Delving into the Latest Updates on Tanta University Hospital with Synapse

Overview

BACKGROUNDMalone antegrade continence enemas (MACE) are increasingly being used to manage severe constipation and fecal incontinence in children. Despite advances in minimally invasive pediatric colorectal surgery, single-incision laparoscopic surgery (SILS) for MACE creation remains relatively unexplored. This study, featuring the largest cohort to date, evaluates the feasibility, safety, and clinical outcomes of SILS MACE creation in children.METHODSA single-institution, retrospective review of pediatric patients who underwent SILS MACE creation for severe constipation and/or fecal incontinence between March 2022 and July 2024. Patient demographics, operative data, postoperative complications, and stooling patterns were assessed. Quantitative variables were analyzed using descriptive statistical methods.RESULTSEighteen patients (10 males, 56 %) underwent SILS MACE creation at a mean age of 10 years (range 4-18) and a median BMI of 17.6 kg/m² (IQR 16.8-19.6). Preoperative diagnoses included anorectal malformation (n = 9, 50 %), functional constipation (n = 4, 22 %), neurogenic bowel (n = 3, 17 %), and Hirschsprung Disease (n = 2, 11 %). Median operative time was 51 min (IQR 38-67), Postoperative complications included channel prolapse (n = 3, 17 %) and wound infection (n = 2, 11 %). Two patients (11 %) required interventional radiology owing to Mini-ACE® button dislodgment and one patient (5 %) required operative revision for skin-level stenosis. At a median follow-up of 13 months (IQR 7-18), 16 patients (89 %) were clean for stool with successful management through antegrade flushes.CONCLUSIONSILS MACE creation is a safe, feasible, and effective minimally invasive approach for managing severe constipation and fecal incontinence in children. The technique demonstrates potential advantages in cosmetic results and comparable surgical outcomes, offering a viable alternative to the traditional multiport laparoscopic approach.TYPE OF STUDYOriginal Research Article.LEVEL OF EVIDENCEIII.

01 Mar 2025·Journal of Pediatric Surgery

Revisiting the Swenson Prolapse Maneuver: A Call to Enhance Pull-through Surgeries for Hirchsprung Disease

Letter

Author: Elhalaby, Essam ; Elhalaby, Ismael

01 Feb 2025·Journal of Pediatric Surgery

Repair of the Bulbospongiosus Muscle to Suspend the Penis to the Pubic Bones in Proximal Hypospadias

Article

Author: Gopal, M ; Ajao, A ; Hennayake, S ; Hajduk, P ; Cserni, T ; Bianchi, A ; Seleim, H M

BACKGROUNDIn proximal hypospadias, ventral curvature is invariable and most have penoscrotal transposition, and we observed that the base of the penis (BOP) was located on the inferior aspect of the pubic bones in those, in contrast to the location of the BOP at the anterior end in normal penises. We also observed an unfused bulbospongiosus muscle (BSM) at surgery in those. The aim was to assess the impact of repairing the unfused BSM or transection and straightening of the urethral plate at the first operation on the low BOP.METHODAll consecutive proximal hypospadias operations from January 2021 to August 2023 that had a low BOP were retrospectively studied. At the first operation, some had urethral plate transection only, with no BSM repair. Some had BSM repair with or without plate transection. The BOP position was reassessed post-intervention.RESULTSThirty-three cases of proximal hypospadias with low BOP were studied. At the first operation, as the key distinguishing step, 18 had BSM repair and 15 urethral plate transections. BOP shifted to the anterior end of the pubic bones in all 18 patients following BSM repair but showed no change in the 15 without BSM repair (p < 0.01). Subsequent BSM repair, during the second stage, normalized BOP in those 15. Normalising the BOP corrected penoscrotal transposition because the anterior end of the scrotum was at the anterior end of the pubic bones.CONCLUSIONRepairing BSM is essential for normalising the BOP, which results in a normal penoscrotal relationship and normal anterior penile projection.LEVEL OF EVIDENCEIV.

100 Deals associated with Tanta University Hospital

Login to view more data

100 Translational Medicine associated with Tanta University Hospital

Login to view more data