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Two millimetere needlescopic instruments induce minimal trauma to the abdominal wall and have excellent cosmetic results. However, these instruments are fragile and expensive with short weak jaws. The aim of this study was to present a novel needlescopic approach for inguinal hernia (IH) repair in girls using 1.6-mm suture grasper device (SGD), modified polypectomy snare (MPS) and a home-made snare (HMS). We refer to this technique as needlescopic inversion and snaring of hernial sac in girls. Over a period of 1 year from March 2018 to March 2019, a prospective study was conducted on girls that presented with IH. Preoperative inguinal ultrasound was performed in all patients to measure the internal inguinal ring (IIR) diameter. All hernias were repaired by our novel technique using two SGDs, MPS or HMS. Follow-up period was at least 12 months. Fifty-three girls with 74 hernias were included in this study, with a mean age of 38 ± 8 months. IIR diameter ranged between 8 and 15 mm with a mean of 11 ± 2 mm. Mean operative time was 15 ± 3 min in bilateral and 11 ± 2 min in unilateral presentations. All procedures were completed successfully with no conversion and without major complications. Follow-up ranged from 12 to 24 (median 16.5) months. Non-visible scars were obtained in all cases and there was no reported recurrence. Needlescopic inversion and snaring of inguinal hernial sac in girls using 1.6-mm instruments, MPS or a HMS is a safe, rapid and feasible method for IH repair. It has the advantage of invisible scars and no recurrence in the short-term outcomes.

Background Neonatal gastro-intestinal perforation [NGIP] is one of the major problems in pediatric surgical practice. Although the outcomes of neonatal surgery have improved markedly over the past decade the mortality rates of neonates with NGIP are still high. The aim of this study was to present the possible etiological factors, clinical findings, and operative procedures of NIP in our locality. Results A total of 34 neonates with NGIP were included in this study. The median age at presentation was (15.8 ± 7.0 SD) days. The median interval between presentation and surgical interference was (2.0 ± 1.1 SD).Necrotizing enterocolitis [NEC] was the commonest cause of neonatal gastro-intestinal perforation. The commonest site of perforation was the colon [11cases]. The overall mortality rate was 11 cases [32.4%]. The main cause of mortality was neonatal NEC [6 cases]. Eight cases [40 %] died out of 20 cases which the interval between the presentation and interference were more than one day. Conclusions Neonatal gastro-intestinal perforations are still associated with high mortality rate in our institutions, and delayed diagnosis with increased interval between the presentation and surgical intervention are associated with increased mortality. In our locality, although NEC is the commonest cause of NGIP, the iatrogenic cause is relatively higher than reported.

Objective To report the outcomes of surgical correction of post-circumcision webbed penis using two previously described techniques: the Heineke-Mikulicz (HM) scrotoplasty and the multiple Z-plasty. Patients and methods A prospective study of children with post-circumcision webbed penis was conducted. The patients were classified into two groups according to the degree of web and the remaining ventral penile skin as to whether adequate or short after circumcision. Group I was repaired by HM scrotoplasty and in Group II the multiple Z-plasty technique was used. Results This study included 86 patients of whom 71 maintained follow-up; 44 (62%) in Group I and 27 (38%) in Group II. The median (range) operative time was 45 (30–55) min in Group I and 75 (60–90) min in Group II. Wound infection occurred in two (4.5%) patients in Group I. In Group II postoperative mild self-limited penile oedema was present in three patients (11.1%). A self-limited scrotal haematoma developed in two (7.4%) patients. Conclusion Correction of post-circumcision webbed penis in children can be done by one of two techniques: HM scrotoplasty in Grade 1 and multiple Z-plasty in Grade 2 and Grade 3, with favourable outcomes. Abbreviations HM: Heineke-Mikulicz; IQR: interquartile range

