Ahmed Elrouby - Academia.edu (original) (raw)

Papers by Ahmed Elrouby

Research paper thumbnail of Two levels vs. one level of phallopexy in the treatment of concealed penis in patients in pediatric age group

Frontiers in Pediatrics

IntroductionConcealed penis, which is the congenital type of buried penis, is a condition in whic... more IntroductionConcealed penis, which is the congenital type of buried penis, is a condition in which a normal-sized penis is totally or partially hidden by pubic, scrotal, or thigh skin. Several procedures had been described for its correction including phallopexy, that is, fixation of penile Buck's fascia to the sub-dermis.Aim of the workOur work aims to study the difference in outcome between performing phallopexy at one level and at two levels.Material and methodsOur study included 180 uncircumcised patients who had a concealed penis while having an average length of an outstretched penis. These patients were divided into two groups: the first one was treated with one level of phallopexy at the 3 and 9 o'clock points, while the second group was treated with the same procedure in addition to another level of stitches at the mid-penile level. The follow-up was carried out for one post-operative year regarding penile skin edema, infection, congestion, necrosis, and/or re-retra...

Research paper thumbnail of Laparoscopic-assisted pyloromyotomy for cases of hypertrophic pyloric stenosis, a safer new technique

Purpose The main difficulty of laparoscopic pyloromyotomy (LP) is the method of spreading and dee... more Purpose The main difficulty of laparoscopic pyloromyotomy (LP) is the method of spreading and deepening the incised pyloric mass. The aim of the work was the presentation of the surgical outcome of a new procedure of laparoscopic-assisted pyloromyotomy using a fine curved artery forceps for muscle spreading. Methods Our prospective study included 24 pediatric patients with IHPS. Under general anesthesia, the patient was positioned transversely on the operating table and the working instruments were inserted directly without ports through the umbilicus, right hypochondrium, and the epigastrium. The mass was grasped by the right instrument holding the duodenum and the pyloromyotomy knife was inserted through the epigastric incision and incised the pyloric mass transversely. The knife was then removed and a fine curved artery forceps was inserted to complete the pyloromyotomy. Results The age of the studied patients was 20–50 days (36.48 ± 8.98 days) and their body weight was 2500–3200...

Research paper thumbnail of Intussusception in preterm neonates: A systematic review of a rare condition

BMC Pediatrics, 2021

BackgroundWhile necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admi... more BackgroundWhile necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly uncommon and often overlooked. This is due to the fact that they share many clinical characteristics. The initial misdiagnosis of intussusception in preterm neonates (IPN) especially has led to a delay in their management, which increases the risk of developing compromised bowel. Additionally, it is difficult to reach a diagnosis as neonatal intussusception does not have any classical radiological signs even when contrast enema is used. This systematic review is based on the published literature including case reports and case series to review the clinical features of IPN and how to differentiate it from NEC in order to shed the light on this rare disease and how having a high index of suspicion would help practitioners to make an early and accurate diagnosisMethodsA systematic literature search to report all cas...

Research paper thumbnail of Single-shot thoracic epidural analgesia for neonates undergoing thoracotomy

Egyptian Journal of Anaesthesia, 2020

Background and Aims: Post-thoracotomy pain in neonates have negative physiological consequences i... more Background and Aims: Post-thoracotomy pain in neonates have negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ function. Methods: A randomized, single center, prospective, controlled study was conducted in El-Shatby university hospital, from august 2017 to September 2019 were 40 neonates, weighing 2.5–4 kg belonging to the ASA physical Grade II to IV, posted for a trachea-oesophagal fistula (TOF) repair via thoracotomy. After general anesthesia, in Group A, intra-operatively received fentanyl 2 µg/kg and paracetamol (10 mg/kg/6 h) intravenously and Group B (thoracic epidural single injection with 0.5 ml/kg of 0.25% of the L-Bupivacaine and 2 µg/kg of fentanyl), postoperatively paracetamol (10 mg/kg/6 h) intravenous (IV) or pain score >4. The primary objective was to compare the effect of the single-shot epidural blockade to intravenous fentanyl on post-thoracotomy pain con...

Research paper thumbnail of Giant mesenteric lipoblastoma; a rare presentation of childhood abdominal mass

Journal of Pediatric Surgery Case Reports, 2022

Research paper thumbnail of Flexible airway endoscopy in esophageal atresia patients undergoing colon interposition

Egyptian Journal of Anaesthesia, 2021

Background: Colon interposition is used for delayed surgical repair of esophageal atresia, but co... more Background: Colon interposition is used for delayed surgical repair of esophageal atresia, but congenital esophageal atresia with or without tracheoesophageal fistula (CEA ± TEF) is associated with long-term respiratory morbidity. This study aimed to examine the prevalence of upper airway anomalies, and detect the implications of the preoperative flexible airway endoscopy (FAE) on the decision of performing tracheopexy whether aortopexy or more recently, posterior tracheopexy in cases of severe tracheomalacia. A randomized, prospective, controlled study was conducted in a tertiary care pediatric surgery center from September 2016 to October 2020 where thirty child of either sex, aged 2–8 years, scheduled for a colon interposition repair for esophageal atresia. After induction of general anesthesia dynamic airway endoscopic examination with ultra-thin fibroptic bronchoscopy was performed Results: Dynamic study of pediatric upper airway showed that only one case out of 30 child enrolled in the present study had grade II subglottic stenosis in the proximal trachea (3.34%), while five cases (16.67%) had tracheomalacia with different degrees and only one severe case required aortopexy Conclusion: Dynamic airway endoscopic examination can predict airway anomalies associated with esophageal atresia and enhance post colon interposition respiratory outcomes. ARTICLE HISTORY Received 15 April 2021 Revised 3 May 2021 Accepted 7 May 2021

