Sameh Shehata

Alexandria University | AU · Department of Pediatric Surgery

Introduction Rectal atresia is a rare subtype of anorectal malformations in which the patients are born with a normal anal canal but have complete atresia located few centimeters proximal to the dentate line. We present the transanal end-to-end rectoanal anastomosis as a surgical technique for the management of these patients, highlight the outcome...

Background: Social media platforms are popular places for discussing difficult cases amongst the surgeons. Paediatric Surgeon's Lounge (PSL) is a closed Facebook group for the interaction of paediatric surgeons from different parts of the world. We aim to assess the safety and utility of the responses given by the members of the PSL group to the q...

Introduction: Rectal atresia is a rare subtype of anorectal malformations in which the patients are born with a normal anal canal but have complete atresia located few centimeters proximal to the dentate line. We present the transanal end-to-end rectoanal anastomosis as a surgical technique for the management of these patients, highlight the outcom...

Biliary atresia (BA) is the most common indication for pediatric liver transplantation. We describe The BA variant: Kotb disease. Liver tissue in the Kotb disease BA is massively damaged by congenital aflatoxicosis resulting in inflammation, adhesions, fibrosis, bile duct proliferation, scarring, cholestasis, focal syncytial giant cell transformati...

Background and Objective The optimal treatment protocol of intraabdominal testis is still a matter of debate and until now there are a lot of areas of controversy as regards this challenging subtype. The aim of this report is to document current practice patterns among surgeons from different continents through an online Redcap survey supervised th...

H-type ano-vestibular fistula with a normal anus is a rare type of anorectal malformations in female children. Although most cases are considered to be congenital, some authors suggested that this was an acquired condition. There is a high incidence of associated anomalies reaching up to 20–60% of the cases. The most common anomalies are anal steno...

There are many lessons we can learn from the history of Hypospadias repair. It has passed through many stages in a long and difficult road over two centuries in search of improving functional and cosmetic results of this common anomaly in males. At each stage, this was highly influenced by the current understanding of the embryology and anatomy of...

Background: There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. Purpose: The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children. Patients and m...

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This internati...

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates an...

Aim: To assess the severity of persistent pulmonary hypertension (PPH) in congenital diaphragmatic hernia (CDH) neonates solely using oxygenation index (OI). Study Design: A prospective study was carried out from April 2016 to March 2019, where all confirmed CDH neonates were evaluated for the possibility repair through thoracoscopic approach. The...

PurposeWe aimed to understand the challenges facing children’s surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children’s surgery.Methods Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children’s Surgery (GICS) with a geographically diverse panel r...

The intra-abdominal testis (IAT) has been always an enigma for both diagnosis and treatment. The interruption of the main vascular supply of the testis, depending on collateral circulation, has been used for many years but with questionable effects on the microscopic delicate structure of the testis. The principle of traction has been used in the p...

Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce...

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Su...

Background: Laparoscopic Nissen fundoplication is the gold standard antireflux procedure in pediatric age group. Intrathoracic migration of the fundic wrap is a common cause failure, leading to recurrence of gastroesophageal reflux disease (GERD) symptoms. Objectives: To investigate the impact of wrap-crural fixation and minimal esophageal dissect...

Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia with an incidence of 1 in 15,000 live births. Surgical reconstruction for girls with CAH and urogenital sinus (UGS) is a great challenge to create normal appearing and functional external genitalia. The purpose of this study is to evaluate the early outc...

Background Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Methods This international cohort study included adult patients undergoing elective surge...

Aim of the Study: We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions. Materials and Methods: This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both...

Purpose: To evaluate the outcome of pediatric malignant ovarian germ cell tumors treated by three tertiary Egyptian institutions, and to compare our national experience to internationally published data. Methods: This is a retrospective analysis of all patients presenting between September 2014 and September 2019. Management protocol was Childre...

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, m...

Preface: It has been a hard time since the outbreak of Coronavirus in late 2019. The rapidly spreading virus didn't respect borders, race, or ethnicity. That is why we need to stand together, to learn from each other and to support each other. The medical staff in different countries are on the front lines and they doing a heroic job at a very diff...

Background Wilms tumor is the commonest malignant renal neoplasm in children. Surgery plays a pivotal role in the management, and evidence-based guidelines for surgical resection have been established by the major international groups. Any deviation from the protocol is considered as a violation. The goal of this study was to evaluate outcomes of t...

