Enema Research Articles

Basti (Medicated Enemata)

Basti (Medicated Enemata)

Efficacy and safety of the Jinling procedure in the treatment of adult Hirschsprung disease

To investigate the safety, efficacy and long-term outcomes of Jinling procedure in the treatment of adult Hirschsprung disease. Clinical and follow-up data of 125 patients with adult Hirschsprung disease undergoing Jinling procedure at the Department of General Surgery between January 2000 and January 2013 were summarized. All the patients were diagnosed by CT, barium enema, anorectal pressure detection and pathology examination. Abdominal symptoms, gastrointestinal quality of life index(GIQLI, the lower score, the worse quality of life), Wexner constipation score (higher score indicated worse symptom), defecography (evaluation included rectocele, mucosal prolapse, intramucosal intussusception, perineal prolapse) and other operative complications were compared before and after operation. Among 125 patients, 69 were male and 56 were female with median age of (41.2±15.5) (18 to 75) years. The follow-up rates were 94.4%(118/125), 92.0%(115/125), 89.6%(112/125) and 88.0%(110/125) at postoperative months 1, 3, 6, and 12. Incidences of abdominal distension and abdominal pain were 100% and 82.4%(103/125) before operation, and were 7.3%(8/110) and 20.9%(23/110) at 12 months after surgery. Wexner score was significantly lower at postoperative months 1(8.7±2.9), 3 (7.2±2.8), 6(6.7±2.2) and 12(6.3±1.7) than that before operation (21.4±7.2) (P<0.01). GIQLI score was 51.6±11.9 before operation, though it decreased at 1 month (47.3±5.5)(P<0.05) after surgery, but increased significantly at postoperative months 3, 6, 12(68.9±8.0, 96.5±8.2, 103.2±8.6)(P<0.01). Abnormal rate of defecography was 70.4%(81/115), 48.2%(54/112) and 27.3%(30/110) at postoperative months 3, 6, 12, which was significantly lower than 91.2%(114/125) before operation (P<0.01). Morbidity of postoperative complication was 29.6%(37/125), including 5 cases of surgical site infection (4.0%), 2 of anastomotic bleeding (1.6%), 8 of anastomotic leakage (6.4%, one died of severe abdominal infection), 4 of urinary retention (3.2%), 3 of recurrent constipation (2.4%, without megacolon relapse), 11 of bowel obstruction (8.8%), 2 of anastomotic stricture(1.6%) and 2 of refractory staphylococcus aureus enteritis (1.6%, diagnosed by stool smear and culture, and both died finally). Jinling procedure is a safe and effective surgical procedure for adult Hirschsprung's disease.

Prevention of intraoperative incidental injuries during sphincter-preserving surgery for rectal cancer and management of postoperative complication

Prevention of intraoperative incidental injuries during radical operation for rectal cancer and management of postoperative complication are associated with successful operation and prognosis of patients. This paper discusses how to prevent such intraoperative incidental injuries and how to manage postoperative complication. (1) Accurate clinical evaluation should be performed before operation and reasonable treatment decision should be made, including determination of the distance from transection to lower margin of the tumor, T and M staging evaluated by MRI, fascia invasion of mesorectum, metastasis of lateral lymph nodes, metastatic station of mesentery lymph node, association between levator ani muscle and anal sphincter, course and length of sigmoid observed by Barium enema, length assessment of pull-through bowel. Meanwhile individual factors of patients and tumors must be realized accurately. (2) Injury of pelvic visceral fascia should be avoided during operation. Negative low and circumference cutting edge must be ensured. Blood supply and adequate length of pull-down bowel must be also ensured. Urinary system injury, pelvic bleeding and intestinal damage should be avoided. Team cooperation and anesthesia procedure should be emphasized. Capacity of handling accident events should be cultivated for the team. (3) intraoperative incidental injuries during operation by instruments should be avoided, such as poor clarity of camera due to spray and smog, ineffective instruments resulted from repeated usage. (4) As to the prevention and management of postoperative complication of rectal cancer operation, prophylactic stoma should be regularly performed for rectal cancer patients undergoing anterior resection, while drainage tube placement does not decrease the morbidities of anastomosis and other complications. After sphincter-preserving surgery for rectal cancer, attentions must be paid to the occurrence of anastomotic bleeding, pelvic bleeding, anastomotic fistula, ileus, intestinal necrosis and anastomotic stenosis. After sphincter-preserving surgery for rectal cancer, if small amount of bleeding happens, titanium clamp or electric coagulation can be used; if delayed pelvic bleeding occurs obviously, embolism should be applied. Conservative treatment may be used for the non-carcinomatous ileus. When small anastomotic stenosis is found, local treatment is available (finger dilation, balloon expansion, transanal radiated cutting or resection), and for severe stenosis, transadominal operation is required.

