Congenital Duodenal Obstruction: Evaluation of 68 Cases

INTRODUCTION: Congenital duodenal obstruction, which is one of the most common causes of intestinal obstruction in neonates, gain importance in terms of associated anomalies. In this study, we aimed to review our experience with congenital duodenal obstruction cases operated in our clinic while evaluating the results of these patients. METHODS: All hospital records of neonates with congenital duodenal obstruction which had operated in our department between 2004 and 2017 were reviewed retrospectively. Patients were evaluated according to their demographic features, clinical presentations, associated anomalies, treatments and outcomes. RESULTS: During 13 years, 68 newborns (36 males, 32 females) with congenital duodenal obstruction were operated. The mean gestational age was 35.7±3.1weeks (28-44weeks), the mean birth weight was 2477±651.5 gram (1100–4100 gram) and 46 (67.7%) of them were premature. Associated abnormalities were detected in 37 neonates (54.4%); 16 of them (23.5%) had congenital cardiac malformations, and 13 of them (19.1%) had Down Syndrome. In neonates with associated abnormalities; the avarage period to start enteral feeding was 9.5±5.8 days (4-37days) and the mean hospitalization period was 25.6±26.2days (9-140days). These values were found 7.6±3.2 days (4-20days) and 17.5±13.7days (8-80days) respectively for the patients having no associated anomalies. Postoperative complications such as ileus, septicemia and nutritional intolerance were seen in 17 patients (25%); 3 of them (4.4%) need re-operation. While 63 patients (92.6%) were discharged on average 21.4±22 days (8-140 days); due to septicemia and severe congenital cardiac malformations 5 patients (7.4%) were died in 27.2±14.1 days (11-43days) postoperatively. The rate of septicemia was statistically significantly higher in patients with excitus than the ones who were discharged (p<0.001). DISCUSSION AND CONCLUSION: The presence of associated abnormalities in patients with congenital duodenal obstruction increases the risk of morbidity and mortality. Septicemia and severe congenital cardiac malformations adversely affect prognosis.

Effectiveness of Frenotomy in Ankyloglossia Treatment Between 0-1 Years Old

Objective: The aim of this study is to present the frenotomy technique in cases of ankyloglossia (tongue-tie), which is diagnosed and treated in the first year of life. Patients were operated by a single surgeon. Method: Cases of ankyloglossia operated at Biruni University Faculty of Medicine Hospital Pediatric Surgery Clinic Between 2016-2020 were evaluated retrospectively in terms of clinical complaints, age, type of ankyloglossia, surgical technique, indications and results of surgery. Results: Frenotomy was performed in 56 patients including 47 boys (84%) and 9 girls (16%), between the ages of 0-1. Average age of the patients was 93 days (1-360). Patients were divided into two groups as Group 1 (n: 40: 0-90 days old) and Group 2 (n: 16: 90-360 days old). Patients were admitted with complaints of having difficulty in sucking the mother’s breast, not being able to take their tongue out, feeding with a bottle, pain at the nipple and not being able to grasp the breast. No additional intervention was required for bleeding in Group 1, and in 12 (75%) patients in Group 2 bleeding control was achieved using bipolar cautery. During follow-up, significant improvement was obtained in all patients who had difficulty in sucking and gripping the nipple. Improvement was observed in 15 of 25 patients with nipple pain. Conclusion: Frenotomy is an easily applied surgical procedure with minimal complications. Additional application may be required for bleeding control in infants older than 3 months. It should be considered that the probability of recurrence may depend on the type, intervention used and thickness of the frenulum, and phrenotomy may not be sufficient. The improvement in breast feeding function of Frenotomy may provide a significant improvement in the complaints of nipple pain, and may contribute to the emotional attachment between the mother and her baby. Randomized controlled trials are required to determine the effects of phrenotomy.

