Experience with anorectal malformations in Ile-Ife, Nigeria

The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.     

Childhood intussusception in Ile-Ife, Nigeria.

A retrospective review of 41 intussusceptions encountered in 39 children seen over an 8-year period in Ile-Ife, Nigeria is presented. Most cases (61.5%) occurred in infancy. This contrasts with previous reports from Nigeria where intussusception has been presented as being commoner in older children. Vomiting, abdominal pain, excessive crying and passage of bloodstained stools were the main presenting symptoms. An abdominal mass was palpable in only 28.2% of patients. Generally, patients presented late in hospital with only two (5.1%) arriving within 24 hours of the onset of illness. Hydrostatic reduction with barium enema was attempted in these two patients, and it successfully reduced the intussusception in one and caused partial reduction in the other. Nineteen patients (46.3%) required bowel resection. There were nine deaths, giving a mortality rate of 23.1%. The relatively high bowel resection and mortality rates were attributed to the delay in seeking medical treatment.     

Large paraesophageal hernias in children. Early experience with laparoscopic repair.

BACKGROUND: Large paraesophageal hernias (LPEH) in children are unusual. The aim of this study is to report the management of LPEH and our initial experience with the laparoscopic approach. METHODS: Since September 2005, four children aged 4-17 years underwent laparoscopic repair of LPEH at the Children's Hospital of Eastern Ontario. Three children had previous fundoplications and two of these had a gastrostomy. Closure of the hiatal defect included crural sutures and prosthetic material, either polytetrafluoroethylene-polypropylene mesh or porcine small intestinal submucosal patch. The charts were retrospectively analyzed. RESULTS: The operative time was 300-540 minutes, with one conversion and two mediastinal pleural tears. Postoperative chest X-ray showed neither mediastinal nor intrapleural air. The median hospital stay was 3 days. Contrast X-ray showed no recurrent hernia and an intact fundoplication. CONCLUSION: LPEH in children is usually a complication of previous fundoplication. Laparoscopic repair is technically demanding but feasible. Adequate crural repair using mesh may reduce the incidence of recurrence. In view of the rarity of LPEH in children, a combined multicenter study is needed to evaluate the results of laparoscopic repair.     

The bacteriology of neonatal septicaemia in Ile-Ife, Nigeria.

The incidence of septicaemia among neonates categorized as being at high risk was 55 per cent in Ile-Ife, Nigeria. Gram-positive organisms, specifically Staphylococcus aureus, were predominant (33.8 per cent) among bacteria cultured from proven cases of septicaemia. Other coagulase-negative staphylococci also contributed 21 per cent, with Staphylococcus epidermidis occurring in 5 per cent of the isolates. Listeria monocytogenes was cultured from 8.4 per cent of septic neonates. Pseudomonas aeruginosa was cultured from 3 per cent, Klebsiella pneumoniae from 14 per cent, and Escherichia coli from 7 per cent. Other Gram-negative bacilli cultured were Enterobacter aerogenes (5 per cent), Citrobacter freundii, Salmonella sp., and Proteus sp. (2 per cent each). The bacterial isolates were relatively resistant to antibiotics traditionally employed to treat cases of septicaemia. The study shows a high prevalence of neonatal bacterial sepsis at the centre and the emerging role of Listeria monocytogenes in the aetiology of neonatal sepsis. It highlights the preponderance of multiple antibiotic resistant organisms among these neonates early in life which is of epidemiological importance in the control of the infectious agents.     