Research paper thumbnail of Management of pediatric benign ovarian tumors in England and Egypt: A comparative study

African Journal of Paediatric Surgery, 2020

Aim of the Study: We aimed to compare the management of pediatric benign ovarian tumors between a... more Aim of the Study: We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions. Materials and Methods: This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both sides. Results: Eighty-nine patients were included (54 English and 35 Egyptians). Median age at diagnosis in England was 13 years (2-16y), while in Egypt it was 7 years (9m-16y) with P =0.001. Mature teratomas or dermoid cysts were the most common findings in England and Egypt; 75.9% and 82.8% of cases, respectively. The presentation with an acute abdomen represented 27.8% of English and 28.6% of Egyptian patients. Incidentally diagnosed lesions constituted 15% of English patients, whereas none of the Egyptian cases were discovered incidentally. There were variations in diagnostic imaging; England: Ultrasound (USS) (54), magnetic resonance imaging (MRI) (37), and computed tomography (CT) (only one)–Egypt: USS (35), CT (17), and MRI (only one). Minimally invasive surgery (MIS) was performed in 15% of English and 23% of Egyptian patients (P = 0.334). Ovarian-sparing surgery (OSS) was performed in: England 35%, Egypt 37%; P = 0.851. OSS was performed using MIS in 87.5% (7/8) of English patients and 100% (8/8) of Egyptians. Patients presented as emergencies generally had open oophorectomies: England; 86.7% open and 80% oophorectomy–Egypt; 100% open and 90% oophorectomy. Recurrences or metachronous disease occurred in 5.6% of English and 5.7% of Egyptian patients. Conclusions: There were no significant differences regarding surgical management, tumor pathology, and recurrence or metachronous disease. However, age, incidental diagnosis, and imaging modalities showed notable differences. MIS was correlated with ovarian preservation, whereas emergency surgery generally resulted in open oophorectomy.

Research paper thumbnail of Acute intrathoracic gastric volvulus: A rare delayed presentation of congenital diaphragmatic hernia: A case report

International Journal of Surgery Case Reports, 2020

INTRODUCTION: Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial ... more INTRODUCTION: Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial rotation in the chest due presence of a diaphragmatic defect. Gastric volvulus associated with congenital diaphragmatic hernia is extremely rare and can be explained as 2 of the 4 ligaments supporting the stomach (gastrophrenic and gastrosplenic) which are connected to the left diaphragm may become elongated or absent. According to the current literature, only 27 pediatric cases have been reported so far. PRESENTATION OF CASE: We describe an 8 years old boy who presented to our emergency department with acute epigastric pain and vomiting. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left hemithorax. A computed tomography scan demonstrated a sizable left diaphragmatic defect admitting stomach, small bowel loops and transverse colon with organoaxial gastric volvulus. Emergent laparotomy was done for reduction of the viscera to the abdominal cavity and repair of the diaphragmatic defect. The patient showed an uneventful recovery without experience any pain or difficulty with eating. DISCUSSION: Acute gastric volvulus is a rare pathology defined as an abnormal rotation of the stomach for more than 180 • leading to a closed-loop obstruction which may progress to ischemia and strangulation. A plain standing abdominal X-ray and an upper gastrointestinal contrast study are useful for diagnosis, but some authors recommend performing CT or MRI to confirm the diagnosis. The standard treatment for volvulus is open laparotomy with detorsion and anterior gastropexy. CONCLUSION: The presented case highlights congenital diaphragmatic hernia associated with gastric volvulus is a serious condition with very high morbidity and mortality. It should be considered in the differential diagnosis of children with epigastric pain and uncontrolled non bilious vomiting. An upper gastrointestinal contrast study is useful for early diagnosis and surgical treatment should not be delayed awaiting further complementary imaging tests.

Research paper thumbnail of Fatal Course of a Male Newborn with Double Duodenal Atresia

European Journal of Pediatric Surgery Reports, 2020

Multiple point duodenal atresia is an extremely rare condition with atretic segments in either tw... more Multiple point duodenal atresia is an extremely rare condition with atretic segments in either two or three sites of the duodenum. We report a newborn male patient who presented to our institution with bilious vomiting, nonpassage of meconium, mild abdominal distension, and a palpable epigastric abdominal mass ∼1 × 1 cm. A faint double bubble was found on abdominal X-ray. On exploratory laparotomy, a duodenal cyst due to double duodenal atresia was found and a typical diamond-shaped duodeno-duodenostomy was created. A postoperative contrast study revealed passage of the contrast media into distal intestine. However, the patient died 2 weeks later due to uncontrolled sepsis and pneumonia. Despite the fact that multiple-point duodenal atresia is a rare condition, it should be considered as a differential diagnosis to avoid missed pathology.

Research paper thumbnail of One Stage Pull-Through Procedure for Hirschsprung’s Disease: Trans-Anal or Trans-Abdominal? A Comparative Study

Acta Scientific Paediatrics, 2019

The aim of our work was to compare between one stage trans-anal endorectal Soave pull-through pro... more The aim of our work was to compare between one stage trans-anal endorectal Soave pull-through procedure and one stage trans-abdominal Soave endorectal pull-through in the treatment of Hirschsprung's disease in infants. Methods: Our retrospective study included 248 patients of Hirschsprung's disease. Group A include 166 patients treated by one stage trans-anal pull through and Group B include 82 patients treated by one stage trans-abdominal pull through. Results: The operative time, intraoperative bleeding, length of the resected segment, time to passage of stool, start of oral feeding and hospital stay were the only statistically significant variables. Most of the postoperative complications didn't differ significantly between the two approaches except wound infection and adhesive intestinal obstruction which develops only in group (B). Conclusion: Trans-anal approach is superior to the trans-abdominal approach due to its simplicity, cost effectiveness and less surgical morbidity. The operative technique can be easily educated and it's suitable for classical uncomplicated rectosigmoid aganglionosis, in patients with aganglionosis which doesn't exceed the splenic flexure or even in those having marked dilated colon because of its high effectiveness and promising results.

