Essam Elhalaby - Academia.edu (original) (raw)

Papers by Essam Elhalaby

Journal of Pediatric Endoscopic Surgery, 2020

Annals of Pediatric Surgery, 2015

Journal of Pediatric Surgery, 1995

Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morb... more Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of > or = II (> or = 2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of > or = III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally thought, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD.

Journal of Pediatric Surgery, 1994

The cases of three full-term infant girls with both Hirschsprung's disease (HD) and Ondine's curs... more The cases of three full-term infant girls with both Hirschsprung's disease (HD) and Ondine's curse (OC) are presented, and the relevant literature is reviewed. All three patients required endotracheal intubation and assisted ventilation during the first 24 hours of life because of respiratory distress. The diagnosis of HD was subsequently established at age 13, 16, and 20 days, respectively. The aganglionic segment was confined to the rectum in one case, extended to the splenic flexure of the colon in the second case, and involved the terminal ileum in the third. The definitive treatment (endorectal pull-through) was completed successfully in all three patients, and the postoperative follow-up period was 3 to 34 months. All of them presently have tracheostomies and are maintained on home ventilation. They tolerate being off the ventilator while awake, and have nearly normal bowel habits and growth curves. Two have bilateral ciliary ganglion dysfunction, and one has strabismus. Based on this review, the authors conclude the following. (1) The incidence of the HD associated with OC may be more common than is generally believed (1.8% of all their HD patients have OC). (2) OC should be suspected in any newborn with HD who requires assisted ventilation in the absence of major cardiopulmonary abnormalities. Likewise, HD should be ruled out in any OC case with gastrointestinal dysfunction. (3) Contrary to the previous impression from the literature, the combination of OC and HD should not be considered fatal, because most such patients can be managed successfully and have a reasonable quality of life. (4) The significant association of HD, OC, and ocular anomalies in all three of the authors' patients further substantiates the syndromic nature of this association, which should alert the clinician to perform regular screening for other possible neurocristopathies such as neuroblastoma.

Controversy exists regarding the appropriate level of sympathectomy for primary palmar hyperhidro... more Controversy exists regarding the appropriate level of sympathectomy for primary palmar hyperhidrosis (PH) as different levels are associated with variable postoperative patients’ satisfaction and potential complications. The aim of this study was to investigate the safety, efficacy, and outcome of T2-T3 thoracoscopic sympathectomy (TS) versus T4 TS in this age group. This prospective study included 32 patients (17 males and 15 females) with primary PH treated at the department of pediatric surgery, in our institution during the period from February 2019 to February 2020. Inclusion criteria included moderate and/or severe degrees of PH not responding to conservative measures. The patients were divided randomly into two groups: group I treated by T2-T3 TS and group II underwent only T4 TS. All patients were evaluated regarding operative details and postoperative outcome. Follow-up ranged from 6 to 24 months. Group I included 18 patients (14 operated on both sides and 4 operated on one...

Background/ Purpose: A growing interest has been noted recently in one -stage Feminizing genitopl... more Background/ Purpose: A growing interest has been noted recently in one -stage Feminizing genitoplasty for patients with congenital adrenal hyperplasia (CAH). The timing of surgery is currently controversial. This study was carried out to investigate the feasibility and outcome of one –stage feminizing genitoplasty at various ages. Materials & Methods: Eighteen female patients with CAH were treated during a six year-period. All patients undergone one- stage clitoroplasty, vaginoplasty, and labioplasty. Fifteen with high or intermediate confluence of vagina and urethra underwent total urogenital mobilization (TUM). A perineal posterior flap vaginoplasty and minimal mobilization of the urogenital sinus (UGS) was adequate in 3 cases with short UGS. Each patient was evaluated as regard to age at surgery, degree of virilization, preoperative diagnostic studies, operative technique, and outcome. Follow up ranged from 2 to 72 months. Results: Patients aged 5 weeks to 6 years. Mean operative...

