Recurrent Fistula Research Articles

HIV-associated rectovaginal fistulae in children: a single-centre retrospective study in the antiretroviral era

PurposeAcquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition.MethodsWe retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011–2023). Information about HIV management, surgical history, and long-term outcomes was collected.ResultsTen patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1–3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5–55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3–25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05).ConclusionWhile HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.

Dural arteriovenous fistulas in the falx cerebri: case series and literature review.

Dural arteriovenous fistulas (DAVFs) within the falx cerebri are infrequently documented and may be linked with the falcine sinus/venous plexus. The falcine sinus/venous plexus, often regarded as a normal venous structure, can exhibit pathological characteristics, differing from the persistent fetal falcine sinus. A retrospective analysis was conducted at a single center to identify all cases of DAVFs within the falx cerebri spanning from 2002 to 2022. Demographic data, fistula features, treatment modalities, clinical outcomes, and fistula closure were collected and analyzed. Additionally, relevant literature on DAVFs in this location was reviewed. Ten cases were identified at our center, supplemented by 13 cases reported in the literature. In our cohort, patients had an average age of 49.4 ± 8.1 years, with a male predominance of 90%. Trans-arterial embolization (TAE) alone achieved immediate complete occlusion in eight cases, while conservative treatment was pursued in two cases. No treatment-related complications or fistula recurrences were observed. In the literature, seven patients underwent direct surgery, three underwent TAE, and one underwent both direct surgery and radiosurgery for complete fistula closure. No instances of fistula recurrence or treatment complications were reported. Dural arteriovenous fistulas within the falx cerebri are rare, with limited literature available. They typically present as aggressive lesions. Treatment options include direct surgery or TAE. However, due to a lack of long-term DSA follow-up, the cure and recurrence rates are unknown for endovasdcular therapy. Further investigation is warranted to elucidate the involvement of the falcine sinus/venous plexus in falx cerebri DAVFs.

Efficacy and Safety of Platelet-Rich Plasma on Bronchopleural Fistula: A Pilot Prospective Cohort Study

IntroductionBronchopleural fistula (BPF) is associated with high morbidity and mortality rates in patients undergoing pulmonary resections. Surgery, bronchoscopy, and conservative management have their limitations for small fistulas. Platelet-rich plasma (PRP) has regenerative properties, which might be efficient in enhancing tissue recovery and repairing small BPF. This study aimed to investigate efficacy and safety of PRP on BPF. MethodsThis is a pilot prospective cohort study. Patients whose fistulas smaller than 4mm were enrolled in this study, treated with PRP under bronchoscopy and followed up at 2 weeks and 4–6 weeks after the last PRP treatment. The cure rate, improvement rate and ineffectiveness rate were investigated. The severity of respiratory symptoms was evaluated by modified Medical Research Council dyspnea scale (mMRC) and COPD Assessment Test (CAT). The recurrence of fistula, new infection and mortality rate were examined. Adverse events were documented to explore the safety profile of PRP therapy. ResultsA total of 16 patients (mean age, 50.1 years) met the eligibility criteria. The median time from the first PRP treatment to the closure of the fistula was 12.0 (IQR 6.0, 21.5) days. Our findings indicate an effectiveness rate of 87.6%, with 68.8% of cure and 18.8% of improvement, along with significant improvement of respiratory symptoms evaluated by mMRC (P<0.001) and CAT (P<0.001). No recurrent of fistulas, newly developed infection, or death was observed. Adverse events of the procedure were most mild (82.6%) and temporary. ConclusionsPRP is a potential treatment for small BPF and is well tolerated.

Recurrent Post-Traumatic Carotid-Cavernous Fistula after Endovascular Treatment

Recurrent Post-Traumatic Carotid-Cavernous Fistula after Endovascular Treatment

Management of traumatic recurrent arteriovenous fistula of the lower extremity: Open versus endoscopic repair

Background: Traumatic Arteriovenous Fistula (TAVF) and traumatic artery aneurysms are the late complications of vascular injuries. Complications arise from neglected or undetected cases of TAVF, hence the need to promptly diagnose and manage them. Aims/Objective: this is to highlight the principles and challenges of managing traumatic recurrent AVF of the lower extremities in a low-income setting like ours. We present a 43- year man with traumatic recurrent AVF of the lower extremity, associated with chronic venous disease and ankle ulcer dating 17 years, who underwent successful treatment via open repair, in our facility, through the combined efforts of a multidisciplinary team involving vascular and plastic surgeons as well as a physiotherapist.

