Introduction: In antegrade colonic enema (ACE) appendicostomy,cecal fixation on the inside of the abdominal wall and cecal wrap around the base of the appendix are often performed as an antireflux procedure. Whether c...Introduction: In antegrade colonic enema (ACE) appendicostomy,cecal fixation on the inside of the abdominal wall and cecal wrap around the base of the appendix are often performed as an antireflux procedure. Whether cecal fixation and wrap and fixation (FW) are necessary is not known. In a retrospective study,we compared laparoscopic and open procedure with FW (LACEfw+ and OACEfw+ ) with laparoscopic procedure without FW (LACEfw-). Materials and Methods: Between 1997 and 2004,44 consecutive patients underwent an ACE appendicostomy for fecal incontinence. Eleven patients (1997-2000) had OACEfw+ ,14 patients (2001 to 2003) had LACEfw+ ,and nineteen (2003-2004) had LACEfw-. The primary disorders included meningomyelocele (n=17),imperforate anus (n=12),sacral agenesis (n=1),presacral teratoma (n=1),osteosarcoma (n=1),diastematomyelia (n=1),tuberose sclerosis (n=1),Hirschsprung’ s disease (n=2),Down syndrome-associated refractory constipation (n=1)-,Jacobsen syndrome (n=1),and chronic constipation (n=1). Twenty-eight patients had undergone previous abdominal surgery. Operative time,theatre time,length of hospitalization,and complications related with procedure and stoma were compared among the 3 groups. Results: Age and age-adjusted body mass index did not differ statistically among the 3 groups. One LACEfw+ and 2 LACEfw-were converted. The median operative time was 38 minutes (range,23-65 minutes) for OACEfw+ ,78 minutes (50-135 minutes) for LACEfw+ ,and 40 minutes (25-120 minutes) for LACEfw-(P < 0.05). The median theatre time for OACEfw+ was 71 minutes (range,50-107 minutes),for LACEfw+ 123 minutes (range,70-173 minutes),and for LACEfw+ 75 minutes (57-160 minutes) (P < 0.05). The median length of hospitalization was 6 days (range,3-8 days) for OACEfw+ ,5 days (4-6 days) for LACEfw+ ,and 4 days (2-9 days) for LACEfw-(P < 0.05). Stomal revisions were required in 6 of 10 patients with open ACE,7 of 14 patients with LACEfw+ ,and 2 of 19 patients with LACEfw-; stomal leak occurred in 3 of 11,3 of 14,and 0 of 19 patients,respectively. Median follow-up time was 62 months (range,36-94 months)-for OACEfw+ ,28 months (25-36 months) for LACEfw+ ,and 9 months (1-20 months) for LACEfw-. Conclusion: Operative time for LACEfw+ was twice as long as that of LACEfw-and OACEfw+ . Hospital time was shortest in LACEfw-. Stomal complications occurred in all 3 procedures. After a medium time follow-up,it appears that FW is unnecessary for ACE appendicostomy.展开更多
Congenital pouch colon(CPC)is a rare malformation in which the distal part o f a shortened colon forms a dilated pouch.It is associated with an anorectal ma lformation.We report 2 patients with CPC,one with a cloaca a...Congenital pouch colon(CPC)is a rare malformation in which the distal part o f a shortened colon forms a dilated pouch.It is associated with an anorectal ma lformation.We report 2 patients with CPC,one with a cloaca and one with vestib ular fistula and vaginal atresia.It is the first description of CPC,vestibular fistula,and vaginal atresia.The purpose of this report was to demonstrate tha t the pouch can be split longitudinally-in analogy with Bianchi’s intestinal l engthening procedure [Bianchi A.Intestinal loop lengthening:a technique for in creasing small intestinal length.J Pediatr Surg 1980;15:145-51]-to create a v agina and to reconstruct the anorectum with preserved blood supply.展开更多
Background/Aim: Imperforate anus without fistula consists of a spectrum of defects with variable distance between the rectal pouch and the perineum. We have developed a novel surgical approach for individual man ageme...Background/Aim: Imperforate anus without fistula consists of a spectrum of defects with variable distance between the rectal pouch and the perineum. We have developed a novel surgical approach for individual man agement of these patients based on precise knowledge of the level of the anomaly. Methods: All consecutive patients with imperforate anus without fistula between 2002 and 2004 had sigmoidostomy performed after having failed to pass meconium in the first 24 hours. The upper pouch was intraluminally visualized using retrograde endoscopy through the sigmoidmucous fistula. The distal termination of the rectum was clearly identified as by convergence of the anal columns. Bright translumination of the endoscope light from the rectum to the anal dimple within the external sphincter indicated a low malformation amenable to transanal proctoplasty. The rectum was incised from below under endoscopic visual control. Poor translumination indicated a higher defect,in which case,the operation was converted to standard posterior sagittal anorectoplasty. Results: Seven patients (6 boys) were identified. Four patients (3 boys) completed transanal endoscopic-assisted proctoplasty. In all cases,the convergence of anal columns indicating rectal termination was right above the anal pit at the site of the maximal external sphincter squeeze. In 3 patients,the operation was converted to posterior sagittal anorectoplasty after verification of a higher anomaly by endoscopy. There were no operative complications. The median follow-up was 3 months (range,1-26 months). All patients have an appropriate size anus and regular bowel actions. Conclusions: Transanal endoscopic-assisted proctoplasty allows safe and anatomical reconstruction of the anorectum,as well as contemporaneous closure of the sigmoidostomy in a significant proportion of patients with imperforate anus without fistula,avoiding the potential complications associated with the open posterior sagittal approach.展开更多
