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Quintero LA, Hernandez J, Orduno Villa N, Romero D, Spector C, Ngo L, Shatawi Z, Levene T, Lao O, Parreco JP. Surgical Urgency, Patient Comorbidities, and Socioeconomic Factors in Surgical Site Infections in Pediatric Surgery. Am Surg 2024; 90:2249-2252. [PMID: 38871348 DOI: 10.1177/00031348241260265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND The rise of value-based purchasing has led to decreased compensation for hospital-acquired conditions, including surgical site infections (SSI). This study aims to assess the risk factors for SSI in children and teenagers undergoing gastrointestinal surgery across US hospitals. METHODS The 2018-2020 Nationwide Readmissions Database was queried for patients undergoing gastrointestinal surgery under the age of 18. The primary outcome was SSI during index admission or readmission within a year. Comparison groups were elective, trauma, and emergent surgery based on anatomic location and urgency. Univariable comparison used chi-squared tests for relevant variables. Confounders were addressed through multivariable logistic regression with significant variables from univariable analysis. RESULTS 113 108 total patients met the study criteria. The SSI rate during admission or readmission was 2.9% (n = 3254). Infections during admission and readmission were 1.4% (n = 1560) and 1.5% (n = 1694), respectively. The most common site was organ space (48.6%, n = 1657). Increased infection risk was associated with trauma (OR 1.80 [1.51-2.16] P < .001), emergency surgery (OR 1.31 [1.17-1.47] P < .001), large bowel surgery (OR 2.78 [2.26-3.43] P < .001), and those with three or more comorbidities (OR 2.03 [1.69-2.45] P < .001). Investor-owned hospitals (OR .65 [.56-.76] P < .001) and highest quartile income (OR .80 [.73-.88] P < .001) were associated with decreased infection risk. CONCLUSIONS Pediatric patients undergoing gastrointestinal surgery face an elevated risk of SSI, especially in trauma and emergency surgeries, particularly with multiple comorbidities. Meanwhile, a reduced risk is observed in high-income and investor-owned hospital settings. Hospitals and surgeons caring for high risk patients should advocate for risk adjustment in value-based payment systems.
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Affiliation(s)
| | - Jennifer Hernandez
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Nancy Orduno Villa
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Dino Romero
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Chelsea Spector
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Lisa Ngo
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Zaineb Shatawi
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Tamar Levene
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Oliver Lao
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Joshua P Parreco
- Trauma Critical Care Surgery, Florida Atlantic University, Hollywood, FL, USA
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Knaus ME, Westgarth-Taylor C, Gasior AC, Halaweish I, Thomas JL, Srinivas S, Levitt MA, Wood RJ. A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence. Eur J Pediatr Surg 2024; 34:222-227. [PMID: 36693415 DOI: 10.1055/a-2019-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Wound dehiscence after posterior sagittal anorectoplasty (PSARP) or anorectal vaginal urethroplasty (PSARVUP) for anorectal malformation (ARM) is a morbid complication. We present a novel anoplasty technique employing para-U-stitches along the anterior and posterior portions of the anoplasty, which helps buttress the midline U-stitch and evert the rectal mucosa. We hypothesized that, in addition to standardized pre- and postoperative protocols, this technique would lower rates of wound dehiscence. MATERIALS AND METHODS A retrospective review of patievnts who underwent primary PSARP or PSARVUP with the para-U-stitch technique from 2015 to 2021 was performed. Wound dehiscence was defined as wound disruption requiring operative intervention within 30 days of the index operation. Superficial wound separations were excluded. Descriptive statistics were calculated. The final cohort included 232 patients. RESULTS Rectoperineal fistula (28.9%) was the most common ARM subtype. PSARP was performed in 75% and PSARVUP in 25%. The majority were reconstructed with a stoma in place (63.4%). Wound dehiscence requiring operative intervention occurred in four patients, for an overall dehiscence rate of 1.7%. The dehiscence rate was lower in PSARPs compared with PSARVUPs (0.6 vs. 5.2%) and lower for reconstruction without a stoma compared with a stoma (1.2 vs. 2.0%). There were additional six patients (2.6%) with superficial wound infections managed conservatively. CONCLUSION We present the para-U-stitch anoplasty technique, which is an adjunct to the standard anoplasty during PSARP and PSARVUP. In conjunction with standardized pre- and postoperative protocols, this technique can help decrease rates of wound dehiscence in this patient population.
