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Research paper thumbnail of 5 Management of Post Hypospadias Urethral Fistula

Research paper thumbnail of One-year outcome of laparoscopic sleeve gastrectomy in morbidly obese adolescents

Annals of Pediatric Surgery, 2021

Adolescent obesity is an important health issue. Non-surgical weight management programs, even th... more Adolescent obesity is an important health issue. Non-surgical weight management programs, even the most aggressive, have shown modest weight reduction results. Laparoscopic sleeve gastrectomy (LSG) is gaining reliability as a low surgical risk bariatric procedure with proper efficiency for this age group. The aim of this study was to present our initial experience with LSG in morbidly obese adolescents and to report short-term clinical and metabolic outcome. Mean age was 16.43 years, and mean preoperative weight and body mass index (BMI) were 132.68 kg and 48.90 respectively. Mean excess weight loss (EWL) was 54.11 kg 1 year after LSG, corresponding to 74 EWL% as well as mean BMI loss (BML) of 19.89. LSG improved fatty infiltration of the liver in 75% of cases and other comorbidities in 100% of patients. LSG proved to be a safe procedure with significant short-term clinical and metabolic success for adolescent obesity.

Research paper thumbnail of Effect of laparoscopic sleeve gastrectomy on metabolic syndrome in adolescent obesity

Journal of Pediatric Endoscopic Surgery, 2020

Background Metabolic syndrome (MeS) is a group of physiological, biochemical, clinical, and metab... more Background Metabolic syndrome (MeS) is a group of physiological, biochemical, clinical, and metabolic factors which increase the incidence of atherosclerosis, type 2 diabetes mellitus, and early mortality. Overall prevalence of MeS is around 3.3%, 11.9% in overweight, 29.2% in obese, and less than 1% in non-obese children. Nearly, 90% of obese children and adolescents have at least one parameter of MeS. Objective Clinical and metabolic evaluation of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG). Subjects and methods Prospective study included analysis of data from 35 adolescents (12-19 years) with body mass index (BMI) above 99th percentile for age and sex. All of them had metabolic syndrome and were submitted to LSG between 2015 and 2017. Anthropometric measurements, clinical and laboratory assessment were performed, preoperatively, 6, 12, and 24 months postoperatively. Results Mean age was 16.43 years and mean preoperative weight and BMI were 132.68 kg and 48.90, respectively. Mean excess weight loss (EWL) was 54.11 kg after 12 months' and 51.19 kg after 24-months post-LSG, corresponding to 74 and 73 EWL%, respectively, as well as mean BMI loss (BML) of 19.89 and 18.7 kg/m 2. LSG improved fatty infiltration of liver in 93% of cases and other comorbidities in 100% of patients. Conclusions Laparoscopic sleeve gastrectomy (LSG) proved as a safe and effective procedure for adolescent obesity and its related metabolic morbidities.

Research paper thumbnail of Anterior Sagittal Anorectoplasty with External Sphincter Preservation for the Treatment of Recto-vestibular Fistula: A New Approach

Journal of Indian Association of Pediatric Surgeons

To our knowledge, there is no description of anterior sagittal anorectoplasty (ASARP) with extern... more To our knowledge, there is no description of anterior sagittal anorectoplasty (ASARP) with external anal sphincter preservation and passing neorectum in the middle of muscle complex under direct vision for the treatment of recto-vestibular fistula (VF). This study evaluates a new modification combining ASARP with under vision sphincter preservation. This prospective study was conducted on thirty female infants with VF. Procedure starts with a vertical midline incision extending from ectopic opening to posterior limit of external sphincter. Sharp dissection of the fistula is carried out. Artery forceps is passed at the center of muscle complex under vision, then neorectum is placed in the middle of the muscle complex. We introduced a new scoring system based on parental interview assessing functional outcome. Each patient was given a score between 0 and 20; good: 14-20, fair: 7-13, and poor: 0-6. ASARP was performed at a mean age of 2.6 months, a mean weight of 5.2 kg, a mean operati...