文摘Introduction: In antegrade colonic enema (ACE) appendicostomy,cecal fixation on the inside of the abdominal wall and cecal wrap around the base of the appendix are often performed as an antireflux procedure. Whether cecal fixation and wrap and fixation (FW) are necessary is not known. In a retrospective study,we compared laparoscopic and open procedure with FW (LACEfw+ and OACEfw+ ) with laparoscopic procedure without FW (LACEfw-). Materials and Methods: Between 1997 and 2004,44 consecutive patients underwent an ACE appendicostomy for fecal incontinence. Eleven patients (1997-2000) had OACEfw+ ,14 patients (2001 to 2003) had LACEfw+ ,and nineteen (2003-2004) had LACEfw-. The primary disorders included meningomyelocele (n=17),imperforate anus (n=12),sacral agenesis (n=1),presacral teratoma (n=1),osteosarcoma (n=1),diastematomyelia (n=1),tuberose sclerosis (n=1),Hirschsprung’ s disease (n=2),Down syndrome-associated refractory constipation (n=1)-,Jacobsen syndrome (n=1),and chronic constipation (n=1). Twenty-eight patients had undergone previous abdominal surgery. Operative time,theatre time,length of hospitalization,and complications related with procedure and stoma were compared among the 3 groups. Results: Age and age-adjusted body mass index did not differ statistically among the 3 groups. One LACEfw+ and 2 LACEfw-were converted. The median operative time was 38 minutes (range,23-65 minutes) for OACEfw+ ,78 minutes (50-135 minutes) for LACEfw+ ,and 40 minutes (25-120 minutes) for LACEfw-(P < 0.05). The median theatre time for OACEfw+ was 71 minutes (range,50-107 minutes),for LACEfw+ 123 minutes (range,70-173 minutes),and for LACEfw+ 75 minutes (57-160 minutes) (P < 0.05). The median length of hospitalization was 6 days (range,3-8 days) for OACEfw+ ,5 days (4-6 days) for LACEfw+ ,and 4 days (2-9 days) for LACEfw-(P < 0.05). Stomal revisions were required in 6 of 10 patients with open ACE,7 of 14 patients with LACEfw+ ,and 2 of 19 patients with LACEfw-; stomal leak occurred in 3 of 11,3 of 14,and 0 of 19 patients,respectively. Median follow-up time was 62 months (range,36-94 months)-for OACEfw+ ,28 months (25-36 months) for LACEfw+ ,and 9 months (1-20 months) for LACEfw-. Conclusion: Operative time for LACEfw+ was twice as long as that of LACEfw-and OACEfw+ . Hospital time was shortest in LACEfw-. Stomal complications occurred in all 3 procedures. After a medium time follow-up,it appears that FW is unnecessary for ACE appendicostomy.
文摘Congenital pouch colon(CPC)is a rare malformation in which the distal part o f a shortened colon forms a dilated pouch.It is associated with an anorectal ma lformation.We report 2 patients with CPC,one with a cloaca and one with vestib ular fistula and vaginal atresia.It is the first description of CPC,vestibular fistula,and vaginal atresia.The purpose of this report was to demonstrate tha t the pouch can be split longitudinally-in analogy with Bianchi’s intestinal l engthening procedure [Bianchi A.Intestinal loop lengthening:a technique for in creasing small intestinal length.J Pediatr Surg 1980;15:145-51]-to create a v agina and to reconstruct the anorectum with preserved blood supply.
文摘Background/Aim: Imperforate anus without fistula consists of a spectrum of defects with variable distance between the rectal pouch and the perineum. We have developed a novel surgical approach for individual man agement of these patients based on precise knowledge of the level of the anomaly. Methods: All consecutive patients with imperforate anus without fistula between 2002 and 2004 had sigmoidostomy performed after having failed to pass meconium in the first 24 hours. The upper pouch was intraluminally visualized using retrograde endoscopy through the sigmoidmucous fistula. The distal termination of the rectum was clearly identified as by convergence of the anal columns. Bright translumination of the endoscope light from the rectum to the anal dimple within the external sphincter indicated a low malformation amenable to transanal proctoplasty. The rectum was incised from below under endoscopic visual control. Poor translumination indicated a higher defect,in which case,the operation was converted to standard posterior sagittal anorectoplasty. Results: Seven patients (6 boys) were identified. Four patients (3 boys) completed transanal endoscopic-assisted proctoplasty. In all cases,the convergence of anal columns indicating rectal termination was right above the anal pit at the site of the maximal external sphincter squeeze. In 3 patients,the operation was converted to posterior sagittal anorectoplasty after verification of a higher anomaly by endoscopy. There were no operative complications. The median follow-up was 3 months (range,1-26 months). All patients have an appropriate size anus and regular bowel actions. Conclusions: Transanal endoscopic-assisted proctoplasty allows safe and anatomical reconstruction of the anorectum,as well as contemporaneous closure of the sigmoidostomy in a significant proportion of patients with imperforate anus without fistula,avoiding the potential complications associated with the open posterior sagittal approach.
