Ashwani K. Pandey

Lingual Mucosal Graft Urethroplasty for Anterior Urethral Strictures

OBJECTIVE To evaluate the effectiveness of a lingual mucosal graft (LMG) urethroplasty for anterior urethral strictures and the donor site complications. METHODS A total of 30 patients underwent urethroplasty for anterior urethral strictures using dorsal on-lay of a LMG from March 2006 to December 2006. Most patients had balanitis xerotica obliterans as the etiology. The mean stricture length was 10.2 cm (range 3.7-16.5). Postoperatively, all patients underwent pericatheter urethrography at 3 weeks, followed by retrograde urethrography with micturating cystourethrography, and uroflowmetry at 3 and 6 months. Repeat uroflowmetry was done as, and when, required. RESULTS The mean period of follow-up was 9 months (range 4-12). The overall success rate was 83.3%. The mean peak flow rate increased postoperatively from 4.36 mL/s to 35.5 mL/s at 3 months and 25.06 mL/s at 6 months of follow-up. One patient developed repeat stricture at the anastomotic site, and 4 patients developed recurrent meatal stenosis. CONCLUSIONS The results of LMG urethroplasty were comparable to that of buccal mucosal graft urethroplasty. LMG is easy to harvest. Most importantly, the donor site complications were minimal without any functional or esthetic deficiency.

Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women.

Study Type – Therapy (case series)
Level of Evidence 4

Dorsal onlay lingual mucosal graft urethroplasty: Comparison of two techniques

Objectives:  To compare the results of two different techniques of dorsal onlay lingual mucosal graft (LMG) urethroplasty for anterior urethral strictures.

Intralesional bleomycin in lymphangioma: An effective and safe non-operative modality of treatment

Introduction: Lymphangiomas are benign hamartomatous lymphatic tumors. The mainstay of the therapy is surgical excision, but due to its infiltration along the nerves and muscles, total excision is not always possible. In the present study, we have evaluated the clinical profile of all the cases of lymphagiomas coming to our department and evaluated the efficacy of intralesional Bleomycin as a sclerosing agent in its management. Materials and Methods: In this prospective study, all patients were evaluated clinically and color Doppler ultrasonography (USG). The required dose was calculated as 0.5 mg/kg body weight, not exceeding 10 units at a time. The response was assessed clinically and on the basis of color Doppler USG. Results: Thirty-five patients of lymphangioma were included in the study. The neck region was the most common site of involvement. The response was excellent in 7 (20%), good in 26 (74.29%), and poor in 2 (5.71%) patients. The complications included fever, transient increase in size of swelling, local infection, intraluminal bleed, and skin discoloration in 10 patients. Conclusion: This therapy may be used as primary modality instead of surgery in selected group of patients.

Pediatric carcinoma of rectum - Varanasi experience

BACKGROUND Primary gastrointestinal system malignancies constitute approximately 2% of pediatric neoplasm and of these; colorectal carcinoma is the second most common malignancy. This is one of the rarer diseases in children. AIM We reviewed our records to study the clinical features, outcome and the follow-up of this condition with evaluation of the prognostic factors. SETTINGS AND DESIGN Tertiary care Pediatric Surgery centre. Retrospective study. MATERIALS AND METHODS The data of all patients with diagnosis of colorectal carcinoma from January 1986 to January 2006 were reviewed. The confirmation of the diagnosis was by biopsy from the lesion. The age, sex, family history, clinical features, response to the treatment and follow-up were studied. RESULTS There were four male patients. All had bleeding per rectum as the presenting complaint. Three patients had advanced disease at presentation. All the patients had signet cell adenocarcinoma. The two patients expired and one was lost to follow-up. One patient is alive after one year of follow up and is receiving treatment. CONCLUSION Colorectal cancer in children though rare can be a reality, hence any children presenting with pain in abdomen along with doubtful history of constipation and rectal bleeding should be examined carefully with special emphasis on digital rectal examination.

Surgical considerations in pediatric necrotizing fasciitis.