Anti-inflammatory effects of enemas containing an oily extract of curcumin in an experimental model of diversion colitis.

Curcumin has powerful anti-inflammatory and antioxidant effects and it has been used for treatment of distal ulcerative colitis. The therapeutic effects of curcumin have not yet been evaluated in diversion colitis. The aim of the present study was to evaluate the anti-inflammatory effects of curcumin on colonic mucosa devoid of a faecal stream. Thirty-six rats were subjected to a proximal colostomy and distal colonic fistulation. They were divided into two groups, which were sacrificed two or four weeks after the intervention. Each group was divided into three subgroups treated with the daily application of enemas containing saline or an oily extract of curcumin at 50 mg/kg/day or 200 mg/kg/day. Colitis was diagnosed by histological analysis. Inflammatory grades were assessed using a previously validated scoring system. The infiltration of neutrophils was evaluated based on the tissue expression of myeloperoxidase (MPO), as determined by immunohistochemistry, and a computer-assisted image analysis program. The Mann-Whitney test was used to compare inflammation grades and myeloperoxidase levels among groups, and ANOVA was used to verify the variance over time, with the level of significance set at 5% (p<0.05) for both tests. Enemas containing curcumin improved the inflammation of the mucosa without a faecal stream and reduced the tissue contents of MPO. MPO tissue levels did not vary with time or between the concentrations of curcumin used. Enemas with curcumin improved the inflammation of the colonic mucosa, reduced the inflammatory grade and decreased the tissue content of MPO in colon segments without a faecal stream.

Role of barium enema preceding colostomy closure in trauma patients is limited and challangeable

The prospective study comprising 50 cases was conducted in West Surgical Ward, Mayo Hospital, Lahore from January 2000 to December 2001. Majority of the patients 45(90%) were male and 5(10%) patients were female. Cause of colostomy in 28(56%) patients was firearm, stab injury in 13(26%), blunt trauma in 4(8%), rectal impalement in 3(6%) and iatrogenic injuries in 2(4%) patients. Barium enema preceding colostomy closure was advised in all patients with 98%(49 patients) negative results and 2%(1 patient) false positive results which were found negative o n further evaluation by proctoscopy/sigmoidoscopy. Gut was prepared pre-operatively by both chemical and mechanical methods. Colostomy closure was performed in 43(86%) and resection and end t o end anastomosis in 7(14%) patients. Skin was left open in all cases. Post-operative complications observed in the series were interloop abscesses in 1(2%), anastomosis narrowing in 1(2%) and urinary tract infection in 1(2%) patient. All complications were managed according to their own protocol and priority. No mortality was recorded in the study.

Bibliometric analysis of current status of TCM nursing technologies application and clinical nursing care

Objective To search for a correspondence relationship between traditional Chinese medicine(TCM) nursing technologies and diseases care, and find out application hot spots of TCM nursing technologies through a bibliometric analysis of current status of clinical application of TCM nursing technologies. Methods A bibliometric analysis method was employed to analyze TCM nursing technologies related literatures retrospectively. Results A total of 4044 studies were collected and analyzed, showing that the literatures about moxibustion therapy, auricular point application, retention enema of TCM, acupoint massage, acupuncture and TCM fumigation these 6 technologies were more common than the others except for those about comprehensive care. The involved diseases in those literatures mainly were stroke, lumbar disc herniation, diabetes, colitis and pelvic inflammatory etc. and most of the symptoms were constipation, insomnia, pain and urinary retention etc. Conclusions The 6 TCM nursing technologies appear the nursing relationships with certain disease: moxibustion therapy has good effects on stroke, spondylitis, lumbar disc herniation and urinary retention etc; auricular point application is applicable among cerebrovascular disease, insomnia and constipation; retention enema of TCM is applied mostly to gastrointestinal disease; acupoint massage is used more in postoperative; acupuncture suits the treatment for facial paralysis and urinary incontinence etc. TCM fumigation is effective for the treatment of arthritis and cervical and lumbar pain. Key words: Bibliometrics; Disease and symptom; Traditional Chinese medicine nursing