Research paper thumbnail of Anterior Sagittal Anorectoplasty as a Technique for the Repair of Female Anorectal Malformations: a Twenty Two-Years-Single-Center Experience

Journal of Pediatric Surgery, 2019

Background: Anorectal malformations (ARMs) are major congenital malformations occurring in female... more Background: Anorectal malformations (ARMs) are major congenital malformations occurring in female children in approximately 1 out of every 4000-5000 births. Posterior sagittal anorectoplasty (PSARP) was introduced for their treatment in early 1980s by Pena and Devries. However, anterior sagittal anorectoplasty (ASARP) was first introduced by Okada as a modification of the previous technique. Purpose: The aim of this study was to report our experience and the long-term follow-up results of 594 female patients with anorectal malformations treated by anterior sagittal anorectoplasty (ASARP) in a single center over 22 years. We chose this approach as the incision is smaller, with minimal cutting of the external sphincter and easier dissection of the vagina and rectum. The type of our study was retrospective study. Results: The study included 594 patients; 342 of them were less than 1 year old. About 526 patients had rectovestibular fistula, anterior perineal anus in 55 patients, anocutaneous fistula in 6 patients and rectovaginal fistula in 7 patients. All of these patients had been subjected to ASARP technique which had been done in one stage without proceeding colostomy in about 470 cases and in staged fashion with a protective colostomy in 124 patients. Postoperative follow up revealed that four patients (0.7%) developed anal retraction, 30 patients (5%) developed anal stricture, 20 patients (3.4%) had rectal prolapse and 40 patients (6.7%) developed anterior anal migration. Constipation was observed in 161 patients (27%) by the end of 1st postoperative year reduced to 41 patients (7%) after one year. 474 patients were assessed for continence by Kelly's continence score and 453 patients showed good result, 16 patients showed fair result and about 5 patients had poor continence outcome. Conclusion: Anterior sagittal anorectoplasty is a procedure with optimal functional outcome especially at if done at an early age in one stage without preliminary colostomy.

Research paper thumbnail of Prognostic factors for the outcome of Kasai portoenterostomy for infants with biliary atresia in Egypt

Alexandria Journal of Pediatrics, 2018

Background Biliary atresia (BA) is the most common surgically correctable liver disorder in the p... more Background Biliary atresia (BA) is the most common surgically correctable liver disorder in the pediatric age group. If untreated, progressive liver cirrhosis leads to death by the age of 2 years. Aim The aim was to study the outcome of Kasai portoenterostomy for infants with BA in Egypt and identify some prognostic factors of this outcome. Patients and methods A prospective clinical and laboratory study including 20 patients with BA who underwent Kasai operation was conducted. A detailed history taking, clinical examination, liver function tests, ultrasound of the abdomen, preoperative liver biopsy, and intraoperative cholangiography were done for all patients. Patients were followed up for a period of 6 months postoperatively. The schedule and indications for liver transplantation were also evaluated. Results Overall, 55% of operated infants showed gradual reduction of serum bilirubin, which reached a level less than 2 mg/dl, as well as reduction of liver enzymes. On the contrary, the remaining 45% of infants failed to show satisfactory reduction of serum bilirubin, which continued to be greater than 2 mg/dl as well as liver enzymes. Both groups showed statistically significant differences regarding age at operation, presence of preoperative ascites, liver size, and patients’ Child–Pugh score. Moreover, preoperative total serum bilirubin and its direct fraction, liver enzymes, and cholestatic enzymes were significantly higher among infants with a bad outcome. There were no mortalities within the 6-month follow-up period. Conclusion Kasai portoenterostomy showed better results with short-term follow-up if done at an early age. Certain preoperative clinical, laboratory, radiological, and pathological factors might predict the outcome of Kasai operation.

Research paper thumbnail of Evaluation of the functional outcome of the neonatal one stage posterior sagittal anorectoplasty (PSARP) as a procedure to treat cases of high anorectal malformation in male neonates

Archives of Clinical and Experimental Surgery (ACES), 2019

Background: Male anorectal malformations have many varieties, from simple types that can be easil... more Background: Male anorectal malformations have many varieties, from simple types that can be easily repaired in one stage to more complex cases that need more sophisticated repairs in a staged approach. The staged approach has higher morbidity than the one-stage approach and includes colostomy complications, risk of repeated anesthesia and surgery, high costs and psychological and psychological burden on parents. Based on these disadvantages of the staged posterior sagittal anorectoplasty (PSARP) for high anorectal malformations, one-stage neonatal PSARP has been developed. The aim of our work is to evaluate the functional and clinical outcome of the one-stage approach in the treatment of selected cases of male neonates with high anorectal malformations Material and methods: This is a retrospective study which included male patients who had neonatal one-stage PSARP for their high anorectal anomalies between 2006 and 2013. Inclusion criteria included patients with flat or mildly distended abdomen; those in whom the cross-table film of the abdomen showed the rectal pouch reaching down to the fifth sacral segment and patients passing meconium from the urethra. However, cases with complete sacral agenesis, major cord anomalies, and a markedly distended abdomen—possibly due to a megarectum—were excluded from the selection. Patients were evaluated for their functional and clinical outcome at the time of the follow-up in January 2018. Patients with poor outcomes were further evaluated by MRI and examination under anesthesia. Results: Our retrospective study included 24 patients with an age range between 5 and 11 years at the time of follow up in January 2018. 16 patients had a recto-bulbar fistula, six patients had a recto-prostatic fistula, and only two patients had recto-bladder neck fistula. According to the continence outcome, 15 patients had a good outcome, all of which had a recto-bulbar fistula. Six patients had a fair outcome; 5 of them had a recto-prostatic fistula, and only one patient had a rectobulbar fistula. The remaining three patients who had poor outcome included all patients with recto-bladder neck fistula (2 patients) and one patient with recto-prostatic fistula; this was statistically significant (P