Background: Necrotizing fasciitis (NF) is a serious infection of soft tissues. This paper presents experience with pediatric NF and suitability of conservative surgery in its management. Materials and Methods: In this retrospective study, 70 patients of NF were managed during the study period of eight years. The study was divided into two time periods- first period (June 1998 to June 2001- group 1) and second period (June 2001 to June 2006- group 2). The parameters studied were age, sex, site of involvement and treatment. The treatment included intravenous antibiotics, supportive therapy and either aggressive (group 1) or conservative surgery (group 2). Results: Age of presentation ranged from 10 days to 11 years. Male to female ratio was 1.69:1. Back was the commonest site to be involved. Culture reports were polymicrobial in 70% with predominance of Staphylococcus species. Predisposing factors included malnourishment, boils, scratch injury, intravenous cannulation and injections. Conservative surgery had better outcome in terms of hospital stay, complications and cost of treatment. Conclusion: NF is a serious and disease which requires immediate and all out attention. Early diagnosis, aggressive supportive treatment and conservative surgery improve survival.

Placement of the Peritoneal End of a Ventriculoperitoneal Shunt in the Suprahepatic Space: Does It Improve Prognosis?

Introduction: Hydrocephalus is a common pediatric problem. Ventriculoperitoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. The peritoneal end is usually placed in the general peritoneal cavity. We present an alternative site of peritoneal end placement in the suprahepatic space in an attempt to reduce the abdominal complications. Material and Methods: All patients with a diagnosis of congenital hydrocephalus were included in the study. In group 1, the lower end of the VPS was placed in the suprahepatic space. Patients were evaluated for abdominal complications like pseudocyst formation, intestinal obstruction and blockage of the lower end of the VPS. The data were compared with those patients in whom the peritoneal end was placed in the general peritoneal cavity (group 2). Results: The total number of patients in groups 1 and 2 was 133 and 175, respectively. Complications in group 1 were dislodgement of the shunt in the general peritoneal cavity in 28 (21.05%), suprahepatic pseudocyst formation in 2 (1.5%) and blocked lower end in 2 patients (1.5%). In group 2, complications noted were pseudocyst formation in 5 (2.8%), blocked lower end in 25 (14.2%), intestinal obstruction in 9 (5.1%), inguinoscrotal migration in 10 (5.7%) and perforation of viscera in 6 patients (3.4%). The overall follow-up period ranged from 1 to 7 years. Conclusions: Placement of the lower end of the shunt in the suprahepatic space can be advantageous to placing it in the general peritoneal cavity. The procedure is simple and results can be rewarding.

Jejunal atresia presenting with mesenteric cyst in a neonate: a case report

Jejunoileal atresia is a congenital anomaly that is characterized clinically by bilious vomiting and abdominal distension. It has been associated with various congenital anomalies but its association with mesenteric cyst has only been reported sporadically. As this is a very rare entity, it is being reported with a brief review of literature.

Our Modified Technique of Total Posterior Reconstruction in Open Retropubic Radical Prostatectomy

Aim: We compared the outcome of retropubic radical prostatectomy with or without our modified technique of total posterior reconstruction. The technique differs from the standard technique in the form of reconstruction of retrotrigonal tissue using a detrusor muscular flap. The free end of the flap is sutured to the Denonvillier’s fascia to complete posterior reconstruction. Materials and Methods: From August 2006 to July 2008, 32 patients with localized prostate carcinoma who underwent radical retropubic prostatecto-my were prospectively evaluated in 2 groups operated on by 1 surgeon. The first 22 patients underwent standard technique of radical retropubic prostatectomy and subsequently we used and are now using a modified technique. The first 10 patients operated on by the modified technique are included in the present study. Both groups were compared for postoperative continence. Continence was assessed using quality of life questionnaires. A patient was considered incontinent if he had to change more than 1 pad per 24 h. Results: Continence rates in group 1 were 72.73, 81.82, 86.40 and 95.46% at 1, 3, 6, and 12 months follow-up respectively as opposed to 80, 90, 90, and 100% respectively in group 2 patients. Conclusion: Total posterior reconstruction is an effective way to achieve an early return of continence.

Rectal atresia with rectolabial fistula

Rectal atresia is a rare condition in which the anus and sphincter muscles are normally developed, with usually no fistulous communication with the urinary tract. We describe an unusual case of membranous rectal atresia with recto-labial fistula. It was treated by blind perforation of rectal membrane with lay opening of fistlous tract.