Background: There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. Purpose:The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children.Patients and Methods: Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy.Results: A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58 ± 1.26 (range = 2 to 8 y) and mean internal inguinal ring diameter was 13.65 ± 3.85 mm (range = 8 to 20 mm). The mean operative time was 23.36 ± 4.67 minutes for bilateral and 14.28 ± 2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6 ± 3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively.Conclusions: Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with pursestring suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.
Background Neonatal gastro-intestinal perforation [NGIP] is one of the major problems in pediatric surgical practice. Although the outcomes of neonatal surgery have improved markedly over the past decade the mortality rates of neonates with NGIP are still high. The aim of this study was to present the possible etiological factors, clinical findings, and operative procedures of NIP in our locality. Results A total of 34 neonates with NGIP were included in this study. The median age at presentation was (15.8 ± 7.0 SD) days. The median interval between presentation and surgical interference was (2.0 ± 1.1 SD).Necrotizing enterocolitis [NEC] was the commonest cause of neonatal gastro-intestinal perforation. The commonest site of perforation was the colon [11cases]. The overall mortality rate was 11 cases [32.4%]. The main cause of mortality was neonatal NEC [6 cases]. Eight cases [40 %] died out of 20 cases which the interval between the presentation and interference were more than one day. Conclusions Neonatal gastro-intestinal perforations are still associated with high mortality rate in our institutions, and delayed diagnosis with increased interval between the presentation and surgical intervention are associated with increased mortality. In our locality, although NEC is the commonest cause of NGIP, the iatrogenic cause is relatively higher than reported.
Objective: To report the outcomes of surgical correction of post-circumcision webbed penis using two previously described techniques: the Heineke-Mikulicz (HM) scrotoplasty and the multiple Z-plasty. Patients and methods: A prospective study of children with post-circumcision webbed penis was conducted. The patients were classified into two groups according to the degree of web and the remaining ventral penile skin as to whether adequate or short after circumcision. Group I was repaired by HM scrotoplasty and in Group II the multiple Z-plasty technique was used. Results: This study included 86 patients of whom 71 maintained follow-up; 44 (62%) in Group I and 27 (38%) in Group II. The median (range) operative time was 45 (30-55) min in Group I and 75 (60-90) min in Group II. Wound infection occurred in two (4.5%) patients in Group I. In Group II postoperative mild self-limited penile oedema was present in three patients (11.1%). A selflimited scrotal haematoma developed in two (7.4%) patients. Conclusion: Correction of post-circumcision webbed penis in children can be done by one of two techniques: HM scrotoplasty in Grade 1 and multiple Z-plasty in Grade 2 and Grade 3, with favourable outcomes.
For the pediatric surgeon, inguinal hernia repair is the frequently surgical operation in daily practice [1]. Although open surgery is considered the gold standard for all pediatric ages, recently laparoscopic repair gained popularity and became widely practiced in many centres worldwide [2, 3] and became one of alternative option of inguinal hernia repair [4]. Laparoscopy for inguinal hernia was firstly done in girls by ElGohary in1997 [5], since then many laparoscopic techniques for inguinal hernia repair was developed aiming for achieving the advantage of minimal invasive surgery and decreasing the rate of recurrence [6][7][8].It is well known that, inguinal hernia repair by laparoscopy in girls is a good candidate for improvement and upgrading the learn-
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