Research paper thumbnail of Megacystis-Microcolon-intestinal hypoperistalsis syndrome

Journal of Pediatric Surgery Case Reports, 2018

Abstract Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare congenital a... more Abstract Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare congenital anomaly that presents with severe form of functional obstruction of the gastrointestinal tract which is usually fatal. Here, we report a full term female infant with MMIHS presented with feeding intolerance, huge abdominal distension, bile-stained vomiting, absent bowel sounds and a large abdominal cystic mass. Exploration revealed hugely distended urinary bladder, micro colon, short bowel and malrotation of the small intestine. Ladd's procedure, ileostomy and vesicostomy were performed.

Research paper thumbnail of Pediatric inguinal hernias, are they all the same? A proposed pediatric hernia classification and tailored treatment

Hernia : the journal of hernias and abdominal wall surgery, Jan 28, 2018

To propose a new clinical classification for pediatric inguinal hernias modified from a similar c... more To propose a new clinical classification for pediatric inguinal hernias modified from a similar classification system for adult inguinal hernia and to propose a tailored repair for each type. The impact of this approach on hernia recurrence will be assessed. This prospective and retrospective cross-sectional study was conducted in two tertiary teaching university hospitals in Egypt (Alexandria and Tanta University Children's Hospitals) from January 2013 to December 2014 on children below 12 years of age with indirect inguinal hernias who were divided into two groups: (a) prospective group I, classified according to our proposed pediatric hernia classification and tailored treatment (PHCTT) into types: pediatric Nyhus 1 (PNI) assigned for herniotomy alone, pediatric Nyhus II (PNII) assigned for herniotomy plus deep ring narrowing, and type pediatric Nyhus III (PNIII) assigned for herniotomy plus posterior wall repair. (b) Retrospective unclassified group II where all cases were a...

Research paper thumbnail of Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique)

Journal of Pediatric Surgery, 2016

Background and objectives: Laparoscopic orchiopexy for intra-abdominal testis is a wellknown and ... more Background and objectives: Laparoscopic orchiopexy for intra-abdominal testis is a wellknown and commonly practiced technique. The traction technique is based on elongation of the testicular vessels without cutting them, in contrast with the two-stage Fowler-Stephens technique in which the testicular vessels are divided. The current study evaluated the feasibility of the traction technique according to the type of intra-abdominal testis. Patients and methods: The study included 20 boys with 22 intra-abdominal testes and who underwent staged laparoscopic traction orchiopexy between October 2013 and October 2015. Eighteen testes were proximal to the internal ring by <2 cm (type III), while the remaining four were high and away from the internal ring by >2 cm (type IVa). The patients' ages ranged between 6 months and 5 years (mean 2.2 years; median 2 years). Patients were followed up for 1 year for testicular atrophy and satisfactory scrotal site relocation. Results: This study did not detect any cases of testicular atrophy among the participants (0/22), while failure to achieve satisfactory scrotal site was found in two out of the four cases with type IVa intra-abdominal testes. Discussion: Traction techniques for elongating the testicular vessels were employed years ago, but this was revisited by Shehata in 2008. It has the advantage of preserving the main testicular blood supply, which can be reflected by the decreasing rate of testicular atrophy when compared with the Fowler-Stephens orchiopexy. The results of the traction technique may be less satisfactory regarding the testicular location for higher types of intra-abdominal testes (type IVa).

Research paper thumbnail of Paravertebral versus single shot epidural blockade for neonates undergoing thoracotomy

Egyptian Journal of Anaesthesia, 2020

Background and Aims: Postthoracotomy pain in neonates has negative physiological consequences inc... more Background and Aims: Postthoracotomy pain in neonates has negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ function. This study aimed to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control. Methods: A prospective study was conducted in El Shatby University Hospital, from April 2018 to March 2020 where forty neonates scheduled for a trachea-esophageal fistula (TOF) repair via thoracotomy were randomized to Group A (thoracic epidural single injection with 0.5 ml/ kg of 0.25% of L-Bupivacaine and 2 µg/kg of fentanyl) or Group B (Paravertebral blockade will be done by probe transverse-Needle In-Plane approach with 0.25% L-Bupivacaine, 0.5 ml/kg and 2 µg/kg of fentanyl). The primary objective was to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control, the length of stay (LOS), supplemental analgesic requirements, and the incidence of adverse respiratory events were also measured. Results: Forty neonates completed the study. Group A remained hemodynamically stable in the intraoperative period with good quality of analgesia for 8 hours postoperative with a lesser doses of rescue opioids required to maintain adequate analgesia, while in group B, paravertebral analgesic effects continued for about 4 hours postoperative with multiple dosage of rescue opioids (fentanyl) was required to maintain adequate analgesia which increased length of hospital stay Conclusion: Very efficient postoperative analgesia can be achieved via single shot epidural blockade compared to paravertebral blockade in neonatal postthoracotomy pain.