Clinical effect of using gut microbes enema combined with humanized nursing intervention on the treatment of pediatric chronic metabolic disease

Objective To observe the clinical effect of using gut microbes enema combined with humanized nursing intervention on the treatment of pediatric chronic metabolic disease. Methods A total of 90 children with chronic diarrhea from January 2012 to June 2013, were randomly divided into observation group and control group, and the patients of control group received routine and montmorillonite powder treatment while the patients of observation group received lactic acid bacteria tablet enema. In two groups, children were given humanized nursing intervention. We compared the curative effects and symptoms improving time between two groups. Results The effective rate of observation group was 95.56% and control group (66.67%), and the difference between the two groups has statistical significance (χ2=12.56, P<0.05); observed in normal defecation group, vomiting disappeared, the fever disappeared time were lower than those in the control group relationship (t=2.25, 2.14, 2.01; P<0.05). Conclusions The treatment of gut microbes enema method combined with humanized nursing is effective on chronic metabolic diseases and diarrhea, which is worthy of further popularization and application. Key words: Infantile diarrhea; Enema; Gut microbes; Children; Humanistic nursing

The clinical study of using a modified type of povidone- iodine for bowel preparation to prevent infection after prostate biopsy

Objective To observe the effect of prevention of infection using a modified type of povidone-iodine for bowel preparation after transrectal ultrasound-guided prostate biopsy. Methods Collecting 318 casesdiagnosed of suspected prostate cancer were divided into two groups by random digital table method. The control group underwent routine bowel preparation, with the concentration of 1% povidone iodine 300 ml in half an hour before the puncture and keeping 5-10 minutes; the experimental group underwent modified povidone iodine bowel preparation, with the concentration of 3% povidone-iodine 50 ml in 10 minutes before the punctureand keeping 10 minutes. All patients were used sensitive antibiotics in 2 hours after prostate biopsy to prevent infection, then compared the two group's infection rates. Results The incidence of infection in the experimental group was 1.25% (2/160), which was significantly lower than 7.59% (12/158) in the control group, the difference was statistically significant (χ2=7.604,P <0.01). Conclusions The modified povidone iodine intestinal preparation can prevent postoperative infection of transrectal ultrasound-guided prostate biopsy effectively and can be used in clinical. Key words: Enema; Prostate; Biopsy, needle; Infection

Effect of modified anal injection on preventing fecal incontinence led by glycerol enema in elderly orthopedic patients

Objective To explore the effect of modified anal injection on preventing fecal incontinence caused by glycerol enema and reliving constipation in elderly orthopedic patients. Methods A total of 78 aged patients with constipation was selected and divided into experimental group (38 cases, modified anal injection enema method) and control group (40 cases, traditional enema anus method) according to the random number table method. And then, we compared the situation of fecal incontinence and relieving constipation. Results In the control group, there were 10 patients with fecal incontinence, while there was no case of fecal incontinence in the experimental group, it was statistically significant between them (P<0.01). After using the enema, there were 14 ineffective cases in the control group and 5 ineffective cases in the experimental group, and the differences were statistically significant between the two groups (P<0.05). The effect in the experimental group was better than that in the control group. Conclusions Modified anal injection enema can prevent fecal incontinence caused by enema and relieve constipation in elderly orthopedic patients. Key words: Orthopedics department, hospital; Elderly; Glycerol enema; Fecal incontinence; Modified anal injection

