Abstracts List

Title
First Name
Last Name
Specialty
Institute
Country
Phone No
E-mail
Preference
Topics
Title of Presentation
Abstract
Prof.
Mohamed
El Debeiky
Pediatric Surgery Department
Ain Shams University
Egypt
+201001425659
mohamedeldebeiky@med.asu.edu.eg
oral
Neonatal Surgery
Neonatal MIS; influence on operative & postoperative care
Abstract: Introduction: With the increased application of MIS, started the worries about the operative & postoperative consequences in NICU with expected fears about increased operative & postoperative stresses. Materials & Methods: Neonates operated upon by MIS over 1 year time has been compared to those with conventional surgery. Results: MIS requires skills and experience. Relatively longer operative time with MIS compared to open surgery, yet with successful technique has less stress during anesthesia and postoperative convalescence in NICU. Conclusion: Despite the initial concerns about increased surgical stress, it seems that MIS has more controllable operative and postoperative influences.
Dr.
Sahar
elleuch
anesthesiology
Hedi chaker hospital
Tunisia
52911835
saharr.eleuchh@gmail.com
poster
Pediatric Genitourinary Surgery
Analgesic efficacy of caudal dexamethasone combined with bupivacaine in ilioinguinal pediatric surgery: prospective randomized controlled trial.
Authors:Elleuch.S1, Jarraya.A1, Zitouni.H2, Mhiri.R2, Kolsi.K1 1: Department of Anesthesiology, Hedi Chaker Hospital, Sfax, Tunisia 2: Department of pediatric surgery,Hedi Chaker Hospital, Sfax, Tunisia Introduction: The aim of the study was to assess the efficacy of caudal dexamethasone with bupivacaine 0.25% for postoperative pain relief in children undergoing sub-umbilical surgical procedures. Patient and Methods: In this prospective randomized double blind study, 56 children of ASA-I class aged from 1 to 5 years scheduled for sub-umbilical surgical procedures were randomly allocated to two groups: - group I received caudal block with : bupivacaine 0.25% (1 ml/kg) with placebo - group II received caudal block with : bupivacaine 0.25% (1 ml/kg) with dexamethasone 0.1 mg/ml. Postoperatively patients were assessed for analgesia and side effects. Results: Demographic parameters (age, weight, size, sex) and per operative heart rate and blood pressure were similar in both groups. Significantly high levels and prolonged duration of post-operative analgesia were observed from the 6th to the 24th post operative hours in group II (P<0.005) with no increased side effects. Conclusions: Caudal dexamethasone may safely improve and prolong post operative analgesia for sub-umblical surgical procedures in children.
Mrs.
Takwa
Mili
Pediatric Surgery
Bachir Hamza Hospital, Pediatric Surgery B, Tunis
Tunisia
+216 53 139 901
mili.takwa@hotmail.com
poster
Pediatric Gastrointestinal Surgery
Apple Peel Intestinal Atresia: Surgical Management and Postoperative Course MILI T., BEN AHMED Y., OUMAYA M., CHARIEG A., NOUIRA F., JOUINI R., JLIDI S.
BACKGROUND: Apple peel atresia is the least frequently encountered type of intestinal atresia. It represents approximately 10% of all atresia. In this study, we aimed to describe the surgical management and the direct postoperative outcome of apple peel atresia. METHODS: In a retrospective analysis of 40 patients with jejunal atresia treated at our department over a 10-year period (2009–2018), 10 were classified as having apple peel atresia (25%). RESULTS: Of the 10 neonates born with apple peel atresia, intestinal obstruction was suspected and diagnosed by antenatal ultrasonography in 6. There was no sex preponderance (5/5). Four neonates were born preterm (40%). The median birth weight was 2,750 g. The median time to surgery was 2 days. Operative management consisted of resection of the atresia with enteroplasty and primary anastomosis in all cases. Three patients ended up with a short bowel syndrom. Postoperative complications consisted of anastomotic leak in 3 patients (10%), 53% suffered from paralytic ileus, 35 % from cholestasis, and 40% were septic. Re-operation was performed in 3 patients. Four patients died (40%). CONCLUSION: Even though survival rates have improved significantly over the years, apple peel atresia remains a life-threatening malformation, which still causes substantial morbidity and mortality.
Mrs.
Takwa
Mili
Pediatric surgery
Bachir Hamza Hospital, Pediatric Surgery "B", Tunis
Tunisia
+216 53 139 901
mili.takwa@hotmail.com
oral
Pediatric Gastrointestinal Surgery
Proximal Jejunal Atresia: Early Postoperative Outcome BEN AHMED Y., MILI T., OUMAYA M., CHARIEG A., NOUIRA F., JOUINI R., JLIDI S.