Background/ Purpose: Although the original Koyanagi technique seemed applicable for the repair of... more Background/ Purpose: Although the original Koyanagi technique seemed applicable for the repair of severe hypospadias at or proximal to the penoscrotal junction, its use has resulted in a high complication rate. The technique was modified to ensure better vascularity of the flaps. The purpose of this study is to report the results of original Koyanagi technique and its modifications in patients with severe hypospadias. Materials and Methods: The original Koyanagi parameatal prepuital flap technique was performed in 16 boys with severe hypospadias (group I). In a subsequent 11 patients, the modified Koyanagi technique was used to preserve blood supply to the flaps (group II). The meatus was located at or proximal to the penoscrotal junction in all patients. Moderate to severe degrees of chordee was noted in all of them. The median age of patients was 13 and 20 months at time of repair for group I and II respectively. Each patient was evaluated as regard to site of the new meatus, stra...

Background/Purpose: The standard treatment of high and intermediate anorectal malformation (ARM) ... more Background/Purpose: The standard treatment of high and intermediate anorectal malformation (ARM) is the staged approach. A growing interest in one- stage correction of ARM was noted recently. The aim of this study was to examine the feasibility, safety, and short-term outcome of primary repair of high and intermediate ARM in neonates. Materials and Methods: This prospective study included 38 full-term infants (22 females and 16 males) with either high (n=9) or intermediate (n= 29 ) ARM treated during a 6- year period. All patients underwent posterior sagittal anorectoplasty (PSARP) without colostomy. The exclusion criteria included: prematurity, associated major congenital anomalies, bad general condition, persistent cloaca in females and unfavorable circumstances. Preoperative imaging using ultrasonography and magnetic resonance imaging (MRI) was performed to assess the severity of ARM and any associated anomalies. All patients were evaluated as regard to operative details, postope...

Annals of Pediatric Surgery

Background Gastric outlet obstruction (GOO) may follow acid corrosive ingestion. Several surgical... more Background Gastric outlet obstruction (GOO) may follow acid corrosive ingestion. Several surgical techniques have been reported after the failure of endoscopic dilatation. The aim of this study was to evaluate the feasibility and safety of Heinecke-Mikulicz pyloroplasty (HMP) through a circum-umbilical skin incision in children with pyloric stricture after accidental acid corrosive ingestion. Results Seven patients were males and 4 were females, their ages ranged from 17 months to 6 years at the time of definitive treatment. The surgery was completed successfully in all patients through the circum-umbilical incision. Vertical extension of skin incision was needed in one patient. The pylorus was grossly affected in 9 patients. Both pylorus and gastric antrum were involved in 2 patients. Nine patients had an excellent postoperative course with the cessation of vomiting and progressive weight gain. One patient developed postoperative recurrent stricture treated by gastrojejunostomy. An...

Journal of Pediatric Endoscopic Surgery

Background/purpose Ventriculoperitoneal (VP) shunt is a common procedure used to drain cerebrospi... more Background/purpose Ventriculoperitoneal (VP) shunt is a common procedure used to drain cerebrospinal fluid to treat hydrocephalus. Advances in laparoscopy tools and techniques made it possible to perform this procedure laparoscopically assisted. Complications of this procedure are also amenable to laparoscopic correction. This study outlines the safety and feasibility of laparoscopy in performing the procedure and management of its complications. Methods A retrospective file review for all cases underwent laparoscopic-assisted VP shunt or laparoscopic management of one of its complications in the period 2015-2019. Laparoscopic-assisted procedure was done either by 3-port technique or a peritoneocentesis needle technique. Management of complications was done according to its nature. Results Over 4 years, we performed 36 laparoscopic-assisted VP shunt placement and 17 laparoscopic interventions for abdominal complications related to VP shunts. There were no intraoperative or postoperative complications related to the laparoscopic technique. Conversion to conventional laparotomy was done in 3 patients presented with hugely infected CSF pseudocysts with amalgamated intestine with the wall of the cyst. Conclusion Laparoscopic-assisted VP shunt placement and revisions in children are feasible and safe. No special tools are required for the procedure.

