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Transanal ileal pouch anal anastomosis for ulcerative colitis in children and adults: a systematic review and meta-analysis. Pediatr Surg Int 2022; 38:1671-1680. [PMID: 36114863 DOI: 10.1007/s00383-022-05222-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The incidence of pediatric onset ulcerative colitis (UC) is increasing, with increasing rate of children eventually requiring surgical treatment. Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment. Although transanal IPAA (ta-IPAA) is becoming widely accepted for adult UC patients, data regarding this procedure in children are scarce. Nevertheless, some adult publications also include patients under 18 years old. This systematic review and meta-analysis aimed to summarize surgical and functional outcomes following ta-IPAA, and extract conclusion regarding pediatric UC patients. METHODS PubMed, Cochrane Library databases, Embase, Web of science and Google Scholar databases were searched, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines. The final search was updated in April 2022. Four comparative cohorts (n = 868) and 11 non-comparative case series (n = 241) were included. Six reports included children. Anastomotic leak, complications, operative time, conversion rate, length of stay and functional outcomes were examined. RESULTS A total of 1103 patients, ranging 9-79 years were included in this review. We found no difference in risk for anastomotic leak (OR 1.36, 95% CI 0.46-4.06), minor and major complications (OR 0.92, 95% CI 0.48-1.76 and OR 0.78 95% CI 0.36-1.69, respectively) comparing ta-IPAA to transabdominal IPAA. Short- and long-term follow-up showed satisfying functional outcomes and quality of life. CONCLUSIONS Our review suggests that ta-IPAA is not inferior to transabdominal IPAA. Implementation of this method in children is technically feasible due to familiarity with the dissection plane. Long-term functional outcomes and quality of life are paramount in the pediatric population and should be particularly investigated. Multicenter prospective studies are required to investigate pediatric UC patients undergoing ta-IPAA.
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Adjuncts to bowel management for fecal incontinence and constipation, the role of surgery; appendicostomy, cecostomy, neoappendicostomy, and colonic resection. Semin Pediatr Surg 2020; 29:150998. [PMID: 33288138 DOI: 10.1016/j.sempedsurg.2020.150998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Constipation and fecal incontinence are common problems in children after repair of an anorectal malformation (ARM). While many children can be effectively managed with an oral laxative regimen, others require a mechanical colonic washout to achieve social continence. Appendicostomy and cecostomy are two techniques which permit antegrade access to the colon for the purpose of enema delivery, which improves compliance and quality of life for patients and families. The purpose of this article is to review, using a case-based approach, the indications for placement of a channel for antegrade enema access, clinical scenarios in which one technique would be preferred over another, common complications following each procedure.
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Halleran DR, Vilanova-Sanchez A, Rentea RM, Vriesman MH, Maloof T, Lu PL, Onwuka A, Weaver L, Vaz KK, Yacob D, Di Lorenzo C, Levitt MA, Wood RJ. A comparison of Malone appendicostomy and cecostomy for antegrade access as adjuncts to a bowel management program for patients with functional constipation or fecal incontinence. J Pediatr Surg 2019; 54:123-128. [PMID: 30361073 DOI: 10.1016/j.jpedsurg.2018.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Appendicostomy and cecostomy are two approaches for antegrade enema access for children with severe constipation or fecal incontinence as adjuncts to a mechanical bowel management program. Each technique is associated with a unique set of complications. The purpose of our study was to report the rates of various complications associated with antegrade enema access techniques to help guide which option a clinician offers to their patients. METHODS We reviewed all patients in our Center who received an appendicostomy or cecostomy from 2014 to 2017 who were participants in our bowel management program. RESULTS 204 patients underwent an antegrade access procedure (150 appendicostomies and 54 cecostomies). Skin-level leakage (3% vs. 22%) and wound infections (7% vs. 28%) occurred less frequently in patients with appendicostomy compared to cecostomy. Nineteen (13%) appendicostomies required revision for stenosis, 4 (3%) for mucosal prolapse, and 1 (1%) for leakage. The rates of stenosis (33 vs. 12%) and wound infection (13 vs. 6%) were higher in patients who received a neoappendicostomy compared to an in situ appendicostomy. Intervention was needed in 19 (35%) cecostomy patients, 15 (28%) for an inability to flush or a dislodged tube, and 5 for major complications including intraperitoneal spillage in 4 (7%) and 1 (2%) for a tube misplaced in the ileum, all occurring in patients with a percutaneously placed cecostomy. One appendicostomy (1%) patient required laparoscopic revision after the appendicostomy detached from the skin. CONCLUSION Patients had a lower rate of minor and major complications after appendicostomy compared to cecostomy. The unique complication profile of each technique should be considered for patients needing these procedures as an adjunct to their care for constipation or fecal incontinence. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH.
