khalid shreef | Zagazig University (original) (raw)

Papers by khalid shreef

Journal of pediatric surgery case reports, Feb 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

the egyptian journal of surgery, 2017

Background and purpose Laparoscopic appendectomy for uncomplicated appendicitis is associated wit... more Background and purpose Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy of laparoscopic appendectomy in complicated appendicitis in young children. Patients and methods From May 2015 to May 2016 83 patients aged less than 7 years old underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications (ileus, wound infection and intraabdominal abscess). Results The mean age of studied cases was 6.3 years. In 81 patients (97.6%) the procedure was completed laparoscopically. Two (2.4%) patients required conversion to open appendectomy. The operative time was 75.5±28.8 minutes. Two patients (4.6%) had post-operative ileus. One patient (1.2%) developed superficial wound infection. Four patients (4.8%) developed intra-abdominal collections. The mean length of hospital stay was 5.3±2.1 days. No mortality was recorded. Conclusion Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

European Journal of Pediatric Surgery, Feb 6, 2017

Introduction Gastrointestinal basidiobolomycosis (GIB) is an emerging fungal infection in childre... more Introduction Gastrointestinal basidiobolomycosis (GIB) is an emerging fungal infection in children that leads to diagnostic confusion. Aim Our study aim was twofold: a systematic review of published literature and an update of some Saudi Arabia hospital series to analyze their as well as our own experience in diagnosis and management of GIB. Material and Methods This clinical study included 18 children whose final diagnosis was GIB. The patients, who ranged in age from 5 to 10 years, were admitted between November 2009 and November 2015 with vague abdominal pains with or without abdominal masses for further investigation. Results Abdominal pain was the most common presenting symptom (94.4%) followed by constipation and abdominal mass (83.3 and 77.8%, respectively); fever was present in only 22.2% of the cases. Elevated inflammatory markers and eosinophilia (94.4%) appeared as prominent laboratory findings. Conclusion We conclude that diagnosing GIB in children requires a high index of suspicion, awareness, and consideration of its possibility in the differential diagnosis in patients with abdominal masses and eosinophilia, particularly in areas where it is endemic. Increased awareness of this clinical entity, early surgical resection of the infected tissue, and prolonged treatment with itraconazole offer the best chance for curing the disease.

African Journal of Paediatric Surgery, 2016

Background: Once it is established that a jaundiced infant has direct hyperbilirubinemia, the pri... more Background: Once it is established that a jaundiced infant has direct hyperbilirubinemia, the principal diagnostic concern is to differentiate hepatocellular from obstructive cholestasis. Traditional tests such as ultrasonography, percutaneous liver biopsy and technetium 99 m hepatobiliary iminodiacetic acid (HIDA) scan are often not sufficiently discriminating. Definitive exclusion of biliary atresia (BA) in the infant with cholestatic jaundice usually requires mini-laparotomy and intra-operative cholangiography. This approach has many drawbacks because those sick infants are subjected to a time-consuming procedure with the probability of negative surgical exploration. Aim of the Study: The aim of this study was to determine the feasibility of laparoscopic-guided cholecystocholangiography (LGCC) and its accuracy and safety in the diagnosis of BA and thus preventing unnecessary laparotomy in infants whose cholestasis is caused by diseases other than BA. Patients and Methods: Twelve cholestatic infants with direct hyperbilirubinemia subjected to LGCC (age, 7–98 days; mean, 56 days) after ultrasound scan and (99 mTc) HIDA scan and percutaneous liver biopsy failed to provide the definitive diagnosis. Results: One patient had completely absent gall bladder (GB) so the laparoscopic procedure was terminated and laparotomy was done (Kasai operation). Four patients had small size GB; they underwent LGCC that showed patent common bile duct with atresia of common hepatic duct, so laparotomy and Kasai operation was performed. Seven patients had well-developed GB, LGCC revealed patent biliary tree, so laparoscopic liver biopsies were taken for histopathology. Five of those patients had neonatal hepatitis, and two had cholestasis as a complication of prolonged TPN. No perioperative complications or mortalities were recorded. Conclusion: When the diagnosis neonatal cholestasis remains elusive after traditional investigations, LGCC is an accurate and simple method for differentiating BA from hepatocellular causes.