Annals of Pediatric Surgery

We are tremendously saddened to let you know that Prof Sidney Cywes passed away on 6 April 2020 f... more We are tremendously saddened to let you know that Prof Sidney Cywes passed away on 6 April 2020 following a short illness. Our immediate thoughts and prayers are with his wife Marlene, children Robert and Colette and their families. Professor Cywes was born on 1 January 1931 in Paarl, in the Western Cape. He graduated from University of Cape Town with MBChB in 1953. He became a lecturer in Surgery (UCT) in 1961 and remained at the Red Cross War Memorial Children's Hospital throughout his career. He was the first surgeon in South Africa to restrict his practice entirely to Paediatric Surgery. In 1975, he was appointed as the first incumbent of the Charles FM Saint Chair of Paediatric Surgery, a position which he held until his retirement in 1996.

Annals of Pediatric Surgery

Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia w... more Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia with an incidence of 1 in 15,000 live births. Surgical reconstruction for girls with CAH and urogenital sinus (UGS) is a great challenge to create normal appearing and functional external genitalia. The purpose of this study is to evaluate the early outcomes of using partial urogenital sinus mobilization in feminizing genitoplasty in females with congenital adrenal hyperplasia regarding vaginal caliber, urinary continence, and genital appearance. Results Patient age at surgery ranged from 4 to 96 months (mean 19.4 months), with a mean follow-up of 15 months. Degree of virilization was Prader type III in 2 children (8%), type IV in 18 (72%), and type V in 5 (20%). Urogenital sinus length was 2.5 cm or less in 18 children. Cosmetic results were good in 19 patients (76%) and satisfactory in 6 (24%). Adequate caliber of the mobilized vagina was achieved in 24 patients (96%). Seven toilet trai...

Annals of Pediatric Surgery

Background/aim Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its manageme... more Background/aim Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its management includes various strategies. This survey aims at detecting the current preferences of Egyptian pediatric surgeons regarding the management of ARM.

World journal of surgery, Jun 28, 2017

Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric ... more Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns....

Annals of Pediatric Surgery, 2017

Background/purpose Oral propranolol has been used successfully for the treatment of infantile hem... more Background/purpose Oral propranolol has been used successfully for the treatment of infantile hemangiomas (IHs). However, its safety is questioned. Topical therapy with 1% propranolol ointment has been reported to be safe and effective. The objective of this study was to compare the effectiveness and safety of oral versus topical propranolol (1% ointment) as a nonselective b-blocker in the management of cutaneous IH. Patients and methods Forty-eight patients with IH were randomly divided into two equal groups: group A (n = 24) was treated with oral propranolol and group B (n = 24) was treated with propranolol ointment 1%. The patients were followed up for 3 months after treatment was stopped. Results There was a significant statistical difference between the two groups as regards the effectiveness of the drug (P = 0.041). In the oral group, 50% (n = 12) showed an excellent response, 33.33% (n = 8) showed good response, and 16.67% (n = 4) showed a fair response, whereas in the topical group 16.67% (n = 4) showed an excellent response, 45.83% (n = 11) showed good response, and 37.5% (n = 9) showed a fair response. There was no significant adverse event in any group during the follow-up period. Conclusion Oral propranolol is an effective, safe, and fastacting drug for treating IH and can be monitored on an outpatient basis. Topical propranolol is an easily prepared drug and seems to be an alternative therapeutic option for superficial cutaneous hemangioma. However, the optimal dosing and duration of treatment are still to be defined.