OBJECTIVE: Atresia of the jejunum and ileum is one of the major causes of neonatal intestinal obstruction. Traditionally, jejunal and ileal atresia have been grouped together as jejunoileal atresia. In this study, we aimed to elucidate separately the early postoperative outcome of jejunal atresia. METHODS: A retrospective analysis of all patients diagnosed with jejunal atresia, who were treated at our department over a 10-year period, 2009–2018 inclusive, was carried out. RESULTS: 30 cases of jejunal atresia were confirmed. They were 15 girls and 15 boys. Fifteen of our patients (50%) was diagnosed prenatally. The mean birth weight was 2640 g and the main gestational age was 35,6 SA. . Associated congenital anomalies were seen in 7 cases (23%). The median age at diagnosis was 2 days (0-27 days) and the main time to surgery 48 hours. The type of atresia was: type 3 in 53%, type 4 in 23%, type 1 in 16% and type 2 in 8% of cases. Operative management consisted of resection and primary anastomosis with plasty in all patients. Postoperative complications consisted of anastomotic leak in 5 patients (16%), anastomotic stricture in 3 patients (10%), paralytic ileus in 4 patients (13%), cholestasis in 2 patients and short bowel in 6 patients (20%). Three patients (10%) presented with an adhesive intestinal obstruction during the early postoperative period. Eight patients (23%) required reoperation. The main time to full oral intake was 12 days. The average duration of hospital stay was 25 days. Nine neonates died, giving a mortality rate of 30 %. CONCLUSION: Prolonged ileus and anastomotic dysfunction requiring long-term parenteral nutrition were the major causes of complications leading to death with a poorer outcome in jejunal atresia by comparison with ileal atresia. We suggest that atresia of the jejunum and ileum be considered differently.
Dr.
sahar
elleuch
anesthesiology
Hedi Chaker hospital
Tunisia
52911835
saharr.eleuchh@gmail.com
poster
Pediatric Gastrointestinal Surgery
Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally
Authors:Elleuch.S1, Jarraya.A1, Zitouni.H2, Abid.A1, Mhiri.R2, Kolsi.K1 1: Department of Anesthesiology, Hedi Chaker Hospital, Sfax, Tunisia 2: Department of pediatric surgery,Hedi Chaker Hospital, Sfax, Tunisia Abstract The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications.Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (P<0.05). Side effects such as respiratory depression, vomiting and bradycardia were similar in both groups. The adjunction of clonidine to fentanyl as additives to bupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.
Ms.
Yosra
Ben ahmed
Pediatric Surgery
Bachir Hamza Hospital, Pediatric Surgery "B", Tunis
Tunisia
+216 22866913
yosra_bahmed@yahoo.fr
oral
Pediatric Genitourinary Surgery
SINGLE SCROTAL INCISION APPROACH: CAN WE GO FURTHER? BEN AHMED Y., MILI T., BEN CHOUCHENE I., NOUIRA F., CHARIEG A., JOUINI R., JLIDI S.
Objective: Transscrotal orchidopexy is emerging as an alternative approach for palpable low-lying undescended testes. In this study, we aimed to evaluate the surgical outcomes of single scrotal incision orchidopexy in children with a palpable cryptorchid testis. Methods: We retrospectively reviewed all patients who underwent transscrotal orchidopexy during a 9-year period. Post-operative complications, testicular location, and testicular trophicity were reviewed at the follow-up evaluation. Results: A total of 113 orchidopexies (96 patients) were included, we thought accessible to do them by scrotal approach. The single incision technique was possible in 111 cases (98%). Two cases required an additional inguinal incision. Age ranged from 2 to 12 years. Average operating time was 20 minutes per testicular unit. A patent processus vaginalis was found in 62 cases (55%). The position of the testis assessed at surgery was at the external inguinal ring in 76% of cases and at the inguinal canal in 24% of cases. But testis drop in the scrotum in all cases, under anesthesia. In the early postoperative period, one patient developed wound dehiscence due to local infection. Six months post operatively; no testicular atrophy or inguinal hernia were noted. 12 patients (10%) presented a testicular ascension requiring a second surgical intervention. During follow-up (ranging from 2 to 24 months), all testes showed good cosmetic results. Conclusion: Single scrotal incision orchidopexy is a simple and safe technique that is associated with a short operation time and hospital stay with a good cosmetic result. Its comparable success and complication rates makes it an attractive alternative of the traditional inguinal approach.
Dr.
sahar
elleuch
anesthesiology
Hedi chaker hospital
Tunisia
52911835
saharr.eleuchh@gmail.com
poster
Pediatric Trauma
Multiple anesthetic drugs allergy in young infant: a case report
Authors:Elleuch.S1, Jarraya.A1, Zitouni.H2, Abdelmoula.M1, Mhiri.R2, Kolsi.K1 1: Department of Anesthesiology, Hedi Chaker Hospital, Sfax, Tunisia 2: Department of pediatric surgery,Hedi Chaker Hospital, Sfax, Tunisia Background: Allergic reaction during anesthesia is a serious, potentially fatal complication. Compared to the total number of per anesthetics allergies, multiple anesthetic drugs allergy remains a rare event, making the choice of anesthetic drugs even more delicate. Perioperative allergic reactions occurring during anesthesia are less common in children than adults because allergen sensitization increases with drug exposures. Case Report: We report the case of an eleven months old patient proposed to resume a cure of a trigger finger. Recurrent rhinitis and a trigger finger cure at the age of 9 months were mentioned by the parents. Two minutes after fentanyl injection, occurred a bradycardia, a cutaneous rash, and a severe bronchospasm. Further questioning to the parents revealed skin redness to areas that were in contact with the electrocardioscope electrodes during the first operation. At the allergoanaesthetic screening after the peri-anaesthetic incident, the skin tests were positive to multiple anesthetic drugs (propofol, thiopental, morphine, fentanyl, suxamethonium, alfentanil, cis-atracurium and vécuronium). Discussion: Twelve cases of adult intraoperative anaphylaxis due to multiple drugs have been reported [1]. In our case, the bronchospasm occurred in an infant immediately after the injection of fentanyl. Literature review shows that opioid analgesics are rarely incriminated in allergies. However, anaphylactic shocks were reported with morphine, fentanyl, and pethidine. References: [1] Levy JH, Rockoff MA. Anaphylaxis to meperidine. AnesthAnalg 1982;61:301–3.