Annals of Pediatric Surgery, Apr 1, 2015

Background and objectives Pancreatic pseudocysts are rare in children, with most series describin... more Background and objectives Pancreatic pseudocysts are rare in children, with most series describing not more than 24 patients. At Zagazig University Hospital we have managed a range of cases of this disorder and feel this experience should add to the existing experience with children. This study aimed to analyze the causes, clinical presentation, and management of symptomatic pancreatic pseudocysts treated at our institution. Patients and methods This study included 19 children. Their ages ranged from 1 month to 17 years. All cases were diagnosed as pancreatic pseudocysts and were admitted and treated in the Pediatric Surgery Unit, Zagazig University Hospital, during the period from 1996 to 2011. The collected data included age, sex, etiology, clinical presentation, radiological information, operative data, postoperative complications, and the final outcome. Results Twelve patients (63.2%) had a history of abdominal trauma, whereas the remaining seven patients (36.8%) had no abdominal trauma. The pseudocysts were acute in 11 patients, chronic in seven patients, and only one patient had congenital pseudocyst. Nine patients improved with expectant treatment; however, 10 patients required surgery. The surgical intervention included cystogastrostomy for four patients, cystojejunostomy for two patients, complete excision with distal pancreatectomy in two children, and partial excision with external drainage in the remaining two patients. One patient developed postoperative wound infection, and two cases had external pancreatic fistula. Conclusion Although spontaneous resolution of pancreatic pseudocysts occurred, more commonly, in acute, small-sized, and post-traumatic cysts, the surgical treatment of pancreatic pseudocyst is a valid, safe, effective, and satisfactory treatment, especially in complicated cases.

Annals of Pediatric Surgery, Apr 1, 2011

Background/Purpose Among children aged from 1 to 14 years, approximately 50% of mortality is rela... more Background/Purpose Among children aged from 1 to 14 years, approximately 50% of mortality is related to trauma. Abdominal injuries account for approximately 10% of trauma deaths in childhood. Child injury has great effects on communities and countries. The agent-hostenvironment model has been used to describe the epidemiology of communicable diseases. It can be adapted for understanding childhood injuries. This study aims to evaluate the Zagazig University experience with blunt abdominal trauma (BAT) in children in light of the epidemiological (agent-host-environment) model. Patients and methods This study included 590 consecutive patients aged from 1 to 14 years, who were admitted to the Emergency Unit at the Zagazig University Hospital, after BAT incidents in the period January 2006-2010. A predesigned format was used to collect targeted data. Results The study included 590 children with BAT. They made up approximately 18% of total children trauma cases. Multisystem trauma occurred in 72.5% of patients. The causative energy in this study was mechanical energy that was most commonly transmitted through road traffic accidents (55.8%). When mechanisms of trauma were related to age groups, we found that road traffic accidents were significantly more common among children aged from 5 to 14 years (P value < 0.001), whereas falls were significantly more common among children aged from 1 to 4 years (P value < 0.001). The most common physical environment was streets. BAT was more in urban areas (65%) and in low socioeconomic states (67%). Conclusion According to this study, most BAT vulnerable children are boys aged from 5 to 14 years, living in urban areas, and with low socioeconomic status. The agenthost-environment model can be used to study causative and contributing factors to trauma. It can be utilized to structure and plan preventive interventions against BAT in children.