Endovascular and medical management strategies for carotid-cavernous fistulas: A safety and efficacy analysis.

Carotid-cavernous fistulas (CCFs) are complex arteriovenous shunting lesions of the cavernous sinus with diverse clinical presentations. This study aimed to analyze clinical outcomes and differentiate patients treated with conservative observation versus those needing endovascular intervention. A retrospective analysis of 84 patients with angiographically confirmed CCF was conducted from 2000 to 2022. Endovascular treatment decisions were made at the discretion of neurointerventionalists. Clinical and angiographic data were collected, including Barrow CCF classification and treatment outcomes. Patients managed conservatively (n = 17) had longer symptom duration (165 vs 42 days) and more indirect CCF (100% vs 68%) compared to those treated with endovascular embolization (n = 67). High-risk clinical symptoms, including proptosis, diplopia, decreased visual acuity, and chemosis, were more common in the embolization group. Cortical venous reflux and ophthalmic venous reflux were more prevalent in the embolization group (39% and 91%, respectively). Overall, 31% of embolized CCFs required retreatment, mainly Barrow type D lesions (65%). Transvenous coil embolization was the primary technique used (78%), followed by feeder artery embolization (16%), and internal carotid artery flow diversion (8%). In selected CCF patients without high-risk symptoms or angiographic features, conservative observation is a safe and effective alternative to endovascular embolization. High-risk symptoms and angiographic features favor endovascular intervention. Complications were rare, and most were transient, emphasizing the safety of endovascular management. Longitudinal angiographic and ophthalmologic surveillance is essential for monitoring fistula persistence or recurrence.

Treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries: A scoping review.

Obstetrical fistula is an abnormal opening between the reproductive tract and lower urinary and/or gastrointestinal tract resulting from obstetrical complications, affecting nearly two million women worldwide. It imposes physical, economic, social, and mental consequences on the affected women. Treatment outcomes vary and, mostly, surgical treatment results in improved quality of life and successful subsequent pregnancy for survivors. The review aimed to chart and examine the treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries. This is a scoping review study to identify treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries. The search was conducted from databases (PUBMED, Embase, CINAHL, Scopus, and Web of Science), and gray literature (Google Scholar, Google, and conference proceedings). The eligibility criteria were constructed using a participant, concept, and context framework and included study types of primary research, reviews, and reports. Studies without full text and in languages other than English were excluded. The relevant characteristics of the included studies were extracted on an Excel spreadsheet and analyzed to chart treatment outcomes. The review examined the full text of 57 studies on the treatment outcomes of obstetrical fistula. The findings were grouped into two themes: early and late outcomes. The early outcomes included incontinence, surgical-site infection, urine retention, hemorrhage, and retained catheter. The late outcomes included fistula recurrence, residual incontinence, quality of life, reproductive issues, mental health, family and social support, and financial status. The treatment outcomes of obstetrical fistula can be grouped into short-term and long-term outcomes. Although this review found adequate studies for the analysis, most study designs were poor. Stronger studies are recommended in the future to guide policy and decision-making. We would like to suggest that researchers conduct systematic reviews and meta-analyses independently for short-term and long-term outcomes.

Loose Seton Technique in the Management of Complex High Anal Fistula: Enhancing Outcomes with Magnetic Resonance Imaging

Background: Complex high anal fistulas challenge treatment efforts, necessitating innovative approaches that balance healing with sphincter preservation. Methods and Results: In a prospective study at Tikrit Teaching Hospital, 39 patients with complex high anal fistulas underwent treatment with loose silicone setons, guided by preoperative MRI mapping. The efficacy of this method was evaluated through follow-up visits at 1, 3, and 6 months, focusing on fistula healing, recurrence rates, continence preservation (assessed by the Wexner Continence Score), and patient satisfaction. Complete healing was achieved in 31 patients (79.5%), with a recurrence rate of 7.7%. There was a significant improvement in continence, with the mean Wexner score reducing from 3.5 to 1.2 (P&lt;0.001). Moreover, 85% of patients expressed satisfaction with their treatment outcomes. Conclusion: The combined use of loose silicone setons and MRI mapping presents an effective, satisfactory method for managing complex high anal fistulas. This technique ensures high healing rates, significantly preserves sphincter function, and achieves high patient satisfaction.

