Sagittal Anorectoplasty Research Articles

Pediatric Surgery Rate of Constipation After Sagittal Anorectoplasty For Rectoperineal Fistula

Abstract Background Rectoperineal fistula is a congenital low anorectal malformation that is presented with constipation and straining at stool. There is argument as regarding name, diagnosis and surgical treatment. Objectives to estimate the incidence of postoperative constipation among patients with rectoperineal fistula treated with anorectoplasty using Krickenbeck classification for postoperative outcomes. Patients and Methods The study was conducted between January 2018 and August 2018. The study included patients with rectoperineal fistula who underwent sagittal anorectoplasty (SARP) in the last five years in two tertiary hospitals; Ain Shams University Children Hospital and Banha Specialized Children Hospital. We excluded patients who underwent operations other than SARP and patients having Currarino syndrome and sacral anomaly like hemisacrum and caudal regression. Krickenbeck classification was used for assessment of constipation before and after operation. A simple questionnaire was used for follow up assessment. Results The study included 30 patients (19 female and 11 male). Their age at time of repair ranged from 3m to 78 months with a median age of 7.5 months. Rate of constipation in patients with rectoperineal fistula after SARP was 39%, while improvement rate was 65%. 14 patients out of 23 having preoperative constipation (61%) were treated from constipation, and one patient (4%) got improved regarding constipation grade and frequency, while remaining 8 patients (35%) were still having the same degree of constipation. There were 7 children who had no constipation before and after repair. These results were statistically significant as measured using McNemar test. Postoperative soiling was recorded in 7 patients; all of them had pseudo-incontinence (ORSI). Conclusion Rectoperineal fistula patients can gain benefit from SARP not just cosmetically, but also functionally (65% of constipated patients got improved).

One-stage repair of anorectal malformations in females with vestibular fistula: a systematic review and meta-analysis.

Females with recto-vestibular fistula (RVF) can be managed either by one-stage sagittal anorectoplasty (SARP) or by conventional multi-stage approach with colostomy followed by SARP. Our aim was to define which approach, one-stage or multi-stage, is safer and more beneficial. Using a defined search strategy, two investigators identified all comparative studies on the mentioned procedures. The study was conducted under PRISMA guidelines. The meta-analysis was performed using RevMan 5.3. Data are mean ± SD. Of 649 titles/abstracts screened, 13 full-text articles were analyzed. Three studies were included (156 females). One-stage SARP was associated with increased risk of wound infection (24.3 ± 8.7%) compared to multi-stage approach (10.9 ± 2.5%; p < 0.01) and increased risk of wound dehiscence (16.2 ± 4.8% vs. 2.4 ± 1.1%, respectively; p < 0.01). The incidence of anorectal stenosis was higher following one-stage repair (33.3%) vs. multi-stage approach (10.7%; p < 0.05). No differences were found with regards to redo SARP in both groups (12.9 ± 7.3% vs. 4.8 ± 0.8%; p = ns). At follow-up, the prevalence of soiling and constipation were similar after one-stage (19.7 ± 10.3% and 29.5 ± 5.4%) and multi-stage repair (13.7 ± 8.9% and 28.7 ± 4.4%; p = ns). In females with RVF, the SARP performed without protective colostomy increases the risk of postoperative complications. However, this one-stage approach seems not to be associated with reduced fecal continence.

新生児期に行うanterior sagittal anorectoplasty

新生児期に行うanterior sagittal anorectoplasty

Long-term bowel functional outcomes in rectourethral fistula treated with PSARP: controlled results after 4–29 years of follow-up: A single-institution, cross-sectional study

Background/purposePosterior sagittal anorectoplasty (PSARP) has become the standard surgical treatment for males rectourethral fistula (RUF) at most surgical centers worldwide. We aimed to define the long-term bowel functional outcomes following PSARP for RUF at our institution between 1983 and 2006, with comparison to age- and gender-matched controls. MethodsPatients were invited to answer a detailed, previously validated Bowel Function Score (BFS) questionnaire by post. Respondents were matched by age and gender to three controls from the general population who had answered identical questionnaires. Case records were reviewed retrospectively for operative details. Ethical approval was obtained. Social continence was defined as soiling or fecal accidents <1/week and no requirement for changes of underwear or protective aids. ResultsOf 34 (79%) respondents (median age 19 (range, 4–29) years), 74% had voluntary bowel movements (VBMs), 24% were reliant on anterograde continence enema (ACE) washouts, and 1 patient had a colostomy. Impairment of bowel function was significantly higher in all aspects of fecal control among patients than controls (p<0.001). A statistically significant decline in fecal accidents and soiling was observed with age (p≤0.03). Thirty-one percent of patients with VBMs had constipation managed with diet or laxatives (vs 2% of controls, p=0.0002). Of patients with VBMs followed up for >12years (n=20), 50% were completely continent (vs 73% of controls; p=NS). Overall, 76% of respondents were socially continent with or without artificial means in the form of ACE washouts. By BFS score, 39% had a good functional outcome, 27% had a moderate outcome, 9% had a clearly poor score and 24% were living with an ACE. ConclusionsOur results suggest that in the long-term, functional symptoms remain highly prevalent among patients treated for RUF with PSARP. However, the majority can be expected to achieve social continence, although for some this will require intervention with ACE bowel management. Approximately one third may report VBMs and complete continence.

Minimal Access Surgery in the Neonate

After completing this article, readers should be able to: 1. Review physiologic, anatomic, and technical issues related to minimal access surgery in the neonate. 2. Describe conditions in which minimal access surgery can be used in neonates. Historically, pediatric surgeons were slow to adapt to minimal access surgery (MAS) techniques compared with the adult surgical community. However, MAS now is widely established in infants and children. Differences in size and physiology have necessitated a number of surgical and technological modifications to apply MAS techniques to this population. This review outlines the important differences between children and adults with respect to MAS and provides examples of the use of MAS for diseases seen in infants. ### Physiologic Issues The physiologic response to pneumoperitoneum in children is more pronounced than in adults. Peritoneal insufflation with carbon dioxide has been shown to cause hypercarbia, acidemia, and decreased oxygenation in the pediatric piglet model. (1) In infants, however, there is no detrimental effect on blood pressure, heart rate, or oxygen saturation during short periods of pneumoperitoneum, and elevations in end-tidal CO2 can be counteracted readily by increasing the minute ventilation. (2) Hypercarbia-induced pneumoperitoneum in infants is associated with changes in cerebral blood flow and cardiac output. Nevertheless, laparoscopic procedures have been performed safely with proper anesthetic management in children who have even severe congenital cardiac abnormalities such as hypoplastic left heart syndrome. (3) Hypothermia also can be a concern due to rapid insufflation of unwarmed CO2 gas, mandating the moderation of flow rates. (4) ### Anatomic Issues A number of anatomic factors set children apart from adults and must be accounted for when performing laparoscopic surgery in this age group. Young children and infants have thinner abdominal walls than adults, so extreme care must be exercised when placing trocars. Due to the small size of the abdomen, the working …