Research paper thumbnail of Short-term outcome of posterior anorectal myectomy for treatment of children with intractable idiopathic constipation

Annals of Pediatric Surgery, 2017

Research paper thumbnail of Urethral advancement procedure in the treatment of primary distal hypospadias

Annals of Pediatric Surgery, 2017

Research paper thumbnail of Acute calcular cholangitis in a diverse multi-ethnic population

International Journal of Surgery Open, 2016

Research paper thumbnail of Short-Term Outcome of “Double Crown” Tackers Mesh Fixation in Laparoscopic Ventral Hernia Repair

Research paper thumbnail of The versatility of the transumbilical approach for laparotomy in infants

Annals of Pediatric Surgery, 2015

ABSTRACT Background/purpose: Although the transumbilical approach became very popular for pylorom... more ABSTRACT Background/purpose: Although the transumbilical approach became very popular for pyloromyotomy, it has not been widely used in other procedures in children. The aim of this work was to evaluate the safety and the versatility of this approach for laparotomy in infants. Patients and methods: All hemodynamically stable neonates and infants with gastrointestinal surgical problems or pelvic or abdominal cystic masses were considered candidates for this approach. The umbilicus was incised nearly circumferentially, and the peritoneum was entered in the midline in a cephalic or caudal direction depending on the site of the lesion. The bowel or the mass was delivered outside the peritoneal cavity, and the procedure was completed in the standard open manner. Patients were evaluated with regard to the feasibility of the surgery and or any difficulty to complete the surgery, any complications related to the approach, and the cosmetic outcome. Results: A total of 141 infants underwent transumbilical laparotomy during the period from June 2008 to December 2013. The primary pathology was hypertrophic pyloric stenosis (n=65), duodenal, small-intestinal atresia/stricture (n=22), colonic atresia (n=2), malrotation with/without volvulus (n=10), ovarian cysts (n=12), intussusception (n=9), spontaneous intestinal perforation (n=7), remnants of vitellointestinal duct (n=4), mesenteric cysts (n=3), patent urachus (n=3), postoperative complications of strangulated inguinal hernia (n=3), and complications in ventriculoperitoneal shunts (n=1). Their age ranged from 1 day to 22 months. The operating time ranged from 30 to 120 min. Three patients required transverse extension of the wound. Two (1.4%) patients developed dehiscence of the wound that required wound closure. Five (3.5%) patients had superficial periumbilical cellulitis and wound infections, and one patient had suture reaction treated conservatively. Late complications (adhesive intestinal obstruction) occurred in three (2%) patients. Parents were very satisfied with the final cosmetic outcome. Conclusion: The transumbilical approach is both a feasible and a safe approach for a broad spectrum of surgical procedures in neonates and infants. The cosmetic results are excellent.

Research paper thumbnail of Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients

Research paper thumbnail of Management of Post Hypospadias Urethral Fistula

Current Concepts of Urethroplasty, 2011

Research paper thumbnail of Outcome of the Rhomboid Flap for Recurrent Pilonidal Disease

World Journal of Surgery, 2009

Research paper thumbnail of Laparoscopy in the Management of Impalpable Testis: Series of 64 Cases

World Journal of Surgery, 2009

Research paper thumbnail of Surgical implantation of a bioengineered internal anal sphincter

Journal of Pediatric Surgery, 2010

Purpose-Fecal incontinence is a common disorder that can have devastating social and psychologic ... more Purpose-Fecal incontinence is a common disorder that can have devastating social and psychologic consequences. However, there are no long-term ideal solutions for such patients. Although loss of continence is multifactorial, the integrity of the internal anal sphincter (IAS) has particular significance. We previously described the development of 3-dimensional bioengineered constructs using isolated smooth muscle tissue from donor C57BL/6 IAS. We hypothesized that the bioengineered ring constructs would retain cellular viability and promote neovascularization upon implantation into a recipient mouse. Methods-Internal anal sphincter ring constructs were surgically implanted into the subcutaneous tissue of syngeneic C57BL/6 mice and treated with either fibroblastic growth factor 2 (0.26 µg daily) or saline controls using a microosmotic pump. Internal anal sphincter constructs were harvested after 25 days (range, 23-26 days) and assessed morphologically and for tissue viability. Result-Gross morphology showed that there was no rejection. Rings showed muscle attachment to the back of the mouse with no sign of inflammation. Fibroblastic growth factor 2 infusion resulted in a significantly improved histologic score and muscle viability compared with the control group. Conclusions-Three-dimensional bioengineered IAS rings can be successfully implanted into the subcutaneous tissue of recipient mice. The addition of fibroblastic growth factor 2 led to improved muscle viability, vascularity, and survival. This approach may become a feasible option for patients with fecal incontinence.