The molecular epidemiology and infectious risk factors of clinical linezolid-resistant Enterococci isolates

Objective To investigate the molecular epidemiology and infectious risk factors of linezolid-resistant Enterococci (LRE) isolates in the First Affiliated Hospital of Chongqing Medical University. Methods Thirteen LRE isolates were collected from 2011 to 2013 and confirmed by broth dilution susceptibility testing. The minimum inhibitory concentrations (MIC) of twelve antimicrobial agents were analyzed using Vitek 2 compact. The molecular epidemiology of LRE isolates was determined by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) and the Diversilab. A case-control study was conducted for the analysis of risk factors, and Logistic regression was performed to evaluate the independent risk factors. Results All thirteen LRE isolates showed low-level resistance to linezolid, and most of these isolates were resistant to tetracycline, erythromycin and ciprofloxacin. However, they had high sensitivity to penicillin, ampicillin and tigecycline. Sequence type 480 was predominant in the hospital, and three isolates (isolates 3, 4, and 5) from July to September 2013 were found to have the same ST, PFGE pattern and rep-PCR group, indicating the same resistance clone. Admission to intensive care unit (ICU), peripheral vascular disease, males, hypoalbuminaemia, enema and linezolid therapy were identified as significant risk factors for LRE infections. Among these factors, admission to ICU, enema and linezolid therapy were independent risk factors for the acquisition of LRE. Conclusions Thirteen LRE isolates collected in the hospital showed a multidrug-resistant phenotype, and a small-scale prevalence was detected from 2011 to 2013. Therefore, attention should be paid to monitor the LRE in the hospital to decrease the prevalence of LRE infections. (Chin J Lab Med, 2015, 38: 756-760) Key words: Acetamides; Oxazolidinones; Enterococcus; Drug resistance, bacterial

Application effects of functional rehabilitation gymnastics combined with glycerini enema for acute urinary retention patient′s prognosis

Objective To explore the application effects of functional rehabilitation gymnastics combined with glycerini enema for acute urinary retention patient′s prognosis. Methods A total of 120 acute urinary retention patients were selected and averagely divided into observation group and control group according to random lottery, and all patients poured into glycerini enema, but the patients of observation group received extra intervention of functional rehabilitation gymnastics with 15 d intervention period. The interventions effects were compared between two groups. Results After interventions, the difference of effective rates was statistically significant between two groups (P<0.05). The residual urine volume in the observation group was lesser than that of the control group, the bladder pressure-volume of the observation group was ligher than that of the control group (P<0.05). Conclusions Functional rehabilitation gymnastics combined with glycerini enema can be applied for acute urinary retention patient′s prognosis and relieve the pain, so as to enhance the quality of life. Key words: Urinary retention; Rehabilitation nursing; Functional rehabilitation gymnastics; Glycerini enema

Therapeutic effects and the possible mechanism of fecal transplantation on rats with Clostridium difficile-associated pseudomembranous colitis

Objective To investigate the therapeutic effects and the possible mechanism of fecal transplantation on rats with Clostridium difficile-associated pseudomembranous colitis. Methods A total of 40 Sprague-Dawley rats were divided into four groups including the healthy control group, model group, fecal transplant treatment group and vancomycin treatment group. Rats in three experimental groups were subcutaneously injected with clindamycin phosphate (10 mg), followed by treatment with toxin producing Clostridium difficile (ACTT43255) enema 24 hours later. The rats in fecal transplant treatment group and vancomycin treatment group were respectively treated with fecal suspension and vancomycin one day after modeling. The rats were fasted for one day after the last administration and then executed. The levels of potassium ion (K), sodium ion (Na), albumin (ALB), white blood cells (WBC), C-reaction protein (CRP), interleukin-1β (IL-1β), interleukin-10 (IL-10), interleukin-12 (IL-12) and interleukin-17 (IL-17) as well as the percentage of neutrophils (N%) in serum samples were detected. The colon tissue samples were collected for pathology examination. Results The rat model of pseudomembranous colitis was successfully established by subcutaneous injection of clindamycin in combination with toxin-producing Clostridium difficile (ACTT43255) enema. The signs of intestinal inflammation including serious weight loss, remarkably shortened colon length and significantly increased colon wet weight index were observed in rats from the model group (P<0.05). Compared with the rats from model group, the rats received fecal transplant showed significantly increased levels of K, ALB, IL-10 and IL-10/IL-12 in serum and decreased levels of WBC, N%, CRP, IL-1β and IL-17 (P<0.05). Conclusion Fecal transplantation was proved to be an effective approach for the treatment of pseudomembranous colitis. The therapeutic mechanism might due to its impacts on serum inflammatory factors. Key words: Fecal transplantation; Pseudomembranous colitis; Inflammatory factor