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Affiliation(s)
- Maria E Knaus
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
| | | | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Ihab Halaweish
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Jessica L Thomas
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Shruthi Srinivas
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
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3
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Nwachukwu I, Visa A, Holbrook C, Tan YW. Identifying Risk Factors for Surgical Site Infection After Stoma Closure in Infants for Targeted Implementation of Surgical Site Infection Reduction Bundle. Surg Infect (Larchmt) 2024; 25:185-191. [PMID: 38394295 DOI: 10.1089/sur.2023.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Background: To determine risk factors for surgical site infection (SSI) in infants after stoma closure, to identify at-risk patients, plan timing of surgery, and implement SSI-reduction strategies. Patients and Methods: A single center retrospective comparison study of all children less than one year of age who underwent enterostomy closure (2018-2020) with SSI diagnosed through a prospective surveillance program, using criteria from Public Health England (PHE). Demographics and risk factors, types of SSI, systemic sepsis, mortality and length of stay were compared between SSI and non-SSI. Significant factors associated with SSI were analyzed in a multivariate binomial logistic regression model. Results: Eighty-nine stoma closures were performed, most commonly for necrotizing enterocolitis (NEC) and anorectal malformation. Fourteen had SSI (16%): 12 superficial and two deep; three developed systemic sepsis, but no 30-day mortality. Surgical site infection was associated with NEC (12/14 vs. 32/75; p = 0.003), younger age (median 76 vs. 89 days; p = 0.014), lower corrected gestation (cutoff: 39 weeks gestation; 11/14 vs. 27/75; p = 0.004) and lower weight (cutoff: 2.2 kg; 7/14 vs. 16/75; p = 0.032), compared with non-SSI. After correcting for age, gestation, and weight, logistic regression showed NEC was an independent predictor for SSI (odds ratio [OR], 12; 95% confidence interval [CI],1.2-125). The at-risk cohort (n = 56; 63%) had seven-fold increased risk of SSI and four-fold longer hospital stay, which may be the target for SSI-reduction strategies. Conclusions: Necrotizing enterocolitis-related stoma closure is at increased risk for SSI. Considerations for delaying stoma closure until achieving 39 weeks gestation or 2.2 kg in weight may further reduce SSI. Targeting SSI-reduction strategies using these criteria may improve resource-rationalization.
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Affiliation(s)
- Ijeoma Nwachukwu
- Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Arjun Visa
- Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Charlotte Holbrook
- Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Yew-Wei Tan
- Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Sharma S, Mazingi D, Imam S, Chowdhury TK, Saldaña LJ, Mashavave NZ, Olivos M, Chowdhury TS, Hoque M, Correa C, Banu T. Anorectal malformations in low and middle-income countries- spectrum, burden and management. Semin Pediatr Surg 2023; 32:151349. [PMID: 37988823 DOI: 10.1016/j.sempedsurg.2023.151349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
The clinical presentation, diagnosis and management of anorectal malformation has been well described in the literature, however the experience with these conditions in low-and middle-income countries is often shaped in unique ways due to the social, cultural and economic factors at work in these regions. This leads to adaptation of modifications in management options for these babies that usually present as delayed cases with added poor prognostic factors like sepsis leading to need for emergency resuscitation and overall increased morbidity and mortality. This article explores the anomaly from a global surgery lens and outlines the spectrum of the anomaly, burden faced in the resource constrained environment and the management options adopted for successful management under the available circumstances.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dennis Mazingi
- Department of surgery, University of Zimbabwe, faculty of health sciences, Harare, Zimbabwe
| | - Sharif Imam
- Department of Pediatric Surgery, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh
| | - Tanvir Kabir Chowdhury
- Department of Pediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chattogram, Bangladesh
| | - Lily J Saldaña
- Pediatric Surgery Service, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Noxolo Z Mashavave
- Paediatric Surgery Specialist, East London Hospital Complex, South Africa
| | - Maricarmen Olivos
- Hospital de Niños Roberto del Río, Universidad de Chile, Santiago, Chile
| | - Tameem Shafayat Chowdhury
- Department of Pediatric Surgery, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh
| | - Mozammel Hoque
- Department of Pediatric Surgery, Chattogram Maa-O-Shishu Hospital Medical College, Chattogram, Bangladesh
| | - Catalina Correa
- Research department, Hospital Militar Central Colombia, Bogota, Colombia
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh.