Research paper thumbnail of Long-term functional outcome and quality of life in patients with high imperforate anus

Journal of Pediatric Surgery, 2010

Anorectal malformations (ARMs) are associated with a large number of functional sequale that may ... more Anorectal malformations (ARMs) are associated with a large number of functional sequale that may affect a child's long-term quality of life (QOL). The purposes of this study were to better quantify patient functional stooling outcome and to identify how these outcomes related to the QOL in patients with high imperforate anus. Methods: Forty-eight patients from 2 children's hospitals underwent scoring of stooling after 4 years of life. Scoring consisted of a 13-item questionnaire to assess long-term stooling habits (score range: 0-30, worst to best). These results were then correlated with a QOL survey as judged by a parent or guardian. Result: Mean (SD) age at survey was 6.5 (1.6) years. Comparison of QOL and clinical scoring showed no signficant difference between the 2 institutions (P N .05). There was a direct correlation between the QOL and stooling score (Pearson r 2 = 0.827; β coefficient = 24.7, P b .001). Interestingly, functional stooling scores worsened with increasing age (Pearson r 2 = 0.318, P = .02). Patients with associated congenital anomalies had a high rate of poor QOL (44% in poor range; P = .001). Stooling scores decreased significantly with increasing severity/complexity of the ARM (P = .001). Conclusion: A large number of children experience functional stooling problems, and these were directly associated with poor QOL. In contrast to previous perceptions, our study showed that stooling patterns are perceived to worsen with age. This suggests that children with ARMs need long-term follow-up and counseling.

Research paper thumbnail of 660 Successful Implantation of Physiologically Functional Bioengineered Mouse Internal Anal Sphincter

Research paper thumbnail of Successful implantation of physiologically functional bioengineered mouse internal anal sphincter

AJP: Gastrointestinal and Liver Physiology, 2010

We have previously developed bioengineered three-dimensional internal anal sphincter (IAS) rings ... more We have previously developed bioengineered three-dimensional internal anal sphincter (IAS) rings from circular smooth muscle cells isolated from rabbit and human IAS. We provide proof of concept that bioengineered mouse IAS rings are neovascularized upon implantation into mice of the same strain and maintain concentric smooth muscle alignment, phenotype, and IAS functionality. Rings were bioengineered by using smooth muscle cells from the IAS of C57BL/6J mice. Bioengineered mouse IAS rings were implanted subcutaneously on the dorsum of C57BL/6J mice along with a microosmotic pump delivering fibroblast growth factor-2. The mice remained healthy during the period of implantation, showing no external signs of rejection. Mice were killed 28 days postsurgery and implanted IAS rings were harvested. IAS rings showed muscle attachment, neovascularization, healthy color, and no external signs of infection or inflammation. Assessment of force generation on harvested IAS rings showed the follo...

Research paper thumbnail of 5 Management of Post Hypospadias Urethral Fistula

Research paper thumbnail of One-year outcome of laparoscopic sleeve gastrectomy in morbidly obese adolescents

Annals of Pediatric Surgery, 2021

Adolescent obesity is an important health issue. Non-surgical weight management programs, even th... more Adolescent obesity is an important health issue. Non-surgical weight management programs, even the most aggressive, have shown modest weight reduction results. Laparoscopic sleeve gastrectomy (LSG) is gaining reliability as a low surgical risk bariatric procedure with proper efficiency for this age group. The aim of this study was to present our initial experience with LSG in morbidly obese adolescents and to report short-term clinical and metabolic outcome. Mean age was 16.43 years, and mean preoperative weight and body mass index (BMI) were 132.68 kg and 48.90 respectively. Mean excess weight loss (EWL) was 54.11 kg 1 year after LSG, corresponding to 74 EWL% as well as mean BMI loss (BML) of 19.89. LSG improved fatty infiltration of the liver in 75% of cases and other comorbidities in 100% of patients. LSG proved to be a safe procedure with significant short-term clinical and metabolic success for adolescent obesity.

Research paper thumbnail of Effect of laparoscopic sleeve gastrectomy on metabolic syndrome in adolescent obesity

Journal of Pediatric Endoscopic Surgery, 2020

Background Metabolic syndrome (MeS) is a group of physiological, biochemical, clinical, and metab... more Background Metabolic syndrome (MeS) is a group of physiological, biochemical, clinical, and metabolic factors which increase the incidence of atherosclerosis, type 2 diabetes mellitus, and early mortality. Overall prevalence of MeS is around 3.3%, 11.9% in overweight, 29.2% in obese, and less than 1% in non-obese children. Nearly, 90% of obese children and adolescents have at least one parameter of MeS. Objective Clinical and metabolic evaluation of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG). Subjects and methods Prospective study included analysis of data from 35 adolescents (12-19 years) with body mass index (BMI) above 99th percentile for age and sex. All of them had metabolic syndrome and were submitted to LSG between 2015 and 2017. Anthropometric measurements, clinical and laboratory assessment were performed, preoperatively, 6, 12, and 24 months postoperatively. Results Mean age was 16.43 years and mean preoperative weight and BMI were 132.68 kg and 48.90, respectively. Mean excess weight loss (EWL) was 54.11 kg after 12 months' and 51.19 kg after 24-months post-LSG, corresponding to 74 and 73 EWL%, respectively, as well as mean BMI loss (BML) of 19.89 and 18.7 kg/m 2. LSG improved fatty infiltration of liver in 93% of cases and other comorbidities in 100% of patients. Conclusions Laparoscopic sleeve gastrectomy (LSG) proved as a safe and effective procedure for adolescent obesity and its related metabolic morbidities.