Annals of Pediatric Surgery, 2016

Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of ... more Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of the commonly performed procedures in pediatric surgery practice. However, the cost effectiveness of the procedure remains a major concern. The present study aimed to evaluate the safety and effectiveness of the operative techniques used to reduce the cost of the procedure. Patients and methods A prospective study was conducted on patients undergoing laparoscopic appendectomy over a period of 2 years. The techniques used to reduce the cost of laparoscopic appendectomy were as follows: (i) using reusable trocars instead of disposable ones; (ii) using monopolar electrogoagualtion to seal the mesoappendix instead of staplers, LigaSure, or Harmonic scalpels; and (iii) using a handmade loop to secure the base of the appendix instead of using endoloops. Results This study included 39 boys and 21 girls. The median age was 10 years. The mean duration of the operation was 56.5 min. No intraoperative complications were encountered. Two cases developed pelvic hematoma and were managed conservatively with success. The mean hospitalization stay was 2 days. Conclusion Division of the mesoappendix using monopolar electrocautry and closing the base of appendix using handmade endloops during laporoscopic appendectomy appears to be a simple, effective, safe, and cost-efficient technique. Therefore, the use of more costly instruments, such as the endostapler, LigaSure, or Harmonic scalpel, seems unwarranted.

Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of ... more Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of the commonly performed procedures in pediatric surgery practice. However, the cost effectiveness of the procedure remains a major concern. The present study aimed to evaluate the safety and effectiveness of the operative techniques used to reduce the cost of the procedure. Patients and methods A prospective study was conducted on patients undergoing laparoscopic appendectomy over a period of 2 years. The techniques used to reduce the cost of laparoscopic appendectomy were as follows: (i) using reusable trocars instead of disposable ones; (ii) using monopolar electrogoagualtion to seal the mesoappendix instead of staplers, LigaSure, or Harmonic scalpels; and (iii) using a handmade loop to secure the base of the appendix instead of using endoloops. Results This study included 39 boys and 21 girls. The median age was 10 years. The mean duration of the operation was 56.5 min. No intraoperative complications were encountered. Two cases developed pelvic hematoma and were managed conservatively with success. The mean hospitalization stay was 2 days. Conclusion Division of the mesoappendix using monopolar electrocautry and closing the base of appendix using handmade endloops during laporoscopic appendectomy appears to be a simple, effective, safe, and cost-efficient technique. Therefore, the use of more costly instruments, such as the endostapler, LigaSure, or Harmonic scalpel, seems unwarranted.

Journal of Pediatric Endoscopic Surgery, 2020

Annals of Pediatric Surgery, 2015

Journal of Pediatric Surgery, 1995

Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morb... more Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of > or = II (> or = 2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of > or = III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally thought, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD.

Journal of Pediatric Surgery, 1994

The cases of three full-term infant girls with both Hirschsprung's disease (HD) and Ondine's curs... more The cases of three full-term infant girls with both Hirschsprung's disease (HD) and Ondine's curse (OC) are presented, and the relevant literature is reviewed. All three patients required endotracheal intubation and assisted ventilation during the first 24 hours of life because of respiratory distress. The diagnosis of HD was subsequently established at age 13, 16, and 20 days, respectively. The aganglionic segment was confined to the rectum in one case, extended to the splenic flexure of the colon in the second case, and involved the terminal ileum in the third. The definitive treatment (endorectal pull-through) was completed successfully in all three patients, and the postoperative follow-up period was 3 to 34 months. All of them presently have tracheostomies and are maintained on home ventilation. They tolerate being off the ventilator while awake, and have nearly normal bowel habits and growth curves. Two have bilateral ciliary ganglion dysfunction, and one has strabismus. Based on this review, the authors conclude the following. (1) The incidence of the HD associated with OC may be more common than is generally believed (1.8% of all their HD patients have OC). (2) OC should be suspected in any newborn with HD who requires assisted ventilation in the absence of major cardiopulmonary abnormalities. Likewise, HD should be ruled out in any OC case with gastrointestinal dysfunction. (3) Contrary to the previous impression from the literature, the combination of OC and HD should not be considered fatal, because most such patients can be managed successfully and have a reasonable quality of life. (4) The significant association of HD, OC, and ocular anomalies in all three of the authors' patients further substantiates the syndromic nature of this association, which should alert the clinician to perform regular screening for other possible neurocristopathies such as neuroblastoma.

