Secondary anorectal surgery for the missed puborectalis muscle.

A detailed analysis and personal follow-up of 25 patients who underwent secondary anorectal surgery for incontinence suggests the following: (1) The puborectalis muscle is missed in pull-through surgery with greater frequency than is generally appreciated. (2) Direct visualization of the muscle at primary surgery can markedly reduce bowel misplacement. (3) Continence after secondary surgery improves with age, especially with the passage through puberty.

The rationale and results in two-stage orchidopexies.

The two-stage orchidopexies for cryptorchidism done over a period of 20 yr were reviewed. It was found that of 60 staged orchidopexies attempted, 56 were successfully completed. Based on follow-up of 40 testes, the 82% anatomical results would seem to support the assertion that staged orchidopexy is the procedure of choice for the "difficult" undescended tests with a primarily short blood supply.

Unilateral inguinal hernias in children: What about the opposite side?

The decision for or against bilateral exploration in unilateral hernias in infants is necessitated by the high incidence of obscure anatomic hernias on the opposite side. On the basis of studies done in 400 pediatric patients (mostly under 2 years of age), we believe that unilateral repair of a known hernia without ascertaining the presence of a contralateral hernia is unjustified. Because of an appreciable risk to the gonads and/or vas deferens, we do not believe routine bilateral herniorrhaphies in all infants are indicated.

Stapled cystograstrotomy. A method of treatment for pediatric pancreatic pseudocyst.

An uncommon complication of pancreatic inflammatory disease or pancreatic trauma in children is the development of a pseudocyst. The English literature records less than 100 cases in children and emphasizes that surgical intervention is the indicated form of treatment. The authors have had experience with nine pediatric patients suffering from pseudocysts in a seven year period.

Imperforate anus: an analysis of mortalities during a 25-year period.

A careful analysis of 53 deaths in a series of 284 patients suggests the following points are important in reducing risk: 1. Imperforate anus is a complicated lesion which should only be done by experienced surgeons in a large-volume pediatric surgical center in order to avoid the wrong choice of procedure. 2.

Alimentary tract duplications in children.

This report reviews the experience with 78 alimentary tract duplications found in 64 patients over a 40 year period at the Children's Hospital of Pittsburgh. Ten patients had the duplication discovered at autopsy. Multiple duplications were found in 15% of patients.

Mediastinal masses in infants and children.

In a group of 93 pediatric patients with mediastinal masses, three quarters of them were diagnosed because they were symptomatic. Approximately one half of the masses were malignant, and of neurogenic or lymphomatous origin. Neurogenic tumors predominated before the age of 4 years, while lymphomas were most common beyond age 4.

Recognizing and referring neonatal surgical emergencies.

Ultimate survival of the neonate with a surgical emergency depends upon early recognition by the family physician, who may refer the infant to a pediatric surgical center. The family physician must prevent infectious and metabolic insults to the critically ill neonate while preparing him for safe and rapid transport to a specialty institution. In many cases, the final outcome is as often determined by the initial care received at the referring hospital and during transport as it is by the surgical procedures and postoperative management.

Imperforate Anus: a five to thirty year follow-up perspective.

A twenty-five year experience with 284 patients with imperforate anus has been reviewed, with a 5 to 30 year assessment after surgical intervention. The following conclusions seem to be suggested by the study: 1. There was a 20% mortality overall, with the greatest number of these occurring in the Type III high lesions.

Imperforate anus.

Sucessful treatment of the child with imperforate anus yields an individual with satisfactory continence and a healthy urinary tract. These goals are achieved by accurate evaluation of the newborn, optimal technical results, and conscientious follow-up. The infant born with one of these malformations frequently has a serious associated anomaly which also requires early specific diagnosis and management.