Evaluation and analysis of the effect of the application of balloon catheter to cleansing enema in elderly patients

Objective To evaluate the effect of balloon catheter to cleansing enema in the elderly patients. Methods A total of 100 elderly patients,who needed cleansing enema and no enema contraindications were randomly divided into control group and experimental groups, the experimental group used sterile silicone catheter and the control group used The disposable anal enema. The enema effect of two groups was compared. Results In the experimental group the cases of enema fluid leakage, numbers of times, bleeding were significantly less than those of the control group(P<0.05). Conclusions The balloon catheter for enema can reduce the suffering of elderly patients and get more effective. It also improve the quality of care and reduce the nursing workload. Key words: Elderly; Cleansing enema; Balloon catheter

The effect of royal jelly versus sulfasalazine on acetic acid-induced colitis in adult albino rats

Objective The present study was designed to investigate the therapeutic effect of royal jelly (RJ) as a new treatment for inflammatory bowel disease (IBD), compared with sulfasalazine, in experimental colitis induced with acetic acid. Background Ulcerative colitis is an inflammatory disease in which patients experience cyclic bouts of symptoms including diarrhea and rectal bleeding. Sulfasalazine is mainly used for the treatment of IBD. RJ is a natural product commonly used to supplement the treatment of various diseases. Materials and methods Sixty adult male albino rats were used in the present work and were divided into two groups: group I (the control group) and group II. In group II experimental colitis was induced with 4% acetic acid enema and the rats were divided into four subgroups: subgroups IIa, IIb, IIc, and IId. The rats in subgroup IIa were killed after 24 h; those in subgroup IIb did not receive treatment; subgroup IIc received sulfasalazine orally at 100 mg/kg daily; and subgroup IId received RJ orally at 150 mg/kg daily. After 1 month the animals were killed and the distal colon was excised and stained with hematoxylin and eosin, alcian blue, and periodic acid-Schiff; immunohistochemical analysis was carried out for inducible nitric oxide synthase and nuclear factor kB. Total Colitis Index score was calculated, and morphometric and statistical studies were carried out. Results Rectal instillation of acetic acid resulted in marked disturbed histological structure of the mucosa and submucosa of the colon. The mucosal crypts showed wide separation and sloughing of the surface epithelium, as well as cellular infiltration. Significant decrease in alcian blue and increase in inducible nitric oxide synthase and nuclear factor kB were observed in the colitis and recovery subgroups. Treatment with RJ or sulfasalazine caused restoration of the mucosal architecture with histological variations more superior in the RJ subgroup than in the sulfasalazine subgroup as proved by histochemical analysis and Total Colitis Index score. Conclusion RJ had greater therapeutic effect against experimental colitis compared with sulfasalazine.

Analysis and research on the application of the comprehensive nursing intervention in 180 cases of jaundice in premature children