Research paper thumbnail of Two levels vs. one level of phallopexy in the treatment of concealed penis in patients in pediatric age group

Frontiers in Pediatrics

IntroductionConcealed penis, which is the congenital type of buried penis, is a condition in whic... more IntroductionConcealed penis, which is the congenital type of buried penis, is a condition in which a normal-sized penis is totally or partially hidden by pubic, scrotal, or thigh skin. Several procedures had been described for its correction including phallopexy, that is, fixation of penile Buck's fascia to the sub-dermis.Aim of the workOur work aims to study the difference in outcome between performing phallopexy at one level and at two levels.Material and methodsOur study included 180 uncircumcised patients who had a concealed penis while having an average length of an outstretched penis. These patients were divided into two groups: the first one was treated with one level of phallopexy at the 3 and 9 o'clock points, while the second group was treated with the same procedure in addition to another level of stitches at the mid-penile level. The follow-up was carried out for one post-operative year regarding penile skin edema, infection, congestion, necrosis, and/or re-retra...

Research paper thumbnail of Laparoscopic-assisted pyloromyotomy for cases of hypertrophic pyloric stenosis, a safer new technique

Purpose The main difficulty of laparoscopic pyloromyotomy (LP) is the method of spreading and dee... more Purpose The main difficulty of laparoscopic pyloromyotomy (LP) is the method of spreading and deepening the incised pyloric mass. The aim of the work was the presentation of the surgical outcome of a new procedure of laparoscopic-assisted pyloromyotomy using a fine curved artery forceps for muscle spreading. Methods Our prospective study included 24 pediatric patients with IHPS. Under general anesthesia, the patient was positioned transversely on the operating table and the working instruments were inserted directly without ports through the umbilicus, right hypochondrium, and the epigastrium. The mass was grasped by the right instrument holding the duodenum and the pyloromyotomy knife was inserted through the epigastric incision and incised the pyloric mass transversely. The knife was then removed and a fine curved artery forceps was inserted to complete the pyloromyotomy. Results The age of the studied patients was 20–50 days (36.48 ± 8.98 days) and their body weight was 2500–3200...

Research paper thumbnail of Intussusception in preterm neonates: A systematic review of a rare condition

BMC Pediatrics, 2021

BackgroundWhile necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admi... more BackgroundWhile necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly uncommon and often overlooked. This is due to the fact that they share many clinical characteristics. The initial misdiagnosis of intussusception in preterm neonates (IPN) especially has led to a delay in their management, which increases the risk of developing compromised bowel. Additionally, it is difficult to reach a diagnosis as neonatal intussusception does not have any classical radiological signs even when contrast enema is used. This systematic review is based on the published literature including case reports and case series to review the clinical features of IPN and how to differentiate it from NEC in order to shed the light on this rare disease and how having a high index of suspicion would help practitioners to make an early and accurate diagnosisMethodsA systematic literature search to report all cas...

Research paper thumbnail of Single-shot thoracic epidural analgesia for neonates undergoing thoracotomy

Egyptian Journal of Anaesthesia, 2020

Background and Aims: Post-thoracotomy pain in neonates have negative physiological consequences i... more Background and Aims: Post-thoracotomy pain in neonates have negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ function. Methods: A randomized, single center, prospective, controlled study was conducted in El-Shatby university hospital, from august 2017 to September 2019 were 40 neonates, weighing 2.5–4 kg belonging to the ASA physical Grade II to IV, posted for a trachea-oesophagal fistula (TOF) repair via thoracotomy. After general anesthesia, in Group A, intra-operatively received fentanyl 2 µg/kg and paracetamol (10 mg/kg/6 h) intravenously and Group B (thoracic epidural single injection with 0.5 ml/kg of 0.25% of the L-Bupivacaine and 2 µg/kg of fentanyl), postoperatively paracetamol (10 mg/kg/6 h) intravenous (IV) or pain score >4. The primary objective was to compare the effect of the single-shot epidural blockade to intravenous fentanyl on post-thoracotomy pain con...

Research paper thumbnail of Giant mesenteric lipoblastoma; a rare presentation of childhood abdominal mass

Journal of Pediatric Surgery Case Reports, 2022

Research paper thumbnail of Flexible airway endoscopy in esophageal atresia patients undergoing colon interposition

Egyptian Journal of Anaesthesia, 2021

Background: Colon interposition is used for delayed surgical repair of esophageal atresia, but co... more Background: Colon interposition is used for delayed surgical repair of esophageal atresia, but congenital esophageal atresia with or without tracheoesophageal fistula (CEA ± TEF) is associated with long-term respiratory morbidity. This study aimed to examine the prevalence of upper airway anomalies, and detect the implications of the preoperative flexible airway endoscopy (FAE) on the decision of performing tracheopexy whether aortopexy or more recently, posterior tracheopexy in cases of severe tracheomalacia. A randomized, prospective, controlled study was conducted in a tertiary care pediatric surgery center from September 2016 to October 2020 where thirty child of either sex, aged 2–8 years, scheduled for a colon interposition repair for esophageal atresia. After induction of general anesthesia dynamic airway endoscopic examination with ultra-thin fibroptic bronchoscopy was performed Results: Dynamic study of pediatric upper airway showed that only one case out of 30 child enrolled in the present study had grade II subglottic stenosis in the proximal trachea (3.34%), while five cases (16.67%) had tracheomalacia with different degrees and only one severe case required aortopexy Conclusion: Dynamic airway endoscopic examination can predict airway anomalies associated with esophageal atresia and enhance post colon interposition respiratory outcomes. ARTICLE HISTORY Received 15 April 2021 Revised 3 May 2021 Accepted 7 May 2021