Ms.
Yosra
Ben Ahmed
Pediatric Surgery
Bachir Hamza Hospital, Pediatric Surgery "B", Tunis
Tunisia
22866913
yosra_bahmed@yahoo.fr
oral
Pediatric Genitourinary Surgery
SINGLE SCROTAL INCISION APPROACH: CAN WE GO FURTHER?
Objective: Transscrotal orchidopexy is emerging as an alternative approach for palpable low-lying undescended testes. In this study, we aimed to evaluate the surgical outcomes of single scrotal incision orchidopexy in children with a palpable cryptorchid testis. Methods: We retrospectively reviewed all patients who underwent transscrotal orchidopexy during a 9-year period. Post-operative complications, testicular location, and testicular trophicity were reviewed at the follow-up evaluation. Results: A total of 113 orchidopexies (96 patients) were included, we thought accessible to do them by scrotal approach. The single incision technique was possible in 111 cases (98%). Two cases required an additional inguinal incision. Age ranged from 2 to 12 years. Average operating time was 20 minutes per testicular unit. A patent processus vaginalis was found in 62 cases (55%). The position of the testis assessed at surgery was at the external inguinal ring in 76% of cases and at the inguinal canal in 24% of cases. But testis drop in the scrotum in all cases, under anesthesia. In the early postoperative period, one patient developed wound dehiscence due to local infection. Six months post operatively; no testicular atrophy or inguinal hernia were noted. 12 patients (10%) presented a testicular ascension requiring a second surgical intervention. During follow-up (ranging from 2 to 24 months), all testes showed good cosmetic results. Conclusion: Single scrotal incision orchidopexy is a simple and safe technique that is associated with a short operation time and hospital stay with a good cosmetic result. Its comparable success and complication rates makes it an attractive alternative of the traditional inguinal approach.
Dr.
sonia
Annabi Bahri
Pediatric surgery
Regional hospital of Gabes
Tunisia
98488245
annabisonia@yahoo.fr
poster
Pediatric Genitourinary Surgery
An unusual localization of lymphangioma of the penis: about 2 cases
Cystic lymphangioma or cystic lymphatic malformations are rare benign dysembryoplasias of the lymphoganglionic system. We report 2 cases , 2 boys presented a cystic formation of the uretral meatus. Treatment consisted of complete resection in one and incomplete resection in the another boy. Histological examination concludes a cystic lymphangioma. The evolution is favorable . The cystic lymphangioma is a rare benign tumor whose localization most frequent is craniofacial. Localization of the penis hase been rarely reported . The diagnosis can be evoked clinically but it's the histological study that confirms. The management of cystic lymphangioma involves several therapies including surgery, percutaneous sclerotherapy and other depending on the type of lesion, its location, its extent and its evolutionary potentiel. It keeps a good prognosis.
Ms.
Meriem
Oumaya
Pediatric Surgery
Department of pediatric surgery B, CHILDREN HOSPITAL TUNIS
Tunisia
0021652374785
meriem.oumaya@gmail.com
poster
Minimally Invasive Pediatric Surgery
Meckel's diverticulum in children: A diagnostic challenge
Authors: Oumaya M, Ben Ahmed Y, Chibani I, Mili T, Charieg A, Nouira F, Jouini R, Jlidi S Objective : Meckel's diverticulum (MD) is one of the most common congenital gastrointestinal malformations in children. However, the nonspecific clinical presentations often cause a diagnostic as well as therapeutic challenge to pediatric surgeon. Material and methods: We retrospectively analyzed the clinical data of all patients diagnosed with MD admitted to our department of pediatric surgery of the Children's hospital of Tunis, during 20 years period between January 1999 and December 2018. Factors documented including demographic criteria, clinical manifestations, preoperative examinations, surgical methods, histopathological characteristics, and outcomes. Results: The patients included 49 males and 8 females, aged from 12 days to 14 years. The mean age of our patients was 5 years. All our patients were symptomatic and presented with various clinical features: The most common presentations were intestinal obstruction (49%) and intestinal bleeding (40%). The preoperative diagnostic rate of MD was only 42.1 % (24/57). Among the patients with bleeding per rectum, 19 underwent a Tc-99m scan that showed a positive tracer in 15 patients. All patients underwent resection of the diverticulum. A segmental ileal resection of the diverticulum with termino-terminal anastomosis was performed in 54 patients, under laparoscopy or laparotomy: Surgical approaches were selected according to the clinical presentations. Enterostomy was performed in the 3 other patients. Histology revealed ectopic gastric mucosa in 21 patients, almost constant in all cases of bleeding Meckel diverticulum. The postoperative courses were uneventful. Conclusion: Meckel's diverticulum remained a challenge, as it is still difficult to be diagnosed preoperatively. Integrative application of multiple approaches can help us to achieve a more accurate diagnosis. The key point of the treatment is to remove the heterotopic tissue completely as it is the cause of most complications. Laparoscopy should become the first choice of methods in diagnosis and treatment of MD.