Annals of Pediatric Surgery, Aug 6, 2010

Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approx... more Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approximately 4%. Recurrence may be attributed to tearing of a friable sac, slipping of the ligature at the neck of the sac or failure to ligate the sac high at the internal ring. In boys, re-operations are difficult and require tedious and careful dissection of the dense fibrous tissue resulting from the earlier surgery. There are definite risks of damaging the vas deferens and testicular vessels. The aim of this study is to evaluate the feasibility and outcome of using the mesh plug technique in the repair of certain difficult cases of recurrent indirect inguinal hernia in male infants and children. Materials & Methods: This prospective study was carried out at the pediatric surgery unit, surgical department, Zagazig University Hospitals, Egypt during the period from April 2008 to September 2009. The study included 10 boys with recurrent indirect inguinal hernia. Patients were included in the study during the surgical procedure if they have one of the following inclusion criteria: marked adhesions and fibrosis surrounding the cord, distorted anatomy of the inguinal region and patulous internal ring Results: A total of 10 operations in 10 infants were performed. The patients age ranged from 3 months to 2 years with the mean age (12.1 months). All cases had severe adhesions surrounding the cord structure with marked distortion of the anatomy. Two cases had associated patulous internal ring. The operative time ranged from 20-30 minutes (mean 25 min). The follow-up period ranged from one month to 11 months (mean 5.8 months), during the follow-up period no major complications were noted. Conclusion: The application of mesh plug technique in the repair of difficult cases of recurrent indirect inguinal hernia in boys is easily applicable, safe and not expensive. Index Word: Laparoscopes, recurrent indirect inguinal hernia in children, mesh plug technique.

Journal of pediatric surgery case reports, Apr 1, 2020

African Journal of Paediatric Surgery, 2017

Background: Rectovestibular fistula (RVF) is the most common type of anorectal malformations in f... more Background: Rectovestibular fistula (RVF) is the most common type of anorectal malformations in females. The need for a diverting colostomy during correction of defect has ignited a heated debate. In this study, we reviewed the girls with RVF that had been treated by either one or two stage procedure in the past 10 years in our institution to define whether one stage or two stage procedures is safer and more beneficial for the patients. Materials and Methods: Seventy girls with RVF that had been operated from January 2005 to January 2015 were studied retrospectively. Data were obtained from medical hospital records. The cases were divided into two groups. Group A (46 patients): were operated by two stages technique (simultaneous sigmoid colostomy and anterior sagittal anorectoplasty [ASARP]). Group B (24 patients): were operated by one stage (ASARP without covering colostomy). The short-term outcome as regard wound infection, wound dehiscence, anal stenosis, anal retraction, recurrence of fistula as well as complications of colostomy was reported. The long-term outcome as regard soiling, constipation and voluntary bowel movement was evaluated. Results: The age of patients at the time of surgery ranged from 3 months to 2 years (mean; 9.5 months). In Group A, seven patients (15.2%) developed wound infection, two patients developed wound disruption. One patient developed anterior anal retraction and required redo-operation, anal stenosis was noticed in five (10.9%) patients. Complications from colostomy had occurred in nine patients (19.5%). In Group B, wound infection occurred in ten patients (41.7%). Seven patients (29.2%) developed wound disruption. Anal stenosis occurred in eight patients (33.3%). Five patients required redo-operation because of anal retraction in three patients and recurrence of fistula in the other two patients. Constipation recorded in 15 patients (32.6%) of Group A and in ten patients (41.3%) of Group B. Soiling was reported in six girls (13.04%) of Group A and five girls (20.8%) of Group B. Conclusion: The avoidance of colostomy is not outweighed achieving sound operation and continent child. Two stages correction of RVF is safer and more beneficial than one stage procedure, especially in our locality and for our paediatric surgeons during their learning curve.