Bacterial isolates in the sick young infant in Ile-Ife, Nigeria

This prospective study was carried out to determine the bacterial pathogens and their antibiotic sensitivity profile in the sick young infant. All consecutive young infants with features suggestive of infection seen over 5 months at a Comprehensive Health Centre in Ile-Ife, were screened for septicaemia and local bacterial infections. Of the 121 sick young infants screened for infection, 94 (77.7 per cent) had confirmed bacterial infection and 54 (57.4 per cent) of the 94 had confirmed septicaemia. Gram-positive organisms were the commonest bacterial isolates accounting for 204 (81.6 per cent) of the 250 isolates in this study. Staphylococcus aureus was the most frequent organism accounting for 61.2 per cent of all isolates. Gram-negative organisms accounted for 46 (18.4 per cent) of all isolates with Salmonella spp. and Proteus vulgaris predominating. All the bacterial isolates in this study were sensitive to ofloxacin and most were sensitive to the antibiotics commonly employed in the treatment of infections caused by these organisms. However, many of both Grampositive and Gram-negative isolates in this study were resistant to cotrimoxazole. The study highlights the high prevalence of bacterial infections (localized or systemic) among young infants. It also shows that Gram-positive organisms, the principal aetiologic agents, were sensitive to commonly used antibiotics. It is recommended that genticin and cloxacillin or erythromycin should be used as the first-line antibiotics in the treatment of young infants with bacterial infections in Ile-Ife, Nigeria.     

Initial experience with laparoscopic adhesiolysis in children

Intra-abdominal adhesions are a well-known complication of laparotomy. We report our initial experience of ten children undergoing laparoscopy for the diagnosis and treatment of intra-abdominal adhesions. Significant adhesions were found in seven patients and successfully treated laparoscopically. Two patients required a second procedure, the first for recurrent adhesions 6 months following laparoscopic adhesiolysis, and the second because of an initial unsuccessful attempt. Even very extensive adhesions can be treated effectively and safely with very low morbidity. There were no conversions to open laparotomy. It has been our observation that pain localised to a healed laparotomy incision may be caused by adhesions to the undersurface of the scar, and lysis of these adhesions resulted in resolution of the pain in our patients. Correspondence to: H. L. Tan     

Laparoscopic nephrectomy for congenital benign renal diseases in children: comparison with adults

AIM: To compare the results of laparoscopic nephrectomy for congenital benign renal diseases in children and adults. METHODS: From August 1996 to February 2003, laparoscopic nephrectomies were performed on 26 children and 60 adults. Of these patients, 33 patients (17 children, 16 adults) with comparable diseases were included in the analysis. RESULTS: Disease was on the right side in 16 patients and on the left in 17. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, conversion rate to open surgery, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. Median operative time in the paediatric group was 140 min compared to 147.5 in adults (p=0.626). The estimated blood loss was significantly different (median 25 and 75 cm(3) in children and adults, respectively; p<0.001). Other operative and convalescence parameters were not statistically different. However, whereas no child required a blood transfusion, three adults (18.8%) did. No major perioperative complications occurred in the paediatric group, but open surgical exploration was needed due to retroperitoneal bleeding in a single adult. CONCLUSION: Our findings indicate that laparoscopic nephrectomy for congenital benign disease in children is achieved safely and that the modality offers additional advantages in children as compared to adults.     

机器人辅助腹腔镜行儿童上尿路手术的护理配合

目的总结机器人辅助腹腔镜行儿童上尿路手术的护理配合经验。方法回顾性分析2017年3月至2017年12月在解放军总医院第七医学中心,接受机器人辅助腹腔镜行上尿路手术140例患儿的临床资料,总结机器人辅助腔镜手术的术前准备、用物准备、手术布局和体位安置等护理配合注意事项。结果 140例患儿中男103例,女37例。平均体重为(18.1±15.0) kg,体重≥40 kg者39例,体重<40 kg者101例。手术的平均体位安置时间为(13.8±5.1)min。所有手术均顺利完成,无中转开放手术,未发生因手术布局及体位不当所导致的手术操作困难及术后相关并发症。结论良好的手术布局、体位安置是机器人辅助腹腔镜行儿童上尿路手术顺利开展与完成的重要前提。良好的手术布局有利于手术团队在手术中协作、交流与配合。良好的体位安置有利于发挥机器人手术优势、有助于主刀灵活操作及其与助手有效地配合,使手术更加安全、有效。     