Dr.
Sonia
Annabi Bahri
Pediatric surgery
Regional hospital of Gabes
Tunisia
98488245
annabisonia@yahoo.fr
poster
Pediatric Trauma
Pancreatic trauma:about 14 cases
Blunt trauma to the abdomen accounts for the majority of abdominal injury in children. Pancreatic injury,although uncommon,is the fourth most common solid organ injury. Unlike other solid organ injuries, pancreatic trauma may be subtle and difficult to diagnose. We reported 14 cases of pancreatic trauma, aged of 2 to 14 years. All trauma macanism are blunt trauma. All the patients undego computer tomography to detect injuries: trauma to adjacent organes is detect in 3 patients. In one patient the initial diagnosis is Frantz tumor. The mots frequent complications were: actue pancreatitis in 85%, pancreatic pseudcyst which one needed endoscopic drainage, rupture of the duodenum in one patient. Conservatif treatment is in indicated in 13 child, and surgical treatment in one who cas a rupture of duodenum. Pancreatic injury alththough uncommon can occur and warrants special attention due to its associated morbidities.
Dr.
Marwa
MESSAOUD
Pediatric surgery
Department of pediatric surgery, Fattouma Bourguiba University Hospital
Tunisia
+21252706035
marwa.mesaoud@gmail.com
poster
Neonatal Surgery
Fibroepithelial polyp of vagina in neonatal girls: Case report and literature review
Background: Congenital anomalies of the female genital tract are relatively common, while the fibroepithelial polyp of vagina in an infant girl is extremely rare. We report a case of a newborn with vaginal fibroepithelial polyp. Materials and Methods: A newborn girl was referred to our hospital because of a vaginal mass discovered during the systematic physical examination of newborn. She was without any other systemic problems. Surgical excision of the polyp was performed at the age of 10 days. Results: The histological analysis revealed to be a fibroepithelial polyp of the vagina (FEPV). A review of the literature showed that there were four cases of FEPV in neonatal girls. Conclusion: A fibroepithelial polyp should be included in the differential diagnosis of an interlabial mass in a newborn. Although it is benign and rarely recurs, it should be excised completely, and a long follow-up is suggested as it may recur at any age.
Dr.
Saida
HIDOURI
Paediatric surgery
Department of Peadiatric Surgery, Fattouma Bourguiba University Hospital
Tunisia
+21293676662
hidourisaida@yahoo.fr
poster
Pediatric Genitourinary Surgery
Circumcision accidents : about 56 cases
Background: Although widely practiced around the world, circumcision still has a lot of difficult getting out of the rubric of minor surgery. Rituals and beliefs make circumcision too often performed in a traditional way in abstraction of rules of aseptic and anatomical bases. That‘s why accident related to circumcision are not lacking. Purpose: This work aims to analyse the epidemiological, anatomo-clinical and therapeutic issues related to the complications of circumcision in order to draw attention to not trivialize this surgical procedure. Methods: This is a retrospective study carried out at tcircumcision he department of pediatric surgery, Fattouma Bourguiba Uiniversity Hospital, Monastir – Tunisia, covering a period of 33 years from 1984 to 2017, 56 cases of circumcision accidents. Results: The average age of the children was 2,5 years. These were accidents following circumcision, by a traditional practitioner in 10 cases, a nurse in 30 cases, a doctor in 13 cases and in three cases the circumciser was not specified. The amputation of the gland was present in 10 cases including one case of amputation of the penis and 4 with complete section of the glans. The other complications were: bleeding in 16 cases, local infection in 10 cases, urethro cutaneous fistula in 8 cases, stenosis of the urethral meatus in 3 cases. The treatment was surgical in all cases of amputation of the penis and glans, different techniques were realized with variable results. For the rest: meatoplasty, repairing fistula, meatotomy, section of a mucous bridge… were performed with a satisfactory results. Conclusion: Complications of circumcision may involve both functional and life-threatening prognosis. This makes this intervention not insignificant and must encourage to realize it in a specialized environment by a competent staff.
Dr.
