scholarly journals OUTCOME OF SINGLE STAGE SPHINCTER SPARING SCARLESS ( 5S) PROCEDURE FOR RECTOVESTIBULAR FISTULA: A RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 8 (11) ◽  
pp. 34-41
Author(s):  
Muhammad Riaz-Ul-Haq ◽  
◽  
Muhammad Kashif Chishti ◽  
Arsalan Raza Wasti ◽  
Mazhar Jam ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Case Series ◽  
Cost Effective ◽  
Anorectal Malformations ◽  
Single Stage ◽  
Anal Stenosis ◽  
Paediatric Surgery ◽  
Retrospective Case ◽  
Renal Anomalies ◽  
Vestibular Fistula

Background: Anorectal malformations (ARM) in girls comprise of a wide spectrum of disease ranging from imperforate anus to common cloaca, a complex malformation. Recto-vestibular fistula (RVF) is the commonest ARM in female patients. Many surgical procedures have been mentioned in the literature but trend is changing from staged to single stage procedure. Objectives: To evaluate post operative results of Single Stage Sphincter Sparing Scarless (5S) procedure for RVF. Methods: It is a retrospective case series of 24 patients with RVF who were admitted in the Department of Paediatric Surgery Jinnah Hospital Lahore and the Children Hospital and the Institute of Child Health Multan from October 2018 to September 2019, between 14 days and 4 years of age , underwent single stage sphincter sparing scarless procedure without any colostomy, anterior or posterior midline incision or division of sphincteric complex. Site of neo-anus was marked with the help of muscle stimulator and all surgeries were done under general anesthesia after meticulous gut preparation. Post operatively patients were kept nil per oral for 5 days to avoid wound contamination due to stool. Follow up was done for six months to evaluate outcome. Authors used a new name for single stage procedure. Results: Mean age was 160 days, operative time 78 minutes and hospital stay 6.8 days. 9 (37.5%) patients were diagnosed with some other associated congenital anomalies like congenital heart disease (CHD), renal anomalies, hemisacrum, syndactyly, talipes equino varus(TEV) and Downs syndrome. As a whole 13(24) presented with complication. 4(16.64%) patients presented with constipation, 3(12.5%) excoriation, 2(8.32%) anal stenosis, 2(8.32%) soiling, 1(4.16%) retraction of rectum and 1(4.16%) superficial wound infection. Patient with retraction was planned for re-do surgery, all others were managed conservatively. Conclusion: Single stage sphincter sparing scarless ( 5S) procedure for recto-vestibular fistula is safe, simple and cost effective technique. Patient suffering is minimum, as there is no colostomy, so no multiple surgeries. Complications are minimum and comparable to staged procedure.

Concurrent surgeries in ENT: a cost-effective and safe approach in patients requiring multiple definitive procedures

2004 ◽  
Vol 118 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Achamma Balraj ◽  
Mary Kurien ◽  
Anand Job
Keyword(s):  
Surgical Procedures ◽  
Tertiary Care ◽  
Case Series ◽  
Cost Effective ◽  
Definitive Treatment ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Average Hospital ◽  
Duration Of Surgery

Treatment of the predisposing factors that are identified in the nose and throat in several ENT diseases is mandatory prior to the definitive management of the latter. When surgical management is indicated it has been traditional to use staged procedures. This study was undertaken to assess the role of concurrent surgical procedures in ENT and evaluate their cost-effectiveness compared to similar staged procedures. This was a retrospective case series of 100 consecutive patients undergoing concurrent and similar staged ENT surgical procedures. On analysis, it was noted that the average duration of surgery, anaesthesia and hospital stay was significantly less in the concurrent procedures group than in the staged procedures (2.35/3.1.hours; 3.05/3.30.hours and 2.5/6.5 days, respectively). The average hospital bill for the concurrent procedures was also lower than for the staged procedures. Hence, in patients requiring multiple ENT surgical procedures for definitive treatment, concurrent procedures are more cost-effective than staged procedures and should be considered the treatment of choice in a tertiary care centre.

scholarly journals Case series: long term experience with different types of hypospadias and its correction by single stage procedure

2018 ◽  
Vol 5 (4) ◽  
pp. 1428
Author(s):  
Amarendra Kumar ◽  
Chandramohan Narayan ◽  
Nameer Faiz
Keyword(s):  
Primary Repair ◽  
Age Groups ◽  
Case Series ◽  
External Genitalia ◽  
Cost Effective ◽  
Single Stage ◽  
Cosmetic Results ◽  
Flap Technique ◽  
Different Types ◽  
Male External Genitalia

