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.