REGAIEG
Chiraz
neonatology
Department of neonatology, Hedi Chaker Hospital. Sfax
Tunisia
+21621147356
chirazregaieg@yahoo.fr
poster
Neonatal Surgery
SPECIFICITIES HIRSCHSPRUNG’S DISEASE IN NEW BORN (ABOUT 17 CASES)
Kamoun Dhouha1, Regaieg Chiraz1, Zitouni Hayet2, Zagdoud Rim1, Ben Hamed Amel1, Bouraoui Amira1, Hmida Nedia1, Ben Thabet Afef1, Mhiri Riadh2, Abdellatif Gargouri1 1 Department of neonatology, Hedi Chaker Hospital. Sfax, Tunisia 2 Department of pediatric surgery. Hedi Chaker Hospital. Sfax, Tunisia. Introduction: Hirschsprung's disease is a congenital intestinal paralysis due to absence of ganglion cells in enteric plexuses. We aim to describe the specificities of the neonatal form. Patients and methods: It is a retrospective study of 17 cases of Hirschsprung’s disease hospitalized in our unit between 2006 and 2018. Diagnosis was based on radiological and/or pathological signs. Results: A male predominance was noted. Two newborns were premature. Two newborns had a congenital heart disease. One of them had Trisomy 21. Another newborn had hypothyroidism. An emission delay of méconium (average of 46 hours) was noted in all cases. The disease was revealed by a lower digestive occlusion in 7 cases, an acute enterocolitis in 2 cases and a bowel perforation in one case. The contrast enema practiced in 15 cases, was pathognomic in 13 cases. Rectal biopsy performed in 6 cases, confirmed histological diagnosis in all cases. Surgical treatment was performed in 9 cases with a median time between symptoms and surgery of 19days. It was a colo-anal lowering in 7 cases, a resection of the right colon with double colostomy in one case and a right transverse colostomy in four cases. Outcome was favorable in 12 cases. Four newborns died consecutively to sever congenital heart disease in one case and sever sepsis in other cases. Conclusion: Hirschsprung's disease is the most common cause of digestive occlusion in the newborn. The main complications in the neonatal form are acute enterocolitis and intestinal perforation
Dr.
REGAIEG
Chiraz
neonatology
Department of neonatology, Hedi Chaker Hospital. Sfax
Tunisia
+21621147356
chirazregaieg@yahoo.fr
poster
Neonatal Surgery
SPECIFICITIES HIRSCHSPRUNG’S DISEASE IN NEW BORN (ABOUT 17 CASES)
Introduction: Hirschsprung's disease is a congenital intestinal paralysis due to absence of ganglion cells in enteric plexuses. We aim to describe the specificities of the neonatal form. Patients and methods: It is a retrospective study of 17 cases of Hirschsprung’s disease hospitalized in our unit between 2006 and 2018. Diagnosis was based on radiological and/or pathological signs. Results: A male predominance was noted. Two newborns were premature. Two newborns had a congenital heart disease. One of them had Trisomy 21. Another newborn had hypothyroidism. An emission delay of méconium (average of 46 hours) was noted in all cases. The disease was revealed by a lower digestive occlusion in 7 cases, an acute enterocolitis in 2 cases and a bowel perforation in one case. The contrast enema practiced in 15 cases, was pathognomic in 13 cases. Rectal biopsy performed in 6 cases, confirmed histological diagnosis in all cases. Surgical treatment was performed in 9 cases with a median time between symptoms and surgery of 19days. It was a colo-anal lowering in 7 cases, a resection of the right colon with double colostomy in one case and a right transverse colostomy in four cases. Outcome was favorable in 12 cases. Four newborns died consecutively to sever congenital heart disease in one case and sever sepsis in other cases. Conclusion: Hirschsprung's disease is the most common cause of digestive occlusion in the newborn. The main complications in the neonatal form are acute enterocolitis and intestinal perforation.
Dr.
Manar
Hbaieb
Pediatric suurgery
Departement of pediatric surgery hedi cheker hospital sfax tunisia
Tunisia
+21696040400
manarhbaieb85@gmail.com
poster
Neonatal Surgery
Voluninous Omphaloceles: Therapeutic approaches and evolution
Voluninous Omphaloceles: Therapeutic approaches and evolution Manar Hbaieb, Saloua Ammar, Hayet Zitouni, Manel Charfi, Myriam Ben Fredj, Chiraz Regaieg, Mohamed Zouari, Mahdi Ben Dhaou, Abdellatif Gargouri2, Riadh Mhiri. INTRODUCTION The aim of this study is to review techniques of treatment of bulky omphaloceles and to study the evolution in order to optimize the management and to guide the prenatal counseling. MATERIAL AND METHODS Retrospective study of cases of newborns with omphalocele type II according to the AITKEN classification from January 2011 to June 2018. RESULT There are four boys and three girls (Sex ratio 1.33) with a mean term of 37SA and a mean birth weight of 2300g. Conservative tanning treatment using the Grob technique was performed in one patient (14.4%) and was complicated by infection of the wall. This patient was operated at the day 21 of life. A primary parietal closure was performed in 3 patients (42.7%). Two cases had a closure according to Gross (28.5%) and one case had a gradual reintegration according to Schuster technique (14.4%). The overall mortality was 43%. After primary parietal closure the mortality rate was 33%. When the omphalocele was associated with malformations the mortality was 50% and 25% if it was isolated. Seventy five percent of the children who survived had neither respiratory failure nor parietal sequelae. Only one patient had major gastroesophageal reflux limiting enteral nutrition. CONCLUSION Despite the progress of neonatal resuscitation and anesthesia, large omphaloceles keep a prognosis reserved whatever the therapeutic technique and especially in case of association with other malformations. Parents should be aware of the risks during the prenatal counseling.
Mrs.
