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Background: cesarean section is a common major hospital surgical procedure performed nowadays. One of the most common postoperative complications is postoperative gastrointestinal paralysis (Ileus) that must be minimized due to its possible serious consequences. Objectives: this study aims to compare the time to regain intestinal motility after general anesthesia versus spinal anesthesia for cesarean section. Methods: this prospective controlled study was carried out at Ain Shams University Maternity Hospital during the period from April 2016 to June 2017 after approval of the hospital health ethical committee. It included 150 patients who had C.S and they were subdivided into 2 groups according to a randomization scale (spinal versus general). Results: spinal anesthesia results in a quicker return of bowel activity after cesarean section, decreased hospital stay and less use of post-operative opioids than general anesthesia. Recommendations: we recommend the use of spinal anesthesia for cesarean section especially if there's no contraindication for that.

Background: Recto-perineal fistula is a common anorectal anomaly, affecting both males and females. The anus is abnormally anteriorly located and is usually stenotic. Management of recto-perineal fistula is a dialectic problem. The most common presenting complaint is constipation; also, long-term follow-up of these patients revealed high incidence of postoperative constipation. Results: The study included 30 patients (19 female and 11 male). Their age at time of repair ranged from 3 to 78 months. We compared the pre-and postoperative constipation rate after limited posterior sagittal anorectoplasty (PSARP) using Krickenbeck score. Overall, the rate of constipation has dropped from 77 (23/30) to 30% (9/30) after surgery. Fourteen patients out of 23 patients with preoperative constipation were cured. Another patient with preoperative constipation improved regarding the grade of constipation. The remaining 8 patients with preoperative constipation did not show improvement after operation. These results were statistically significant (McNemar test). Out of the 9 patients who were still constipated after surgery, 7 had associated fecal soiling that showed good response with bowel management of constipation. Conclusion: Limited posterior sagittal anorectoplasty can have a role in treating constipation among cases of recto-perineal fistula.

Background Rectoperineal fistula is a congenital low anorectal malformation that is presented with constipation and straining at stool. There is argument as regarding name, diagnosis and surgical treatment. Objectives to estimate the incidence of postoperative constipation among patients with rectoperineal fistula treated with anorectoplasty using Krickenbeck classification for postoperative outcomes. Patients and Methods The study was conducted between January 2018 and August 2018. The study included patients with rectoperineal fistula who underwent sagittal anorectoplasty (SARP) in the last five years in two tertiary hospitals; Ain Shams University Children Hospital and Banha Specialized Children Hospital. We excluded patients who underwent operations other than SARP and patients having Currarino syndrome and sacral anomaly like hemisacrum and caudal regression. Krickenbeck classification was used for assessment of constipation before and after operation. A simple questionnaire was used for follow up assessment. Results The study included 30 patients (19 female and 11 male). Their age at time of repair ranged from 3m to 78 months with a median age of 7.5 months. Rate of constipation in patients with rectoperineal fistula after SARP was 39%, while improvement rate was 65%. 14 patients out of 23 having preoperative constipation (61%) were treated from constipation, and one patient (4%) got improved regarding constipation grade and frequency, while remaining 8 patients (35%) were still having the same degree of constipation. There were 7 children who had no constipation before and after repair. These results were statistically significant as measured using McNemar test. Postoperative soiling was recorded in 7 patients; all of them had pseudo-incontinence (ORSI). Conclusion Rectoperineal fistula patients can gain benefit from SARP not just cosmetically, but also functionally (65% of constipated patients got improved).