Search

Background: Dysphagia refers to feeding or swallowing disorders characterized by challenges with the placement, reception, maintenance, and transmission of food and liquids from the oral cavity to the esophagus and stomach. Purpose: To evaluate the socioeconomic and medical impact of percutaneous endoscopic gastrostomy in children suffering from neurological digestive disorders. Patients & methods: This was a follow up prospective study performed on thirty children who had neurological swallowing difficulties that was predetermined at the Outpatient Clinic of the Pediatric Gastroenterology Unit and the Inpatient of the Pediatric department, Faculty of Medicine, Al-Azhar University Hospitals, from January 2022 to January 2024. Results: Our results showed that regarding demographic data of the studied group. The patients age was 7.25±4.290 years. Male were 17while female were 13. Distribution of studied sample according to manifestations it shows that 21 had Intractable convulsions, 13 with Frequent chocking, 11patients complaining from recurrent pneumonia, regarding to complications of PEG Major Complications show that one patient had Buried bumper syndrome. Minor Complications 12(40.0%) had Local infection, 9(30.0%) had Accidental removal, 1(3.3%) had Leakage and 1(3.3%) had Fistula formation. Our study revealed, significant decrease in all medical outcomes except neurological signs, Also, there was statistically significant improvement of family social impact of PEG and it shows that 25(83.3%) had good family's satisfaction, 30(100.0%) of caregiver had no difficulties in finding a place to feed outside the home, Also there was significant positive economic impact where the majority of patients had reduce the costs of repeatedly hospitalizing. Conclusion: PEG had a positive medical improvement for children with neurological swallowing difficulties and a positive socioeconomic impact on both the child and the caregiver. [ABSTRACT FROM AUTHOR]

Background: Atypical presentation of intestinal malrotation provide a diagnostic and therapeutic dilemma for the surgeon to answer the question is it wisdom to operate or not? Upper gastrointestinal (UGI) contrast study is essential for diagnosis; however, 'soft' radiologic findings place the responsibility of excluding malrotation directly on the surgeon. Recently, minimally invasive surgical techniques would be able to accomplish the identical evaluation and treatment of this group of patients.Patients and Methods: A total of 40 patients (25 male, 15 female), age of 2-14 years, presented with symptoms of chronic abdominal pain, intermittent upper intestinal obstruction, recurrent bilious vomiting and failure to thrive. On clinical examination, none of the patients had signs of acute abdominal emergency. UGI contrast study was done and it was equivocal. All patients underwent laparoscopic evaluation.Results: A total of 36 patients (90%) were found on laparoscopy to have a discrepant finding of chronic intestinal malrotation. With narrow mesenteric base which put them at significant risk of midgut volvulus. Two patients (5%) were found to have chronic appendicitis with extensive adhesion at the right iliac fossa, one patient (2.5%) has annular pancreas and one patient has negative laparoscopic exploration. Laparoscopic findings of chronic intestinal malrotation includes, huge dilated stomach and the first part of duodenum, ectopic site of caecum central in the abdomen or under the liver, medial and low position of duodenojejunal junction, congested mesenteric veins with lymphatic oedema, generalised mesenteric lymphadenopathy, reversed relation of superior mesenteric artery and vein, right-sided small bowel.Conclusion: Laparoscopic diagnostic finding permits direct evaluation and treatment of undocumented malrotation in children, with equivocal UGI contrast study. Furthermore, laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children with a narrow base should undergo laparoscopic Ladd procedure to avoid catastrophic midgut volvulus. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair using a percutaneous internal ring suturing technique is an effective alternative technique to conventional laparoscopic hernia repair. It is one of the most commonly used approaches for laparoscopic hernia repair in children. However, most percutaneous techniques have utilized extracorporeal knotting of the suture and burying the knot subcutaneously. This approach has several drawbacks. The aim of this study is to present a modified technique for single cannula needlescopic assisted hernia repair in children., Patients and Methods: Three-hundred and fifty-seven patients with 397 indirect inguinal hernias underwent a one port needlescopic assisted inguinal hernia repair. The open internal inguinal ring [IIR] was closed using an 18-gauge epidural needle [EN], a 14-gauge venous access cannula [VAC], and a homemade suture device. Saline was injected extraperitoneally around the IIR for hydrodissection. The main outcome measurements were: feasibility, safety of the technique, operative time, recurrence rate, and cosmetic results., Results: This prospective study was conducted on 357 patients at Al-Azhar, Alexandria, and Mansoura University Hospitals during the period from June 2012 to October 2015. There were 286 males and 71 females. The mean age was 2.6±1.3years (range=4months to 6years). One-hundred and ninety-eight patients presented with a right-sided inguinal hernia, 119 patients with a left-sided hernia, and 40 patients with bilateral inguinal hernia. The mean operative time was 12.6±1.7min (range=8-15min) for unilateral cases and 18.6±1.7min (range=14-20min) for the bilateral repairs. No wound complications or umbilical hernias developed. The mean follow-up period was 18.6±1.2months (range=11-36months). During the follow-up period, no recurrence was detected, and the scars were nearly invisible., Conclusion: This preliminary study shows that a single port needlescopic assisted hernia repair in infants and children is a very promising technique to achieve nearly scarless surgery. The procedure is very safe, rapid, easy to learn, and reproducible., (Published by Elsevier Inc.)