Yosra
Ben Ahmed
Pediatric surgery
Department of pediatric surgery B, CHILDREN HOSPITAL TUNIS
Tunisia
0021622866913
yosra_bahmed@yahoo.fr
oral
Minimally Invasive Pediatric Surgery
Pediatric Spigelian Hernia: A rare clinical entity
Authors: Ben Ahmed Y, Oumaya M, Chibani I, Charieg A, Nouira F, Jouini R, Jlidi S Introduction: Spigelian hernia is a rare entity and very few cases have been reported in children. Spigelian hernias are often difficult to diagnose: This could probably be caused by variation in location, size, shape, variable symptoms of presentation and anatomical proximity to other abdominal hernias. Presentation of case: We report a documented case of a four-year-old child, who previously underwent laparotomy for appendicitis, and who was admitted for a painful left lower quadrant swelling. It started initially as pain, but progressively his mother noticed a swelling which has increased swiftly in size. He had no other symptoms. Abdominal examination revealed a well-defined, firm, irreducible tender mass measuring four centimeter in length and situated in the left flank. The skin over the lump was inflammatory. An abdominal ultrasound demonstrated a left-sided, anterior abdominal wall hernia, along the Spigelian line. The diagnosis of Spigelian hernia was made, repair was recommended due to high risk of incarceration and subsequent strangulation. A laparoscopic hernia repair was performed. A centimetric defect just lateral to the edge of the rectus muscle below the arcuate line was seen, with protruding omentum and edema. The defect was closed using interrupted sutures. The procedure was well tolerated and the boy was discharged home the next day. Conclusion: Spigelian hernias are rare entities. Once the diagnosis of Spigelian hernia is made, repair is recommended due to risk of incarceration and subsequent strangulation. Laparoscopic repair and open repair have previously been described as effective techniques though little data is currently available on their respective long term durabilities.
Dr.
Makhlouf
Dorsaf
Pediatric surgeon
Department of paediatric surgery, Fattouma Bourguiba Hospital Monastir Tunisia
Tunisia
+21655094224
Makhlouf.Dorsaf@gmail.com
poster
Neonatal Surgery
High and intermediate anorectal malformations: about 53 cases
Aim: The goal of our study is to identify the epidemic, clinical, para-clinical, therapeutics and outcomes of operated children. Methods: A retrospective study was conducted for 10 years from January 2004 to December 2014 at the Pediatric Department of Fattouma Bourguiba University Hospital in Monastir, Tunisia. The patients were included 53 pateints: 45 males and 8 females. We had 46 high anorectal malformations were found in 71% of cases, with a predominance of urogenital malformations. The diagnosis was done after birth in 98 % of cases. All of our patients had the invertography to identify the level of the rectal pouch. The three-staged treatment was one in all cases: first a colostomy discharge, second a lowering and finally a restoration of continuity. Our patients were operated by posterior sagittal anorectoplasty in 41 cases. The laparoscopy approach was used in two cases. The postoperative courses were eventless in 40 cases. Fecal continence was good in 31 % of cases. Constipation was noted in 25% of cases. Important soilings were noted in 46% of cases. The mortality rate was 15%. The follow up was average five and a half years. Conclusion: It can be noted that high and intermediate anorectal malformations are rare congenital malformations with a higher incidence in male.
Dr.
Dorsaf
MAKHLOUF
Paediatric surgery
Department of Paediatric surgery, Fattouma Bourguiba University Hospital Monastir
Tunisia
+21255094224
makhlouf.dorsaf@gmail.com
poster
Neonatal Surgery
Our experience in te management of cleftlip and palate: A study about 373 cases
Purpose: The aim of our study is to precise the management of cleftlip and palate in our department and to evaluate our resluts. Patients and Methods: It’s a retrospective study including patients with cleft lip and palate treated at the Pediatric Surgery Department of CHU Fattouma Bourguiba Monastir, Tunisia from January 1988 to December 2015. We analyzed the epidemologic, clinical and therapeutic aspects of this malformation. Results: We compiled 373 patients treated for cleft lip and palate. Only 4 children had ante-natal diagnosis. More than 67% were seen before the age of 6 months. We reported cleftlip in 36, 1% of cases, cleftpalate in 32% and cleftlip and palate in 31,1%. Millard’s technique was most used for liprepair. However since 2004, Tennisson’s technique was used and naso-labial results were judged to be better. The surgical revision rate was 33,55%. The incidence of fitulas was 24,47%. These rates are slightly higher than world rates. Orthophonic evaluation is obligatory for all our patients. Only 2 patients had pharingoplasty for velar insuffiency. Orthodentic management is started since 3 years old to prepare patients for gingivoperiostoplasty at 5 years old. Conclusion : We have bennworking to impose an operatigprotocolthatmeetsfidderent global referenceprotocols. However, we do find in ourresults a delay in reparwith a rate of surgicalrevision and fistulashigherthan global figures. This is due, in ourexperience, to the delay of consultation, the frequency of brochopneumopathy in thesechildren and badsocio-economiclevel.