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Tobias J, Padilla BE, Lee J, Chen S, Wang KS, Kelley-Quon LI, Mueller C, Shew SB, Joskowitz K, Ignacio RC, Evans LL, Jensen AR, Acker SN, Mason A, Johnson A, McConahey J, Hansen E, Pandya SR, Short SS, Russell KW, Nicassio L, Smith CA, Fialkowski E. Standardized perioperative care reduces colorectal surgical site infection in children: A Western Pediatric Surgery Research Consortium multicenter analysis. J Pediatr Surg 2023; 58:45-51. [PMID: 36289033 DOI: 10.1016/j.jpedsurg.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Surgical site infection (SSI) remains a significant source of patient morbidity and resource utilization in children undergoing colorectal surgery. We examined the utility of a protocolized perioperative care bundle in reducing SSI in pediatric patients undergoing colorectal surgery. METHODS We conducted a prospective cohort study of patients ≤18 years of age undergoing colorectal surgery at ten United States children's hospitals. Using a perioperative care protocol comprising eight elements, or "colon bundle", we divided patients into low (1-4 elements) or high (5-8 elements) compliance cohorts. Procedures involving colorectal repair or anastomosis with abdominal closure were included. Demographics and clinical outcomes were compared between low and high compliance cohorts. Compliance was compared with a retrospective cohort. The primary outcome was superficial SSI incidence at 30 days. RESULTS Three hundred and thirty-six patients were included in our analysis: 138 from the low compliance cohort and 198 from the high compliance cohort. Age and gender were similar between groups. Preoperative diagnosis was similar except for more patients in the high compliance cohort having inflammatory bowel disease (18.2% versus 5.8%, p<0.01). The most common procedure performed was small bowel to colorectal anastomosis. Wound classification and procedure acuity were similar between groups. Superficial SSI at 30 days occurred less frequently among the high compliance compared to the low compliance cohort (4% versus 9.7%, p = 0.036). Median postoperative length of stay and 30-day rates of readmission, reoperation, intra-abdominal abscess and anastomotic leak requiring operation were not significantly different between groups. None of the individual colon bundle elements were independently protective against superficial SSI. CONCLUSION Standardization of perioperative care is associated with a reduction in superficial SSI in pediatric colorectal surgery. Expansion of standardized protocols for children undergoing colorectal surgery may improve outcomes and decrease perioperative morbidity. TYPE OF STUDY Clinical Research Paper LEVEL OF EVIDENCE: Level II.
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Affiliation(s)
- Joseph Tobias
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States.