Results of the Surgical Treatment in Children with Hirschprung Disease: A 12-Year Experience

Objective: In the treatment of Hirschsprung’s disease, many surgical techniques have been developed and modified including laparotomy, resection of the affected colon segment, and pull-through of the functional bowel segment to the anus. Conventional surgical methods have many early and late postoperative complications, albeit at a reduced rate today. In this study, it was aimed to compare the treatment results of children with Hirschsprung Disease who were operated with single or two-stage techniques in our department. Method: Hospital records of the patients operated for Hirschsprung disease were retrospectively evaluated. Demografic characteristics, findings of physical and rectal examinations, X-rays findings, rectal biopsy results, surgical treatment methods and outcomes were analyzed. Results: Fifty-two children including 41-male (78.8%) and 11-female (21.2%) patients with age ranging from 1-day to 5-year and mean age of 6.8-day in neonates and 6.3-month in others were enrolled in the study. All patients presented with acute or subacute intestinal obstruction. Levels were observed on supine abdominal radiographs in all; transition zone and retention of opaque material were observed on opaque enema or retention radiographs.In patients whose rectal biopsies revealed aganglionic megacolon two staged procedures were performed including initial colostomy followed by definitive procedure of Duhamel with stapler in 30, and Soave in 12, and Swenson in 1 patient. Nine patients were operated with one-stage endorectal pull-through technique. The complication rate in 43 patients with Hirschsprung disease managed by two staged operative procedure was (78.8%), and it was 11.1% in 9 cases that underwent transanal endorectal pullthrough procedure. It was learned that effective anal dilatation was not performed in 22-patients who had postoperative enterocolitis attacks. Conclusion: In addition to the low complication rate, the morbidity rates in the transanal endorectal pull-through method, which achieved successful results with only one procedure, were very low compared to multiple-stage operations.

Orthopaedic Management of Bladder Exstrophy

Bladder exstrophy is an embryologic malformation that affects urogenital and skeletal systems. Non-operative treatment of this rare problem is impossible. Urogenital reconstructions can be facilitated by orthopedic procedures. These reconstructions can be performed in a single stage as a complete repair or multi-stage approaches. The goal of the treatment is closure of the bladder and abdominal wall for the achievement of continence, preservation of renal functions, and cosmetic and functional reconstruction of genital organs. Orthopedic procedures are performed to decrease the tension that complicates the bladder and abdominal wall closure by approximating the pubic rami to achieve a secure closure and a low recurrence rate. Surgical interventions consist of the approximation of the pubic rami with different materials such as suture materials and plaque or the application of different osteotomy types such as posterior iliac, anterior pelvic (pubic), diagonal iliac, horizontal iliac and posterior pelvic resection osteotomies. The age of the patient, the amount of pubic diastasis and history of previous operations that the patient has undergone should be considered during the operation planning. Pubic rami can be approximated without performing pelvic osteotomy in patients who are operated within the first 72 hours after birth. But, osteotomy is required in children older than 2 years of age with severe pubic diastasis, concomitant cloacal exstrophy and unsuccessful operation history. The surgical team should have enough knowledge and experience to perform different osteotomy types in case of need to combine anterior and posterior iliac osteotomies. With these multidisciplinary approaches, much more successful outcomes could be achieved.

Çocuklarda Brankiyal Yarık Anomalileri

INTRODUCTION: Objective: A retrospective study was planned to evaluate the clinical and radiological findings of childhood branchial anomalies together with the subclasses of the anomaly and to discuss the surgical results. Method: The medical records of the patients managed for branchial cleft anomaly between 2014 and 2019 were examined. Demographic features, clinical and radiological findings, surgical managements and outcomes were recorded. Results: Eighteen cases were included in the study. Median age of the cases was 5 years (1-14). Male/female ratio was 9/9. The complaints were discharge from the BC (n=13, 72%) and painless neck mass (n=3, 17%). The BC was at right side in 8 (44%), left side in 9 (%50) and bilateral in 1 case (6%). Physical examination revealed the presence of a fistula, and its orifice in 14 cases and cystic lesion was palpable in 4 cases. Ultrasound was performed in 9 cases (50%) and cyst could be detected in 3 of them. All cases were operated and step-ladder incision was used in 8 cases. The fistula tract was ended near to pharynx in 2, near to pretonsillar fossa in 10, submandibular region in 5, and external auditory tract in 1 case. Histopathological examination revealed inflammation in 2 cases and cartilage in 1 case. Stratified ciliary columnar and stratified squamous cell epithelium was detected in samples. Conclusion: Physical examination is the most important diagnostic method. The management is surgery and excision of whole lesion is important in preventing recurrences. Although using methylene blue is a guiding technique in surgical excision of tracts, the effect of its use on surgical outcome and recurrence rates is still debatable.