حيدر محمد محسن العذاري

Abstract: Introduction: Hirschsprung disease (HD) or congenital megacolon is an ancient disease first described in 1887 by Hindu surgeons. It is characterized by an absence of ganglion cells in the myenteric and submucosal plexus in the distal colon, making the condition a considerable surgical cause of early childhood constipation, soiling, and enterocolitis (EC). Surgical correction represents the definitive treatment. Swenson, Duhamel, and Soave, in addition to State and Rehbein, are well-known surgical procedures described with various modifications. Methods: In our study, 80 cases of Hirschsprung disease have been identified, investigated, and operated on in different hospitals in Najaf city over 7 years. Aim: This study aims to measure the incidence and severity of EC in HD patients treated with the trans-anal Swenson pull-through operation (TSPT). Results: The follow-up period ranged from 2 to 5 years. Questionnaires and medical record reviews have been used to assess the incidence and severity of EC among patients with the Swenson operation. Conclusion: We concluded that the incidence and severity of the EC were less in the cohort operated on with TSPT than among the patients who underwent a two-stage Swenson procedure.

Abstract: CAPD is a peritoneal dialysis (PD) technique introduced in 1978 as a renal replacement therapy more often in children, whenever high-level centers are available. It represents a typical treatment for end-stage kidney disease and can be inserted as a bedside procedure (Cook Medical, Bloomington) or operatively under general anesthesia (Tenckhoff catheter). Complications associated with catheter placement are well-known and have been extensively studied. Multiple factors influence catheter survival and functions, including the shape of the subcutaneous segment, the number of cuffs, and the design of the intraperitoneal part. Comprehensive research was conducted to study the outcomes of the straight and coiled-tip catheters. A pooled dataset produced by a systematic review and metaanalysis of 13 randomized controlled trials examined catheter survival, blockage, migration, leakage, exit site infection, hernia, intestinal obstruction, peritonitis, and catheter removal, favoring a surgically inserted, straight-tip catheter [2]. In our study, we included 74 cases of children under 18 with end-stage renal disease (ESRD) from different hospitals in the Najaf Directorate of Health (NDoH) between July 2022 and July 2025. Both designs have been used according to the age of patients (straight-tip double cuff catheter used in infants, while the coiled-tip CAPD catheter was inserted in older age group patients). 72 (98%) had a CAPD coil-tip catheter inserted operatively. This study aims to investigate the complications associated with CAPD catheters in our center and to examine the factors contributing to failure, survival, and removal. We concluded that peritonitis is the commonly reported complication over the follow-up period, followed by CAPD obstruction and exit site infection.

Abstract: Background: Postoperative antibiotics are still a contentious topic in clean pediatric surgery, especially when it comes to routine hernioplasty for infants with indirect inguinal hernias. Goal: To determine whether postoperative antibiotics are necessary and effective in lowering complications in infants who have had hernioplasty. Techniques: At one tertiary facility, 552 infants with indirect inguinal hernias received elective hernioplasty procedures. Two equal groups of participants were formed. After surgery, Group A (n = 276) was given oral amoxicillin syrup for five days. Following surgery, Group B (n = 276) was not given any antibiotics. Over the course of a three-month follow-up, both groups were observed for indications of local swelling at the surgical site, recurrence, or wound infection. Findings: There were no statistically significant differences between the groups in terms of local swelling (3.2% in Group A, 3.6% in Group B), recurrence (0.4% in both groups), or postoperative wound infection (1.4% in Group A and 1.1% in Group B). Every issue was minor and handled carefully. Conclusion: The rate of surgical complications is not considerably impacted by the routine postoperative administration of antibiotics in infants undergoing clean elective hernioplasty. Without endangering patient safety, prudent antibiotic avoidance can help reduce needless drug exposure and fend off antimicrobial resistance.

Abstract Background: In male infants, rectourinary fistulas frequently coexist with anorectal malformations (ARM). The most common preoperative imaging technique for defining the distal bowel anatomy and identifying fistulas is the high-pressure distal colostogram (HPDC). Its diagnostic precision is still uneven, though. Objective: Aim: Over an eight-year period, assess the diagnostic precision of HPDC in identifying the presence and anatomical location of rectourinary fistulas in male infants with ARM. Methods: Over the course of eight years, 45 male infants with ARM who had HPDC before definitive surgery (posterior sagittal anorectoplasty, or PSARP) were included in this observational study. The accuracy of the diagnosis was assessed by comparing the HPDC results with the intraoperative findings. Results: In 23 out of 45 patients (51.1%), HPDC correctly detected the existence and location of rectourinary fistulas. The HPDC was incorrect in 22 patients (48.9%). Inadequate contrast injection (n = 9), obstruction of the fistula tract by inspissated stool or secretions (n = 7), and failure to create a high-pressure closed space (n = 6) were the most frequent reasons for misdiagnosis. Conclusion: Although HPDC is still a vital component of preoperative assessment for ARM, it should be acknowledged that it has limitations. Diagnostic yield can be increased by standardizing the procedure and making sure contrast is administered optimally.