| | | | - Justin Lee
- Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Stephanie Chen
- Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA, United States
| | - Kasper S Wang
- Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA, United States
| | - Lorraine I Kelley-Quon
- Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA, United States
| | - Claudia Mueller
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States
| | - Stephen B Shew
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States
| | - Katie Joskowitz
- Rady Children's Hospital, University of California San Diego, San Diego, CA, United States
| | - Romeo C Ignacio
- Rady Children's Hospital, University of California San Diego, San Diego, CA, United States
| | - Lauren L Evans
- UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Aaron R Jensen
- UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Shannon N Acker
- Children's Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - Andrew Mason
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States
| | - Alicia Johnson
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States
| | | | - Erik Hansen
- University of Texas Southwestern, Dallas, TX, United States
| | - Samir R Pandya
- University of Texas Southwestern, Dallas, TX, United States
| | - Scott S Short
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, United States
| | - Katie W Russell
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, United States
| | - Lauren Nicassio
- Seattle Children's, University of Washington, Seattle, WA, United States
| | - Caitlin A Smith
- Seattle Children's, University of Washington, Seattle, WA, United States
| | - Elizabeth Fialkowski
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States
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6
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Aseme S, Negussie T, Tadesse A, Dejene B, Temesgen F, Getachew H, Derbew M, Kiflu W. Evaluation of Factors Affecting Colostomy Closure Outcome in Children: A One-Year Prospective Cohort Study. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s360157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Isserman RS, Cheung J, Varallo D, Cafone J, Lee J, Chiotos K, Muhly WT, Metjian TA, Swami S, Baldwin K, Tan JM. Increasing Cefazolin Use for Perioperative Antibiotic Prophylaxis in Penicillin-Allergic Children. Pediatrics 2022; 149:184738. [PMID: 35229120 DOI: 10.1542/peds.2021-050694] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cefazolin, a first-generation cephalosporin, is the most commonly recommended antibiotic for perioperative prophylaxis to reduce surgical site infections. Children with a reported penicillin allergy often receive an alternative antibiotic because of a common misunderstanding of the cross-reactivity between these antibiotics. This use of alternative antibiotics in surgical populations have been associated with increased infections, antibiotic resistance, and health care costs. We aimed to increase the percentage of patients with nonsevere penicillin-class allergies who receive cefazolin for antibiotic prophylaxis. METHODS A multidisciplinary team conducted this quality improvement initiative, with a series of 3 plan-do-study-act cycles aimed at children with nonsevere penicillin-class allergies undergoing surgical procedures that require antibiotic prophylaxis. The primary outcome measure was the percentage of surgical encounters among patients with nonsevere penicillin-class allergies who received cefazolin as antibiotic prophylaxis. Statistical process control charts were used to measure improvement over time. RESULTS Approximately 400 children were involved in this project. There was special cause variation and a shift in the center line from 60% to 80% of eligible patients receiving cefazolin for antibiotic prophylaxis, which was sustained for the duration of the project. In the last month, 90% of eligible patient received cefazolin, surpassing our goal of 85%. This improvement has been sustained in the 5 months after project completion. We had no cases of severe allergic reactions in the operating room. CONCLUSIONS Our multidisciplinary education-focused interventions were associated with a significant increase in the use of cefazolin for perioperative antibiotic prophylaxis in patient with penicillin allergies.
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Affiliation(s)
- Rebecca S Isserman
- Department of Anesthesiology and Critical Care Medicine.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jazreel Cheung
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Domonique Varallo
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Juhee Lee
- Divisions of Allergy and Immunology and
| | - Kathleen Chiotos
- Department of Anesthesiology and Critical Care Medicine.,Infectious Diseases, Department of Pediatrics.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wallis T Muhly
- Department of Anesthesiology and Critical Care Medicine.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Sanjeev Swami
- Infectious Diseases, Department of Pediatrics.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Keith Baldwin
- Division of Orthopaedics, Department of Surgery.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jonathan M Tan
- Children's Hospital Los Angeles and Keck School of Medicine, University of Southern CaliforniaLos Angeles, California
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Sayuen C, Phannua R, Chusilp S, Tanming P, Areemit S, Decharun K, Vejchapipat P, Thaiwatcharamas K. A comparison of surgical site infections in children after stoma reversal between purse-string and linear closure. Pediatr Surg Int 2022; 38:149-156. [PMID: 34546402 DOI: 10.1007/s00383-021-05011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To reduce the surgical site infections (SSI), the purse-string closure technique has been widely performed and has also been recommended in adult stoma reversal. However, for children, some debate still exists. This study aims to compare the SSI rates in children between the purse-string and the linear for the skin closure of stoma reversal. METHODS The data were collected from pediatric patients, who had undergone either purse-string or linear closure for elective surgery of stoma reversal from two university hospitals between January 2016 and December 2019. RESULTS The purse-string and linear closure had been performed on 31 and 45 patients, respectively. At 30 days after surgery, three patients in the purse-string closure group had developed SSI compared to 14 patients in the linear closure group (9.7 vs. 31.1%, p = 0.028). Furthermore, there had been no significant difference in the overall post-operative complications. In multivariate analysis, the SSI had been significantly lower in patients with purse-string closure (OR 0.21, 95% CI 0.05-0.86, p = 0.029). CONCLUSION By employing the purse-string closure technique for skin closure of stoma reversal, there had been a significantly lower SSI rate compared to linear closure with no difference in the length of hospital stay.