Research paper thumbnail of Management of pediatric benign ovarian tumors in England and Egypt: A comparative study

African Journal of Paediatric Surgery, 2020

Aim of the Study: We aimed to compare the management of pediatric benign ovarian tumors between a... more Aim of the Study: We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions. Materials and Methods: This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both sides. Results: Eighty-nine patients were included (54 English and 35 Egyptians). Median age at diagnosis in England was 13 years (2-16y), while in Egypt it was 7 years (9m-16y) with P =0.001. Mature teratomas or dermoid cysts were the most common findings in England and Egypt; 75.9% and 82.8% of cases, respectively. The presentation with an acute abdomen represented 27.8% of English and 28.6% of Egyptian patients. Incidentally diagnosed lesions constituted 15% of English patients, whereas none of the Egyptian cases were discovered incidentally. There were variations in diagnostic imaging; England: Ultrasound (USS) (54), magnetic resonance imaging (MRI) (37), and computed tomography (CT) (only one)–Egypt: USS (35), CT (17), and MRI (only one). Minimally invasive surgery (MIS) was performed in 15% of English and 23% of Egyptian patients (P = 0.334). Ovarian-sparing surgery (OSS) was performed in: England 35%, Egypt 37%; P = 0.851. OSS was performed using MIS in 87.5% (7/8) of English patients and 100% (8/8) of Egyptians. Patients presented as emergencies generally had open oophorectomies: England; 86.7% open and 80% oophorectomy–Egypt; 100% open and 90% oophorectomy. Recurrences or metachronous disease occurred in 5.6% of English and 5.7% of Egyptian patients. Conclusions: There were no significant differences regarding surgical management, tumor pathology, and recurrence or metachronous disease. However, age, incidental diagnosis, and imaging modalities showed notable differences. MIS was correlated with ovarian preservation, whereas emergency surgery generally resulted in open oophorectomy.

Research paper thumbnail of Acute intrathoracic gastric volvulus: A rare delayed presentation of congenital diaphragmatic hernia: A case report

International Journal of Surgery Case Reports, 2020

INTRODUCTION: Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial ... more INTRODUCTION: Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial rotation in the chest due presence of a diaphragmatic defect. Gastric volvulus associated with congenital diaphragmatic hernia is extremely rare and can be explained as 2 of the 4 ligaments supporting the stomach (gastrophrenic and gastrosplenic) which are connected to the left diaphragm may become elongated or absent. According to the current literature, only 27 pediatric cases have been reported so far. PRESENTATION OF CASE: We describe an 8 years old boy who presented to our emergency department with acute epigastric pain and vomiting. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left hemithorax. A computed tomography scan demonstrated a sizable left diaphragmatic defect admitting stomach, small bowel loops and transverse colon with organoaxial gastric volvulus. Emergent laparotomy was done for reduction of the viscera to the abdominal cavity and repair of the diaphragmatic defect. The patient showed an uneventful recovery without experience any pain or difficulty with eating. DISCUSSION: Acute gastric volvulus is a rare pathology defined as an abnormal rotation of the stomach for more than 180 • leading to a closed-loop obstruction which may progress to ischemia and strangulation. A plain standing abdominal X-ray and an upper gastrointestinal contrast study are useful for diagnosis, but some authors recommend performing CT or MRI to confirm the diagnosis. The standard treatment for volvulus is open laparotomy with detorsion and anterior gastropexy. CONCLUSION: The presented case highlights congenital diaphragmatic hernia associated with gastric volvulus is a serious condition with very high morbidity and mortality. It should be considered in the differential diagnosis of children with epigastric pain and uncontrolled non bilious vomiting. An upper gastrointestinal contrast study is useful for early diagnosis and surgical treatment should not be delayed awaiting further complementary imaging tests.

Research paper thumbnail of Fatal Course of a Male Newborn with Double Duodenal Atresia

European Journal of Pediatric Surgery Reports, 2020

Multiple point duodenal atresia is an extremely rare condition with atretic segments in either tw... more Multiple point duodenal atresia is an extremely rare condition with atretic segments in either two or three sites of the duodenum. We report a newborn male patient who presented to our institution with bilious vomiting, nonpassage of meconium, mild abdominal distension, and a palpable epigastric abdominal mass ∼1 × 1 cm. A faint double bubble was found on abdominal X-ray. On exploratory laparotomy, a duodenal cyst due to double duodenal atresia was found and a typical diamond-shaped duodeno-duodenostomy was created. A postoperative contrast study revealed passage of the contrast media into distal intestine. However, the patient died 2 weeks later due to uncontrolled sepsis and pneumonia. Despite the fact that multiple-point duodenal atresia is a rare condition, it should be considered as a differential diagnosis to avoid missed pathology.

Research paper thumbnail of One Stage Pull-Through Procedure for Hirschsprung’s Disease: Trans-Anal or Trans-Abdominal? A Comparative Study

Acta Scientific Paediatrics, 2019

The aim of our work was to compare between one stage trans-anal endorectal Soave pull-through pro... more The aim of our work was to compare between one stage trans-anal endorectal Soave pull-through procedure and one stage trans-abdominal Soave endorectal pull-through in the treatment of Hirschsprung's disease in infants. Methods: Our retrospective study included 248 patients of Hirschsprung's disease. Group A include 166 patients treated by one stage trans-anal pull through and Group B include 82 patients treated by one stage trans-abdominal pull through. Results: The operative time, intraoperative bleeding, length of the resected segment, time to passage of stool, start of oral feeding and hospital stay were the only statistically significant variables. Most of the postoperative complications didn't differ significantly between the two approaches except wound infection and adhesive intestinal obstruction which develops only in group (B). Conclusion: Trans-anal approach is superior to the trans-abdominal approach due to its simplicity, cost effectiveness and less surgical morbidity. The operative technique can be easily educated and it's suitable for classical uncomplicated rectosigmoid aganglionosis, in patients with aganglionosis which doesn't exceed the splenic flexure or even in those having marked dilated colon because of its high effectiveness and promising results.