Objective To explore the clinical effect of the comprehensive nursing intervention on premature children with jaundice. Methods 180 cases of premature children which were suffered from jaundice during 2009.12- 2011.12 were selected as subjects and were randomly divided into control and observation groups. Children in the control group(n= 90) were given conventional treatment and care, and in the observation group(n= 90) were given comprehensive nursing intervention with abdominal massage and enema on the basis of conventional treatment and care. Jaundice occurrence, duration and regression time, 1 d, 3 d, 5 d serum bilirubin values and bowel movement, defecation time and shape were compared between the two groups. Results The emergence time of jaundice was(2.2±0.9) d in control group, which was significantly less than that of observation group(4.4±1.6)d. The duration and regression of jaundice of control group were significantly longer than those of the observation group. The 1 d, 3 d, 5 d serum bilirubin values(unit:μmol/ L) of control group were respectively(49.9±15.5),(122.6±28.9)and(199.9±37.7), and 1 d, 3 d, 5 d serum bilirubin values(unit:μmol/ L) of the observation group were respectively(51.1±16.7),(86.8±19.8)and(121.1±22.5). There were no significant difference between the two groups in 1 d serum bilirubin(P> 0.05), there was significant difference in 3 d and 5 d serum bilirubin between two groups(P< 0.01). There were significant differences in the first meconium exclude, the first defecation turn yellow time and the daily number of bowel movements between two groups(P<0.05, P<0.01). Conclusions The comprehensive nursing intervention in preterm children has good clinical effect, which should be promoted and widely used. Key words: Comprehensive nursing intervention; Preterm children; Jaundice; Clinical effects

Effect of methotrexate intervention combined with herbal enema in the treatment of ectopic pregnancy

Objective To study the effect of methotrexate intervention combined with herbal enema in the treatment of ectopic pregnancy. Methods 220 cases with ectopic pregnancy were selected and divided into two groups according to the methods of random number table: the observation group and the control group, each group of 110 cases. The observation group used methotrexate intervention combined with herbal enema treatment, the control groups only used methotrexate intervention treatment. The clinical effect and adverse reactions of the two groups were observed. Results The observation groups:74 cases with marked effect,30 cases were effective,6 cases without effect, the total efficiency was 94.5%;The control groups:44 cases with marked effect,50 cases with effective,16 cases without effect,the total efficiency was 85.4%, the difference between the two groups was statistically significant(The total effective rateχ2=5.05,P 0.05). Conclusion Methotrexate intervention combined with herbal enema in the treatment of ectopic pregnancy can obtain fast and exact curative effect, it's less adverse reaction and worthy of clinical promotion. Key words: Pregnancy ectopic; Herbal enema; Methotrexate

Evidence of Mortality Reduction from FIT in Italy

Randomized, controlled trial findings support guaiac-based fecal occult blood testing (FOBT) and sigmoidoscopy for colorectal cancer (CRC) mortality reduction but have not been conducted for colonoscopy, barium enema, computed tomographic colonography, or fecal immunochemical testing (FIT) for blood. FIT has higher adherence rates and better performance characteristics than guaiac-based FOBT. Biennial FIT-based screening programs were introduced in some Italian regions in 2002–2004 and in other regions in 2008–2009. In …

Diagnostic value of 0.9% sodium chloride solution enema towards secondary intussusception in children under ultrasound

Objective To discussion of secondary intussusception in children based on ultrasound image, and the diagnosis and the therapeutic value. Methods 23 cases of secondary intussusception in children by the ultrasound image were reviewed and pathogeny analyzed. Results Within this 23 cases of secondary intussusception in children:8 cases in 23 cases were caused by Meckel di-verticulum,4 cases were caused by juvenile polyps,4 cases were caused by intestinal duplication,3 cases were caused by intestinal lymphoma,2 were caused by appendicitis, and 2 cases were caused by intestinal adhesion. And 23 cases of them were all detected by ultrasound at the very first time.22 cases of 23 cases was operated by hydrostatic enema of ultrasonic monitoring treating intussusception successfully,and 1 failed.13 cases were confirmed as secondary intussusception after first enema(Meckel di-verticulum 6 cases, juvenile polyps 3 cases,intestinal duplication 2 cases,intestinal lymphoma 1,and appendicitis 1 cases).9 cases were operated by hydrostatic enema of ultrasonic monitoring treating intussusception again when palindromia happened,which were confirmed as secondary intussusception(Meckel di-verticulum 2 cases,juvenile polyps 1 cases,intestinal duplication 2 cases, intestinal lymphoma 2 cases,appendicitis 1 cases, and intestinal adhesion 1 cases). Conclusion Meckel di-verticulum, juvenile polyps and intestinal duplication are the most common pathologic lead points caused the secondary intussusception in children. The diagnosis of ultrasound is sensitive to children secondary intussusception, and hydrostatic enema of ultrasonic monitoring treating intussusception can be operated under ultrasonic monitoring, which has an even better result than air enema under X-ray. The situation of bowel, which is full of 0.9%sodium chloride solution, gives operators a good effect of visual to find pathologic lead points. And that really helps to provide valuable image in accordance with clinical surgery therapy of secondary intussusception. Key words: Intussusception; Treatment; Ultrasonography, interventional; Child