Controversy exists regarding the appropriate level of sympathectomy for primary palmar hyperhidro... more Controversy exists regarding the appropriate level of sympathectomy for primary palmar hyperhidrosis (PH) as different levels are associated with variable postoperative patients’ satisfaction and potential complications. The aim of this study was to investigate the safety, efficacy, and outcome of T2-T3 thoracoscopic sympathectomy (TS) versus T4 TS in this age group. This prospective study included 32 patients (17 males and 15 females) with primary PH treated at the department of pediatric surgery, in our institution during the period from February 2019 to February 2020. Inclusion criteria included moderate and/or severe degrees of PH not responding to conservative measures. The patients were divided randomly into two groups: group I treated by T2-T3 TS and group II underwent only T4 TS. All patients were evaluated regarding operative details and postoperative outcome. Follow-up ranged from 6 to 24 months. Group I included 18 patients (14 operated on both sides and 4 operated on one...

Background/ Purpose: A growing interest has been noted recently in one -stage Feminizing genitopl... more Background/ Purpose: A growing interest has been noted recently in one -stage Feminizing genitoplasty for patients with congenital adrenal hyperplasia (CAH). The timing of surgery is currently controversial. This study was carried out to investigate the feasibility and outcome of one –stage feminizing genitoplasty at various ages. Materials & Methods: Eighteen female patients with CAH were treated during a six year-period. All patients undergone one- stage clitoroplasty, vaginoplasty, and labioplasty. Fifteen with high or intermediate confluence of vagina and urethra underwent total urogenital mobilization (TUM). A perineal posterior flap vaginoplasty and minimal mobilization of the urogenital sinus (UGS) was adequate in 3 cases with short UGS. Each patient was evaluated as regard to age at surgery, degree of virilization, preoperative diagnostic studies, operative technique, and outcome. Follow up ranged from 2 to 72 months. Results: Patients aged 5 weeks to 6 years. Mean operative...

Background/ Purpose: Although the original Koyanagi technique seemed applicable for the repair of... more Background/ Purpose: Although the original Koyanagi technique seemed applicable for the repair of severe hypospadias at or proximal to the penoscrotal junction, its use has resulted in a high complication rate. The technique was modified to ensure better vascularity of the flaps. The purpose of this study is to report the results of original Koyanagi technique and its modifications in patients with severe hypospadias. Materials and Methods: The original Koyanagi parameatal prepuital flap technique was performed in 16 boys with severe hypospadias (group I). In a subsequent 11 patients, the modified Koyanagi technique was used to preserve blood supply to the flaps (group II). The meatus was located at or proximal to the penoscrotal junction in all patients. Moderate to severe degrees of chordee was noted in all of them. The median age of patients was 13 and 20 months at time of repair for group I and II respectively. Each patient was evaluated as regard to site of the new meatus, stra...

Background/Purpose: The standard treatment of high and intermediate anorectal malformation (ARM) ... more Background/Purpose: The standard treatment of high and intermediate anorectal malformation (ARM) is the staged approach. A growing interest in one- stage correction of ARM was noted recently. The aim of this study was to examine the feasibility, safety, and short-term outcome of primary repair of high and intermediate ARM in neonates. Materials and Methods: This prospective study included 38 full-term infants (22 females and 16 males) with either high (n=9) or intermediate (n= 29 ) ARM treated during a 6- year period. All patients underwent posterior sagittal anorectoplasty (PSARP) without colostomy. The exclusion criteria included: prematurity, associated major congenital anomalies, bad general condition, persistent cloaca in females and unfavorable circumstances. Preoperative imaging using ultrasonography and magnetic resonance imaging (MRI) was performed to assess the severity of ARM and any associated anomalies. All patients were evaluated as regard to operative details, postope...