Tsukamurella Bacteremia in a Surgical Patient: Case Report and Review of the Literature.

Background: Tsukamurella species were first isolated in 1941. Since then, 48 cases of Tsukamurella bacteremia have been reported, a majority of which were immunosuppressed patients with central venous catheters.A case is described and previous cases of Tsukamurella bacteremia are reviewed. Patients and Methods: A 70-year-old total parenteral nutrition (TPN)-dependent female with recurrent enterocutaneous fistula (ECF), developed leukocytosis one week after a challenging ECF takedown. After starting broad-spectrum antibiotic agents, undergoing percutaneous drainage of intra-abdominal abscess, and subsequent repositioning of the drain, her leukocytosis resolved. Blood and peripherally inserted central catheter (PICC) cultures grew Tsukamurella spp. The patient was discharged to home with 14 days of daily 2 g ceftriaxone, with resolution of bacteremia. Conclusions: Tsukamurella spp. are a rare opportunistic pathogen predominantly affecting immunocompromised patients, with central venous catheters present in most cases. However, there have been few reported cases in immunocompetent individuals with predisposing conditions such as end-stage renal disease and uncontrolled diabetes mellitus.

Preventing Pilonidal Sinus Recurrence With Laser Hair Epilation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Pilonidal sinus disease (PSD) is a common condition associated with significant morbidity and healthcare costs. High recurrence rates still pose a considerable challenge in managing PSD, with no universally accepted guideline inplace to guide management. Laser hair epilation offers a way to reduce recurrence rates with reports within the current literature demonstrating positive outcomes compared to alternative approaches. This review was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement standards. The primary outcome measure was the recurrence rate of PSD at a minimum of one year following laser hair epilation. The electronic databases of MEDLINE, EMBASE, CINAHL, Google Scholar, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL)were searched. OpenMeta Analyst (Brown University School of Public Health, Providence, RI) software was used for data synthesis. Three randomized controlled trials met the inclusion criteria with laser hair epilation treatments offering a significant reduction in PSD recurrence rateson odds ratio analysis: 0.319 ( 0.160, 0.636), P-value = 0.0001. Secondary outcomes involving patient disability days, caregiver disability days, health-related quality-of-life (HRQOL) scores, healthcare satisfaction scores, and perceived stigma were discussed qualitatively. The authors offer a decisive recommendation in favor of laser hair epilation in PSD; however, they recommend further high-quality trials to investigate the ideal timing and frequency of laser hair epilation sessions.

Management of neo-esophagus-airway fistula after esophagectomy for oesophageal cancer: systematic literature review and meta-analysis.

Neo-oesophageal-airway fistula (NEAF) between gastric conduit and airway is a rare but life-threatening complication of oesophagectomy for oesophageal cancer. Optimal treatment remains unknown. A meta-analysis of good-quality case series may help determine whether nonoperative management (NOM) only, upfront surgery (S), or NOM followed by surgery is associated with better 1-year post-treatment mortality, resumption of oral diet and fistula recurrence. We systematically searched PubMed, EMBASE and Web of Science for publications in English reporting case series of management and survival in patients with NEAF. Of the 177 identified studies, 62 were duplicates and 95 were not relevant to our topic. Three studies were excluded after a full-text review, due to absence of reporting of 1-year survival. Exclusion criteria to identified publications were: abstract only, malignant NEAF, absence of oesophagectomy and esogastric anastomosis, fewer than 5 patients and NEAF not the main focus of the study. Data-extraction was conducted in accordance with MOOSE guidelines. Data were pooled using random-effects model. Seventeen studies (302 patients) were included. One-year post-treatment mortality was considerably lower with NOM followed by surgery [33%; 95% confidence interval (CI), 0.17-0.48] than with NOM (68%; 95% CI, 0.39-0.97) or S (67%; 95% CI, 0.36-0.98). Fistula location was not associated with 1-year mortality. Neither resumption of an oral diet nor fistula recurrence differed significantly across treatment strategies. NOM to prepare patients for surgery followed by surgical repair may provide the highest 1-year survival of patients with NEAF. However, patient selection criteria to each of 3 treatment strategies may have affected our findings.

