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Seblewongel Aseme,1 Tihitena Negussie,2 Amezene Tadesse,2 Belachew Dejene,2 Fisseha Temesgen,2 Hana Getachew,2 Milliard Derbew,2 Woubedel Kiflu2 1Department of Surgery, Defense University College of Health Sciences, Addis Ababa, Ethiopia; 2Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, EthiopiaCorrespondence: Seblewongel Aseme, Tel +251931284157, Email Sewongel29@gmail.comBackground: Colostomy Closure is a routine procedure in pediatric surgery services. It is usually done for indications such as anorectal malformation, Hirschsprung’s disease, and trauma. It is associated with significant complications.Purpose: To assess the effect of perioperative factors on colostomy closure outcome in children.Methods: This is a prospective observational study on all children who underwent colostomy closure at Tikur Anbessa Specialized Hospital and Menelik II Referral Hospital from January 2019-February 2020, and Demographic data, nutritional status of the child, duration of mechanical bowel preparation, prophylactic antibiotic, type of anastomosis, operative details, and other perioperative factors were recorded, and patients were followed postoperatively for any complications. Data were entered and analyzed using SPSS 23, and perioperative factors were analyzed using χ2 tests for association with outcome. A p value of < 0.05 was considered statistically significant.Results: A total of 71 patients were included in the study, and forty-two (59%) were female, and the median age was 2.3 years. A total of 23 complications occurred in 13 (18.3%) patients, and surgical site infection (SSI) was the most common complication occurring in 8 (11.3%) patients. Four (5.6%) patients had anemia which required transfusion, and complete wound dehiscence and adhesive intestinal obstruction each occurred in 1 (1.4%) patient. Duration of surgery > 120 min was associated with an increased risk for postoperative need for transfusion; otherwise, there was no association between other perioperative factors and other complications.Conclusion: In this study, except for the duration of surgery, none of the other perioperative factors are associated with the complications of colostomy closure, so a guideline for optimal and uniform perioperative care of children undergoing colostomy closure should be prepared.Keywords: mechanical bowel preparation, surgical site infection, prophylactic antibiotic, colorectal surgery, duration of surgery, anemia, wound class

BACKGROUND፡ Surgical Site Infection (SSI) and wound dehiscence are two early complications of laparotomy causing significant morbidity and mortality. This study was conducted to determine the prevalence and risk factors of SSI and wound dehiscence in pediatric surgical patients.METHODS: We performed a prospective observational study of all pediatric surgical patients who underwent laparotomy at Tikur Anbessa Specialized Hospital, Ethiopia, from December 2017 to May 2018. Data collected included demographics, operative indication, nutritional status, prophylactic antibiotics administration, and duration of operation. Primary outcome was SSI; secondary outcomes were hospital stay and other postoperative complications, including wound dehiscence and mortality. Data were analyzed using SPSS, Version 23. Fisher’s exact and Chi-squared tests used to report outcomes. Multivariable logistic regression was used to identify variables associated with SSI, wound dehiscence and other outcomes.RESULTS: Of 114 patients, median age was 46 months [range: 1day-13years]; 77(67.5 %) were males. Overall SSI rate was 21.05%. Nine (7.9%) developed wound dehiscence while 3(2.6%) had abdominal contents evisceration. Overall mortality rate was 2.6%. In multivariate analysis, prophylactic antibiotics administration (AOR=13.05, (p=0.006)), duration of procedure (AOR=8.62, (p=0.012)) and wound class (AOR=16.63, (p=0.034)) were independent risk factors for SSI while SSI was an independent predictor of prolonged hospital stay, >1 week (AOR=4.7, p=.003,) and of wound dehiscence (AOR=33. 96,p=0.003). Age (p=0.004) and malnutrition (p1 hour before surgery and operative time >2 hours are independent predictors of SSI.