Dermatology Research and Practice, 2014

Background. Infantile hemangiomas (IHs) are the most common benign tumours of infancy. Propranolo... more Background. Infantile hemangiomas (IHs) are the most common benign tumours of infancy. Propranolol has recently been reported to be a highly effective treatment for IHs. This study aimed to evaluate the efficacy and side effects of propranolol for treatment of complicated cases of IHs. Patients and Methods. This prospective clinical study included 30 children with huge or complicated IHs; their ages ranged from 2 months to 1 year. They were treated by oral propranolol. Treatment outcomes were clinically evaluated. Results. Superficial cutaneous hemangiomas began to respond to propranolol therapy within one to two weeks after the onset of treatment. The mean treatment period that was needed for the occurrence of complete resolution was 9.4 months. Treatment with propranolol was well tolerated and had few side effects. No rebound growth of the tumors was noted when propranolol dosing stopped except in one case. Conclusion. Propranolol is a promising treatment for IHs without obvious side effects. However, further studies with longer follow-up periods are needed.

Ain Shams Journal of Surgery, 2009

The management of CBD stones has traditionally required open laparotomy and bile duct exploration... more The management of CBD stones has traditionally required open laparotomy and bile duct exploration. Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP), preoperative clearance of common bile duct (CBD) stones prior to cholecystectomy has been widely adopted. 1 However, in the present laparoscopic era, the best treatment for patients with choledocholithiasis is a matter of debate and the management of choledocholithiasis continues to evolve. If the stones are found by intraoperative cholangiography during laparoscopic cholecystectomy(LC), the surgeon may either do the LC and refer the patient to endoscopic sphincterotomy(ES) postoperatively,or he may convert to open CBD exploration or in the current times he may do laparoscopic CBD exploration (LCBDE). 2

Gastrointestinal Basidiobolomycosis (GIB) is an emerging fungal infection that manifests in the s... more Gastrointestinal Basidiobolomycosis (GIB) is an emerging fungal infection that manifests in the skin and rarely involves other systems. Visceral involvement by basidiobolomycosis is rare with only few cases (73 cases) have been reported worldwide so far. Most of the cases of pediatric GIB were reported from the southern region of Saudi Arabia. It is caused by Basidiobolus ranarum, which does not usually invade blood vessels and rarely disseminates. All age groups are susceptible to infection. According to a recent reviews, the mean age was 37 years. Male to female ratio is 5:1.

Annals of Pediatric Surgery, 2015

Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approx... more Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approximately 4%. Recurrence may be attributed to tearing of a friable sac, slipping of the ligature at the neck of the sac or failure to ligate the sac high at the internal ring. In boys, re-operations are difficult and require tedious and careful dissection of the dense fibrous tissue resulting from the earlier surgery. There are definite risks of damaging the vas deferens and testicular vessels. The aim of this study is to evaluate the feasibility and outcome of using the mesh plug technique in the repair of certain difficult cases of recurrent indirect inguinal hernia in male infants and children. Materials & Methods: This prospective study was carried out at the pediatric surgery unit, surgical department, Zagazig University Hospitals, Egypt during the period from April 2008 to September 2009. The study included 10 boys with recurrent indirect inguinal hernia. Patients were included in th...

Background: Nasal dermoid sinus cyst is a rare congenital anomaly affecting approximately 1 in 20... more Background: Nasal dermoid sinus cyst is a rare congenital anomaly affecting approximately 1 in 20,000–40,000 live births. It is liable for infection and may communicate with the central nervous system. The treatment is complete surgical excision. Case history: Nine months old male presented by a pea-size fronto-nasal swelling over the nasal bridge since birth, gradually increasing in size with recent history of local redness and discharge. Sagittal CT of the skull showed osteolytic lesion at the fronto-nasal bone with eroded inner and outer tables). MRI showed no intracranial extension. Surgical excision was done by combined nasal and bicoronal incisions. A big abscess cavity was encountered at the fronto-nasal bone junction. The diagnosis of Nasal dermoid sinus cyst was confirmed by histopathology. The patient was followed in the outpatient clinic; MRI was done after one month. No recurrence was detected.