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Affiliation(s)
- Chanathip Sayuen
- Department of Surgery, Khon Kaen University, Khon Kaen, 40002, Thailand.,Department of Surgery, Roi-Et Hospital, Roi-Et, 45000, Thailand
| | | | - Sinobol Chusilp
- Department of Surgery, Khon Kaen University, Khon Kaen, 40002, Thailand
| | | | - Suchat Areemit
- Department of Surgery, Khon Kaen University, Khon Kaen, 40002, Thailand
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Brisighelli G, Etwire V, Lawal T, Arnold M, Westgarth-Taylor C. Treating pediatric colorectal patients in low and middle income settings: Creative adaptation to the resources available. Semin Pediatr Surg 2020; 29:150989. [PMID: 33288130 DOI: 10.1016/j.sempedsurg.2020.150989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Colorectal disease profiles for children in low- and middle-income settings (LMIC) are characterized by late presentation, increased complications and limited follow-up in many cases. There is a high prevalence of infectious conditions causing secondary colorectal disease such as Mycobacterium Tuberculosis(TB), Human Immunodeficiency Virus(HIV) and Human Papilloma Virus(HPV), which also impact the management of other primary colorectal conditions, such as wound-healing and intestinal anastomosis. Perineal trauma from sexual assault, motor vehicle or pedestrian accidents, burns, and traditional enemas are commonly encountered and may require adaptation of principles used in treatment of congenital anomalies such as Hirschsprung's disease and Anorectal Malformations for reconstruction. Endemic conditions in certain LMIC require further research to delineate underlying causes and optimize management, such as "African" degenerative visceral leiomyopathy, congenital pouch colon in the Indian subcontinent, and congenital H-type rectal fistulae prevalent in Asia. These unique disease profiles require creative adaptations of resources within poor healthcare infrastructure settings. These special challenges and pitfalls in colorectal care and complications of adverse socioeconomic conditions, are discussed.
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Affiliation(s)
- Giulia Brisighelli
- Department of Pediatric Surgery, Pediatric Colorectal and Pelvic Reconstruction Centre, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
| | - Victor Etwire
- Department of Surgery, Pediatric Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Taiwo Lawal
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Marion Arnold
- Division of Pediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Chris Westgarth-Taylor
- Department of Pediatric Surgery, Pediatric Colorectal and Pelvic Reconstruction Centre, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
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Rentea RM, Badillo AT, Hosie S, Sutcliffe JR, Dickie B. Lasting impact on children with an anorectal malformations with proper surgical preparation, respect for anatomic principles, and precise surgical management. Semin Pediatr Surg 2020; 29:150986. [PMID: 33288132 DOI: 10.1016/j.sempedsurg.2020.150986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Optimal outcomes in the management of children with Anorectal Malformation (ARM) require careful surgical preparation and detailed understanding of the anatomic principles and operative setup. A clear understanding of operative anatomy and surgical principals guides decision making. Adherence to the principles of ARM repair, as well as the application of operative and imaging adjuncts, will yield the safest and most successful approach to ARM. In this review, we detail the surgical preparation, anatomic principles, and surgical management issues unique to ARM.
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Affiliation(s)
- Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy-Kansas City, Kansas City, MO 64108, USA.
| | - Andrea T Badillo
- Divisions of Pediatric Surgery and Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC, USA
| | - Stuart Hosie
- Department of Pediatric Surgery, Stadtisches Kinikum Munchen GmBH, Munich, Germany
| | - Jonathan R Sutcliffe
- Department of Pediatric Surgery, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom
| | - Belinda Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
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