Introduction: Corrosive esophageal injuries result in mucosal damage related to the type, exposure time, and volume of the ingested substance, ranging from mild burns to severe necrosis. These injuries are usually seen in childhood,stricture and dysphagia are common. Swallowing problems are due to prolonged stricture and require surgery. However, postoperative problems should also be considered. The purpose of this study was to determine the results of esophageal replacement in the management of corrosive esophageal injury via three methods: COLON INTERPOSITION, gastric pull-up, and reverse gastric tube. Methods: In this observational descriptive-comparative study, 50 consecutive patients admitted to Mofid Children’, s Hospital with corrosive esophageal injury from 2006 to 2016 were enrolled, and the results of esophageal replacement by COLON INTERPOSITION, gastric pull-up, or reverse gastric tube were determined and compared according to other variables. Results: The results of this study demonstrated that 68% of the patients required surgery, with 82. 3% undergoing repeated surgery. A total of 22 patients underwent surgery via the gastric pull-up method, which was the most successful procedure. Esophageal stricture (74%), vomiting (46%), and dysphagia (40%) were the most common preoperative complaints, whereas dysphagia (46%), stricture (36%), and vomiting (26%) were the most common postoperative problems. There were four cases of mortality. Conclusion: According to the obtained results, it may be concluded that esophageal replacement in the management of corrosive esophageal injuries is effective, and that the gastric pull-up method is the best surgical option.

Gastroesophageal reflux (GER) is a common pediatric problem which is not perceived adequately by parents and medical providers. Clinical manifestations such as regurgitation of unprocessed milk, poor weight gain, and respiratory symptoms should alert the physician about this disorder. Endoscopy, 24 hour esophageal pH monitoring, the upper GI series, and scintigraphy are among the used diagnostic modalities of this disorder. Prompt diagnosis and medical or surgical treatment with antireflux procedures as needed can prevent its complications such as Barrett’s esophagus and stricture. In this article we present an 18 month old patient who developed severe esophageal stricture as a complication of prolonged GER because of delayed diagnosis, and underwent a previous unsuccessful antireflux procedure, treated with COLON INTERPOSITION procedure at Tabriz Imam Khomeini Hospital.

Background & Aim: Esophageal replacement is done for patients with long gap esophageal atresia, severe stenosis of esophagus due to gastroesophageal reflux, and burns due to chemical agents. A suitable replacement for esophagus must have the following qualities: appropriate function, no tendency to malignancy, straight direction, no gastroesophageal reflux, and fewer complications. Today gastric tube, stomach, jejenum, and COLON are used for esophageal replacement and each has its own advantages and disadvantages. The appropriate time for esophageal replacement is the age of 3-6 months in the case of esophageal atresia. However, when the stenosis needs over a 12-month period for dilation or the length of the stenosis is more than 5 cm and in the case of esophageal burns due to chemical agents and esophageal reflux, replacement seems to be necessary.Patients & Method: In this retrospective study, we examined the results of different methods of esophageal replacement and their complications in Ali-Asghar Hospital from 1996 to 2004. Then the results were compared with the international scientific findings. In Ali-Asghar Hospital, 18 children were operated for esophageal replacement. Among these cases, 3 patients were severe stenosis due to esophageal burns and the others were cases of long gap esophageal atresia. Replacement was done for 15 cases by COLON INTERPOSITION, 2 patients by gastric replacement and one case by gastric tube procedure. The third gastric replacement was performed on complicated patients who had undergone COLON INTERPOSITION before. COLON can be used for esophageal replacement by two methods: isoperistaltic and antiperistaltic. The rate of complications and mortality is higher in antiperistaltic method. Anastomotic leakage and stenosis of the anastomotic line are the most common complications in esophageal replacement. The common causes of mortality are aspiration pneumonia and congenital heart disease.Results: 14 out of 18 patients were male and the rest were female. The range of age to have a replacement operation was 3.5-12 months in the case of esophageal atresia and 15-30 months in the case of GER (gastroesophageal reflux) and esophagitis. Three cases of GER and chemical esophagitis underwent two methods of surgery including gastric replacement(two cases) and gastric tube(one case). 15 cases of esophageal atresia underwent COLON INTERPOSITION. The COLON segments used for replacement were right COLON in 9, left COLON in 5, and transverse COLON in 1 case.Conclusion: In Ali-Asghar Children’s Hospital and most other pediatric surgery centers around the world, COLON is most commonly used for esophageal replacement. This kind of replacement can be carried out by two methods named isoperistaltic and antiperistaltic. In comparison with antiperistaltic method, the isoperistaltic one is accompanied by fewer complications. However, if COLON INTERPOSITION fails, the best replacement is the whole stomach.