Research paper thumbnail of Anterior Sagittal Anorectoplasty as a Technique for the Repair of Female Anorectal Malformations: a Twenty Two-Years-Single-Center Experience

Journal of Pediatric Surgery, 2019

Background: Anorectal malformations (ARMs) are major congenital malformations occurring in female... more Background: Anorectal malformations (ARMs) are major congenital malformations occurring in female children in approximately 1 out of every 4000-5000 births. Posterior sagittal anorectoplasty (PSARP) was introduced for their treatment in early 1980s by Pena and Devries. However, anterior sagittal anorectoplasty (ASARP) was first introduced by Okada as a modification of the previous technique. Purpose: The aim of this study was to report our experience and the long-term follow-up results of 594 female patients with anorectal malformations treated by anterior sagittal anorectoplasty (ASARP) in a single center over 22 years. We chose this approach as the incision is smaller, with minimal cutting of the external sphincter and easier dissection of the vagina and rectum. The type of our study was retrospective study. Results: The study included 594 patients; 342 of them were less than 1 year old. About 526 patients had rectovestibular fistula, anterior perineal anus in 55 patients, anocutaneous fistula in 6 patients and rectovaginal fistula in 7 patients. All of these patients had been subjected to ASARP technique which had been done in one stage without proceeding colostomy in about 470 cases and in staged fashion with a protective colostomy in 124 patients. Postoperative follow up revealed that four patients (0.7%) developed anal retraction, 30 patients (5%) developed anal stricture, 20 patients (3.4%) had rectal prolapse and 40 patients (6.7%) developed anterior anal migration. Constipation was observed in 161 patients (27%) by the end of 1st postoperative year reduced to 41 patients (7%) after one year. 474 patients were assessed for continence by Kelly's continence score and 453 patients showed good result, 16 patients showed fair result and about 5 patients had poor continence outcome. Conclusion: Anterior sagittal anorectoplasty is a procedure with optimal functional outcome especially at if done at an early age in one stage without preliminary colostomy.

Research paper thumbnail of Prognostic factors for the outcome of Kasai portoenterostomy for infants with biliary atresia in Egypt

Alexandria Journal of Pediatrics, 2018

Background Biliary atresia (BA) is the most common surgically correctable liver disorder in the p... more Background Biliary atresia (BA) is the most common surgically correctable liver disorder in the pediatric age group. If untreated, progressive liver cirrhosis leads to death by the age of 2 years. Aim The aim was to study the outcome of Kasai portoenterostomy for infants with BA in Egypt and identify some prognostic factors of this outcome. Patients and methods A prospective clinical and laboratory study including 20 patients with BA who underwent Kasai operation was conducted. A detailed history taking, clinical examination, liver function tests, ultrasound of the abdomen, preoperative liver biopsy, and intraoperative cholangiography were done for all patients. Patients were followed up for a period of 6 months postoperatively. The schedule and indications for liver transplantation were also evaluated. Results Overall, 55% of operated infants showed gradual reduction of serum bilirubin, which reached a level less than 2 mg/dl, as well as reduction of liver enzymes. On the contrary, the remaining 45% of infants failed to show satisfactory reduction of serum bilirubin, which continued to be greater than 2 mg/dl as well as liver enzymes. Both groups showed statistically significant differences regarding age at operation, presence of preoperative ascites, liver size, and patients’ Child–Pugh score. Moreover, preoperative total serum bilirubin and its direct fraction, liver enzymes, and cholestatic enzymes were significantly higher among infants with a bad outcome. There were no mortalities within the 6-month follow-up period. Conclusion Kasai portoenterostomy showed better results with short-term follow-up if done at an early age. Certain preoperative clinical, laboratory, radiological, and pathological factors might predict the outcome of Kasai operation.

Research paper thumbnail of Evaluation of the functional outcome of the neonatal one stage posterior sagittal anorectoplasty (PSARP) as a procedure to treat cases of high anorectal malformation in male neonates

Archives of Clinical and Experimental Surgery (ACES), 2019

Background: Male anorectal malformations have many varieties, from simple types that can be easil... more Background: Male anorectal malformations have many varieties, from simple types that can be easily repaired in one stage to more complex cases that need more sophisticated repairs in a staged approach. The staged approach has higher morbidity than the one-stage approach and includes colostomy complications, risk of repeated anesthesia and surgery, high costs and psychological and psychological burden on parents. Based on these disadvantages of the staged posterior sagittal anorectoplasty (PSARP) for high anorectal malformations, one-stage neonatal PSARP has been developed. The aim of our work is to evaluate the functional and clinical outcome of the one-stage approach in the treatment of selected cases of male neonates with high anorectal malformations Material and methods: This is a retrospective study which included male patients who had neonatal one-stage PSARP for their high anorectal anomalies between 2006 and 2013. Inclusion criteria included patients with flat or mildly distended abdomen; those in whom the cross-table film of the abdomen showed the rectal pouch reaching down to the fifth sacral segment and patients passing meconium from the urethra. However, cases with complete sacral agenesis, major cord anomalies, and a markedly distended abdomen—possibly due to a megarectum—were excluded from the selection. Patients were evaluated for their functional and clinical outcome at the time of the follow-up in January 2018. Patients with poor outcomes were further evaluated by MRI and examination under anesthesia. Results: Our retrospective study included 24 patients with an age range between 5 and 11 years at the time of follow up in January 2018. 16 patients had a recto-bulbar fistula, six patients had a recto-prostatic fistula, and only two patients had recto-bladder neck fistula. According to the continence outcome, 15 patients had a good outcome, all of which had a recto-bulbar fistula. Six patients had a fair outcome; 5 of them had a recto-prostatic fistula, and only one patient had a rectobulbar fistula. The remaining three patients who had poor outcome included all patients with recto-bladder neck fistula (2 patients) and one patient with recto-prostatic fistula; this was statistically significant (P

