Canine fossa approaches in endoscopic sinus surgery - our experience

Objective

To define the role of canine fossa approach when standard endoscopic endonasal sinus surgery technique fails.

Study design

Retrospective review of all endoscopic sinus surgeries performed from 1992 to 2007.

Result

Out of 1612 endoscopic sinus surgeries for various indications, CFA was used in 80 patients (4.96%) and among this 15 had bilateral procedure.The various diseases which required CFA were allergic fungal sinusitis (AFS), Fungal ball, Chronic invasive aspergillosis,antro choanal polyp, inflammatory polyp, Mucocoele and Maxillary cyst,inverted papilloma and Juvenile Nasopharyngeal Angiofibroma (JNA). Eight patients had minor complications (cheek swelling-6, facial pain-2 ) which resolved in 5 days.

Conclusion

Canine fossa approach offers an ancillary approach to failed standard endoscopic endonasal technique thereby avoiding other more invasive procedures.     

Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair

Urethrocutaneous fistula is one of the most common complications after hypospadias surgery.The incidence of fistula development has varied from 4% to 20% in larger series. We sought to investigate the role of fibrin glue (Tisseel manufactured by Baxter India Pvt Ltd, Chennai, India) to reduce the chances of fistula formation in cases in proximal penile hypospadias.

Method

A total of 120 patients with proximal penile hypospadias (patients having urethral meatus at posterior third of penile shaft and at penoscrotal junction) were included in the present study. Patients were randomly allocated into 2 groups of 60 each by using Strata 9 software random number table. In group A, fibrin glue was used as a sealant after hypospadias surgery, whereas in group B, no sealant was used. All the operations were performed by single surgeon using transverse preputial tubularized island flap urethroplasty.

Result

Fistula formation occurred in 6 cases in group A (10%) and 19 cases in group B (32%) (P = .027). The fistulae observed in fibrin glue group A were single and small in size (<1 mm). Multiple (≥2 fistulae) and larger fistulae (>2 mm) were observed in group B. Overall complication was significantly higher in group B (P = .006).

Conclusion

Fibrin glue in hypospadias repair does not eliminate fistula formation. However, it seems that it minimizes the incidence of fistula formation.     

A Pilot Study on the Role of T-Tube in Typhoid Ileal Perforation in Children

BACKGROUND: Ileostomy is usually performed for patients of typhoid intestinal perforation with poor general condition, but it is associated with significant morbidity. We have used the T-tube in such patients as an alternative to ileostomy. METHODS: This is a prospective evaluation of a cohort of children with proven typhoid intestinal perforation. Patients with multiple perforations and poor general condition were managed with a T-tube inserted into the bowel lumen after closing all distal perforations (group 3). They were compared with patients who had primary closure of perforation (group 1) or bowel resection (group 2) to determine the efficacy of the use of T-tube. RESULTS: The total number of patients for groups 1, 2, and 3 was 51, 4, and 12 (n = 67). The mean number of perforations for the three groups was 1, 3.5 +/- 0.58, and 4.25 +/- 0.97. The operation time for the three groups was 37.29 +/- 3.24, 59.25 +/- 3.09, and 59.17 +/- 4.17 minutes, respectively. The T-tube was removed after 13.17 days. The mean duration of fistula at T-tube site to heal was 8.58 +/- 2.11 days. The overall follow-up period was 10.94 +/- 1.15 months and none of the patients with T-tube placement had features of intestinal obstruction. CONCLUSIONS: In children with multiple typhoid intestinal perforations and poor general condition, the use of T-tube may be an effective management option.     

Aortic valve replacement with simultaneous chest wall reconstruction for radiation-induced sarcoma

Sarcomas, a rare complication of radiotherapy for breast carcinoma, have a poor prognosis. We describe a lady with previous mantle radiotherapy exposure, who developed a radiation-induced chest wall sarcoma. She underwent simultaneous aortic valve replacement (AVR) for severe aortic stenosis and excision of the sarcoma. Chest wall reconstruction was achieved with a composite marlex cement plate and a pedicled latissimus dorsi muscle flap.     

Day case emergency laparoscopic appendectomy

Background Laparoscopic appendectomy (LA) is associated with a shorter hospital stay and fewer complications than conventional open appendectomy (OA). This study aimed to examine the safety and efficacy of day case emergency LA. Methods The records of patients undergoing emergency LA under the care of two laparoscopic surgeons over a 3-year period (Februrary 2003 to February 2006) were reviewed to examine hospital length of stay (LOS), complications, histology, grade of the operating surgeon, and time required to perform the procedure. Results A total of 104 patients (median age, 25 years; range, 11–72 years; 58 men) underwent LA, with 9 and 66 patients discharged in 8 and 24 hours, respectively (median LOS 22 hours: range 6–170 hours). One patient underwent conversion to OA. Histologically, 86 patients had appendicitis and 18 had normal appendices with another pathology present. The median operative time was 35 min (range, 20–80 min). The complications included three wound infections and two pelvic abscesses not requiring further operative intervention. Conclusion Day case emergency LA is safe and effective for treating selected patients.     

Thymic cyst causing superior venacava syndrome relieved by mediastinoscopy--a rare presentation

Superior venacava obstruction is most often caused by intrathoracic malignant masses. The commonest cause of benign superior venacava obstruction is fibrosing mediastinitis. A thymic cyst causing marked superior venacava obstruction is very rare and has not been reported. We hereby present a case of a 40-year-old man with such a finding who presented with chest pain and facial congestion. Evaluation revealed a mediastinal mass causing marked superior venacaval obstruction. He underwent a mediastinoscopy, which showed a cyst. It was drained following which there was complete resolution of symptoms post-operatively. Histopathology of the lesion confirmed a thymic cyst.