Annals of Pediatric Surgery

Background Gastric outlet obstruction (GOO) may follow acid corrosive ingestion. Several surgical... more Background Gastric outlet obstruction (GOO) may follow acid corrosive ingestion. Several surgical techniques have been reported after the failure of endoscopic dilatation. The aim of this study was to evaluate the feasibility and safety of Heinecke-Mikulicz pyloroplasty (HMP) through a circum-umbilical skin incision in children with pyloric stricture after accidental acid corrosive ingestion. Results Seven patients were males and 4 were females, their ages ranged from 17 months to 6 years at the time of definitive treatment. The surgery was completed successfully in all patients through the circum-umbilical incision. Vertical extension of skin incision was needed in one patient. The pylorus was grossly affected in 9 patients. Both pylorus and gastric antrum were involved in 2 patients. Nine patients had an excellent postoperative course with the cessation of vomiting and progressive weight gain. One patient developed postoperative recurrent stricture treated by gastrojejunostomy. An...

Journal of Pediatric Endoscopic Surgery

Background/purpose Ventriculoperitoneal (VP) shunt is a common procedure used to drain cerebrospi... more Background/purpose Ventriculoperitoneal (VP) shunt is a common procedure used to drain cerebrospinal fluid to treat hydrocephalus. Advances in laparoscopy tools and techniques made it possible to perform this procedure laparoscopically assisted. Complications of this procedure are also amenable to laparoscopic correction. This study outlines the safety and feasibility of laparoscopy in performing the procedure and management of its complications. Methods A retrospective file review for all cases underwent laparoscopic-assisted VP shunt or laparoscopic management of one of its complications in the period 2015-2019. Laparoscopic-assisted procedure was done either by 3-port technique or a peritoneocentesis needle technique. Management of complications was done according to its nature. Results Over 4 years, we performed 36 laparoscopic-assisted VP shunt placement and 17 laparoscopic interventions for abdominal complications related to VP shunts. There were no intraoperative or postoperative complications related to the laparoscopic technique. Conversion to conventional laparotomy was done in 3 patients presented with hugely infected CSF pseudocysts with amalgamated intestine with the wall of the cyst. Conclusion Laparoscopic-assisted VP shunt placement and revisions in children are feasible and safe. No special tools are required for the procedure.

Annals of Pediatric Surgery

We are tremendously saddened to let you know that Prof Sidney Cywes passed away on 6 April 2020 f... more We are tremendously saddened to let you know that Prof Sidney Cywes passed away on 6 April 2020 following a short illness. Our immediate thoughts and prayers are with his wife Marlene, children Robert and Colette and their families. Professor Cywes was born on 1 January 1931 in Paarl, in the Western Cape. He graduated from University of Cape Town with MBChB in 1953. He became a lecturer in Surgery (UCT) in 1961 and remained at the Red Cross War Memorial Children's Hospital throughout his career. He was the first surgeon in South Africa to restrict his practice entirely to Paediatric Surgery. In 1975, he was appointed as the first incumbent of the Charles FM Saint Chair of Paediatric Surgery, a position which he held until his retirement in 1996.

Annals of Pediatric Surgery

Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia w... more Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia with an incidence of 1 in 15,000 live births. Surgical reconstruction for girls with CAH and urogenital sinus (UGS) is a great challenge to create normal appearing and functional external genitalia. The purpose of this study is to evaluate the early outcomes of using partial urogenital sinus mobilization in feminizing genitoplasty in females with congenital adrenal hyperplasia regarding vaginal caliber, urinary continence, and genital appearance. Results Patient age at surgery ranged from 4 to 96 months (mean 19.4 months), with a mean follow-up of 15 months. Degree of virilization was Prader type III in 2 children (8%), type IV in 18 (72%), and type V in 5 (20%). Urogenital sinus length was 2.5 cm or less in 18 children. Cosmetic results were good in 19 patients (76%) and satisfactory in 6 (24%). Adequate caliber of the mobilized vagina was achieved in 24 patients (96%). Seven toilet trai...

Annals of Pediatric Surgery

Background/aim Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its manageme... more Background/aim Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its management includes various strategies. This survey aims at detecting the current preferences of Egyptian pediatric surgeons regarding the management of ARM.

World journal of surgery, Jun 28, 2017

Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric ... more Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns....