Research paper thumbnail of Megacystis-Microcolon-intestinal hypoperistalsis syndrome

Journal of Pediatric Surgery Case Reports, 2018

Abstract Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare congenital a... more Abstract Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare congenital anomaly that presents with severe form of functional obstruction of the gastrointestinal tract which is usually fatal. Here, we report a full term female infant with MMIHS presented with feeding intolerance, huge abdominal distension, bile-stained vomiting, absent bowel sounds and a large abdominal cystic mass. Exploration revealed hugely distended urinary bladder, micro colon, short bowel and malrotation of the small intestine. Ladd's procedure, ileostomy and vesicostomy were performed.

Research paper thumbnail of Pediatric inguinal hernias, are they all the same? A proposed pediatric hernia classification and tailored treatment

Hernia : the journal of hernias and abdominal wall surgery, Jan 28, 2018

To propose a new clinical classification for pediatric inguinal hernias modified from a similar c... more To propose a new clinical classification for pediatric inguinal hernias modified from a similar classification system for adult inguinal hernia and to propose a tailored repair for each type. The impact of this approach on hernia recurrence will be assessed. This prospective and retrospective cross-sectional study was conducted in two tertiary teaching university hospitals in Egypt (Alexandria and Tanta University Children's Hospitals) from January 2013 to December 2014 on children below 12 years of age with indirect inguinal hernias who were divided into two groups: (a) prospective group I, classified according to our proposed pediatric hernia classification and tailored treatment (PHCTT) into types: pediatric Nyhus 1 (PNI) assigned for herniotomy alone, pediatric Nyhus II (PNII) assigned for herniotomy plus deep ring narrowing, and type pediatric Nyhus III (PNIII) assigned for herniotomy plus posterior wall repair. (b) Retrospective unclassified group II where all cases were a...

Research paper thumbnail of Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique)

Journal of Pediatric Surgery, 2016

Background and objectives: Laparoscopic orchiopexy for intra-abdominal testis is a wellknown and ... more Background and objectives: Laparoscopic orchiopexy for intra-abdominal testis is a wellknown and commonly practiced technique. The traction technique is based on elongation of the testicular vessels without cutting them, in contrast with the two-stage Fowler-Stephens technique in which the testicular vessels are divided. The current study evaluated the feasibility of the traction technique according to the type of intra-abdominal testis. Patients and methods: The study included 20 boys with 22 intra-abdominal testes and who underwent staged laparoscopic traction orchiopexy between October 2013 and October 2015. Eighteen testes were proximal to the internal ring by <2 cm (type III), while the remaining four were high and away from the internal ring by >2 cm (type IVa). The patients' ages ranged between 6 months and 5 years (mean 2.2 years; median 2 years). Patients were followed up for 1 year for testicular atrophy and satisfactory scrotal site relocation. Results: This study did not detect any cases of testicular atrophy among the participants (0/22), while failure to achieve satisfactory scrotal site was found in two out of the four cases with type IVa intra-abdominal testes. Discussion: Traction techniques for elongating the testicular vessels were employed years ago, but this was revisited by Shehata in 2008. It has the advantage of preserving the main testicular blood supply, which can be reflected by the decreasing rate of testicular atrophy when compared with the Fowler-Stephens orchiopexy. The results of the traction technique may be less satisfactory regarding the testicular location for higher types of intra-abdominal testes (type IVa).

Research paper thumbnail of Paravertebral versus single shot epidural blockade for neonates undergoing thoracotomy

Egyptian Journal of Anaesthesia, 2020

Background and Aims: Postthoracotomy pain in neonates has negative physiological consequences inc... more Background and Aims: Postthoracotomy pain in neonates has negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ function. This study aimed to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control. Methods: A prospective study was conducted in El Shatby University Hospital, from April 2018 to March 2020 where forty neonates scheduled for a trachea-esophageal fistula (TOF) repair via thoracotomy were randomized to Group A (thoracic epidural single injection with 0.5 ml/ kg of 0.25% of L-Bupivacaine and 2 µg/kg of fentanyl) or Group B (Paravertebral blockade will be done by probe transverse-Needle In-Plane approach with 0.25% L-Bupivacaine, 0.5 ml/kg and 2 µg/kg of fentanyl). The primary objective was to compare the effect of paravertebral blockade to single shot epidural blockade on postthoracotomy pain control, the length of stay (LOS), supplemental analgesic requirements, and the incidence of adverse respiratory events were also measured. Results: Forty neonates completed the study. Group A remained hemodynamically stable in the intraoperative period with good quality of analgesia for 8 hours postoperative with a lesser doses of rescue opioids required to maintain adequate analgesia, while in group B, paravertebral analgesic effects continued for about 4 hours postoperative with multiple dosage of rescue opioids (fentanyl) was required to maintain adequate analgesia which increased length of hospital stay Conclusion: Very efficient postoperative analgesia can be achieved via single shot epidural blockade compared to paravertebral blockade in neonatal postthoracotomy pain.