Ashish Namdeo Gavade ¹, Mandar Vaidya ²

Affiliations
1 Former PG Resident, Department of General Surgery, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Associate Professor, Department of General Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Phimosis is Inability to retract prepuce. At birth the foreskin is normally adherent to the glans penis. Incidence of pathological phimosis is 0.6%. Circumcision is a very old procedure. Any technique for surgery can be applied but rate of morbidity should be low. Materials and Methods: Study conducted in Department of surgery of a tertiary care hospital. Data collection of selected patients with relevant history, clinical examination, appropriate investigation and surgical intervention were included. Results: Study was conducted with 116 subjects with mean age of 3.1 years with surgery done by the dorsal slit method and mean age of 3.7 years by plastibell method. The average duration for dorsal slit procedure to complete is 15.7 minutes and for plastibell is 12.2 minutes. Mean blood loss occurred in dorsal slit method is 9.0 while that in plastibell is 6.0. Frequency of surgical site infection in dorsal slit method is 5.2% while that in plastibell method is 6.9%. Post-operative heamorrhage seen in dorsal slit method is 5.2% while that in plastibell is 1.7%. 89.7% of parents satisfied with dorsal slit method while 96.6% parents were satisfied with modified plastibell method. Conclusion: Study showed that plastibell has advantage of shorter time for surgery and relatively lower risk of post-operative bleeding when compared with dorsal slit method of circumcision. The cosmetic outcome as judged by parental satisfaction was also better with plastibell technique.

Keywords

Dorsal Slit Method, Cosmetic Outcome, Modified Plastibell Method, Phimosis

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Mandar Vaidya ¹, Suyog Shetye ², Jyotsna Kulkarni ³

Affiliations
1 Associate Professor, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN
2 Former PG Resident, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN
3 Assistant Professor, Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, IN

Abstract

Introduction: Hypospadias is defined as a condition where the urethra opens on the ventral aspect of the penis. It is commonly associated with penile curvature, usually ventral and is one of the most common genital birth defects in males. Hypospadias can be treated with numerous different surgical approaches numbering upto 200, and historically has been treated with procedures like Trans-Verse Island Flap (TVIF) on lay, Tubularised Incised-Plate (TIP), vertical preputial island flap, tubularised preputial flap, vertical preputial flap with double skin island etc. Present study was conducted to compare Snodgrass Tubularised Incised Plate Urethroplasty (TIP procedure) and Duckett Onlay Transverse Preputial Patch Urethroplasty for penile hypospadias correction. Material and Methods: Male patients between the age of 2-14 years who underwent correction of penile hypospadias by either of the two techniques viz. TIP (procedure) Urethroplasty and Duckett Onlay Transverse Preputial Patch Urethroplasty were included in the present prospective observational study after written informed consent. Results: The study was carried out with 40 patients and sorted into two groups, i.e. Snodgrass (S) and Duckett (D) group with 20 patients each. No difference was observed among study groups withregards to incidence of individual complications like urethrocutaneous fistula, stricture, or wound infection (p>0.05). However, total complication rate was marginally higher (55%) in Snodgrass’ procedure as compared to Duckett’s procedure (35%). All the cases of stricture (10%) and wound dehiscence (5%) were reported in Snodgrass group.

Keywords

Snodgrass Urethroplasty, Duckett Onlay, Transverse Preputial, Patch Urethroplasty, Penile, Hypospadias, Ventral Penile Curvature

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Dinesh Joshi ¹, Nikunj Varandani ², Mandar Vaidya ¹

Affiliations
1 Associate Professor, Department of Surgery, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Former PG Resident, Department of Surgery, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Background: The closure of such a laparotomy wound is important to minimize the postoperative complications like wound pain, infection, dehiscence and incisional hernia Aims: The objectives of this study was to study the various techniques of midline laparotomy incision closure and their outcomes like wound dehiscence, wound infection and incisional hernia up to six months. Materials and Methods: A total of 100 patients who were operated for midline laparotomy were included as subject material after they satisfied the inclusion and exclusion criteria. Results: Most common indication of laparotomy in the study was gastric ulcer perforation. Incidence rate of surgical site infection, wound dehiscence and incisional hernia was lower in cases of smaller bite length. Incidence rate of surgical site infection wound dehiscence and incisional hernia was lower with continuous suturing. Conclusion: The study results showed that best technique for midline laparotomy incision closure is small bite continuous suturing with mass closure. The small bites technique with continuous suturing showed better results than small bite technique with interrupted suturing. Present study thus recommends that small bite continuous suturing with mass closure should be considered as the standard closure technique for midline incisions.

Keywords

Incisional Hernia, Small Bite Continuous Suturing with Mass Closure, Surgical Site Infection, Wound Dehiscence

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Shishir Kamble ¹, Mandar Vaidya ²

Affiliations
1 Former PG Resident, Department of Surgery, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
2 Associate Professor, Department of Surgery, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Background: Pelvi Ureteric Junction Obstruction (PUJO) is defined as an obstruction to the free flow of urine from the renal pelvis to the proximal ureter1. It is the most common cause of obstructive uropathy in the paediatric age group. Aims: To check for improvement in renal function following Anderson Hynes pyeloplasty for congenital PUJ obstruction and to find out at what age should a child be operated for best improvement in renal functions. Material and Methods: A total of 20 patients undergoing Anderson Hynes Pyeloplasty were included after they satisfied the inclusion and exclusion criteria. Results: In this study it was observed that post Anderson Hynes pyeloplasty, a total of 60% children showed improvement in renal functions, in 30% there was no change in renal function while 10% showed deterioration in renal functions, requiring re-operation. The improvement was statistically significant Mean eGFR in cases improved from 32.25 to 38.5 mL/min/1.73 m2 after Anderson Hynes pyeloplasty. The improvement was statistically significant Mean renal functions in cases improved from 29.05% to 33.7% after Anderson Hynes pyeloplasty. No complications were reported in 85% of the cases after Anderson Hynes pyeloplasty. UTI developed in 2 cases (10%) while pyonephrosis was seen in 1 case (5%). Conclusion: Anderson Hynes Pyeloplasty is an effective treatment for congenital Pelvi Ureteric Junction obstruction in pediatric population. In this study it was observed that the earlier we operate the better is the improvement in function.

Keywords

Anderson Hyles Pyeloplasty, Congenital, Hydronephrosis, Pelvi-ureteric Obstruction

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