SAGA OF A DECADE! BILATERAL GROIN MESH EXPLANTATION WITH COLOCUTANEOUS FISTULA

Abstract Background Mesh-related complications following previous laparoscopic hernia repair, especially transabdominal preperitoneal (TAPP) surgery, can present significant challenges. This case report highlights the utilization of the Mesh Explantation Classification in a 60-year-old male with a colocutaneous fistula a decade after index surgery &amp; emphasises the use of mesh explantation classification for standardisation &amp; case reporting (Published in Hernia Surgery). Objective Describe the laparoscopic mesh explantation and stapled disconnection of a colocutaneous fistula in a patient with mesh-related complications post-TAPP surgery 10 years back and emphasize the mitigation strategies and technical nuances. Methods A 60-year-old male, previously subjected to TAPP surgery, presented with a colocutaneous fistula with faecal discharge secondary to mesh-related complications. Pre-operative colonoscopy, marking the site of the fistula and use of fluoroscopy for identification of any metal tacks were performed. The Laparoscopic mesh explantation and the disconnection of the colocutaneous fistula using an intestinal stapler and intraoperative sigmoidoscopy performed to avoid any luminal narrowing. Two pieces of polyester mesh, with metal tackers were successfully explanted without any collateral vascular injury. Results The patient experienced resolution of symptoms postoperatively, and there were no signs of recurrent fistula during follow-up; the explanted mesh showed features of atypical mycobacterium on the microbiology, and hence, the patient was put on one year of treatment for atypical mycobacterium, he tolerated the treatment well and recovered. Conclusion This case emphasises the importance of a team approach at Index surgery in every case of Mesh Explantation to get the best surgical outcomes. Mesh explantation standardisation classification helps in proper documentation by the surgeon and guides future additional treatment if required. Further research and collective documentation using standardized classifications are essential to refine and validate the approach for mesh explantation in hernia surgery.

Long-term (> 10years) bowel function of anorectal malformations: a retrospective single-center study.

To describe the long-term bowel function of anorectal malformation (ARM) patients and explore the potential influence factors. ARM patients with follow-up data > 10years were included. Cases of cloaca, Currarino syndrome, and VACTERL syndrome were excluded. Rintala score and PedsQL 4.0 were used to assess bowel function score (BFS) and quality of life (QoL). Based on the results, patients were divided into satisfactory group with BFS ≥ 17 and unsatisfactory group with it < 17. Comparisons between the groups were made. Among the 81 patients were 44 males and 37 females. Follow-up time was 138 (126,151) months. 16 (19.75%) patients had associated anomalies. 23 (28.40%) patients had reoperations, and fistula recurrence was the most common reason. BFS of the patients was 20 (18,20). QoL score was 100 (100,100), which correlated positively with BFS (r = 0.648, P < 0.001). The satisfactory and the unsatisfactory groups had 69 and 12 cases, and their BFS were 20 (20,20) and 11 (8,15) respectively, which had statistical difference (P < 0.001). Total QoL score and psycho-social health score of the unsatisfactory group were lower (P < 0.001). Only reoperations were statistically different between the groups (P < 0.001). Long-term (> 10years) bowel function of ARM patients is good in this study. Defecation problems have negative impacts on QoL and mainly affects their psycho-social health. Primary anorectoplasty is extremely important. Reoperations, which are most commonly seen in recto-urethral fistula recurrence, adversely affect the outcome.

The Necessity of Incorporating an Interposition Flap During Vesicovaginal Fistula Repair: Can Modifying the Method of Vaginal Repair Serve as a Substitute? A Randomized Clinical Trial.

Traditionally, an omental flap is employed to reduce the risk of recurrence of vesicovaginal fistula (VVF) repair. In this study, we employed a modified surgical technique wherein the vaginal defect was closed using Connell sutures, without incorporation of an omental flap, aiming to mitigate potential complications. Between 2010 to 2018, the current randomized clinical trial was conducted on 52 women who were candidates for open fistula repair. The patients were randomly allocated into two groups. In one group, the conventional method of fistula repair was performed involving an omental flap, while in the other group, we used a modified approach with a variation in the vaginal wall closure technique. In-hospital variables, including the length of surgery, hospital stay, and occurrences of ileus, were recorded. Patient follow-up extended for one year, with assessments conducted one, six, and twelve months postoperatively. These evaluations encompassed pad test to ascertain success rates and identify any potential complications. The final analysis comprised 49 patients, with an average age of 46.5 years. Baseline characteristics were comparable between the two groups (P-values > 0.05). The modified technique was associated with significantly reduced surgical duration (P = ˂ 0.001), and shorter hospital stays (P < 0.001). Ileus occurrence was reduced, but it was not significant(P = 0.856). However, the success rate showed no significant difference between the groups, with a success rate of 100% for the modified technique compared to 91.6% for the classic O'Conner method (P = 0.288). Based on the findings of this study, vaginal wall closure using Connell sutures during VVF repair demonstrates a success rate equivalent to the classic approach involving an omental flap. Moreover, this technique presents a reduced incidence of adverse effects, along with decreased surgical duration, hospital stay, and postoperative ileus.