Introduction: The major obstacles for routine application of thoracoscopic repair for congenital diaphragmatic hernia (CHH) in neonates include intraoperative hypercarbia, acidosis and conversion to open surgery. Therefore, strict preoperative selection criteria should be followed for successful primary thoracoscopic repair of the diaphragm and ach...

The prolific advances of minimal invasive surgery (MIS) have made many of the complex pediatric surgical problems amenable to these procedures for more benefits. Nowadays, successful repair of congenital diaphragmatic hernia (CDH) by thoracoscopic and laparoscopic techniques is no exception. Our study aims to highlight the surgical technique, initi...

The kidney is one of the commonest organs for cyst occurrence [1]. Causes are listed in Box 57.1 [2]. Autosomal dominant polycystic kidney disease (ADPKD) is the most common renal cystic disease in the United States [3]. On the other hand, simple renal cysts are comparatively rare in children and adolescents up to 18 years of age. Incidence ranges...

Urinary bladder tumors are not common in children and adolescents. They are either urothelial or non-urothelial (Fig. 65.1). The commonest is rhabdomyosarcoma (RMS) of the bladder or prostate/vagina followed by papillary urothelial tumors (Table 65.1) [1]. RMS, being the commonest childhood soft tissue sarcoma, ranks third commonest pediatric solid...

Congenital anterior urethrocutaneous fistula is an extremely rare anomaly which may present in an isolated form or accompanying hypospadias or chordee. We describe an 8-month-old boy who presented to our outpatient clinic with a congenital anterior urethrocutaneous fistula on the ventral aspect of the penile shaft. He underwent single stage tubular...

Background: Wilms tumor is the commonest malignant renal neoplasm in children. Surgery plays a pivotal role in the management, and evidence-based guidelines for surgical resection have been established by the major international groups. Any deviation from the protocol is considered as a violation. The goal of this study was to evaluate outcomes of...

Background Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants and children. Single port laparoscopic hernia repair using percutaneous internal inguinal ring (IIR) suturing procedure is a widely employed technique for indirect inguinal hernia repair in children. The majority of extracorporeal techniques use extrac...

Background: Metachromatic leukodystrophy (MLD) is a lipid storage disease characterized the accumulation of sulfatides in different viscera including the gallbladder. Case report: A 2-year-old girl had upper right quadrant lesion that was preoperatively thought to be a biliary cystadenoma. Histologically, the gallbladder lesion was a tubulo-villous...

Purpose To propose a new clinical classification for pediatric inguinal hernias modified from a similar classification system for adult inguinal hernia and to propose a tailored repair for each type. The impact of this approach on hernia recurrence will be assessed. Methods This prospective and retrospective cross-sectional study was conducted in...

Acute gastric volvulus occurs when the stomach undergoes torsion in the thoracic cavity. It may result from an accompanying enlargement of the hiatus or a missed congenital diaphragmatic hernia (CDH). We describe a 12-year-old girl who presented to our emergency department with acute epigastric pain and non-bilious vomiting. An incidental finding o...

This study aims to investigate the management of Wilms tumor by the Egyptian pediatric surgical association (EPSA) consultants. After approval of the EPSA executive board, a questionnaire was distributed individually to all consultants attending the general assembly of EPSA 2017 annual congress. Of 88 consultants, responses were received from 61. P...

Background: Cloacal malformation is a spectrum of diseases affecting females, resulting in abnormal confluence of the urinary system, genital system, and/or gastrointestinal system. Proper reconstruction depends mainly on accurate preoperative illustration of the abnormal anatomy. Among the various modalities to delineate the urogenital sinus and...

Background: Inguinal hernia repair using a percutaneous internal ring suturing technique is an effective alternative technique to conventional laparoscopic hernia repair. It is one of the most commonly used approaches for laparoscopic hernia repair in children. However, most percutaneous techniques have utilized extracorporeal knotting of the sutu...

Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral...

Background: laparoscopic hernia repair (LHR) in children is becoming more popular

Background: We present the midterm results of the novel technique of two-stage laparoscopic traction orchiopexy (SLTO) for the high intraabdominal testis (IAT) for elongation of the testicular vessels without division. Patients and methods: Boys with IAT proven by laparoscopy were selected for the technique between September 2009 and April 2013...

The desire to reduce incision related morbidity and pain while achieving improve cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES]. Over the last few years, SIPES has been increasingly used for a variety of procedures; single incision laparoscopic hernia repair [SILHR] is perhaps its common appli...