Research paper thumbnail of Anterior Sagittal Anorectoplasty with External Sphincter Preservation for the Treatment of Recto-vestibular Fistula: A New Approach

Journal of Indian Association of Pediatric Surgeons

To our knowledge, there is no description of anterior sagittal anorectoplasty (ASARP) with extern... more To our knowledge, there is no description of anterior sagittal anorectoplasty (ASARP) with external anal sphincter preservation and passing neorectum in the middle of muscle complex under direct vision for the treatment of recto-vestibular fistula (VF). This study evaluates a new modification combining ASARP with under vision sphincter preservation. This prospective study was conducted on thirty female infants with VF. Procedure starts with a vertical midline incision extending from ectopic opening to posterior limit of external sphincter. Sharp dissection of the fistula is carried out. Artery forceps is passed at the center of muscle complex under vision, then neorectum is placed in the middle of the muscle complex. We introduced a new scoring system based on parental interview assessing functional outcome. Each patient was given a score between 0 and 20; good: 14-20, fair: 7-13, and poor: 0-6. ASARP was performed at a mean age of 2.6 months, a mean weight of 5.2 kg, a mean operati...

Research paper thumbnail of Short-term outcome of posterior anorectal myectomy for treatment of children with intractable idiopathic constipation

Annals of Pediatric Surgery, 2017

Research paper thumbnail of Urethral advancement procedure in the treatment of primary distal hypospadias

Annals of Pediatric Surgery, 2017

Research paper thumbnail of Acute calcular cholangitis in a diverse multi-ethnic population

International Journal of Surgery Open, 2016

Research paper thumbnail of Short-Term Outcome of “Double Crown” Tackers Mesh Fixation in Laparoscopic Ventral Hernia Repair

Research paper thumbnail of The versatility of the transumbilical approach for laparotomy in infants

Annals of Pediatric Surgery, 2015

ABSTRACT Background/purpose: Although the transumbilical approach became very popular for pylorom... more ABSTRACT Background/purpose: Although the transumbilical approach became very popular for pyloromyotomy, it has not been widely used in other procedures in children. The aim of this work was to evaluate the safety and the versatility of this approach for laparotomy in infants. Patients and methods: All hemodynamically stable neonates and infants with gastrointestinal surgical problems or pelvic or abdominal cystic masses were considered candidates for this approach. The umbilicus was incised nearly circumferentially, and the peritoneum was entered in the midline in a cephalic or caudal direction depending on the site of the lesion. The bowel or the mass was delivered outside the peritoneal cavity, and the procedure was completed in the standard open manner. Patients were evaluated with regard to the feasibility of the surgery and or any difficulty to complete the surgery, any complications related to the approach, and the cosmetic outcome. Results: A total of 141 infants underwent transumbilical laparotomy during the period from June 2008 to December 2013. The primary pathology was hypertrophic pyloric stenosis (n=65), duodenal, small-intestinal atresia/stricture (n=22), colonic atresia (n=2), malrotation with/without volvulus (n=10), ovarian cysts (n=12), intussusception (n=9), spontaneous intestinal perforation (n=7), remnants of vitellointestinal duct (n=4), mesenteric cysts (n=3), patent urachus (n=3), postoperative complications of strangulated inguinal hernia (n=3), and complications in ventriculoperitoneal shunts (n=1). Their age ranged from 1 day to 22 months. The operating time ranged from 30 to 120 min. Three patients required transverse extension of the wound. Two (1.4%) patients developed dehiscence of the wound that required wound closure. Five (3.5%) patients had superficial periumbilical cellulitis and wound infections, and one patient had suture reaction treated conservatively. Late complications (adhesive intestinal obstruction) occurred in three (2%) patients. Parents were very satisfied with the final cosmetic outcome. Conclusion: The transumbilical approach is both a feasible and a safe approach for a broad spectrum of surgical procedures in neonates and infants. The cosmetic results are excellent.