Modified supraauricular approach in recurrent preauricular sinus: A case report

The preauricular sinus (PAS) also known as the fossa fistula sac or depression is located near the external auricle at the posterior end of the stalk of the ascending helix. Most cases of PAS are asymptomatic and do not require treatment. Surgery is performed if there are signs of infection or recurrence. Incomplete PAS resection is the most common cause of recurrence. The real problem with surgical resection of PAS is the high recurrence rate after sinusectomy. We report the case of a 22-year-old woman who complained of a mass in her left ear that was enlarging for the past 3 months. The patient had previously undergone two operations at the same site but they were recurrent. Physical examination revealed a non-hyperemic painful cystic mass. A few days after the operation the patient recovered and the pain in front of his left ear disappeared. The patient can close his eyes and lift his forehead symmetrically and show no signs of infection. A follow-up examination 1-2 weeks after surgery in the Department of Ear Nose Throat Head and Neck Surgery (ENT-HNS) showed that the general condition of the patient was good and there were no signs of infection. After 6 months the patients ears returned to normal and there was no recurrence 6 months after surgery. There is a scar along the leading edge of the helix. The patient was diagnosed with a recurrent PAS complicated by a preauricular cyst and treated with sinusectomy using a modified supraauricular approach and resection of the preauricular cyst. Sinusectomy with a modified supraauricular approach is an effective technique and is superior to simple sinusectomy due to its low recurrence rate with minimal complications and superior aesthetic appearance. This modified supraauricular approach achieved excellent functional and aesthetic results in this patient.

Endoscopic Repair of Refractory Tracheoesophageal Fistula with a Cardiac Septal Occluder Device in a 12 Years-Old Patient

Purpose: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are rare anomalies in neonates that must be surgically repaired by esophageal reconstruction with or without ligation of the fistula. Recurrent tracheoesophageal fistula (rTEF) occurs in 3-15% of primary surgical repairs in esophageal atresia; it is associated with recurrent hospital admissions and up to 27% short term mortality. Dependable reparation very often proves difficult by standard surgical techniques. Using oesophageal fully covered self-expandable metal stents in adult patients yields a &amp;lt;50% efficacy and other endoscopic techniques such as occlusion by clips or glue show no better results. A minimally invasive alternative is the use of vascular plug septal occluders. We report the efficacy of endoscopic placement of a cardiac septal occluder (CSO) in a paediatric patient. Clinical case: A 12-year-old female with recurrent (rTEF) and refractory tracheoesophageal fistula (refTEF) was subjected to an refTEF closure procedure via endoscopic placement of a cardiac septal occlusion device. Conclusion: Debate regarding the gold standard of rTEF treatment closure a hot debate but flexible endoscopy is an accepted alternative. This report describes the successful fixing of a refTEF using a cardiac septal occluder. After four weeks follow up, no re-incidence of the tracheoesophageal fistula was detected. The results advocate for the endoscopic closure of refractory tracheoesophageal fistula with cardiac occluders in children thus establishing a promising therapeutical alternative in refTEF in paediatric population patients.

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study.

The goal of therapy for traumatic carotid-cavernous fistula (TCCF) is the elimination of fistula while maintaining patency of the parent artery. The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons, coils, liquid embolic agents, covered stents, or flow-diverter stent through arterial or venous approaches. Despite the withdrawal of detachable balloons from the market in the United States since 2004, transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries. However, the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up. To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF. Between January 2009 and December 2019, 79 patients diagnosed with TCCF were treated using detachable latex balloons (GOLDBAL) of four sizes. Pseudoaneurysm sizes were stratified into five grades for analysis. Initial and follow-up assessments involved computed tomography angiography at 1 month, 6 month, 1 year, and longer intervals for significant cases. Clinical follow-ups occurred semi-annually for 2 years, then annually. Factors analyzed included sex, age, fistula size and location, and balloon size. In our cohort of 79 patients treated for TCCF, pseudoaneurysms formed in 67.1%, with classifications ranging from grade 0 to grade 3; no grade 4 or giant pseudoaneurysms were observed. The majority of pseudoaneurysms did not progress in size, and some regressed spontaneously. Calcifications developed in most large pseudoaneurysms over 5-10 years. Parent artery occlusion occurred in 7.6% and recurrent fistulas in 16.5%. The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes, with balloon SP and No. 6 significantly associated with its occurrence (P = 0.005 and P = 0.002, respectively), whereas sex, age, fistula size, location, and the number of balloons used were not significant predictors. Pseudoaneurysm formation following detachable balloon embolization for TCCF is common, primarily influenced by the size of the balloon used. Despite this, all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.