Workye Tigabie,1 Woubedel Kiflu,2 Fisseha Temesgen,2 Hanna Getachew,2 Tihitena Nigussie,2 Belachew Dejenie,2 Amezene Tadesse,2 Miliard Derbew2 1Department of Surgery, St. Peter Specialized Hospital, Addis Ababa, Ethiopia; 2Department of Surgery, Pediatrics Surgery Unit, Tikur Anbessa Hospital, Addis Ababa, EthiopiaCorrespondence: Workye Tigabie, Email workye62@gmail.comBackground: Inguinal hernia is one of the most frequent reasons for referral to the pediatric surgery unit. The incidence ranges from 1% to 5% in the pediatric population. Surgery for inguinal hernia is among the most commonly performed procedures, with good overall outcomes and few complications.Objective: The study aimed to evaluate the pattern and outcome of inguinal hernia surgery in children.Methodology: This retrospective 5-year cross-sectional study was conducted on all pediatric patients with inguinal hernia (age < 13 years) operated on between September 1, 2014, and August 31, 2019, in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.Results: The male to female ratio of inguinal hernia was 19:1. It was slightly more predominant on the right side and bilaterality occurred in about 10.6% of cases. The mean age at presentation was 15 months, and the average waiting time for patients to be operated on was 5 months. The overall incarceration and strangulation rates were 24% and 3.8%, respectively. Infants had a higher risk of incarceration/strangulation than other children. Among patients who underwent elective surgery, 63% (53/84) of operations were carried out as day-case surgery. The overall mortality, complication rate, and recurrence risk following surgery were 0.9%, 11.5%, and 9.6%, respectively. Bilaterality increased the occurrence of late postoperative complications.Conclusion: All inguinal hernia cases were indirect hernias operated on by standard open surgical techniques. Our study showed increased incarceration rates, recurrences, and complications after surgery. This is because of the delayed presentation of patients and delayed intervention for patients. Therefore, early and timely intervention with proper surgical techniques should always be considered.Keywords: inguinal hernia, incarceration, outcome, pattern, day-case surgery

Hiwote G Assefa,1 Hanna Getachew,2 Amezene Tadesse,2 Woubedel Kiflu,2 Fisseha Temesgen,2 Belachew Dejene,2 Tihitena Negussie Mammo2 1Department of Surgery, St Paul’s Hospital, Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, EthiopiaCorrespondence: Hiwote G Assefa; Tihitena Negussie Mammo Email hiwotesc@gmail.com; tihutin@yahoo.comBackground: Posterior urethral valve (PUV) is the most common cause of congenital lower urinary tract obstruction in boys. It is considered that early diagnosis and intervention have good outcomes in terms of renal function, though the varying extent of embryological insult requires these boys to remain in extended follow-up and care.Objective: To assess the renal outcome of patients following PUV ablation.Methods: This was a descriptive retrospective study. Data were collected from the operation logbooks of patients from 2015 to 2019 that had been admitted to the Tikur Anbessa Specialized Hospital pediatric surgery unit with a working diagnosis of PUV and had ablation done primarily or following diversion. Data were collected from January to April 2020 and analyzed using SPSS 25. P value≤ 0.05 was considered significant.Results: Seventy patients were analyzed and followed for 3 years for the development of postoperative chronic kidney disease (CKD) after PUV ablation. Postoperative CKD was found in 52.9% of patients and end-stage renal disease in 2.9%. Risk factors associated with postoperative CKD were the presence of preoperative and postoperative proteinuria, postoperative hypertension, and elevated nadir serum creatinine. Results also showed that a delay between the development of vesicostomy and ablation had a significant correlation with renal outcome. Elevated nadir serum creatinine, postoperative proteinuria, and delay between the development of vesicostomy and ablation were found to be independent risk factors of development of CKD.Conclusion: There was a high rate of CKD development in patients who had had ablation for PUV, which was comparable to other studies. Three variables were found to be independent risk factors for the progression of CKD, unlike other findings seen in low- and middle-income countries.Keywords: posterior urethral valve, primary ablation, vesicostomy, nadir serum creatinine, proteinuria, chronic kidney disease, end-stage renal disease

Background: Thrombocytopenia is one of the most common hematologic disorders affecting neonates who are admitted to the neonatal intensive care unit with a reported incidence of 18-35%. Several maternal, neonatal and perinatal factors contribute to the development of thrombocytopenia. This study is aimed to determine the incidence and associated risk factors of neonatal thrombocytopenia. Methods: An observational prospective cohort study was conducted and all neonates admitted to the neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders in the study period were included. Data was collected using a checklist and analysed by SPSS version 23. Chi square test and independent sample T- test were used to asses the association among different variables. Findings: A total of 210 neonates were included in the study out of which 56.2% were males. The incidence of thrombocytopenia in the study period was 55.8%. Among neonates with thrombocytopenia, 90.9% had a late onset thrombocytopenia and half of them were in the severe range (

Heteropagus (parasitic) twin is a type of conjoined twinning in which a partially formed defective twin is attached to an otherwise normal twin. It is an extremely rare anomaly. In this paper, we describe five cases we encountered over the past 9 years. Except one, all presented early within a few days of birth. None of them shared an organ but two had bony/visceral connections. All surgeries were successful, and we only encountered wound complications. To the best of our knowledge this is the largest compilation of original cases in a parasitic twin report. Keywords: Conjoined twin, Parasitic twin, Heteropagus twin, Ethiopia