Influence of length of preserved ileocecum on the efficacy of laparoscopic subtotal colectomy antiperistaltic cecorectal anastomosis in the treatment of slow transit constipation

To investigate the influence of length of preserved ileocecum on the efficacy of laparoscopic subtotal colectomy antiperistaltic cecorectal anastomosis (LSCACRA) in treating slow transit constipation (STC). Clinical data of 81 STC patients who received LSCACRA between April 2007 And December 2011 in the 150th Center Hospital of PLA were continuously collected. Patients were divided into two groups: 10 cm to 15 cm ascending colon preserved above ileocecal junction(10-15 cm group, n=41), and 2 cm to 3 cm ascending colon preserved above ileocecal junction (2-3 cm group, n=40). The Wexner constipation scale (WCS), Wexner incontinence scale(WIS), gastrointestinal quality of life index(GIQLI), abdominal pain intensity scale(NRS), abdominal pain frequency scale and abdominal bloating frequency scale in the two groups were determined and compared before and 6, 12, 24 months after operation. No postoperative incontinence was found in all the patients. There were no significant differences in evacuation frequency between two groups at 6th and 12th month after surgery (all P>0.05). Two years after operation, barium enema emptying time examination revealed 2-3 cm group was (17.7±9.5) h, which was remarkably shorter than (21.2±20.7) h in 10-15 cm group (P=0.011). The WCS, GIQLI, NRS and abdominal pain frequency scale of two groups were improved obviously at 6th, 12th and 24th month after surgery (all P<0.01). Above parameters in 2-3 cm group were superior to 10-15 cm group (all P<0.01), but abdominal bloating frequency scale was not significantly different between the two groups (P>0.05). As compared with before operation, NRS in 2-3 cm group 6, 12, 24 months after operation reduced remarkably (all P<0.01), but did not improve obviously in 10-15 cm group (P>0.05). The shorter length of ascending colon preserved above ileocecal junction can improve the efficacy of LSCACRA in the treatment of STC and the prognosis of patients. Two to three cm length of ascending colon preserved above the ileocecal junction should be recommended.

Umbilicus: A Site for Stoma in Hirschsprung's Disease.

A 13-day-old male baby with the symptoms suggestive of HD and barium enema showing the transition zone (TZ) at the recto-sigmoid was admitted with progressive abdominal distention not responding to rectal washes. The baby was planned for sigmoid colostomy and seromuscular biopsy. A transverse skin incision of 2cms was made through the umbilicus under general anesthesia. The skin, subcutaneous tissue, and fascia were incised, and the umbilical vessels and urachal remnant were individually ligated apart from the opening in the fascia. At this point, a urethral sound was passed per rectally to guide the sigmoid loop towards the umbilicus. Stay sutures were taken and the loop of sigmoid colon was taken out. Biopsies were taken from the recto-sigmoid junction and site proximal to TZ. The bowel wall was fixed separately to the peritoneum and fascia with interrupted 5-0 absorbable sutures. The bowel was opened and everted with suturing to the skin (Fig. 1). Management of Hirschsprung’s disease (HD) has evolved in last one decade from staged procedure to single stage trans-anal pull through. But in developing country like ours, the presentation is generally late (most of them brought with severely dilated colon or enterocolitis) and where there is lack of facility for frozen section biopsy, staged procedures are still the standard of care. In this era of minimal access surgery, where a lot of stress is laid on cosmesis, role of umbilical incision for fashioning of colostomy and taking biopsies is a good alternative. Though trans-umbilical colostomies have been occasionally done in past for HD and anorectal malformations1,2,3, they are still not widely used.