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Background and objectives: Soave transanal procedure for Hirschsprung disease (HD) is most commonly performed at early age with good outcome. In our center we adopted this technique in many patients in different age groups without assisted laparoscopic abdominal approach. We herein aim to describe different technical aspects, outcome and success rate of Soave procedure among our patients. Methods: We retrospectively reviewed our series of HD patients who underwent the Soave transanal approach, for postoperative stricture, anastomotic leak, enterocolitis, and subsequent bowel functions. Patients were divided into two groups: group 1: the early neonatal group (0-1month) and group 2: the late presentation group(3-14years). Results: Among the 17 patients with HD operated in our center, 13 underwent Soave transanal resection, 1 was lost from follow up, 2 had a levelling colostomy prior to referral and 1 had ileostomy. The average length of resection was 20±10.5 cm. The mean follow-up period was 12.2 months (range 5-22 months). Seven patients were 3-14 years old. At follow-up none had fecalincontinence or constipation requiring laxatives. All patients had voluntary bowel movements. Conclusions: Our results support the fact that a single stage Soave approach without transabdominal dissection is an excellent technique for patients presenting with late HD with an excellent outcome. A multicenter prospective study with larger number of patient is essential to validate our results. [ABSTRACT FROM AUTHOR]

Pyloric atresia (PA) is uncommon. It occurs in 1:100000 live births. Neonates usually present soon after birth with copious non-bilious vomiting. The treatment is surgical and its prognosis is poor, especially, when it is associated with epidermolysis bullosa (EB). The aim of this study was to evaluate the clinical presentation, diagnosis, operative management, post-operative courses, and outcome in infant with PA, based in our cases and literature review. Charts of 10 patients who underwent surgery for PA in the department of paediatric surgery in a Teaching Hospital in Tunisia (Monastir) between 1990 and 2012 were reviewed. Data were analysed for demographic, clinical, therapeutic, and prognostic characteristics. The average of age at presentation was 2 days and there were six males and four females. The main presenting symptoms were non-bilious vomiting in 90% of cases. Abdominal X-ray showed gastric dilatation with an absence of gas in the rest of the intestinal tract in 90%, and a pneumoperitoneum in one. The surgical approach was laparotomy in all cases. Gastric perforation was observed in one patient and was completely repaired. The distribution of the anatomic variations was type A in nine cases and type B in one. Five patients underwent excision of the diaphragm and Heineke-Mikulicz pyloroplasty and gastroduodenostomy in the other five cases. Identified associated anomalies were Down’s syndrome in one and EB in 2 (20%), one family has three affected sibling. Post-operative mortality rate was 70%. No standard surgical approach can be adopted a better management of PA or the associated anomalies depends on an early diagnosis and the availability of neonatal intensive care unit. [ABSTRACT FROM AUTHOR]