Journal of Pediatric Surgery Case Reports

African Journal of Paediatric Surgery

Journal of Pediatric Surgery Case Reports

Journal of pediatric surgery case reports, Feb 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

the egyptian journal of surgery, 2017

Background and purpose Laparoscopic appendectomy for uncomplicated appendicitis is associated wit... more Background and purpose Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy of laparoscopic appendectomy in complicated appendicitis in young children. Patients and methods From May 2015 to May 2016 83 patients aged less than 7 years old underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications (ileus, wound infection and intraabdominal abscess). Results The mean age of studied cases was 6.3 years. In 81 patients (97.6%) the procedure was completed laparoscopically. Two (2.4%) patients required conversion to open appendectomy. The operative time was 75.5±28.8 minutes. Two patients (4.6%) had post-operative ileus. One patient (1.2%) developed superficial wound infection. Four patients (4.8%) developed intra-abdominal collections. The mean length of hospital stay was 5.3±2.1 days. No mortality was recorded. Conclusion Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

European Journal of Pediatric Surgery, Feb 6, 2017

Introduction Gastrointestinal basidiobolomycosis (GIB) is an emerging fungal infection in childre... more Introduction Gastrointestinal basidiobolomycosis (GIB) is an emerging fungal infection in children that leads to diagnostic confusion. Aim Our study aim was twofold: a systematic review of published literature and an update of some Saudi Arabia hospital series to analyze their as well as our own experience in diagnosis and management of GIB. Material and Methods This clinical study included 18 children whose final diagnosis was GIB. The patients, who ranged in age from 5 to 10 years, were admitted between November 2009 and November 2015 with vague abdominal pains with or without abdominal masses for further investigation. Results Abdominal pain was the most common presenting symptom (94.4%) followed by constipation and abdominal mass (83.3 and 77.8%, respectively); fever was present in only 22.2% of the cases. Elevated inflammatory markers and eosinophilia (94.4%) appeared as prominent laboratory findings. Conclusion We conclude that diagnosing GIB in children requires a high index of suspicion, awareness, and consideration of its possibility in the differential diagnosis in patients with abdominal masses and eosinophilia, particularly in areas where it is endemic. Increased awareness of this clinical entity, early surgical resection of the infected tissue, and prolonged treatment with itraconazole offer the best chance for curing the disease.

African Journal of Paediatric Surgery, 2016

Background: Once it is established that a jaundiced infant has direct hyperbilirubinemia, the pri... more Background: Once it is established that a jaundiced infant has direct hyperbilirubinemia, the principal diagnostic concern is to differentiate hepatocellular from obstructive cholestasis. Traditional tests such as ultrasonography, percutaneous liver biopsy and technetium 99 m hepatobiliary iminodiacetic acid (HIDA) scan are often not sufficiently discriminating. Definitive exclusion of biliary atresia (BA) in the infant with cholestatic jaundice usually requires mini-laparotomy and intra-operative cholangiography. This approach has many drawbacks because those sick infants are subjected to a time-consuming procedure with the probability of negative surgical exploration. Aim of the Study: The aim of this study was to determine the feasibility of laparoscopic-guided cholecystocholangiography (LGCC) and its accuracy and safety in the diagnosis of BA and thus preventing unnecessary laparotomy in infants whose cholestasis is caused by diseases other than BA. Patients and Methods: Twelve cholestatic infants with direct hyperbilirubinemia subjected to LGCC (age, 7–98 days; mean, 56 days) after ultrasound scan and (99 mTc) HIDA scan and percutaneous liver biopsy failed to provide the definitive diagnosis. Results: One patient had completely absent gall bladder (GB) so the laparoscopic procedure was terminated and laparotomy was done (Kasai operation). Four patients had small size GB; they underwent LGCC that showed patent common bile duct with atresia of common hepatic duct, so laparotomy and Kasai operation was performed. Seven patients had well-developed GB, LGCC revealed patent biliary tree, so laparoscopic liver biopsies were taken for histopathology. Five of those patients had neonatal hepatitis, and two had cholestasis as a complication of prolonged TPN. No perioperative complications or mortalities were recorded. Conclusion: When the diagnosis neonatal cholestasis remains elusive after traditional investigations, LGCC is an accurate and simple method for differentiating BA from hepatocellular causes.

