Posterior hemivertebra resection with short-segment internal fixation for unbalanced multiple hemivertebra in children

Abstract

Objective To explore the causes of reoperations for anorectal malformations, discuss how to avoid operative complications and reduce the incidence of reoperation. Methods Medical records of 25 reoperated patients from December 2009 to January 2015 were retrospectively reviewed. The age range was 12 days to 9 years. There were fecal incontinence (n=8) and fecal & urinary incontinence (n=2). Six patients with rectal mucosal prolapse underwent prolapsed mucosa resection and one case had anal external sphincter reconstruction. And 11/12 case with megarectum underwent magerectum resection, including Malone stoma (n=1), prolapsed mucosa resection and Malone stoma (n=1), urethral diverticulum resection and Malone stoma simultaneously (n=1) and Malone stoma (n=1). Rectourethral fistula (n=2) were repaired through perineal approach. Anoplasty for rectal mislocation (n=1), colostomy for rectum incision fistula (n=2), resection for inflammatory granuloma (n=1) and enterolysis for adhesive intestinal obstruction (n=1) were performed. Matching t test was used for comparing preoperative and postoperative anal function scores in patients with fecal incontinence. Results The average time of resuming feeding was 3.48 days and the length of post-operative hospitalization stay 6.76 days. During a follow-up period of 3-36 months, defecation dysfunction persisted in 2 cases and the remaining had no long-term complications. Postoperative anal function scores in patients with fecal incontinence were significantly higher than preoperative values (t=-8.631, P<0.01). Conclusions Reasonable operative scheme for initial surgery and meticulous handling can reduce the postoperative complications and incidence of reoperation. Rectal prolapse and megarectum are two major complications. Comprehensive evaluations based on specific situations may achieve excellent therapeutic outcomes. Key words: Imperforate anus; Complication; Dysfunction