Background: Laparoscopic leal inter Position (II) with sleeve gastrectomy (SG) is an upcoming procedure that helps to improve metabolic profile and leads to weight reduction without causing significant malabsorption, paving the way for usage of the term "metabolic surgery." Objectives: To determine the impact of this novel procedure on glycemic control and the accompanying metabolic abnormalities of type 2 diabetes mellitus (T2DM).Patients and Methods: The II and SG procedures were performed in 38 patients (M: F=24: 14). Despite their usage of optimum dosage of oral hypoglycemic agents (OHAs) and/ or insulin, all patients exhibited poorly controlled T2DM (mean glycosylated hemoglobin [HbA1C]: 9.57±2 %). The primary outcome was a remission of diabetes (HbA1C<6.5% without OHA/insulin). Secondary outcomes included a reduced need for antidiabetic agents and a reduction in symptoms of metabolic syndrome.Results: The mean follow up time was 11.3±9 months (range: 3–32 months). Participants were 47.5±8.8 years of age (range: 29–64 years), had diabetes for a mean duration of 9.7±8.8 years (range: 1–32 years), and had a mean preoperative body mass index (BMI) of 32.05±7.5 kg/m2. Thirty patients (79%) exhibited hypertension, 19 (50%) had dyslipidemia, and 19 (50%) harbored significant micro albuminuria. Postoperatively, glycemic parameters (fasting and post lunch blood sugars, and HbA1C) improved for all patients (P<0.05) at all intervals. Eighteen patients (47%) experienced a remission in diabetes and the remaining patients received a significantly lower OHA dosage. All patients demonstrated 15–30% weight loss (P<0.05). Twenty-seven patients (90%) experienced a remission in hypertension.At 2 years, the mean reduction in HbA1C (36%) was greater than the reduction in BMI (20%). A declining trend in postoperative levels of lipids and micro albuminuria became evident, although the reduction was significant for micro albuminuria only.Conclusions: The laparoscopic II with SG procedure appears promising for gaining control of T2DM and associated morbidities. To substantiate our preliminary findings, additional long-term data that involves a larger number of patients is necessary.

Introduction: Patients with primary acute aortic dissection are at higher risk of complications, including increasing aortic aneurysm diameter, aortic rupture, aortic pseudo aneurysm, and recurrent aortic dissection. Case presentation: We presented the case of a recurrent pseudo aneurysm and rupture of the aorta in the distal ascending aorta and proximal arch 3 years after the initial procedure for acute aortic dissection. The patient had bleeding from previous skin incision. In computed tomography angiography, the site of rupture of the aorta and abnormal communication with sternum were confirmed. Conclusion: Recurrent aortic dissection is a catastrophic event and has high mortality; however, it is rare and is treated in a short time by redo surgery.

Introduction: Rectourethral fistula is a relatively rare condition with a worldwide incidence rate of less than 3%, featuring a wide range of clinical presentations. Treatment mostly involves surgical correction via different techniques. Here, we look at a case series of complex rectourethral fistulae and their management involving local tissue flaps. Case Presentation: Three patients with complex rectourethral fistulae underwent surgical repair with pedicled gracilis muscle flaps. All patients underwent a pelvic magnetic resonance scan and a flexible antegrade and retrograde cystoscopy before their repair. The gracilis muscle flap was harvested from the left thigh in two patients and the right thigh in the third patient. Conclusion: Trauma and radiation are the two most common causes of rectourethral fistulae. Most of these patients have a poor quality of life and require surgical repair with some form of tissue INTERPOSITION. The failure of a prior rectourethral fistula repair worsens the patient’, s quality of life and makes the subsequent surgery more challenging. Diversion of both the urine and feces as the initial treatment results in better outcomes of the final repair and hence should always be included in the management protocol of this rare entity.

Background: Peripheral vascular injury associated with lower limb trauma is a well-known emergency. The experience for the management of popliteal artery trauma has mainly come from managing the traumas of military personnels during Iran- Iraq war. The present study compared the effects of two currently- used surgical techniques in the management of popliteal trauma, namley femoropopliteal bypass graft and INTERPOSITION vein graft on limb salvage.Methods: A retrospective review of 40 patients with popliteal artery trauma admitted to the trauma unit of a university teaching hospital during 2003 to 2008. The patients had undergone femoropopliteal bypass graft (n=26) or INTERPOSITION vein graft (n=14) for the management of popliteal trauma.Results: The amputation rate among patients managed by femoropopliteal bypass or INTERPOSITION vein graft was 35.7% and 61.5%, respectively. Knee stability among patients managed by INTERPOSITION graft group was 57.7% and in those managed by femoropopliteal bypass graft was 85.7%.Conclusion: The rates of knee stability achieved by the employed techniques indicate that femoropopliteal bypass vein graft is superior, and therefore, preferable to the INTERPOSITION vein graft in the management of popliteal artery trauma.