Five-year recurrence/survival after pancreatoduodenectomy for pancreatic adenocarcinoma: does pre-existing diabetes matter? Results from the Recurrence After Whipple's (RAW) study

BackgroundDiabetes mellitus (DM) has a complex relationship with pancreatic cancer. This study examines the impact of preoperative DM, both recent-onset and pre-existing, on long-term outcomes following pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). MethodsData were extracted from the Recurrence After Whipple's (RAW) study, a multi-centre cohort of PD for pancreatic head malignancy (2012–2015). Recurrence and five-year survival rates of patients with DM were compared to those without, and subgroup analysis performed to compare patients with recent-onset DM (less than one year) to patients with established DM. ResultsOut of 758 patients included, 187 (24.7%) had DM, of whom, 47 of the 187 (25.1%) had recent-onset DM. There was no difference in the rate of postoperative pancreatic fistula (DM: 5.9% vs no DM 9.8%; p = 0.11), five-year survival (DM: 24.1% vs no DM: 22.9%; p = 0.77) or five-year recurrence (DM: 71.7% vs no DM: 67.4%; p = 0.32). There was also no difference between patients with recent-onset DM and patients with established DM in postoperative outcomes, recurrence, or survival. ConclusionWe found no difference in five-year recurrence and survival between diabetic patients and those without diabetes. Patients with pre-existing DM should be evaluated for PD on a comparable basis to non-diabetic patients.

Role of MRI in the diagnosis of Actinomycosis: A Case Report

Actinomycosis is caused by non-spore-forming, anaerobic, gram-positive bacteria called actinomyces. Its wide range of manifestations and non-specific symptoms cause complications by delaying diagnosis. We here present a case of a 34-year-old female with a history of recurrent discharging sinus and skin rashes in the posterior chest wall for 1 year and 6 months. Initially, it was suspected of malignancy with secondary infection. The patient was advised for MRI which shows suspicion of actinomyces. Later on, it was confirmed with a biopsy of the posterior chest wall. Here we present a case to describe the role of MRI in the diagnosis of actinomycosis.

Result of simple versus layered repair of urethro-cutaneous fistula developing after hypospadias surgery

Background: Urethro-cutaneous fistula (UCF) after hypospadias surgery occurs regardless of the location of the meatus, procedure performed or experience of the surgeon. Hypospadias repair continues to be a singularly demanding form of surgical expression with considerable artistic latitude. The commonest complication of hypospadias surgery is fistula formation, which almost always requires repeat and similarly demanding surgery. Aims and Objectives: The aim of our study was to compare the result between simple and layered repair of UCF developing after hypospadias surgery. Materials and Methods: This comparative type of study was carried out in the Department of Paediatric Surgery, BSMMU, Dhaka from June 2015 to August 2016 for a period of 15 (fifteen) months. Forty (40) diagnosed cases of UCF were included in the study. All the participants were randomized into two groups named Group A &amp; Group B. Group A was assigned to the simple repair technique &amp; Group B was assigned to the layered repair technique. Relevant data were collected in a predesigned questionnaire. Results: The recurrent fistula formation rate was much higher in Group A (30%) than in Group B (05%), which was statistically significant in between the two groups. The majority of the fistulae recurred within a few days of the removal of the stent (from 7th to 10th POD). 6, out of 7 recurrent UCF were observed in this period. No recurrent fistula was observed beyond 4 weeks after operation. Conclusions: This study revealed that, the layered repair technique, with the addition of vascularized dorsal dartos fascia reduces the recurrent fistula formation rate in a significant number. Though more time consuming and technically difficult, we recommend wide application of layered repair technique in the management of post hypospadias UCF. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 &amp; 2): 37-42