Background: In mitral valve prolapse is associated with severe mitral regurgitation, mitral valve repairor surgical replacement may be necessary. In Mitral valve replacement, some surgeon use continuoussuture, others use interrupted suture technique.Aim of the work: to compare efficacy of semi-continuous technique & interrupted suture of prosthesticvalve replacement in mitral valve replacement.Patients and Methods: it was a prospective randomized comparative study done at the CardiothoracicSurgery Department, Qena University Hospitals, South Valley University, Egypt between April 2016 toApril 2018. It included 31 patients with rheumatic mitral valve disease whatever the cause. They weredivided into group1: patients underwent semi-continuous technique for MVR (18 cases) and group2:patients underwent interrupted technique (13 cases).All of patients were subjected to preoperative data:complete history, general examination including general condition of the patient and vital signs,investigations including routine laboratory investigations, especially complete blood count, chest X ray(CXR), 12 lead Electrocardiography (ECG), echocardiography and coronary angiography if patientmore than 40 years old, operative data including total bypass time, aortic CCT, number of sutures, andpostoperative outcome including ICU stage and inotrope use, postoperative complications, pulmonaryhypertension and echo findings as immediate postoperative and echo after 1 and 3 monthspostoperative.Results: We found that the mean total bypass time was significantly higher among interrupted group compared to semicontinuous one.Conclusion: Semicontinuous sutures showed significantly better results than interrupted ones,especially regarding the total bypass time

Background: congenital inguinal hernia is considered to be among the commonest paediatric surgical procedures in daily practice. Open herniotomy with high ligation is of the hernial sac is the gold standard treatment against which all modalities of laparoscopic repair should be compared. With the advances of minimally invasive laparoscopic techniques, less complications and better cosmesis has become the point of study. Objective: was to review the current literature about laparoscopic and needlescopic techniques and highlighting its surgical outcomes. Data source: English midline search using the keywords inguinal hernia, paediatric age, laparoscopy, minimally invasive surgery, needlescopic repair in PubMed, Google scholar, research gate and science direct during the period 1997- 2020. Study selection: article of high quality, randomised controlled trial are only included Data extraction: data were collected, organised according the type of study and extracted systematicallyfrom these studies Data analysis: performed with the IBM SPSS 20.0 software. Conclusion: Laparoscopy has become a good substitution for the open method in the last years due to its advantages and by time minimally invasive manoeuvres became a good substitution for the conventional type of laparoscopic repair as they are easier for the laparoscopic beginners, carry less learning curve, almost have the same results, recurrence rate and have better cosmoses.

Background There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. Purpose The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children. Patients and methods Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy. Results A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58±1.26 (range=2 to 8 y) and mean internal inguinal ring diameter was 13.65±3.85 mm (range=8 to 20 mm). The mean operative time was 23.36±4.67 minutes for bilateral and 14.28±2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6±3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively. Conclusions Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with purse-string suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.

Summary Background Webbed penis is a cause of concealed penis. It reflects abnormal attachment of the scrotal skin to different ventral penile shaft levels, possibly due to abnormal scrotal dartos insertion. Different techniques are available for correction of congenital webbed penis. However, there is no single one versatile for correction of different grades. Objective To evaluate the surgical outcome of penile degloving, excision of abnormal dartos fascia with penoscrotal fixation sutures to correct different grades of congenital webbed penis. Study design This prospective study was conducted on boys with congenital webbed penis. Thorough clinical examination to determine the degree of webbed penis and associated anomalies were done. A technical modification of previously described technique by Frenkl et al. 2004 (22) was used. The principles include; complete penile degloving with excision of all abnormal scrotal dartos attached to the penile shaft, creation of a well-defined penoscrotal angle by penoscrotal fixation sutures and the short ventral skin was compensated from the prepuce with circumcision. Assessments of surgical outcomes and parents' satisfaction were done during follow up visits. Results This study included 107 boys. The median age was 9 (range, 6–40) months, and the median operative time was 55 (range, 50–65) min. Five patients (4.7%) developed self-limited postoperative penile edema, two (1.9%) developed wound infections, and two (1.9%) had a self-limited scrotal hematoma. The median follow-up period was 19 months. At the 6 months follow-up, we had two patients with persistent mild grade I webs, with a success rate of 98.13%. Parental satisfaction was obtained for all patients. Discussion Currently, there is no current single technique suitable for the correction of all grades of webbed penis. In this study, we presented a technical modification of previously described technique by Frenkl et al. 2004 (9), this modified technique is versatile for correction of different grades of congenital webbed penis without leaving a scar at the penoscrotal angle. But, absence of a comparative group is considered a limitation; however, the versatility of this technique overcomes this limitation. Conclusions This described technique is simple and feasible. It could correct all types of congenital webbed penis. Short term outcome showed good cosmetic and functional results with parental satisfaction. Download : Download high-res image (2MB) Download : Download full-size image Summary Figure. . The principles of the technique.