完全腹腔镜下肠肠吻合技术在消化道畸形中的运用

目的 探讨完全腹腔镜下肠肠吻合技术在消化道畸形治疗中运用的可行性及安全性.方法 回顾性分析2015年1月至2015年12月完全腹腔镜下肠切除肠吻合治疗8例消化道畸形患儿的临床资料.其中,男6例,女2例;年龄1岁10个月～12岁8个月,平均5.4岁.患儿取仰卧位,气管插管.脐轮右上、左下分别置入3.5、5.0 mm Trocar.腹腔镜监视下,经病变于腹壁体表投影水平与左/右腹直肌外侧缘交界处置入5 mm Trocar.脐轮左上Trocar置入3mm目镜,另2个5mmTrocar置入操作器械.探查肠管,找到病变位置后,超声刀切除病变两端肠管,经腹壁进针(4-0带针丝线),浆肌层缝合两断端肠壁后牵引.5-0可吸收线连续全层缝合肠腔后壁(超过系膜侧肠壁),前壁连续浆肌层单层缝合.结果 本组8例均顺利完成完全腹腔镜下肠切除肠吻合.手术时间1.5～2.5h,平均1.9h.术中均未出血,术后6～12 h下床活动,疼痛均可耐受.术后未见切口感染、吻合口漏及粘连性肠梗阻发生.病理检查报告肠重复畸形5例,梅克尔憩室3例.结论 完全腹腔镜下肠肠吻合技术对于部分消化道畸形患儿是安全、有效的技术,但在病例选择上要严格把握指征.     

Laproscopic and thoracoscopic surgery in children and adolescents: A 3-year experience

Our initial experience over the last 3 years with laparoscopic and thoracoscopic surgery in children and adolescents is reported. Between September 1992 and August 1995, a total of 215 laparoscopic and thoracoscopic procedures were performed: 32 appendectomies for acute appendicitis, 10 cholecystectomies for symptomatic gallstones, 11 procedures for adnexal pathology, 6 laparoscopies in children with nonpalpable testes, 3 diagnostic laparoscopies, and 153 thoracoscopic sympathectomies in children suffering from primary palmar hyperhidrosis. The post-operative course was uneventful in all cases. In 2 children with acute appendicitis we converted to the open technique due to technical difficulties. We are encouraged by the results of our initial experience. There is no doubt that laparoscopic cholecystectomy, laparoscopic surgery of adnexal pathology, and thoracoscopic sympathectomy, because of their numerous benefits - shorter operative time, hospitalization, and convalescence as well as less postoperative pain and improved cosmetic results - are replacing the open techniques. We are not convinced as yet of the advantages of laparoscopic appendectomy in children; we are presently performing both laparoscopic and conventional techniques and studying the various parameters in order to reach a more definite conclusion. Various other endoscopic surgical procedures will be carefully considered in the near future.     

腹腔镜在小儿脾切除术中的应用

目的：探讨腹腔镜在小儿脾切除术中的应用。方法：2002年8月至2003年2月我院采用经腹腔镜对3例患儿行脾切除，其中2例为遗传性球形红细胞增多症，男女各1例，年龄分别是5岁、8岁，另1例17岁女孩，为血小板减少性紫癜。从手术指征、术前准备、腹腔镜手术的关键步骤及术后恢复等方面进行总结。结果：3例手术过程顺利，手术全程平均2．1h，其中经腹腔镜切脾时间平均为1．1h，将脾脏取出腹腔时间平均约1h。术中出血5～60ml不等。术后次日下床活动，术后观察7～11d，血常规化验正常后出院。随访2～6个月，一切正常。结论：经腹腔镜脾切除术具有创伤小、出血少、术后恢复快、腹部切口美观等优点，明显优于传统的手术方法。     

腹腔镜下肛门成形术治疗直肠肛门畸形的并发症分析

目的 探讨腹腔镜下肛门成形术治疗直肠肛门畸形的并发症的产生原因和应对方法.方法 总结分析本中心2010年1月至2015年12月共腹腔镜手术治疗的直肠肛门畸形92例,全部为男性患儿,其中直肠膀胱颈瘘23例,直肠前列腺球部瘘35例,直肠尿道瘘34例.全部患儿均行横结肠造瘘或乙状结肠造瘘的分期手术.术后平均随访时间2.5年(4个月～5年),统计术后并发症和肛门排便情况,其中31例患儿随访大于3年.结果 术后直肠回缩11例,有1例再次手术缝合,另10例保守治疗.术后直肠黏膜外翻7例,均为早期病例,有4例再次手术切除局部外翻黏膜,有3例游离拖出结肠切除部分后再次肛门成形.腹腔残余感染4例,均经抗感染后好转.在已随访3年以上的31例患儿中术后排便失禁3例,其中有1例患儿由于严重瘢痕狭窄予扩肛治疗,另外有2例患儿伴发脊髓栓系.结论 虽然手术并发症难以完全避免,但注意围术期处理和手术技巧,能减少术后并发症的发生.     