| | | | - Rebecca M Rentea
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Mana H Vriesman
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Tassiana Maloof
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Peter L Lu
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Karla Kh Vaz
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Desale Yacob
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Carlo Di Lorenzo
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
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Implementation of a bowel management program in the treatment of incontinence in children for primary healthcare providers. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000508439.29481.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Bandi AS, Bradshaw CJ, Giuliani S. Advances in minimally invasive neonatal colorectal surgery. World J Gastrointest Surg 2016; 8:670-678. [PMID: 27830038 PMCID: PMC5081548 DOI: 10.4240/wjgs.v8.i10.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/27/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Over the last two decades, advances in laparoscopic surgery and minimally invasive techniques have transformed the operative management of neonatal colorectal surgery for conditions such as anorectal malformations (ARMs) and Hirschsprung’s disease. Evolution of surgical care has mainly occurred due to the use of laparoscopy, as opposed to a laparotomy, for intra-abdominal procedures and the development of trans-anal techniques. This review describes these advances and outlines the main minimally invasive techniques currently used for management of ARMs and Hirschsprung’s disease. There does still remain significant variation in the procedures used and this review aims to report the current literature comparing techniques with an emphasis on the short- and long-term clinical outcomes.
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Laparoscopically assisted anorectal pull-through for rectovestibular fistula. ANNALS OF PEDIATRIC SURGERY 2016. [DOI: 10.1097/01.xps.0000476081.35040.a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Thomson D, Allin B, Long AM, Bradnock T, Walker G, Knight M. Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis. BMJ Open 2015; 5:e006063. [PMID: 25805527 PMCID: PMC4386272 DOI: 10.1136/bmjopen-2014-006063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To compare outcomes following totally transanal endorectal pull-through (TTERPT) versus pull-through with any form of laparoscopic assistance (LAPT) for infants with uncomplicated Hirschsprung's disease. DESIGN Systematic review and meta-analysis. SETTING Five hospitals with a paediatric surgical service. PARTICIPANTS 405 infants with uncomplicated Hirschsprung's disease. INTERVENTIONS TTERPT versus LAPT. PRIMARY OUTCOMES mortality, postoperative enterocolitis, faecal incontinence, constipation, unplanned laparotomy or stoma formation, and injury to abdominal viscera. SECONDARY OUTCOMES Haemorrhage requiring transfusion of blood products, abscess formation, intestinal obstruction, intestinal ischaemia, enteric fistula formation, urinary incontinence or retention, impotency and duration of procedure. RESULTS Five eligible studies comprising 405 patients were identified from 2107 studies. All studies were retrospective case series, with variability in outcome assessment quality and length of follow-up. Operative duration was 50.29 min shorter with TTERPT (95% CI 39.83 to 60.74, p<0.00001). There were no significant differences identified between TTERPT and LAPT for incidence of postoperative enterocolitis (OR=0.78, 95% CI 0.44 to 1.38, p=0.39), faecal incontinence (OR=0.44, 95% CI 0.09 to 2.20, p=0.32) or constipation (OR=0.84, 95% CI 0.32 to 2.17, p=0.71). CONCLUSIONS This meta-analysis did not find any evidence to suggest a higher rate of enterocolitis, incontinence or constipation following TTERPT compared with LAPT. Further long-term comparative studies and multicentre data pooling are needed to determine whether a purely transanal approach offers any advantages over a laparoscopically assisted approach to rectosigmoid Hirschsprung's disease. TRIAL REGISTRATION NUMBER PROSPERO registry- CRD42013005698.
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Affiliation(s)
- David Thomson
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Benjamin Allin
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Anna-May Long
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Tim Bradnock
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, UK
| | - Gregor Walker
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Huibregtse ECP, Draaisma JMT, Hofmeester MJ, Kluivers K, van Rooij IALM, de Blaauw I. The influence of anorectal malformations on fertility: a systematic review. Pediatr Surg Int 2014; 30:773-81. [PMID: 24969818 DOI: 10.1007/s00383-014-3535-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE This systematic review aims to give an overview of available evidence concerning the influence of anorectal malformations (ARM) on fertility. METHODS We conducted a search in PubMed, EMBASE and Cochrane Library conformed to the PRISMA standards. All studies reporting on fertility and ARM were included. RESULTS 2,905 studies were identified. Based on title, abstract and full text, nine articles on 429 patients remained to answer the research question. Childbirth rate was the only reported outcome parameter to describe fertility. An overall childbirth rate of 27 % (range 0-57 %) was found. Mean age at time of study ranged from 23 to 35 years. There was no statistical significant difference in childbirth rate between female and male patients, based on seven studies (p = 0.45). Patients with a more complex type of ARM (imperforated anus without fistula, rectourethral bulbar and prostatic fistulas, rectobladderneck fistulas and cloacal malformations) had a lower childbirth rate compared to healthy controls, whereas in patients with a less complex ARM (rectoperineal or rectovestibular fistula) the childbirth rate was similar to healthy controls. Patients with a more complex type of ARM had a significant lower childbirth rate than patients with a less complex type of ARM (18 vs 47 %, respectively) (p = 0.0001). When further dividing these patients by gender, this difference was only seen in female patients (p = 0.04). CONCLUSION In patients with a more complex type of ARM a lower childbirth rate was found compared to healthy controls and patients with a less complex type of ARM. The latter was only seen in female patients. However, conclusions concerning fertility in ARM patients have to be taken with caution due to limited quality of the studies. Further investigation is recommended.