Annals of Pediatric Surgery, Apr 1, 2015

Background and objectives Pancreatic pseudocysts are rare in children, with most series describin... more Background and objectives Pancreatic pseudocysts are rare in children, with most series describing not more than 24 patients. At Zagazig University Hospital we have managed a range of cases of this disorder and feel this experience should add to the existing experience with children. This study aimed to analyze the causes, clinical presentation, and management of symptomatic pancreatic pseudocysts treated at our institution. Patients and methods This study included 19 children. Their ages ranged from 1 month to 17 years. All cases were diagnosed as pancreatic pseudocysts and were admitted and treated in the Pediatric Surgery Unit, Zagazig University Hospital, during the period from 1996 to 2011. The collected data included age, sex, etiology, clinical presentation, radiological information, operative data, postoperative complications, and the final outcome. Results Twelve patients (63.2%) had a history of abdominal trauma, whereas the remaining seven patients (36.8%) had no abdominal trauma. The pseudocysts were acute in 11 patients, chronic in seven patients, and only one patient had congenital pseudocyst. Nine patients improved with expectant treatment; however, 10 patients required surgery. The surgical intervention included cystogastrostomy for four patients, cystojejunostomy for two patients, complete excision with distal pancreatectomy in two children, and partial excision with external drainage in the remaining two patients. One patient developed postoperative wound infection, and two cases had external pancreatic fistula. Conclusion Although spontaneous resolution of pancreatic pseudocysts occurred, more commonly, in acute, small-sized, and post-traumatic cysts, the surgical treatment of pancreatic pseudocyst is a valid, safe, effective, and satisfactory treatment, especially in complicated cases.

Annals of Pediatric Surgery, Apr 1, 2011

Background/Purpose Among children aged from 1 to 14 years, approximately 50% of mortality is rela... more Background/Purpose Among children aged from 1 to 14 years, approximately 50% of mortality is related to trauma. Abdominal injuries account for approximately 10% of trauma deaths in childhood. Child injury has great effects on communities and countries. The agent-hostenvironment model has been used to describe the epidemiology of communicable diseases. It can be adapted for understanding childhood injuries. This study aims to evaluate the Zagazig University experience with blunt abdominal trauma (BAT) in children in light of the epidemiological (agent-host-environment) model. Patients and methods This study included 590 consecutive patients aged from 1 to 14 years, who were admitted to the Emergency Unit at the Zagazig University Hospital, after BAT incidents in the period January 2006-2010. A predesigned format was used to collect targeted data. Results The study included 590 children with BAT. They made up approximately 18% of total children trauma cases. Multisystem trauma occurred in 72.5% of patients. The causative energy in this study was mechanical energy that was most commonly transmitted through road traffic accidents (55.8%). When mechanisms of trauma were related to age groups, we found that road traffic accidents were significantly more common among children aged from 5 to 14 years (P value < 0.001), whereas falls were significantly more common among children aged from 1 to 4 years (P value < 0.001). The most common physical environment was streets. BAT was more in urban areas (65%) and in low socioeconomic states (67%). Conclusion According to this study, most BAT vulnerable children are boys aged from 5 to 14 years, living in urban areas, and with low socioeconomic status. The agenthost-environment model can be used to study causative and contributing factors to trauma. It can be utilized to structure and plan preventive interventions against BAT in children.

