Хірургічне лікування ізольованої та асоційованої природженої ректопромежинної нориці в дітей

Abstract

Congenital anorectal malformations (CARM) include a number of different options that differ in their anatomical and functional features. One of these options is rectoperineal fistula (RPF). Purpose - to evaluate the results of surgical treatment of congenital RPF in children, using a differentiated approach to diagnosis and methods of correction of its isolated and associated forms. Materials and methods. The study included 28 patients with RPF, which accounted for 18.2% of all treated CARM: boys - 18 (64.3%), girls - 10 (35.7%). Verification of the main disease and associated developmental defects was carried out on the basis of clinical and instrumental research methods. Isolated anorectal malformation (ARM) was diagnosed in 15 (53.6%) children, 8 (53.3%) boys, 7 (46.7%) girls, and associated - in 13 (46.4%) patients, 10 (76.9%) boys, 3 (23.1%) girls. Results. One-stage surgical treatment was performed in 2 (7.1%) patients with associated ARM. Staged surgical treatment, with colostomy removal and anorectoplasty, was performed in 26 (92.9%) children. Anterosagittal anorectoplasty was performed in 14/26 (53.8%) of children: 10 (71.4%) boys, 4 (28.6%) girls; minimal posterior sagittal - in 26.9% (7/26): 2 (28.6%) boys, 5 (71.4%) girls; posterior sagittal according to Pen, applied in 19, 2% (5/26), and only in boys. The third stage of treatment included closing the stoma from local access. Removal of the colostomy and formation of an end-to-end anastomosis was performed in 25 (96.1%) patients without complications. Conclusions. The use of a differentiated approach to diagnostics and methods of anorectoplasty, as well as the use of a complex of rehabilitation treatment for isolated and associated forms of ARM, allowed to obtain good results - in 81.5% and satisfactory results - in 18.5% of children. The choice of tactics for surgical correction of RPF should be individual for each patient, considering the anatomical and functional features of the defect, gender and the presence of a certain range of associated malformations. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.