Background/aim In spite of advances in knowledge and techniques in the management of anorectal malformation (ARM), delayed presentation of female ARM with vestibular and perineal fistulae is quite common especially in developing countries. In this literature, there is no standardized surgical algorithm for late presentation of these female ARM. This study aimed to present the experience of two pediatric surgery tertiary centers regarding delayed presentation of vestibular and perineal fistulae using two-stage procedures. Patients and methods This prospective study was conducted on 28 female patients with late presentation of vestibular and perineal fistulae from November 2014 to April 2019. Lower contrast study was done for all patients. Laxative, frequent rectal wash enemas, and Hegar’s dilators were used for 2–3 weeks preoperatively. All patients were repaired by anterior sagittal anorectoplasty (ASARP) with covering high sigmoid loop colostomy, and colostomy closure was performed after 2–3 months. Krickenbeck continence score was used for assessment of anal continence. Results Of 28 patients included, 25 patients completed the study. There were 14 patients with perineal and 11 with vestibular fistulae. The age of patients ranged from 8 months to 18 years. The main reasons for delay were socioeconomic, unawareness, and overlapping causes. Sphincter-saving ASARP was used in 15 patients and the classic ASARP was used in 10 patients. Tapering proctoplasty was needed in one patient. Minor wound infection developed in three patients. Constipation occurred in 11 (44%) patients. Follow-up period ranged from 6 to 50 months (median 30 months). Good continence was obtained. Conclusion Although delayed presentation of vestibular and perineal fistulae in female patients is accompanied by comorbidities, with good surgical management, successful results can be obtained by using two-stage procedure.

Background/aim Vestibular and perineal fistulae are the most common anorectal malformations in female infants. The progress in surgical correction has been aimed at achievement of both good continence and cosmetic outcome. This study aimed to present two-center experiences in one-stage sphincter-saving modification of anterior sagittal anorectoplasty for vestibular and perineal fistulae in female infants. Patients and methods This prospective study was conducted on 38 patients. They were divided into vestibular and perineal groups. The position of anus was marked by Pena stimulator, and traction suture were placed around the fistula. With longitudinal midline perineal incision, separation of the rectum from posterior vaginal wall. The center of anal sphincter muscle complex was identified and the rectum was passed through it, finally anoplasty with reconstruction of perineal body. Continence was evaluated by Krickenbeck and Holschneider scores in patients older than 3 years. Results The mean age was 60.26 days. The mean operative time was 109.61 min. The rectum was passed through the intact sphincter in all cases. A total of three (7.89%) cases developed superficial wound dehiscence that was treated conservatively, one (2.63%) case needed colostomy and anal dilatation was done for 3 months, one (2.6%) case developed anal stenosis corrected by anoplasty, and five (13.15%) cases developed minor mucosal prolapse, with spontaneous improvement. Constipation occurred in six (15.78%) patients and was controlled by diet modification and laxatives. Good continence was obtained. Conclusion One-stage sphincter-saving anterior sagittal anorectoplasty is safe and feasible technique in vestibular and perineal fistulae in female infants. The short-term outcome show good cosmetic and functional results regarding continence.

Introduction Several techniques have been reported for mid-penile hypospadias repair, including Snodgrass tubularized incised plate (TIP) and onlay island flap (OIF) procedures, which are two popular procedures. Aim of the work To compare the outcomes and complication rates for both TIP and OIF techniques. Patients and methods A prospective randomized study was conducted on 140 boys (age range, 1–6 years) with primary mid-penile hypospadias who underwent repair from June 2011 to December 2016 at our university hospitals. The patients were prospectively randomly divided into two equal groups: group A (n=70), underwent Snodgrass TIP urethroplasty, and group B (n=70), underwent OIF. Inclusion criteria only males with fresh mid penile hypospadias without ventral chordee from 1 to 6years old. Exclusion criteria were recurrent cases, presence of ventral chordee, parental refusal or children more than 6years of age. Outcomes were assessed in terms of success rates, operative time complication rates, and cosmetic appearance during follow-up. All children were subjected to full history taking, thorough clinical examination, and routine laboratory investigations (CBC, BT, CT, FBS, urinalysis, liver and renal profile), results were compiled and compared statistically. Results There were statistically significant differences between the two techniques regarding success rate, operative time incidence of complications and cosmetic results. Conclusion Both techniques are reliable and feasible for treatment of mid-penile hypospadias, but there was a statistically significant difference regarding operative time, complications, and cosmetic outcome with TIP procedure. So, the authors preferred it if suitable urethral plate is present.