No abstract
Aim of the study: The purposes of our study are to evaluate the role of laparoscopy in localizing impalpable testes and the management strategy for both unilateral and bilateral impalpable testes. Patients and methods: Throughout the period between January 2005 to December 2008, 36 patients with impalpable testes were admitted to pediatric surgery centre at Al-Khanssa Teaching Hospital in Mosul, Laparoscopy done for them to assess and manage 42 impalpable testes. In all patients 10 mm canula port was inserted in surpaumbilical position using an open technique, a single 5 mm port was occasionally required in contralateral iliac fosse to manipulate bowel and testes. A further port was used for laparoscopic clipping and division of the testicular vessels. These performed as the first part of the one or two stages Fowler-Stephen orchiopexy (high division of testicular vessels), and all patients has been followed for period of about two years. Results: Twenty seven testes found to be positive, ten of them near the internal inguinal ring and nine in the iliac fossae, while two testes where found intra canalicular. Fifteen testes were absent with closed ring, 12 of them showed vas and vessels enter the internal ring (vanished testes), while three with no vas and vessels entering the ring (agenesis). Assisted laparoscopic orchiopexy using sub dartous pouch was successfully done in 16 testes. Single stage Fowler-Stephen technique was adopted in four testes. Two stages for another two testes, in one patient, fixation done near upper scrotum which was then re fixed by second operation few months later. Conclusion: Laparoscopy is a safe and reliable technique in diagnosing the presence or absence of impalpable testes, provides a valuable information about the associated anomalies and condition of the internal ring, it can direct the surgeon to chose the proper technique for orchiopexy, with no mortality and very low morbidity.
Most sacrococcygeal teratomas present between the 22nd and the 34th week of gestation. The diagnosis of sacrococcygeal teratoma on routine antenatal sonograms is associated with a greater than expected incidence of prenatal and perinatal complications. We report a premature baby with intrauterine spontaneous rupture of giant sacrococcygeal teratoma which was managed successfully.
Umbilical cord pyloromyotomy for infant hypertrophic pyloric stenosis (IHPS) shows excellent cosmetic results, in up to 30% of cases, be this is because there is a possibility that the point of the skin fold over the muscle does not allow comfortable placement of the hypertrophic pylorus, leading to undesirable serous lacerations. The aim of this study was to evaluate the safety of hysterectomy for IHPS using a modification of the Tan-Bianchi method. Patients and methodsThis study was conduct in the Pediatric Surgery Unit, Central Pediatric Teaching Hospital Baghdad and Alkhansaa Teaching Hospital Mosul, during June 2016 to June 2020. The present study included infants presented with repeated projectile non-bilious vomiting who underwent pyloromyotomy for IHPS. Most patients underwent pylorectomy with Tan-Bianchi umbilical incision. Sometimes the incision must be widened to the side. After surgery, the following data were collected: duration of surgery, postoperative course and length of hospital stay after surgery. Result Pyloromyotomy used to manage them using the modified umbilical skim incision. The study included 18 male (78.7%) and 5 female (18.3%) patients; their ages at presentation ranged from 30 to 90 days, and their weights ranged from 2600 to 3500 g .The skin incision were extended in 9 infants to deliver the pylorus, particularly when it was large. The operating time ranged between 23 and 35 min. The length of hospital stay after surgery varies from 24 to 72 hours. Wounds mostly heal without wound infection, laceration, or incisional hernia. In all patients, the perineal incision left an almost undetectable scar. ConclusionEntering the abdominal cavity through making a circumumbilical skin incision with a lateral extension have excellent results even in a large pyloric mass. We recommend using this technique for large pyloric masses.
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