Iranian Journal of Pediatric Surgery
Volume:3 Issue: 1, Oct 2017

Anal incontinence is of potential clinical interest and significance. Comprehensive knowledge of anal clinical anatomy and function is essential to understand pathophysiological processes that lead to sphincter malfunction. We review anatomy, physiology and surgical pathology of anal sphincter. We also discuss surgical procedures which may be used for patients with fecal incontinence.

Previous studies have shown that according to the learning curve, one’s knowledge and skills increase with experience and repetition. However, no studies have yet proved that the learning curve can be generalized to medical procedures. Therefore, this study aimed to evaluate the learning curve and complications of hand assisted laparoscopic appendectomy (HALA) in children with acute appendicitis.
In a time-series study in 2016, ninety 13-16 year-old children were selected as candidates for appendectomy. The participants were then consecutively divided into three groups according to admission time. The first, second, and third groups were operated on by an attending pediatric surgeon, an attending pediatric surgeon and a pediatric surgical fellow, and a pediatric surgical fellow, respectively. For each surgery, duration of surgery and hospitalization was determined and recorded, and the time trend of surgery was determined and compared in all three groups using the learning curve.
Findings: The mean duration of surgery of the groups operated on by an attending, an attending and a resident, and a resident alone was 38.7±12.8, 46.9±8.8, and 48.5±11.3, respectively, and there was a significant difference among the three groups (p=0.002). During the surgery, duration of surgery in resident and attending group and resident group decreased over time.
The learning curve can be generalized to medical lessons and experiences. Duration of appendectomy for residents can decrease over time as they become more skilled. Usually after performing 30 surgeries and gaining experience, residents will be able to perform appendectomy nearly as fast as surgeons. In the meantime, the root causes of the fluctuations observed during surgery should be scientifically examined and taken care of.

Neonatal intestinal obstruction NIO is one of the most common emergency conditions a pediatric surgeon is called to assess during neonatal period, Successful management of NIO depends on timely diagnosis and referrals for therapy (1).Neonatal intestinal obstructions have improved in many developed countries, but still show high morbidity and mortality in developing countries(2) .
This study was done to evaluate the incidence and short term outcome of neonatal intestinal obstruction at department of pediatric surgery, Zagazig university hospitals.
Patients and This retrospective study had done at department of pediatric surgery, Zagazig university hospitals, Egypt; include 84 patients presented by intestinal obstruction during the first month of life from Jan 2008 to Jan 2011and was managed surgically.
There were 84 patients presented by intestinal obstruction during the first month of life,50 males and 34 females; in which 10 patients(11.9%) with duodenal atresia, and 7 patients( 8.3%)with jejunoileal atresia, and 5 patients(5.9%) with meconium ileus with perforation, and 5 patient (5.9%) with volvulus ,and 5patients(5.9%)with colonic atresia ,and 15patients (17.8%)with Hirschsprung disease, and 17patients(20.2%)with obstructed congenital inguinal hernia, and 20 patients(23.8%) with anorectal malformations. The mean age at presentation to surgeon was 3.5(2-10) days for duodenal atresia,and2.5(3-5) days for jejunoileal atresia ,and 2 (1-10)days for meconium ileus with perforation, and 2(1-5)days for patients with volvulus ,and 7(5-20) days for colonic atresia , and 20(10-30) days for Hirschsprung disease, and 25(5-30) days for patients with obstructed congenital inguinal hernia, and 2(1-4)days for anorectal malformations. Surgery was done for all patients after resuscitation. The morality was happed in 10 patients (12%), in which 3 patients with jejunoileal atresia was developed leakage from anastomosis and re-operated and died, and 3 patients with duodenal atresia was died postoperative from sepsis and DIC, and 2 patients with high anorectal malformations was died 2 days post operative from associated cardiac anomalies, and 2 patients with colonic atresia was died post operative from sepsis and electrolyte imbalance.
From our study the most common cause of neonatal intestinal obstruction was anorectal malformations and obstructed congenital inguinal hernia. Mortality and morbidity is still high compared with statistics from developed countries due to late presentation to pediatric surgeon and there is no specific neonatal surgical intensive care unit beside the pediatric surgery department.v