Annals of Pediatric Surgery, Aug 6, 2010

Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approx... more Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approximately 4%. Recurrence may be attributed to tearing of a friable sac, slipping of the ligature at the neck of the sac or failure to ligate the sac high at the internal ring. In boys, re-operations are difficult and require tedious and careful dissection of the dense fibrous tissue resulting from the earlier surgery. There are definite risks of damaging the vas deferens and testicular vessels. The aim of this study is to evaluate the feasibility and outcome of using the mesh plug technique in the repair of certain difficult cases of recurrent indirect inguinal hernia in male infants and children. Materials & Methods: This prospective study was carried out at the pediatric surgery unit, surgical department, Zagazig University Hospitals, Egypt during the period from April 2008 to September 2009. The study included 10 boys with recurrent indirect inguinal hernia. Patients were included in the study during the surgical procedure if they have one of the following inclusion criteria: marked adhesions and fibrosis surrounding the cord, distorted anatomy of the inguinal region and patulous internal ring Results: A total of 10 operations in 10 infants were performed. The patients age ranged from 3 months to 2 years with the mean age (12.1 months). All cases had severe adhesions surrounding the cord structure with marked distortion of the anatomy. Two cases had associated patulous internal ring. The operative time ranged from 20-30 minutes (mean 25 min). The follow-up period ranged from one month to 11 months (mean 5.8 months), during the follow-up period no major complications were noted. Conclusion: The application of mesh plug technique in the repair of difficult cases of recurrent indirect inguinal hernia in boys is easily applicable, safe and not expensive. Index Word: Laparoscopes, recurrent indirect inguinal hernia in children, mesh plug technique.

Journal of pediatric surgery case reports, Apr 1, 2020

African Journal of Paediatric Surgery, 2017

Background: Rectovestibular fistula (RVF) is the most common type of anorectal malformations in f... more Background: Rectovestibular fistula (RVF) is the most common type of anorectal malformations in females. The need for a diverting colostomy during correction of defect has ignited a heated debate. In this study, we reviewed the girls with RVF that had been treated by either one or two stage procedure in the past 10 years in our institution to define whether one stage or two stage procedures is safer and more beneficial for the patients. Materials and Methods: Seventy girls with RVF that had been operated from January 2005 to January 2015 were studied retrospectively. Data were obtained from medical hospital records. The cases were divided into two groups. Group A (46 patients): were operated by two stages technique (simultaneous sigmoid colostomy and anterior sagittal anorectoplasty [ASARP]). Group B (24 patients): were operated by one stage (ASARP without covering colostomy). The short-term outcome as regard wound infection, wound dehiscence, anal stenosis, anal retraction, recurrence of fistula as well as complications of colostomy was reported. The long-term outcome as regard soiling, constipation and voluntary bowel movement was evaluated. Results: The age of patients at the time of surgery ranged from 3 months to 2 years (mean; 9.5 months). In Group A, seven patients (15.2%) developed wound infection, two patients developed wound disruption. One patient developed anterior anal retraction and required redo-operation, anal stenosis was noticed in five (10.9%) patients. Complications from colostomy had occurred in nine patients (19.5%). In Group B, wound infection occurred in ten patients (41.7%). Seven patients (29.2%) developed wound disruption. Anal stenosis occurred in eight patients (33.3%). Five patients required redo-operation because of anal retraction in three patients and recurrence of fistula in the other two patients. Constipation recorded in 15 patients (32.6%) of Group A and in ten patients (41.3%) of Group B. Soiling was reported in six girls (13.04%) of Group A and five girls (20.8%) of Group B. Conclusion: The avoidance of colostomy is not outweighed achieving sound operation and continent child. Two stages correction of RVF is safer and more beneficial than one stage procedure, especially in our locality and for our paediatric surgeons during their learning curve.