A high proportion of children with bladder exstrophy will continue to suffer from urinary incontinence and a miserable life even after a well-performed staged reconstruction in specialized centers. Most of those children usually have a normal anal sphincter allowing construction of a neobladder from the rectum, so they are continent without an abdo...

The intra-abdominal testis (IAT) has been always an enigma for both diagnosis and treatment. Imaging techniques are known for low sensitivity for localizing the IAT. It has been universally accepted that the gold standard for localizing the IAT is diagnostic laparoscopy. Orchiopexy techniques for IAT are complicated and attended with a higher rate...

Abstract Background Many new tools for management of impalpable testes have emerged during the last few years, yet, not many studies have compared them to the traditional ways of managing this problem. This work aims to reiterate the importance of the physical examination under general anesthesia prior to the surgical procedure in order to decide t...

Background: Many new tools for management of impalpable testes have emerged during the last few years, yet, not many studies have compared them to the traditional ways of managing this problem. This work aims to reiterate the importance of the physical examination under general anesthesia prior to the surgical procedure in order to decide the best...

We aimed to identify potential risk factors for intussusception (ISS) among children presenting to two pediatric hospitals in Egypt. In this case-control study, enrolled children < 3 years old with ISS (confirmed radiologically and/or surgically) were matched by age and gender to controls admitted with acute non-abdominal surgical illnesses. Stool...

Background: During laparoscopic orchidopexy, some authors routinely close the peritoneum over the area of the deep inguinal ring (DIR). We report our experience, to determine whether leaving the peritoneum over the DIR without closure is associated with an increase in the occurrence of postoperative inguinal hernia. Patients & methods: This is a...

Laparoscopic orchidopexy has become the routine tool in managing abdominal testes. Many techniques have been used to deliver the dissected testis to the scrotal position; a trans-scrotal port is one of them. We present a technique in which the trans-scrotal port is inserted early on, and used not only for testis delivery but also to aid the testicu...

Background: Various techniques such as endoloops, endoscopic linear cutting staplers, electrothermal vessel-sealing system (LigaSure), Harmonic scalpel, clips, and bipolar coagulation have been used for the division of the mesoappendix during laparoscopic appendectomy. This study was conducted to evaluate the potential benefits and limitation of Li...

The study was performed to assess the benefit of gradual traction for the management of abdominal testis by lengthening instead of dividing the testicular vessels. After approval by the ethical committee of the Faculty of Medicine of the University of Alexandria, and after parents signed a detailed informed consent, ten children with unilateral int...

During laparoscopy for impalpable testes (IT), if the vas and vessels are found exiting the deep ring, many surgeons proceed to inguinal exploration as a routine, regardless of the adequacy of the vessels or the presence or absence of the processus vaginalis (PV). We tried to find out whether this was necessary in cases with hypoplastic vessels. Th...

Transanal endorectal pull-through (TEPT) is the latest development in treatment of Hirschsprung's disease (HD). This prospective study was designed to evaluate the safety and efficacy of 1 stage TEPT technique in the management of patients with HD. One hundred forty-nine children (116 boys and 33 girls) aged 8 days to 14 years underwent 1 stage TEP...

While there is agreement that hydrostatic reduction (HR) is the ideal first-line treatment for childhood intussusception, there is controversy about which technique is best, namely, barium, air, or saline. We present our experience in the Pediatric Surgical Center, University of Alexandria, in HR of intussusception under ultrasound (US) guidance. T...

The most common type of anomaly in adrenogenital syndrome is medium entry of the vagina into the urogenital sinus. This can be confirmed before surgery through ascending genitogram. The recommended age of correction is at one year of age. Complete correction in one stage is the treatment of choice. Reduction clitoroplasty is the best procedure for...

We report 2 infants with intestinal (midgut) malrotation presenting beyond the neonatal period. The first infant had features of protein-losing enteropathy and the second had stagnant (blind) loop syndrome. Surgical correction of the anatomical abnormality in the first case was followed by complete cure. Surgery was not feasible for the second case...

Background: In the last decade, stimulated "dynamic" graciloplasty has shown promising results in the treatment of patients with fecal incontinence. Good results with dynamic graciloplasty have been reported by individual investigators, but the applicability of these results to a broader range of surgeons yet to be shown. Objectives: The aim of thi...