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Affiliation(s)
- E C P Huibregtse
- Department of Pediatric Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
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de Blaauw I, Wijers CHW, Schmiedeke E, Holland-Cunz S, Gamba P, Marcelis CLM, Reutter H, Aminoff D, Schipper M, Schwarzer N, Grasshoff-Derr S, Midrio P, Jenetzky E, van Rooij IALM. First results of a European multi-center registry of patients with anorectal malformations. J Pediatr Surg 2013; 48:2530-5. [PMID: 24314198 DOI: 10.1016/j.jpedsurg.2013.07.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European consortium on anorectal malformations (ARM-NET) was established to improve the health care of patients and to identify genetic and environmental risk factors. The aim of the present study was to present the first results on clinical data of a large European cohort of ARM patients based on our registry. METHODS In 2010, the registry was established including patient characteristics and data on diagnosis, surgical therapy, and outcome regarding complications. Patients born between 2007 and 2012 were retrospectively added. A descriptive analysis of this cohort was performed. RESULTS Two hundred and three ARM patients were included. Syndromes or chromosomal abnormalities were present in 9%. Perineal fistulas were seen most in boys (42%) and girls (29%). Rare forms of ARM were found in 4% of the male and in 14% of the female patients. Forty-five percent of the patients had additional urogenital abnormalities. However, 32% of the patients were never screened for bladder abnormalities. Eight percent were never screened for renal malformations. In the majority of patients (79%), a PSARP was performed for the definitive reconstruction. CONCLUSION This collaborative effort provides a representative basis to estimate incidence of ARM types, to discuss differences and similarities in treatment, and health consequences throughout Europe.
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Affiliation(s)
- Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands; Department of Pediatric Surgery, Sophia Children's Hospital-Erasmus MC, Rotterdam, The Netherlands.
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10
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Zhu T, Feng J, Zhang W, Wei M, Yu D, Zhang X, Yu K, Kuang H. Subtotal colectomy with a single-incision laparoscopic surgery technique in children with long-segment Hirschsprung disease and allied disorders. Pediatr Surg Int 2013; 29:197-201. [PMID: 23239286 DOI: 10.1007/s00383-012-3221-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Over the last 15 years, the laparoscopic-assisted endorectal pull-through procedure has become the standard treatment for Hirschsprung disease in many centers around the world. Recently, single-incision laparoscopic techniques have drawn more attention. We describe a single-incision laparoscopic surgery (SILS) subtotal colectomy to treat long-segment Hirschsprung disease (LSHD) and Hirschsprung disease allied disorder (HAD) in children. METHODS A total of 22 patients who underwent SILS subtotal colectomy, including three patients with a failed first surgery, were included in this retrospective study. For SILS, a 1-cm skin incision was first made below the umbilical margin and a 5-mm trocar was placed into the abdomen after incising the peritoneum. Two 5-mm trocars were then placed on both sides of the umbilicus. Subsequently, based upon preoperative examination and biopsy results, we performed subtotal colectomy. The affected colon was mobilized successively beyond the peritoneum using high-frequency cutting and sealing devices, followed by a pull-through procedure and colon-anal anastomosis. RESULTS The average operative time was 206.39 min. No case needed conversion from SILS to either conventional laparoscopy or open surgery. Of the 22 patients, 15 were diagnosed as LSHD, while 6 cases were diagnosed with intestinal neuronal dysplasia and one was diagnosed with hypoganglionosis. There were no intra-operative complications. One child had incision dehiscence on postoperative day three. During the follow-up over 12 months, all patients were noted to have excellent cosmetic outcomes, and enterocolitis was observed in four children. CONCLUSIONS Subtotal colectomy with the SILS technique can be safely performed in LSHD or HAD patients in the pediatric population without major complications.
