Sameh Shehata | Alexandria University ,Egypt (original) (raw)

Papers by Sameh Shehata

Introduction: Rectal atresia is a rare subtype of anorectal malformations in which the patients a... more Introduction: Rectal atresia is a rare subtype of anorectal malformations in which the patients are born with a normal anal canal but have complete atresia located few centimeters proximal to the dentate line. We present the transanal end-to-end rectoanal anastomosis as a surgical technique for the management of these patients, highlight the outcomes, and emphasize on some clinical tips. Methods: Four patients were diagnosed as having rectal atresia on clinical and radiological basis. All of them underwent single loop low sigmoid colostomy in the first 24 hours. After 6 months, transanal end-to-end rectoanal anastomosis was performed followed by closure of the stoma 3 months later. Results: The 2 cases that are older than 3 years demonstrated normal continence and are clean between bowel movements, while the other two showed good anal tone and passing stools between 1–3 times daily, being dry in between. Conclusion: Transanal end-to-end rectoanal anastomosis allows a safer route of ...

Journal of Pediatric Surgery Case Reports, 2022

The Lancet, 2020

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoper... more Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74•0%) had emergency surgery and 280 (24•8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26•1%) patients. 30-day mortality was 23•8% (268 of 1128). Pulmonary complications occurred in 577 (51•2%) of 1128 patients; 30-day mortality in these patients was 38•0% (219 of 577), accounting for 82•6% (219 of 265) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1•75 [95% CI 1•28-2•40], p<0•0001), age 70 years or older versus younger than 70 years (2•30 [1•65-3•22], p<0•0001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (2•35 [1•57-3•53], p<0•0001), malignant versus benign or obstetric diagnosis (1•55 [1•01-2•39], p=0•046), emergency versus elective surgery (1•67 [1•06-2•63], p=0•026), and major versus minor surgery (1•52 [1•01-2•31], p=0•047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.

A lot of lessons can be learned by studying the evolution of surgical techniques and concepts use... more A lot of lessons can be learned by studying the evolution of surgical techniques and concepts used to treat a certain surgical entity over time. The eighteenth-century landmark anatomic descriptions of Baron Albrecht von Haller and John Hunter marked the start of the study of cryptorchidism. Hunter described the abdominal origin of fetal testicular development, he coined the term; musculus testis (the cremaster) and in 1762 he first used the term ‘‘gubernaculum’’ for the structure he believed was responsible for guiding testicular descent. Hunter studies were influenced by Baron von Haller’s observations [1].

Introduction: The major obstacles for routine application of thoracoscopic repair for congenital ... more Introduction: The major obstacles for routine application of thoracoscopic repair for congenital diaphragmatic hernia (CHH) in neonates include intraoperative hypercarbia, acidosis and conversion to open surgery. Therefore, strict preoperative selection criteria should be followed for successful primary thoracoscopic repair of the diaphragm and achievement of minimal conversion rate. Materials and Methods: A prospective study was conducted from April 2016 to March 2018, where all neonates confirmed to have CDH were assessed by a specialized anaesthesia team for the possibility of undergoing thoracoscopic repair. In order to assess the severity of persistent pulmonary hypertension (PPH), oxygenation index (OI) was used and babies who had OI <5 were considered to have mild pulmonary hypertension; and consequently underwent thoracoscopic repair. Results: Twenty nine CDH cases met the selection criteria; hence, they underwent thoracoscopic repair. Primary diaphragmatic repair was suc...

... Departments of Radiology, Alexandria University. Shehata Sameh; Alexandria Sporting's Ho... more ... Departments of Radiology, Alexandria University. Shehata Sameh; Alexandria Sporting's Hospital for Sick ... El-Din Yasser Saad; Departments of Paediatric Surgery Alexandria University:Alexandria Sporting's ... no significant difference in neither the operative timing nor the incidence ...

Hernia, 2019

Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants... more Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants and children. Single port laparoscopic hernia repair using percutaneous internal inguinal ring (IIR) suturing procedure is a widely employed technique for indirect inguinal hernia repair in children. The majority of extracorporeal techniques use extracorporeal knotting and burying the knot subcutaneously. This may result in many drawbacks. The aim of this multicenter study is to introduce a new technique for pediatric inguinal hernia repair using only needles without any laparoscopic instruments. Patients and methods This is a multicenter study which was conducted at Pediatric Surgical Departments of Al-Azhar, Mansoura, Alexandria and Tanta Universities during the period from January 2015 to June 2017. 314 patients with CIH underwent Needlescopic Assisted Internal Ring Suturing (NAIRS) after cauterization of the hernia sac at its neck. The main outcome measures were: feasibility, safety of the technique, operative time, recurrence rate, hydrocele and cosmetic results. Results A total of 314 patients with CIH were corrected by NAIRS. They were 232 males and 82 females. The mean age was 28.12 ± 1.3 months (range 6-120 months). The mean operative time was 12.6 ± 1.7 min (range 8-15 min) for unilateral cases and 18.6 ± 1.7 min (range 14-20 min) for the bilateral repairs. All cases were completed laparoscopically without major intraoperative complications. No recurrence was detected in this study. No wound complications or umbilical hernias developed. Hydrocele occurred in five males (2.16%), without detection of testicular atrophy or iatrogenic ascent of the testis. Conclusion This preliminary study showed that NAIRS after cauterization of the neck of the hernia sac in infants and children is safe, feasible, reproducible with excellent cosmetic results.