Dermatology Research and Practice, 2014

Background. Infantile hemangiomas (IHs) are the most common benign tumours of infancy. Propranolo... more Background. Infantile hemangiomas (IHs) are the most common benign tumours of infancy. Propranolol has recently been reported to be a highly effective treatment for IHs. This study aimed to evaluate the efficacy and side effects of propranolol for treatment of complicated cases of IHs. Patients and Methods. This prospective clinical study included 30 children with huge or complicated IHs; their ages ranged from 2 months to 1 year. They were treated by oral propranolol. Treatment outcomes were clinically evaluated. Results. Superficial cutaneous hemangiomas began to respond to propranolol therapy within one to two weeks after the onset of treatment. The mean treatment period that was needed for the occurrence of complete resolution was 9.4 months. Treatment with propranolol was well tolerated and had few side effects. No rebound growth of the tumors was noted when propranolol dosing stopped except in one case. Conclusion. Propranolol is a promising treatment for IHs without obvious side effects. However, further studies with longer follow-up periods are needed.

Ain Shams Journal of Surgery, 2009

The management of CBD stones has traditionally required open laparotomy and bile duct exploration... more The management of CBD stones has traditionally required open laparotomy and bile duct exploration. Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP), preoperative clearance of common bile duct (CBD) stones prior to cholecystectomy has been widely adopted. 1 However, in the present laparoscopic era, the best treatment for patients with choledocholithiasis is a matter of debate and the management of choledocholithiasis continues to evolve. If the stones are found by intraoperative cholangiography during laparoscopic cholecystectomy(LC), the surgeon may either do the LC and refer the patient to endoscopic sphincterotomy(ES) postoperatively,or he may convert to open CBD exploration or in the current times he may do laparoscopic CBD exploration (LCBDE). 2

Gastrointestinal Basidiobolomycosis (GIB) is an emerging fungal infection that manifests in the s... more Gastrointestinal Basidiobolomycosis (GIB) is an emerging fungal infection that manifests in the skin and rarely involves other systems. Visceral involvement by basidiobolomycosis is rare with only few cases (73 cases) have been reported worldwide so far. Most of the cases of pediatric GIB were reported from the southern region of Saudi Arabia. It is caused by Basidiobolus ranarum, which does not usually invade blood vessels and rarely disseminates. All age groups are susceptible to infection. According to a recent reviews, the mean age was 37 years. Male to female ratio is 5:1.

Annals of Pediatric Surgery, 2015

Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approx... more Background/Purpose: The recurrence of indirect inguinal hernia vary from less than 0.5% to approximately 4%. Recurrence may be attributed to tearing of a friable sac, slipping of the ligature at the neck of the sac or failure to ligate the sac high at the internal ring. In boys, re-operations are difficult and require tedious and careful dissection of the dense fibrous tissue resulting from the earlier surgery. There are definite risks of damaging the vas deferens and testicular vessels. The aim of this study is to evaluate the feasibility and outcome of using the mesh plug technique in the repair of certain difficult cases of recurrent indirect inguinal hernia in male infants and children. Materials & Methods: This prospective study was carried out at the pediatric surgery unit, surgical department, Zagazig University Hospitals, Egypt during the period from April 2008 to September 2009. The study included 10 boys with recurrent indirect inguinal hernia. Patients were included in th...

Background: Nasal dermoid sinus cyst is a rare congenital anomaly affecting approximately 1 in 20... more Background: Nasal dermoid sinus cyst is a rare congenital anomaly affecting approximately 1 in 20,000–40,000 live births. It is liable for infection and may communicate with the central nervous system. The treatment is complete surgical excision. Case history: Nine months old male presented by a pea-size fronto-nasal swelling over the nasal bridge since birth, gradually increasing in size with recent history of local redness and discharge. Sagittal CT of the skull showed osteolytic lesion at the fronto-nasal bone with eroded inner and outer tables). MRI showed no intracranial extension. Surgical excision was done by combined nasal and bicoronal incisions. A big abscess cavity was encountered at the fronto-nasal bone junction. The diagnosis of Nasal dermoid sinus cyst was confirmed by histopathology. The patient was followed in the outpatient clinic; MRI was done after one month. No recurrence was detected.

Journal of Pediatric Surgery Case Reports

African Journal of Paediatric Surgery

Journal of Pediatric Surgery Case Reports