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Affiliation(s)
- Tianqi Zhu
- Pediatric Surgery Department, Tongji Hospital, 1095# Jiefang Avenue, Wuhan, China
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11
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Lamas-Pinheiro R, Henriques-Coelho T, Carvalho JL, Correia-Pinto J. Duhamel pull-through assisted by transrectal port: a hybrid natural orifice transluminal endoscopic surgery approach. J Pediatr Surg 2012; 47:1962-5. [PMID: 23084218 DOI: 10.1016/j.jpedsurg.2012.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/09/2012] [Accepted: 05/24/2012] [Indexed: 11/15/2022]
Abstract
One of the latest surgical innovations is natural orifice transluminal endoscopic surgery (NOTES). We hypothesize that the principles of NOTES could be applied to the laparoscopic Duhamel procedure. Between March 2008 and May 2010, 3 children underwent the laparoscopic Duhamel procedure assisted by transrectal NOTES. Three 5-mm transabdominal trocars were combined with a 12-mm transrectal trocar. We were able to safely apply the principles of NOTES, improving the performance of laparoscopic Duhamel pull-through using current instruments and technology. This new approach avoids the need of an extra transabdominal 12-mm trocar for the endoscopic stapler, allows an easier creation of a smaller rectal stump, and offers the possibility of an extra working port. This hybrid concept can be seen as a transition into the emerging field of NOTES in colorectal surgery.
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Dingemann J, Kuebler JF, Ure BM. Laparoscopic and computer-assisted surgery in children. Scand J Surg 2012; 100:236-42. [PMID: 22182844 DOI: 10.1177/145749691110000402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Dingemann
- Centre of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
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Lawal TA, Rangel SJ, Bischoff A, Peña A, Levitt MA. Laparoscopic-Assisted Malone Appendicostomy in the Management of Fecal Incontinence in Children. J Laparoendosc Adv Surg Tech A 2011; 21:455-9. [DOI: 10.1089/lap.2010.0359] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Taiwo A. Lawal
- Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Shawn J. Rangel
- Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Andrea Bischoff
- Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Alberto Peña
- Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Marc A. Levitt
- Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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Levitt MA, Mathis KL, Pemberton JH. Surgical treatment for constipation in children and adults. Best Pract Res Clin Gastroenterol 2011; 25:167-79. [PMID: 21382588 DOI: 10.1016/j.bpg.2010.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/06/2010] [Accepted: 12/16/2010] [Indexed: 02/06/2023]
Abstract
Functional constipation is one of the most common gastrointestinal disorders. In both children and adults, most patients are managed conservatively with good results. In this review, we focus on the surgical approach to constipation. Patients who lack the capacity to consistently have voluntary bowel movements may need mechanical emptying of the colon through an enema program; for them, surgery to allow for antegrade enemas, (via the appendix or using a button device) is useful. Those patients with severe constipation not responsive to intense medical treatment may be candidates for other surgical interventions, such as resection of the dysfunctional colonic segment (rectosigmoid or whole colon), or plication, -pexy, and STARR techniques for evacuatory disorders secondary to obstructive anatomical features. Permanent stomas are an option of last resort.
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Affiliation(s)
- Marc A Levitt
- Department of Surgery, University of Cincinnati, Colorectal Center for Children, Cincinnati Children's Hospital, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA.
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Abstract
PURPOSE After 25 years of practice and positive results of the Rehbein-procedure (RB) for children with Hirschsprung Disease (HD), we changed to the less invasive transanal endorectal pull through (TERPT). The aim of this study was to compare short- and mid-term complications of these two procedures in our patients with HD. METHODS Retrospective data of 50 HD patients were analyzed. Of these patients, 25 underwent RB (2000-2006) and in 25 the TERPT was performed (2005-2009). Medical records were reviewed to score complications and outcomes. Differences were analyzed using Chi-Square and Mann-Whitney U tests. RESULTS All RB patients (100%) were given a colostomy compared with four patients (16%) in the TERPT group (p < 0.001). The average age at surgery in the RB group was 191 days whereas this was 72 days in the TERPT group (p < 0.01). The mean length of time of surgery in the RB group (158 min) was not significantly different from that in the TERPT group (183 min). Ganglion cells were located in all specimens at the proximal end of the specimens. The median time to first feeding significantly decreased from 2 days (range 1-11) in the RB group to 1 day (range 1-3) in the TERPT group (p < 0.01). The median length of hospital stay decreased in the TERPT group (8 days) compared with the RB group (10 days) (p < 0.001). There was a significant reduction in postoperative obstructive symptoms during the first 6 months in the TERPT group (48%) compared with the RB group (84%) (p = 0.016). Postoperative enterocolitis decreased from 40% in the RB group to 24% in the TERPT group although this was not statistically significant. CONCLUSIONS The introduction of TERPT reduced the need for colostomies; it shortened days to first feeding after surgery and reduced hospital stay. It also improved short-term outcome with less obstructive symptoms. We recommend TERPT surgery as a first choice in children with HD. we consider the RB now to be obsolete.
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