BACKGROUND : Pediatric surgical emergency condition is a broad spectrum of surgical pathologies/disorders occurring in pediatric age group requiring proper emergency surgical care as the only option of management to salvage life, avoid/minimize disability or palliation. The objective of this study is to analyze the pattern and outcome of pediatric surgical emergencies managed at Tikur Anbesa Hospital and the factors associated with outcome. METHODS : Retrospective analysis of medical records of patients was conducted to assess the pattern, outcome and factors associated with outcome of pediatric surgical emergencies admitted and managed at Tikur Anbesa Specialized Hospital, from January 1, 2015 to December 31, 2015. Data was checked for completeness and entered into SPSS version 20 for statistical analysis. RESULTS : A total of 454 patients’ medical records were analyzed. The presentation was after 5 days of illness in 182(40%), and >3 days in 243(53.4%), while only 89(19.6%) of them come within 24 hours of the illness. The etiologies were abdominal/gastrointestinal emergencies 210(46.3%), foreign body in aero digestive system in 133(29.3%), urogenital surgical emergencies in 27(5.9%). The other causes include superficial and deep tissue abscess collections in 22(4.8%), trauma /injury related cases in 24(5.3%) and others in 38(8.4%) respectively while congenital malformations were only 57(12.6%) of the cases. Finally, 439(96.7%) were discharged cured or improved without major disabilities documented, while 9(2%) died. CONCLUSIONS : Delayed presentation, unstable condition on arrival, younger age group and the nature of underlying pathology could have contributed for the death, but this needs further study. KEYWORDS : Pediatric surgery, Emergency Surgery, Ethiopia

BACKGROUND: Hypospadias repair is one of the problematic issues in pediatric surgery. As a result of the multiple complications following the procedure, a variety of techniques have been used and newer methods continue to emerge. There is still controversy regarding the best method of repair. We aimed to determine the outcome of surgery and factors contributing to unfavorable outcomes in children with hypospadias.MATERIALS AND METHODS: This is a retrospective review undertaken from September 2009 to August 2014. The research was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. All children who underwent hypospadias repair and had regular follow-up were included in the study.RESULTS: A total of 202 boys aged less than 13 years were assessed. Most surgeries (80.3%) were performed in children older than 18 months. Transverse incised plate urethroplasty (TIP) was frequently performed for distal hypospadias (71.2 %), while transverse ventral preputal flap (TVPF) was the most common procedure done for proximal hypospadias (62.8 %). Overall success rate for first surgery was 55.9 %. There was a high rate of major post-operative complications (44.1%) of which urethrocutaneous fistula (UCF) was the most common (31.2%) followed by meatal stenosis and glans breakdown (7.4 % each). These complications were found to be higher in those who were operated at a later age and those with proximal hypospadias (p=0.03 and p=0.01 respectively). There was also a significant difference among the type of procedures with TIP and TVPF having the least complications (p

Background: Undescended testis is one of the commonest congenital malformations seen in boys. The aim of this study is to evaluate the pattern of presentation, approach to diagnosis, treatment and follow up in Tikur Anbesa Specialized Hospital, a tertiary teaching hospital in Ethiopia. Methods: This is a retrospective cross sectional study of all boys with undescended testis operated in Tikur Anbesa Specialized Hospital between September 2012 and August 2014. Results: Of 82 boys operated within the study period, 66 boys with 78 undescended testes are studied. Twenty-six percent (17/66)came before the age of 2 years, while the majority of the study group, 50% (33/66), presented beyond 5 years of age. Of the 17 boys brought to the hospital before 2 years, only 41% (7/17) them were treated before the age of two years. The majority 89% (59/66) of the boys were treated after 2 years of age. Seventy-one testes of 78 [91%] were in the inguinal canal, 5 were intra-abdominal and 2 were absent. 46% (36/78) were on the left side, 29% (23/78) on the right side and the rest were bilateral. Among the 54 boys who had ultrasound examination, the ultrasound report is consistent with operative findings in 33 [61%]. Associated congenital malformations were found in 31.8% (21/66) of the boys. Hypospadia was the predominant malformation comprising 38% (8/21) of the total congenital malformations. Orchidopexy was done for 82% (64/78) of the total testes, orchiectomy was done for 9% (7/78) and biopsy was taken in 1 case. Among the total operated boys only 62% (41/66) were followed in our clinic; of those who had follow up 10% (4/41) testes atrophied and 1 [2%] testis retracted. Conclusion: Boys with undescended testes present and are treated late in Tikur Anbesa Hospital. As opposed to the literatures most of the undescended testes were found on the left side. Ultrasound examination cannot be the only mode of examination for undescended testes as it misses more than one third of the cases. Hypospadia is the commonest associated congenital malformation. Post operative follow up is very poor after treatment for undescended testes https://dx.doi.org/10.4314/ecajs.v22i1.10 This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.