Mrs.
ben fredj
myriam
pediatric surgery
pediatric surgery departement,EPS Fattouma Bourguiba, Monastir
Tunisia
0021693003595
myriam.benfredj@yahoo.fr
poster
Pediatric Hepato-Biliary & Pancreatic Surgery
Choledochocele miming duodenal duplication : diagnosis and management : 2 cases report
Objectives: to highlights the difficulty of distinguishing between choledochocele and duodenal duplication cysts in pre-operatively. Materials and methods: we report two cases of infant who were operated for duodenal duplication and the finally diagnosis was the type III choledochal cyst Case 1: 5 years old, girl. Admitted on our department to explore intra abdominal cyst who was fortuitously discovered by abdominal US. The physical examination and blood tests were normal. The abdominal ultrasound showed a cystic formation between the right kidney and the gallbladder and its contents are fluid containing multiple lithiases. The abdominal CT-scan added that this cyst formation is depended on D2. then we suspected a duodenal duplication. The laparoscopy exploration found an intraluminal duodenal mass. After conversion a five cm longitudinal duodenotomy was performed we saw the intra-duodenal lesion. The opacification through the gallbladder showed a communication between the cyst and the choledochal duct. We performed a transduodenal marsupialization without sphincterotomy. After 9 years of follow up the girl was asymptomatic with normal abdominal ultra-sound. Case 2: Male,5 years old, he suffered from paroxysmal abdominal pain and vomiting. Abdominal US showed bowel intussusceptions which was reduced with enema. The second abdominal US found a cystic formation in the second part of the duodenum, its size is 18 *11*27 mm with laminated wall. In the abdominal CT-Scan we saw the same formation without common biliary duct dilation orienting to the diagnosis of duodenal duplication. The laparotomy exploration found dilation in D2 and the duodenotomy highlight a cyst that contain a biliary liquid and multiple lithaiasis relevant to choledechocele. The choledechocele was flattened and we resected a collar of 1 cm without sphincterotomy. The post operatively evolution was. The anatomopatologic exam confirmed the diagnosis of choledechocele which was lining with duodenal epithelium. Conclusion: The choledecocele is the rarest form of choledocal cyst especially in the pediatric population, the CPRE is the gold standard investigation to help to the pre-operatively diagnosis which offers the possibility of endoscopic treatment. This endoscopic treatment is more developed in the adult population than the pediatric population due to the pre-operatively misdiagnosis but it is a safe, effectively and easy way of treatment.
Dr.
Marwa
Messaoud
Peadiatric surgery
Department of Paediatric Surgery, Fattouma Bourguiba University Hospital
Tunisia
+21252706035
marwa.mesaoud@gmail.com
poster
Pediatric Gastrointestinal Surgery
Esophageal replacement in children: the experience of Pediatric Surgery Department at Monastir University
Background: Replacement of the esophagus in children is indicated more commonly in long gap esophageal atresia, severe peptic, caustic or anastomotic strictures and some other rare esophageal disorders. It remains a significant challenge for pediatric surgeons due to operative difficulties and a high risk of complications. The aim of our work is to report the outcomes of our department experience. Methods: This is a retrospective descriptive study of patients who undergone esophageal replacement in the pediatric surgery department at Monastir University Hospital between 1989 and 2018. Results: Our study included 20 patients (12 boys and 8 girls). More than 10 patients were excluded from this study for useless or lost medical records. The age of studied patients ranged from 1 to 12 years. The indications of esophageal replacement were intractable post-corrosive esophageal strictures in 15 cases and esophageal atresia in 5 cases. All the patients underwent colon interposition and oesophagectomy. Pneumothorax was the most frequent immediate post-operative complication. Two patients died by chest related complications. The main medium and long term complication was anastomotic stenosis managed by dilatations. The majority of surviving patients did well during long term follow up (mean follow up 11 years) in terms of weight gain, swallowing pattern, quality of life, and overall satisfaction. Conclusion: Esophageal replacement is the only therapeutic choice for pediatric patients with end-stage esophageal disease, in order to provide a good functional results and a better life quality. Therefore, many techniques are practiced with no clear consensus. A long-term follouw-up is to be done to watch for late complications.
Dr.
Sana
MOSBAHI
Peadiatric surgeon
Department of Paediatric Surgery, Fattouma Bourguiba University Hospital Monastir
Tunisia
+21297222174
sana_mosbahi@yahoo.fr
poster
Pediatric Genitourinary Surgery
CROSSED TESTICULAR ECTOPIA OF THE CHILD: ABOUT 7 CASES
Introduction: Crossed testicular ectopia is a rare anomaly of testicular migration, characterized by the descent of both testicles through the same inguinal canal, to the same hemiscrotum. It poses diagnostic and therapeutic problems. Aim: The aim of this work is to illustrate the cases of crossed testicular ectopia and to discuss their therapeutic modalities. Patients and method: This is a retrospective study of seven cases of crossed testicular ectopia, collected in the Department of Pediatric Surgery in Monastir between January 2002 and December 2016. Discussion and literature review: The etiology of crossed testicular ectopia remains unclear, a genetic factor has been suggested but not confirmed yet, the type I is the most common. This condition should be suspected in the association of inguinal hernia on one side and cryptorchidism on the other side or bilateral cryptorchidism. It can be associated with other urogenital anomalies. Ultrasound can make the preoperative diagnosis. Laparoscopy is recommended for the diagnosis and management. The treatment consists in transseptal, intra- or extra-peritoneal orchidopexy. Complications could be malignant transformation and infertility. Conclusion: Crossed testicular ectopia should be kept in mind. The treatment should provide a palpable testicular position.
