Search

Background: Kasai portoenterostomy (KPE) is the standard surgical management for biliary atresia (BA). To improve the outcome these infants were operated on within the first two months of life. The success of the procedure is reflected by clearance of jaundice and either absence or occurrence of fewer attacks of cholangitis. The failure of the procedure indicates liver transplantation (LT)., Objective: to reduce the incidence of the recurrent attacks of cholangitis by peri-KPE sutures anchoring the jejunal loop to the Glisson capsule., Methods: It is a retrospective study that included 45 infants diagnosed with BA and who were operated on at an age younger than 60 days. They were categorized into two groups, Group A (n = 23) included infants treated with the classic KPE, and Group B (n = 22) included infants treated in the same way plus peri KPE sutures anchoring the jejunal loop to the Glisson capsule., Results: The mean operative time in Group A was 149.3 min versus 164.8 min in Group B (p-value 0.039). The mean level of bilirubin was 2.2 versus 2.1 in Group A and Group B respectively at two years follow up. The total attacks of cholangitis per patient were significantly lower in Group B than in Group A (cutoff value = 3), which was reflected by the significant reduction of the incidence of LT in Group B., Conclusion: peri KPE sutures anchoring the jejunal loop to the Glisson capsule significantly reduced the incidence of recurrent attacks of cholangitis and subsequently decreased the requirement of LT on the short-term follow-up., Competing Interests: Declaration of competing interest All the Authors declare that they have no conflict of interest., (Copyright © 2022 Asian Surgical Association and Taiwan Robotic Surgery Association. Published by Elsevier B.V. All rights reserved.)

Objective: Although many techniques have been described for reconstruction of the protruding umbilicus in children with umbilical hernia, we present a simple new technique for umbilicoplasty., Methods: Ten children (six males and four females) with umbilical hernias and protruding skin were operated upon. Operative description consists of amputation of the protruding umbilical skin, leaving two unequal half-cones, a short cephalic half-cone (0.5 cm) and a long caudal half-cone (1 cm). These two half-cones are fashioned, closed, and inverted to constitute the new umbilicus following a classic hernia repair., Results: The early results were excellent in all cases with no infection and no ischaemic changes encountered in the skin of the reconstructed umbilicus. Follow-up periods between 6 and 18 months revealed a cosmetically pleasing shape of the umbilicus. Only one case developed hypertrophy of the resulting scar., Conclusion: We present our initial experience with the new technique. This new technique provides a good solution for reconstruction of the protruding umbilical skin. Our double half-cone flap umbilicoplasty technique is easy to learn and to perform.

To solve the problem of limited abdominal cavity in cases of giant inguino-scrotal hernias, a new technique is described, aiming, while repairing the hernia, to provide a larger abdominal cavity into which the hernial contents can be replaced without compromising respiratory and cardiac functions. The idea of this technique is to create a midline abdominal wall defect to increase the intra-abdominal capacity to accommodate the hernial contents. The hernial sac is then pulled up to the abdomen and fashioned as a rotation flap to augment and close the peritoneum over the replaced contents. Lastly, a giant Polypropylene mesh is inserted in the preperitoneal space to cover the created midline defect and to buttress both inguinal regions. Eight patients with giant inguinoscrotal hernias were operated upon using this technique. The results showed that the procedure is safe and all postoperative complications (three seromas, two wound infections, and two cases of severe scrotal edema) were treated conservatively. All patients were discharged home within 7-15 days and no recurrences have been reported in a follow-up period of between 2 and 4 years. In addition to repairing hernial defects, this new technique allows reduction of massive hernias without compromising respiratory and cardiac functions by enlarging the shrunken peritoneal cavity before returning the hernia's contents. Moreover, in covering the abdominal defect which has been created by the hernial sac, direct contact between the intestine and the mesh is prevented, thus minimizing the risk of adhesions and fistulas.