Background: Hypospadias is a relatively common congenital defect of the male external genitalia. It is present in approximately 1 in 250 male newborns. Hypospadias, in boys, is defined as an association of three anomalies of the penis: an abnormal ventral opening of the urethral meatus that may be located anywhere from the ventral aspect of the glans penis to the perineum, an abnormal ventral curvature of the penis (chordee), and an abnormal distribution of foreskin with a “hood” present dorsally and deficient foreskin ventrally.Methods: In this study author operated 250 cases of Hypospadias of different types in different age groups during (1992-2017) using MAGPI for glandular, TIP and Flip-flap procedure for distal penile and Ducket Onlay Flap technique for Proximal penile, penoscrotal and perineal Hypospadias. Complicated / Failed Hypospadias was repaired by Trap door technique or Byer’s double tube technique.Results: After the primary repair of Hypospadias fistula was found in 4.5% of patients. Post-operative haemorrhage was seen in 3.2% of patients. Flap Necrosis was found in 8% of patients after Mathieu’s Flip- Flap technique. The success rate of Complicated Hypospadias was quite satisfactory and Meatal Stenosis was seen in 10% of the cases. Over All study has shown superior cosmetic results and one stage repair is cost effective, satisfactory and less psychologically affecting the parents and the patients.Conclusions: MAGPI and its different modifications in the repair for Glandular and Flip-flap or TIP for distal penile in cases of mild or no chordee. Proximal Penile has sufficient Chordee and can be corrected by dorsal plication and urethroplasty by Ducket’s Onlay flap technique. The cost-effectiveness due to single stage repair and its cosmetic results and there least complications prove the efficacy of this protocol. Single stage repair is also beneficial for developing countries like India where the follow-up compliance in the rural patients is extremely poor.

scholarly journals Wound Dehiscence after Posterior Sagittal Anorectoplasty in Children with Anorectal Malformations

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Louise Tofft ◽  
Martin Salö ◽  
Einar Arnbjörnsson ◽  
Pernilla Stenström
Keyword(s):  
Congenital Malformations ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Single Stage ◽  
Paediatric Surgery ◽  
Posterior Sagittal Anorectoplasty ◽  
Contributing Factors ◽  
Tertiary Centre ◽  
Low Weight ◽  
Ethical Approval

Aim of the Study. To assess the frequency of and identify contributing factors to wound dehiscence after posterior sagittal anorectoplasty (PSARP) in children born with anorectal malformations (ARM). Methods. Ethical approval was obtained (DNR 2017/191). Charts of all children with anorectal malformations (ARM) reconstructed with PSARP, limited PSARP, or PSARVUP at a tertiary centre of paediatric surgery between 2001 and 2016 were reviewed. Wound dehiscence within 30 days postoperatively was analysed regarding gender, prematurity, birth weight, type of ARM, other congenital malformations, single- or multistaged reconstruction, age and weight at reconstruction, postoperative antibiotics, and fasting. Multiple regression analysis was performed for risk factors in single-stage PSARP or limited PSARP, presented as odds ratio (OR) with 95% confidence interval (CI). Main Results. Ninety patients were included, of which 53 (59%) were males. Single-staged PSARP was performed in 40 (44%) patients and 50 (56%) had a multistaged reconstruction with a colostomy. Wound dehiscence was significantly more common among patients without a colostomy; 17 (43%) vs. 11 (22%) (p=0.043). In patients with single-stage PSARP, no single factor was identified to increase the risk for wound dehiscence: cardiac malformations (OR 3.73) (95% CI 0.78-17.88), low weight at surgery (OR 1.56) (95% CI 0.36-6.99), antibiotics < 1 day (OR 1.6) (95% CI 0.43-5.94), or short fasting 0-3 days (OR 4.44) (95% CI 0.47-42.18). Conclusions. A divided colostomy protected against wound dehiscence after PSARP. No risk factor for wound dehiscence after single-staged PSARP was identified. Further studies are needed to establish contributing factors to uncomplicated wound healing after PSARP.

scholarly journals The use of elexacaftor/tezacaftor/ivacaftor in patients with cystic fibrosis post-liver transplant: a case series

2021 ◽  
Author(s):  
Hunter Ragan ◽  
Elizabeth Autry ◽  
Taryn Bomersback ◽  
Jennifer Hewlett ◽  
Lauren Kormelink ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Liver Transplantation ◽  
Wide Spectrum ◽  
Case Series ◽  
Retrospective Case ◽  
Clinical Benefits ◽  
Tacrolimus Trough Concentration ◽  
Life Improvement ◽  
Immunosuppressant Medications ◽  
Related Liver Disease