Research paper thumbnail of Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients

Research paper thumbnail of Management of Post Hypospadias Urethral Fistula

Current Concepts of Urethroplasty, 2011

Research paper thumbnail of Outcome of the Rhomboid Flap for Recurrent Pilonidal Disease

World Journal of Surgery, 2009

Research paper thumbnail of Laparoscopy in the Management of Impalpable Testis: Series of 64 Cases

World Journal of Surgery, 2009

Research paper thumbnail of Surgical implantation of a bioengineered internal anal sphincter

Journal of Pediatric Surgery, 2010

Purpose-Fecal incontinence is a common disorder that can have devastating social and psychologic ... more Purpose-Fecal incontinence is a common disorder that can have devastating social and psychologic consequences. However, there are no long-term ideal solutions for such patients. Although loss of continence is multifactorial, the integrity of the internal anal sphincter (IAS) has particular significance. We previously described the development of 3-dimensional bioengineered constructs using isolated smooth muscle tissue from donor C57BL/6 IAS. We hypothesized that the bioengineered ring constructs would retain cellular viability and promote neovascularization upon implantation into a recipient mouse. Methods-Internal anal sphincter ring constructs were surgically implanted into the subcutaneous tissue of syngeneic C57BL/6 mice and treated with either fibroblastic growth factor 2 (0.26 µg daily) or saline controls using a microosmotic pump. Internal anal sphincter constructs were harvested after 25 days (range, 23-26 days) and assessed morphologically and for tissue viability. Result-Gross morphology showed that there was no rejection. Rings showed muscle attachment to the back of the mouse with no sign of inflammation. Fibroblastic growth factor 2 infusion resulted in a significantly improved histologic score and muscle viability compared with the control group. Conclusions-Three-dimensional bioengineered IAS rings can be successfully implanted into the subcutaneous tissue of recipient mice. The addition of fibroblastic growth factor 2 led to improved muscle viability, vascularity, and survival. This approach may become a feasible option for patients with fecal incontinence.

Research paper thumbnail of Long-term functional outcome and quality of life in patients with high imperforate anus

Journal of Pediatric Surgery, 2010

Anorectal malformations (ARMs) are associated with a large number of functional sequale that may ... more Anorectal malformations (ARMs) are associated with a large number of functional sequale that may affect a child's long-term quality of life (QOL). The purposes of this study were to better quantify patient functional stooling outcome and to identify how these outcomes related to the QOL in patients with high imperforate anus. Methods: Forty-eight patients from 2 children's hospitals underwent scoring of stooling after 4 years of life. Scoring consisted of a 13-item questionnaire to assess long-term stooling habits (score range: 0-30, worst to best). These results were then correlated with a QOL survey as judged by a parent or guardian. Result: Mean (SD) age at survey was 6.5 (1.6) years. Comparison of QOL and clinical scoring showed no signficant difference between the 2 institutions (P N .05). There was a direct correlation between the QOL and stooling score (Pearson r 2 = 0.827; β coefficient = 24.7, P b .001). Interestingly, functional stooling scores worsened with increasing age (Pearson r 2 = 0.318, P = .02). Patients with associated congenital anomalies had a high rate of poor QOL (44% in poor range; P = .001). Stooling scores decreased significantly with increasing severity/complexity of the ARM (P = .001). Conclusion: A large number of children experience functional stooling problems, and these were directly associated with poor QOL. In contrast to previous perceptions, our study showed that stooling patterns are perceived to worsen with age. This suggests that children with ARMs need long-term follow-up and counseling.

Research paper thumbnail of 660 Successful Implantation of Physiologically Functional Bioengineered Mouse Internal Anal Sphincter

Research paper thumbnail of Successful implantation of physiologically functional bioengineered mouse internal anal sphincter

AJP: Gastrointestinal and Liver Physiology, 2010

We have previously developed bioengineered three-dimensional internal anal sphincter (IAS) rings ... more We have previously developed bioengineered three-dimensional internal anal sphincter (IAS) rings from circular smooth muscle cells isolated from rabbit and human IAS. We provide proof of concept that bioengineered mouse IAS rings are neovascularized upon implantation into mice of the same strain and maintain concentric smooth muscle alignment, phenotype, and IAS functionality. Rings were bioengineered by using smooth muscle cells from the IAS of C57BL/6J mice. Bioengineered mouse IAS rings were implanted subcutaneously on the dorsum of C57BL/6J mice along with a microosmotic pump delivering fibroblast growth factor-2. The mice remained healthy during the period of implantation, showing no external signs of rejection. Mice were killed 28 days postsurgery and implanted IAS rings were harvested. IAS rings showed muscle attachment, neovascularization, healthy color, and no external signs of infection or inflammation. Assessment of force generation on harvested IAS rings showed the follo...