Mrs.
ben fredj
Myriam
pediatric surgery
pediatric surgery departement,EPS Hedi Chaker,Sfax
Tunisia
0021693003595
myriam.benfredj@yahoo.fr
poster
Pediatric Genitourinary Surgery
Single site laparoscopic surgery for the diagnosis and management of a variant of Mullerian duct anomalie in a prepubertal case
Objectives : To insist on the difficulty of diagnosing of the utero-vaginal malformation like Uterus didelphys with obstructed hemi-vagina and ipsilateral renal agenesis and the place of laparoscopy in its management through a case report. Case report: A six year-old girl presented with recurrent abdominal pain, physical examination revealed pelvic mass lateralized on the right lower quadrant, normal urethral meatus and a labial adhesion. Abdominal ultrasound and MRI suggested hydrocolpos due to a vaginal diaphragm with uterine malformation and right renal agenesis. Perineal examination under general anesthesia showed right hemi-vagina obstructed by a diaphragm. The incision of the vagina diaphragm allowed the drainage of the hydrocolpos. Single site laparoscopic exploration showed a right renal agenesis with a normal size of the right uterus with a left cystic mass, which seems communicating with the right uterus and the left ovary. Mini incision of this mass and introduction of the optic showed continuity with the opened hemi-vagina. Outcomes were simples. Conclusion: Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of Mullerian duct anomalies consisting of uterine didelphys, obstructed hemi-vagina, and ipsilateral renal agenesis. This diagnosis can be suspected if we have renal agenesis with vulvar mass. It is important to recognize the limitations of MRI in this subset of patients. Laparoscopy exploration seems useful for the diagnosis and management of this anomaly the others authors: Amma.S, Zitouni.H, Sallemi.S, Zouari.M, Ben Dhaou.M, Mhiri.R
Mrs.
ben fredj
myriam
pediatric surgery
pediatric surgery departement,EPS Fattouma Bourguiba , Monastir
Tunisia
0021693003595
myriam.benfredj@yahoo.fr
poster
Pediatric Oncosurgery
Lipoblastoma, clinical and therapeutic particularity : 12 cases
Lipoblastoma is a rare benign mesenchymal tumor of embryonal fat that occurs almost exclusively in infants and children. Objectives: This study was done to determine the epidemiological, clinical and therapeutic aspect of lipoblastoma. Materials and methods: we reviewed ten cases of lipoblastoma admitted in our department and treated from 2003 to 2017. Results: There were 7 boys and 5 girls ranging in age from 7 months to 9 years. A soft tissue mass was the chief complaint in 10 patients, abdominal pain in 2 patient with a mesentry mass. It was located in different sites (mediastinal one case, thigh 2 cases, buttock two cases, inguino-scrotal 2 cases, the greater omentum 2 cases and the Latissimus dorsi 3 cases). Lesions measured 5 to 15 cm and it was limited in 8 cases. complete excision was done. Average follow-up was 35 months. There were no recurrences. Conclusion: It is important to consider lipoblastoma in the diagnosis of a rapidly enlarging fatty mass in children. Complete resection is the only definitive treatment and should not be delayed when impingement on surrounding structures is imminent. There is a tendency for these lesions to recur despite presumed complete excision. Therefore, follow-up for a minimum of 5 years is recommended. The others authors: , Sahnoun .L, Makhlouf. D, Kechiche. N, Lamiri. R, Ksiaa. A, Mekki. M, Belguith. M, Nouri. A
Dr.
Sana
MOSBAHI
Paediatric surgeon
Department of Paediatric Surgery, Fattouma Bourguiba Hospital Monastir
Tunisia
+21297222174
sana_mosbahi@yahoo.fr
oral
Neonatal Surgery
Congenital pulmonary cystic lesions in infant: challenged radiologic diagnosis
Aim: The aim of our work is to describe the radiological particularities of congenital bronchopulmonary malformations (CBPM) in the pre and post-natal period. Material and methods: We conducted a retrospective descriptive study of 50 patients with CBPM treated in the pediatric surgery department of Fattouma Bourguiba Hospital in Monastir Tunisia during 18 years (January 2000 to December 2017). Results: There were 23 girls and 27 boys. The first symptoms begun at a median age of 2 months. The diagnosis was made at a median age of 4 months. The prenatal diagnosis was made by the obstetrical ultrasound in 8 patients and an MRI was performed in 4 cases. The prenatal ultrasound showed a round well defined hypoechoic mass of the lung in 5 cases and a posterior mediastinal hyperechoic mass in 3 cases. Plain radiograph and CT-scan showed unicystic lesion with lung distentionin 27 patients, a multicystic lesion in 14 cases, a mediastinal mass with systemic arterial blood supply in 5 patients and a pneumothorax in 1 case. The mass was located in the left superior lobe in 24 cases. Fourty-four patients were operated at the mean age of 3.17 months. Histopathological examination showed : 18 congenital lobar overinflation, 12 congenital cystic adenomatoid malformation, 2 bronchopulmonary sequestration and one case of bronchogenic cyst. Conclusion: Congenital bronchopumonary malformations can be very similar either clinically and radiologically. The role of pre and post natal radiological exams, especially CT-scan, remains a major determinant for preoperative diagnosis. The final diagnosis is anatomopathological.
Mrs.
ben fredj
myriam
pediatric surgery
pediatric surgery departement, EPS fattouma bourguiba, Monastir
Tunisia
0021693003595
myriam.benfredj@yahoo.fr