Introduction Cystic fibrosis (CF) related liver disease (CFLD) manifests as a wide spectrum of hepatobiliary disease and can progress to need liver transplantation. Elexacaftor/tezacaftor/ivacaftor (elx/tez/iva) is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator which has superior efficacy compared to previously approved modulators. Use of elx/tez/iva, should be approached with caution in individuals with CFLD or following liver transplantation due to possible increases in LFTs and drug-drug interactions with several immunosuppressant medications. Objective The purpose of this case series was to explore if the use of elx/tez/iva is safe and tolerable in patients with CF post-liver transplantation. Methods A retrospective case series including patients prescribed elx/tez/iva following liver transplantation and an immunosuppressive regimen consisting of drug therapy metabolized by P-glycoprotein was completed. Results Ten patients at six CF centers with a median age of 22.1 years (range 14-43.4 years) and median time from transplant of 6.9 years (range 0.6-22 years) were included. Most patients (8, 80%) received a reduced or full dose of elx/tez/iva for a mean duration of 10.4 months (range 7-12 months). Fluctuations in LFTs occurred in all patients (10, 100%) and led to therapy discontinuation in two patients (20%). Elx/tez/iva initiation resulted in elevations in tacrolimus trough concentration in 7 patients (70%). Most patients who tolerated elx/tez/iva had symptomatic and quality of life improvement, increased body-mass-index, and maintained or improved lung function. Conclusion Initiation of elx/tez/iva in patients with CF who received a liver transplantation may be safe with clinical benefits.

Routine Histopathologic Evaluation in Hallux Valgus Surgery

2009 ◽  
Vol 30 (8) ◽  
pp. 763-766 ◽  
Author(s):  
Irvin C. Oh ◽  
Scott J. Ellis ◽  
Martin J. O'Malley
Keyword(s):  
Cost Effectiveness ◽  
Hallux Valgus ◽  
Gouty Arthritis ◽  
Case Series ◽  
Cost Effective ◽  
Postoperative Management ◽  
Degenerative Changes ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
New Diagnosis

Background: Anecdotal evidence suggests that specimens submitted for histopathologic assessment during hallux valgus surgery most commonly reveal degenerative changes. The purpose of this study was to evaluate the cost effectiveness of routine examination of tissue from hallux valgus procedures. We hypothesized that such examination rarely diagnoses a new condition and does not alter postoperative management. Materials and Methods: Specimens from 315 consecutive primary hallux valgus reconstructions performed between November 1995 and August 2002 were retrospectively analyzed. Patient charts were reviewed to determine the number of cases in which new diagnoses were made or treatment altered based upon histopathologic examination. Cost effectiveness was assessed by identifying the reimbursement for professional fees charged for these analyses. The total reimbursement per new diagnosis made and per alteration of treatment were calculated. Results: Degenerative changes were diagnosed in the majority of speciments (97.5%, 307 of 315). Other diagnoses included rheumatoid arthritis (1.3%, four of 315), gouty arthritis (1.0%, three of 315), and pseudogout (0.3%, one of 315). A new diagnosis was made only in the one patient (0.3%, one of 315) with pseudogout. Postoperative management was unchanged in every case. Conclusion: Routine submission of specimens obtained during hallux valgus surgery is not cost effective. New diagnoses are very rare and postoperative management did not change. Level of Evidence: IV, Retrospective Case Series

Screening the apparently healthy athlete for risk: a paradigm in transition

2017 ◽  
Vol 27 (S1) ◽  
pp. S89-S93 ◽  
Author(s):  
Joshua D. Kurtz ◽  
Ronald J. Kanter ◽  
Melissa Olen ◽  
Anthony F. Rossi
Keyword(s):  
Primary Prevention ◽  
False Positive ◽  
False Positive Rate ◽  
Case Series ◽  
Cost Effective ◽  
Risk Groups ◽  
Screening Tools ◽  
Retrospective Case ◽  
European Society Of Cardiology ◽  
Healthy Athlete

AbstractIt has largely been accepted that pre-participation screening for student athletes is necessary, but there is still no consensus on the most effective and efficient ways to accomplish this. Most clinical strategies are based on retrospective case series. By applying the European Society of Cardiology and Seattle criteria, electrocardiography appears to afford the lowest false-positive rate for identifying potentially dangerous cardiac abnormalities in athletes. Prospective, randomised trials may help determine the most effective primary prevention. Normative data for age, gender, and ethnicity for screening tools need to be formulated to further reduce false-positive results. Targeted advanced screening aimed at the highest risk groups may be the most beneficial and cost-effective application of primary prevention.