Epilepsy surgery in children with accompanying impairments

The aim of this study was to assess seizure outcome 2 years after epilepsy surgery in a consecutive series of paediatric patients, with special focus on children with learning disabilities and other neuroimpairments in addition to the epilepsy.Outcome 2 years after surgery was assessed in 110 of 125 children operated upon for drug resistant epilepsy in Gothenburg 1987–2006.More than half of the children had learning disabilities, 43% motor impairments and 30% a neuropsychiatric diagnosis. Fifty-six per cent of those with an IQ < 70 became seizure-free or had a >75% reduction in seizure frequency, and two thirds if the operation was a resection. The corresponding figure in those with more than 100 seizures per month was 15 out of 31, and another seven had a 50–75% reduction in seizure frequency.The message is that learning disability, motor impairment and psychiatric morbidity should not be contraindications for paediatric epilepsy surgery. More than half of the children with learning disabilities had a worthwhile seizure outcome, with even better results after resective surgery. Children with drug resistant epilepsy and additional severe neurological impairments should have the benefit of referral to a tertiary centre for evaluation for epilepsy surgery.     

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??Objective??To approach the performance of digital subtraction angiography??DSA?? in the early diagnosis and treatment with drug perfusion therapy in children with cerebral infarction after the congenital heart disease surgery??then assess the outcome. Methods??From January 2015 to December 2016??6 patients with cerebral infarction developed neurologic symptoms??including facial paralysis??physical activity disorders or convulsions within 12 hours to 3 days after surgery for congenital heart disease. After being diagnosed with ischemic cerebrovascular disease by initial magnetic resonance imaging??MRI???? patients were made a definite diagnosis through DSA and given intravenous infusion of internal carotid artery at the same time. Patients were treated to improve circulation??anticoagulation??intravenous thrombolysis and rehabilitation after DSA. Clinical symptoms were observed at 6 hours??1 day??3 days??1 week and 1 month after operation. Patients were followed up for 1 month to 3 months. Results??After successful DSA surgery and drug perfusion therapy??neurologic symptoms in patients were improved. Facial paralysis was improved in 5 of 6 patients at 6 h??1 d and 2 d of DSA??and limb muscle strength was also improved. Physical activity was gradually improved in 2 patients at the third day after DSA surgery. All cases had no signs of recurrence??serious complications or sequalae??no DSA perioperative bleeding??infection??cognitive dysfunction or physical disability?? in the follow-up??and muscle strength was significanthy improved. Conclusion??The early diagnosis is crucial to children with cerebral infarction after the surgery for congenital heart disease.     

减少儿童腹腔镜下胆总管囊肿切除术并发症的对策

目的介绍儿童腹腔镜下胆总管囊肿切除、空肠肝管Roux-Y吻合术的初步临床经验,并就如何减少术中风险和术后并发症展开讨论。方法总结上海交通大学医学院附属新华医院儿外科和上海儿童医学中心外科的61例儿童胆总管囊肿经腹腔镜手术病例。其中男18例,女43例,年龄8 d～14岁,术前均行磁共振胰胆管造影(MRCP)并提示为Ⅰ型胆总管囊肿,囊肿直径1.2～12 cm,均未作外引流。结果 61例中54例成功经腹腔镜完成囊肿切除、空肠肝总管Roux-Y吻合术,7例分别因囊肿巨大、炎性粘连、出血或技术原因中转开腹。术后出现吻合口漏2例;随访2～43个月,胰头部囊肿形成2例,存在胰腺炎发作1例,有粘连性肠梗阻2例,均保守治疗后缓解。结论腹腔镜下儿童胆总管囊肿切除术具有显著的微创手术优点,但需要娴熟的镜下操作技能和经验的积累,减少手术并发症的风险是将该技术在临床推广的重要前提。