AimIn this study, we aimed to define the spontaneous regression rate in the types of hydroceles, the regression age, the timing of surgery, and the optimal treatment approaches for each hydrocele type in cases with isolated hydroceles in children.
MethodThis retrospective cohortstudy included 2625 patients reviewed between January 2004 and December 2012. The hydroceles were classified as: ‘non-communicating hydroceles’, ‘communicating hydroceles’, ‘spermatic cord hydroceles’ and ‘abdomino-scrotal hydroceles’(ASH). The patients were divided into two groups with regard to their ages at the diagnosis as follows: those presenting in the newborn period and before 24 months of age (Younger– Group 1)and those presenting after 24 months of age (Older – Group 2).Determining the type of isolated hydrocele, the decision making for follow-up or surgery, and the follow-up period were conducted by 7 attending pediatric surgeons and 6 residents.
ResultsIn Group 1, 93% of 1086 non-communicating hydroceles, 40% of 158 cord hydroceles, and 15% of 34 communicating hydroceles resolved during the follow-up, and the remaining patients with each type of hydrocele had undergone surgery. In Group 2, 8.7% of 183 non-communicating hydroceles resolved during the follow-up.
ConclusionsThe primary treatment of patients with isolated hydrocele should be decided regarding the type of hydrocele, along with age at admission, and accordingly, conservative or surgical treatment should be considered.

undiagnosed metopic synostosis (Trigonocephaly) have many complications for infant such as Brian damage and cognitive & behavioral disorders also aesthetic malformations.There are a lot of surgical techniques for it that have their advantages and disadvantages but with this new method we can solve some of these problems and minimize damages.
In this study, 45 infants with Metopicsynostosis underwent surgery in Tehran Mofid Hospital. The Minimum of age were 4 months and Maximum 9 months with average of 6.72 months .Our cases in this study are infants with trigonicephaly that their diagnosis is confirmed with clinical symptoms & signs also with CTScan and paraclinical findings. The most common classification of surgical revision of Craniosynostosis named Whitaker, has been c as follows.
After analysis in this study we find significant differences in anthropometric indeces before & after surgery such as lowering of biparietal width after surgery and elevating of frontoparital index after surgery. As in this procedure, we don’t separate the frontal bone segments and it keeps its frame , so less plaques and screws are needed which will decrease the costs of the surgery and the surgical time is much more fewer than the other techniques.And last but not the least, the satisfactions of parents were high and there was no need for secondary surgery.
Based on all the perfect results we got , it is safe to say that,Staggered osteotomy as a surgical method for correction of trigonocephaly is useful method and we can use it as a new method in correction of metopic synostosis.

meconium ileus is obstruction of the terminal ileum by abnormally tenacious meconium; it most often occurs in neonates with cystic fibrosis. Meconium ileus accounts for up to 33% of neonatal small-bowel obstructions. Symptoms include emesis that may be bilious, abdominal distention, and failure to pass meconium in the first several days of life. Diagnosis is based on clinical presentation and x-rays. Treatment is enemas with dilute contrast under fluoroscopy and surgery if enemas fail. Various surgical procedures are described and practiced for operative management of uncomplicated meconium ileus. In our series, we have compared two differnt method of surgery.primary resection and anastomosis and bishop koop method of enterostomy .we compared their effectivness and complications.

Forty neonates with ileus meconium included in study, 20 patient in each group., allocating every other subject to each treatment group (alternating allocation) for the bishop koop enterostomy and anastomosis(study group) or primary resection and anastomosis(controll group). The results of treatment and complications during and after the surgery were recorded in both groups and compared together.
there was 3 case of mortality in study group(%15) and 8 case of mortality in controll group(%40).there was meaningful statistical differrences between mortality in two groups..p=0/30 and p=0/002.
in contrast of advantage of one stage repair and primary resection and anastomosis in meconium ileus neonates it has more mortality compare to bishop koop method., performing the two-stage bishop koop repair is more safe and recommended for this anomally

We report the case of a 4 years old girl who present a cervico-thoracic ganglioneuroblastome with none response to chemotherapy and radiotherapy.
The girl was operated using the Cormier Dartevelle-Grünenwald incision which helped to remove the tumor completely with optimal control of noble elements. The follow up was uneventful.
The Cormier Dartevelle-Grünenwald incision can be a good option in case of big cervico-thoracic malignant tumors.

Congenital mesoblastic nephroma (CMN) is a rare benign renal tumor, typically occurring in utero or during infancy. We are reporting a youngest case of left sided classical congenital mesoblastic nephroma in a fullterm, small for gestational age, male neonate, who was detected with left sided flank mass immediately after birth. The patient was managed successfully by total nephrectomy. The diagnosis of CMN-classical type was confirmed on histopathological examination.