scholarly journals Single stage Anterior Sagittal Anorectoplasty (ASARP) for Anorectal Malformations with Vestibular Fistula and Perineal Ectopic Anus in Females: A New Approach

1970 ◽  
Vol 30 (1) ◽  
pp. 37-43
Author(s):  
Ramananda Prasad Chaudhary ◽  
Bijay Thapa ◽  
Santosh Thana ◽  
Pradeep B Singh
Keyword(s):  
Bowel Function ◽  
Anorectal Malformations ◽  
Skin Incision ◽  
Single Stage ◽  
Lithotomy Position ◽  
Surgical Morbidity ◽  
Anterior Portion ◽  
Vestibular Fistula ◽  
Perineal Skin ◽  
Anterior Sagittal Anorectoplasty

Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 - 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided. Key words: Anterior sagittal anorectoplasty, anorectal malformations, perineal ectopic anus, vestibular fistula. DOI: 10.3126/jnps.v30i1.2458 Journal of Nepal Paediatric Society Vol.30(1) 2010 37-43

scholarly journals The outcome of two stage repair in anorectal malformations with rectovestibular fistula.

2020 ◽  
Vol 27 (07) ◽  
pp. 1527-1532
Author(s):  
Shafiq ur Rehman ◽  
Yasir Makki ◽  
Fareena Ishtiaq ◽  
Saad Fazal ◽  
Nauman Aziz ◽  
...  
Keyword(s):  
Wound Infection ◽  
Age Distribution ◽  
Bowel Function ◽  
Anorectal Malformations ◽  
Anal Stenosis ◽  
Posterior Sagittal Anorectoplasty ◽  
Two Stage ◽  
Stoma Formation ◽  
Vestibular Fistula ◽  
Protective Colostomy

Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material & Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.

scholarly journals Assessment of post-surgical functional outcome in children with anorectal malformation

2018 ◽  
Vol 5 (4) ◽  
pp. 1286 ◽  
Author(s):  
Jiwan Lal Patel ◽  
M. Amin Memon ◽  
Shipra Sharma ◽  
Jeewan Verma
Keyword(s):  
Functional Outcome ◽  
Anorectal Malformation ◽  
Bowel Movement ◽  
Surgical Techniques ◽  
Anorectal Malformations ◽  
Paediatric Surgery ◽  
Vaginal Fistula ◽  
Number Of Patients ◽  
Vestibular Fistula ◽  
Pouch Colon

Background: Anorectal malformations (ARMs) comprise a spectrum of congenital anomalies that continue to present a challenge for paediatric surgeons. Advances in modern surgical techniques and neonatal care have greatly improved survival among ARM patients over the last decades, and early mortality is now unusual in the absence of fatal associated cardiac or chromosomal defects. The aim of this study is to measure the functional outcome of ARM by most recent krickenburg classification.Methods: The present longitudinal study was conducted in Department of paediatric surgery, Dr. BRAM hospital, Raipur, Chhattisgarh during study period February 2016 to September 2017. Those patients who had completed their all stages of surgery for anorectal malformation at-least 6 months back and arriving at outpatient department of paediatric surgery were included.Results: Maximum number of patients were in age group of 3 to 5 years (77.8%) and minimum were 9 to 11 years (3.7%). A 50.6% male and 49.4% female child were included in the study. Maximum number of patients had vestibular fistula (38.27% followed by perineal fistula (24.69%), rectobulbar (18.51%) then rectovaginal (7.4%) and rectoprostatic (7.4%). Minimum patients had pouch colon (2.4%) and cloaca (1.09%). Voluntary bowel movement was present in 50% of rectoprostatic and 66.6% of rectovaginal fistula. Eighty percentage rectobulbar and 83.87% vestibular fistula had voluntary bowel movement. Cloaca and Pouch colon had no voluntary bowel movement. In recto-vaginal fistula 66.6% had soiling, of which 50% had grade 1 and 16.6% had grade 2 soiling. In recto-bulbar fistula 40% cases had soiling, out of which 20% had grade1 and 20% had grade 2. In recto-vaginal fistula cases 33 % had constipation, of which 16.5% had grade 1 and 16.6 % had grade 2. In recto-prostatic fistula 16% had constipation which was grade1.Conclusions: In this study, author showed that functional outcomes comparable to matched peers are achieved in the majority of low ARMs after minimally invasive, individualized perineal procedures and regular surgical follow-up. In high type of ARM soiling is the prominent feature while in intermediate ARM constipation is more common.

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