World Journal of Surgery, 2013

Background Many new tools for management of impalpable testes have emerged during the last few ye... more Background Many new tools for management of impalpable testes have emerged during the last few years, yet, not many studies have compared them to the traditional ways of managing this problem. This work aims to reiterate the importance of the physical examination under general anesthesia prior to the surgical procedure in order to decide the best surgical approach for patients with impalpable undescended testis, especially in developing countries where expensive investigations are at premium. Patients and methods The study included boys who were treated consecutively and recorded prospectively from 2000 to 2010. Examination under anesthesia (EUA) was performed during the study period. Those in whom the testes were palpable underwent the standard orchiopexy procedure. In those boys where EUA failed to detect the testes, laparoscopy or extended inguinal exploration was carried out, and the testes were treated accordingly. Results On initial clinical evaluation at the outpatient clinic, 545 boys were recorded to have impalpable testes. Undescended testis was unilateral in 529 boys and bilateral in 16 boys. However, on examination under anesthesia only 189 (34.7 %) were impalpable. Among boys in whom the testes were palpable after EUA, 38 had small-size testes, 18 had normal size, and the remaining 300 boys had a sac or cord-like structure. Conclusions Meticulous EUA facilitates the accurate diagnosis and planning of the surgical approach to patients with an impalpable testis and should remain part of the surgeon's skill set. It is an inexpensive initial evaluation tool that may help in saving hospital resources, especially in developing countries.

Mini-invasive Surgery, 2017

Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usuall... more Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy.

Pediatric Surgery International, 2021

We aimed to understand the challenges facing children’s surgical care providers globally and real... more We aimed to understand the challenges facing children’s surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children’s surgery. Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children’s Surgery (GICS) with a geographically diverse panel representing four children’s surgical, anesthesia, and nursing subspecialties. Qualitative analysis was performed to identify codes, themes, and subthemes. The most frequently reported challenges were delayed access to care for children; fear among the public and patients; unavailability of appropriate personal protective equipment (PPE); diversion of resources toward COVID-19 care; and interruption in student and trainee hands-on education. To address these challenges, panelists recommended human resource and funding support to minimize backlog; setting up international, multi-center studies for systematic data collection specifically for children; prov...

The kidney is one of the commonest organs for cyst occurrence [1]. Causes are listed in Box 57.1 ... more The kidney is one of the commonest organs for cyst occurrence [1]. Causes are listed in Box 57.1 [2]. Autosomal dominant polycystic kidney disease (ADPKD) is the most common renal cystic disease in the United States [3]. On the other hand, simple renal cysts are comparatively rare in children and adolescents up to 18 years of age. Incidence ranges from 0.1 to 0.45% with a mean of 0.22% without sex predilection [4]. The incidence, however, rises with age reaching 20% and 50% at 40 and 60 years of age, respectively, with apparent male preponderance [5]. Despite originating within the nephron, simple renal cysts lose communication later and become excluded. They usually range from 1 to 10 cm in size, the majority being less than 2 cm [6]. They are usually oval or rounded, solitary or multiple, and unilateral or bilateral. Most cysts are unilocular and cortical in location and, rarely, medullary. They look glistening blue usually distorting renal contour. They are lined by a single laye...

Imperforate anus is a malformation of the anus, children with such type of congenital malformatio... more Imperforate anus is a malformation of the anus, children with such type of congenital malformation usually undergo reconstructive surgery and be looked after by pediatric surgery nurses due to the problems with constipation and fecal incontinence after the colostomy is closed. Lack of control over bowels may affect a child’s psychosocial adjustment. The Aims of This Study are: (a) To evaluate the psychometric properties of the Arabic version of the Imperforate Anus Psychosocial Questionnaire (IAPSQ) on a sample of Egyptian children. (b) To assess the effect of (IA deformity, hypospadias, and rectal prolapse) on the psychosocial functioning of Egyptian children. (c) To compare the psychosocial functioning of children with congenital anomalies of the anus with those suffering from chronic diseases. Methodology: Subjects and Methods Study sample consisted of 35 children (with congenital anomalies of the anus) from Mansoura University Children’s Hospital (n=30), and Alexandria Universit...

ESPES Manual of Pediatric Minimally Invasive Surgery

Urinary bladder tumors are not common in children and adolescents. They are either urothelial or ... more Urinary bladder tumors are not common in children and adolescents. They are either urothelial or non-urothelial (Fig. 65.1). The commonest is rhabdomyosarcoma (RMS) of the bladder or prostate/vagina followed by papillary urothelial tumors (Table 65.1) [1]. RMS, being the commonest childhood soft tissue sarcoma, ranks third commonest pediatric solid tumor (5–15%) [2, 3]. A recent analysis of 57 reports of pediatric urothelial bladder tumors which included 127 cases reported patients younger than 20 years old, of which only 21 patients (16.5%) were below 10 years old [4]. Both tumor categories exhibit a 3–9:1 male-to-female preponderance [5].

Video Atlas of Pediatric Endosurgery (VAPE)

Annals of Pediatric Surgery, 2010

Background/Purpose: The period taken for complete weaning from ventilation in cases of repaired c... more Background/Purpose: The period taken for complete weaning from ventilation in cases of repaired congenital diaphragmatic hernia (CDH) varies greatly. We tried to relate the endo-tracheal tube removal time (ETTRT) in these cases with the different variables; both preoperative and operative. Materials & Methods: This is a retrospective study of cases of CDH survivors managed by the authors over the period from January 2003 till February 2010. The preoperative variables included gestational age, gender, birth weight, Apgar score, the time of intubation, the ventilation strategy, the presence of a significant PDA in the ECHO study and the time-lapse till surgery. The operative variables (all by laparotomy approach) included the side of the hernia, the herniated contents, the presence of a sac, the insertion of a chest tube and the degree of abdominal wall stretch required. The successful weaning from ventilation and ETTRT were classified into two groups; ≤7 days and > 7 days postoper...