Annals of Pediatric Surgery, 2017

Background/purpose Oral propranolol has been used successfully for the treatment of infantile hem... more Background/purpose Oral propranolol has been used successfully for the treatment of infantile hemangiomas (IHs). However, its safety is questioned. Topical therapy with 1% propranolol ointment has been reported to be safe and effective. The objective of this study was to compare the effectiveness and safety of oral versus topical propranolol (1% ointment) as a nonselective b-blocker in the management of cutaneous IH. Patients and methods Forty-eight patients with IH were randomly divided into two equal groups: group A (n = 24) was treated with oral propranolol and group B (n = 24) was treated with propranolol ointment 1%. The patients were followed up for 3 months after treatment was stopped. Results There was a significant statistical difference between the two groups as regards the effectiveness of the drug (P = 0.041). In the oral group, 50% (n = 12) showed an excellent response, 33.33% (n = 8) showed good response, and 16.67% (n = 4) showed a fair response, whereas in the topical group 16.67% (n = 4) showed an excellent response, 45.83% (n = 11) showed good response, and 37.5% (n = 9) showed a fair response. There was no significant adverse event in any group during the follow-up period. Conclusion Oral propranolol is an effective, safe, and fastacting drug for treating IH and can be monitored on an outpatient basis. Topical propranolol is an easily prepared drug and seems to be an alternative therapeutic option for superficial cutaneous hemangioma. However, the optimal dosing and duration of treatment are still to be defined.

Annals of Pediatric Surgery, 2016

Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of ... more Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of the commonly performed procedures in pediatric surgery practice. However, the cost effectiveness of the procedure remains a major concern. The present study aimed to evaluate the safety and effectiveness of the operative techniques used to reduce the cost of the procedure. Patients and methods A prospective study was conducted on patients undergoing laparoscopic appendectomy over a period of 2 years. The techniques used to reduce the cost of laparoscopic appendectomy were as follows: (i) using reusable trocars instead of disposable ones; (ii) using monopolar electrogoagualtion to seal the mesoappendix instead of staplers, LigaSure, or Harmonic scalpels; and (iii) using a handmade loop to secure the base of the appendix instead of using endoloops. Results This study included 39 boys and 21 girls. The median age was 10 years. The mean duration of the operation was 56.5 min. No intraoperative complications were encountered. Two cases developed pelvic hematoma and were managed conservatively with success. The mean hospitalization stay was 2 days. Conclusion Division of the mesoappendix using monopolar electrocautry and closing the base of appendix using handmade endloops during laporoscopic appendectomy appears to be a simple, effective, safe, and cost-efficient technique. Therefore, the use of more costly instruments, such as the endostapler, LigaSure, or Harmonic scalpel, seems unwarranted.

Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of ... more Background/purpose Laparoscopic appendectomy is widely practiced worldwide and has become one of the commonly performed procedures in pediatric surgery practice. However, the cost effectiveness of the procedure remains a major concern. The present study aimed to evaluate the safety and effectiveness of the operative techniques used to reduce the cost of the procedure. Patients and methods A prospective study was conducted on patients undergoing laparoscopic appendectomy over a period of 2 years. The techniques used to reduce the cost of laparoscopic appendectomy were as follows: (i) using reusable trocars instead of disposable ones; (ii) using monopolar electrogoagualtion to seal the mesoappendix instead of staplers, LigaSure, or Harmonic scalpels; and (iii) using a handmade loop to secure the base of the appendix instead of using endoloops. Results This study included 39 boys and 21 girls. The median age was 10 years. The mean duration of the operation was 56.5 min. No intraoperative complications were encountered. Two cases developed pelvic hematoma and were managed conservatively with success. The mean hospitalization stay was 2 days. Conclusion Division of the mesoappendix using monopolar electrocautry and closing the base of appendix using handmade endloops during laporoscopic appendectomy appears to be a simple, effective, safe, and cost-efficient technique. Therefore, the use of more costly instruments, such as the endostapler, LigaSure, or Harmonic scalpel, seems unwarranted.