscopic appendectomy has been widely applied and became popular procedure for the surgical management of appendicitis. Glove single port laparoscopic appendectomy [GSPLA] is a new technical modification of single incision laparoscopic surgery [SILS]. By this approach the laparoscopic instruments introduced to the abdomen through a longitudinal one umbilical incision only. Purpose: This study aimed to present two centres initial experiences using home-made glove single port for laparoscopic appendectomy [GSPLA] in children and adolescents. Patients and Methods:This prospective study was conducted on patients of pediatric age with uncomplicated appendicitis using GSPLA. This was done through a 2 -cm trans-umbilical longitudinal incision. Then the inner flexible plastic ring (FPR) inside the out folded glove was inserted into the abdominal cavity using a curved artery forceps. The open end of the glove was passed through the rigid outer ring (ROR) where it was stretched and folded several times around the ROR for tightening over the anterior abdominal wall. The fingers of glove act as site for introduction of [laparoscopic instruments, ports and camera.Results: Seventy-two children with acute uncomplicated appendicitis were surgically treated by GSPLA. Their mean age was 13 ± 2.8 years (ranged from 7-16 years). All procedures were completed laparoscopically without conversion. Only two cases were converted to multiport laparoscopic procedure. The operative time was ranged from 35 -79 (mean = 45.24 ± 12.14 min). Post-operative ileus was seen in 2 patients (2.77%) and improved under conservative treatment. No report of umbilical infection or hernia after 6 months of follow up. Conclusion:The GSPLA is a new procedure which is very cheap, easy to be done. In addition to high flexibility and wide range of movement of the instruments in comparison with the other single incision laparoscopic trocar (SILT) devices in the market. Appendectomy is a well-established surgical procedure for the treatment of appendicitis. The operation can be performed as an open surgery or by laparoscopy. A further development in the minimally invasive appendectomy technique has been the introduction of single incision laparoscopic appendectomy (SILAP) [1,2].

Background Open pyeloplasty has been the gold standard for the treatment of ureteropelvic junction obstruction (UPJO) in children and young adolescents. However, the use of laparoscopy for the treatment of pyeloplasty is increasing as it has the potential to provide a better and more desirable cosmetic outcome in addition to less postoperative pain and decreased recovery time. The aim of this study was to evaluate the long-term outcome of transperitoneal laparoscopic pyeloplasty (TLP) for the treatment of UPJO in children and young adolescents.Patients and methods Twenty-nine patients with UPJO with 32 renal units were subjected to TLP at Al-Azhar University Hospitals, Egypt, during the period from May 2008 to December 2012. The outcome measurements of this study included operative time, internal stent placement, hospital stay, intraoperative complications, and success rates. Success is defined as both symptomatic relief and radiographic resolution of hydronephrosis at the last follow-up. Patients were followed up with intravenous urography and diethylene triamine penta-acetic acid scan at 3, 6, and 12 months regularly for both functional and morphological outcomes. ResultsThe study included 29 patients (12 male and 17 female) with 32 obstructed renal units. The mean age was 4.23 ± 2.1 years (range 3-16 years). All procedures were completed laparoscopically without conversion. The mean operative time was 143.41 ± 23 min (range 110-220 min). The mean postoperative hospital stay was 4.1 days (range 3-8 days). All patients achieved full recovery without any complications. The mean follow-up period of the patients was 36.34 ± 5.18 months (range 22-60 months). Success rate was 96.9%. Only one case developed recurrent UPJO and was treated with retrograde endopyelotomy and stenting.Conclusion TLP has the advantages of less postoperative pain, short hospital stay, and rapid recovery, with excellent functional and cosmetic outcomes. However, it requires advanced skill level for intracorporeal suturing and knot tying.