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Ano recto

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By Alejandro Peñarrieta Daher Pediatric Surgeon / Neonatal Surgeon
Ankush Gosain, Philip K Frykman, Robert A Cowles, John Horton, Marc Levitt, David H Rothstein, Jacob C Langer, Allan M Goldstein
BACKGROUND: Patients with Hirschsprung disease are at risk for Hirschsprung-associated enterocolitis (HAEC), an inflammatory disorder of the bowel that represents the leading cause of serious morbidity and death in these patients. The diagnosis of HAEC is made based on clinical signs and symptoms which are often non-specific, making it difficult to establish a definitive diagnosis in many patients. The purpose of this guideline is to present a rational, expert-based approach to the diagnosis and management of HAEC...
May 2017: Pediatric Surgery International
J C Langer, M D Rollins, M Levitt, A Gosain, L de la Torre, R P Kapur, R A Cowles, J Horton, D H Rothstein, A M Goldstein
Although most children with Hirschsprung disease ultimately do well, many experience a variety of ongoing problems after pull-through surgery. The most common include obstructive symptoms, soiling, enterocolitis and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative obstructive symptoms in children with Hirschsprung disease. The American Pediatric Surgical Association Board of Governors established a Hirschsprung Disease Interest Group. Group discussions, literature review and expert consensus were then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with obstructive symptoms following pull-through for Hirschsprung disease...
May 2017: Pediatric Surgery International
Koichiro Yoshimaru, Yoshiaki Kinoshita, Yusuke Yanagi, Satoshi Obata, Takahiro Jimbo, Tsuyoshi Iwanaka, Yoshiaki Takahashi, Genshiro Esumi, Junko A Miyata, Toshiharu Matsuura, Tomoko Izaki, Tomoaki Taguchi
PURPOSE: For 30 years, we have consecutively performed rectal mucosal punch biopsy to diagnose Hirschsprung's disease. The aim of this study was to evaluate the safety of our technique. METHODS: Patients with suspected Hirschsprung's disease who underwent punch biopsy, including our original "K-PUNCH" method using an S-moid forceps and non-specific blood-collecting tube at our department and branch hospital between April 1986 and March 2016 were included in the present study...
February 2017: Pediatric Surgery International
Scott C Dolejs, John K Smith, Justin Sheplock, Joseph M Croffie, Frederick J Rescorla
PURPOSE: The primary aim of this study is to determine the natural history of patients who undergo an antegrade continence enema (ACE) procedure including complications, functional results, and long-term outcomes. METHODS: Patients aged 3-18years who underwent an ACE procedure from 2008 to 2015 for unremitting constipation and fecal incontinence with at least thirty day follow-up were included. Patients with congenital anatomic disorders of the spine, rectum, and anus were excluded...
January 2017: Journal of Pediatric Surgery
Alessandra Gasior, Giulia Brisighelli, Karen Diefenbach, Victoria Alison Lane, Carlos Reck, Richard J Wood, Marc Levitt
Introduction  Functional constipation is a common problem in children. It usually can be managed with laxatives but a small subset of patients develop intolerable cramps and need to be temporarily treated with enemas. The senior author has previously reported: 1) open sigmoid resection as a surgical option, but this did not sufficiently reduce the laxative need, then 2) a transanal approach (with resection of rectosigmoid), but this led to a high rate of soiling due to extensive stretching of the anal canal and loss of the rectal reservoir...
August 2017: European Journal of Pediatric Surgery
Jessie L Leung, Patrick H Y Chung, Paul K H Tam, Kenneth K Y Wong
BACKGROUND: Rectal prolapse has been reported after laparoscopic assisted anorectal pullthrough in children with anorectal malformation. We report our clinical outcome and study the application of an anchoring stitch to tack the rectum to the presacral fascia and the occurrence of rectal prolapse. MATERIAL AND METHODS: A retrospective review of all children who had undergone laparoscopic assisted anorectal pullthrough for anorectal malformation from 2000 to 2015 was performed...
December 2016: Journal of Pediatric Surgery
Andrea Bischoff, Jason Frischer, Jennifer Leslie Knod, Belinda Dickie, Marc A Levitt, Monica Holder, Lyndsey Jackson, Alberto Peña
INTRODUCTION: Fecal incontinence after the surgical repair of Hirschsprung disease is a potentially preventable complication that carries a negative impact on patient's quality of life. METHODS: Patients that were previously operated for Hirschsprung disease and presented to our bowel management clinic with the complaint of fecal incontinence were retrospectively reviewed. All patients underwent a rectal examination under anesthesia looking for anatomic explanations for their incontinence...
April 2017: Journal of Pediatric Surgery
Luis De la Torre, Kimberly Cogley, Juan L Calisto, Karla Santos, Alejandro Ruiz, María Zornoza
BACKGROUND: The association of rectovestibular fistula (RVF) and vaginal agenesis (VA) presents a diagnostic and management challenge. The vaginal replacement is usually performed with rectum or sigmoid, which are the natural fecal reservoirs; thus, the fecal control could be affected. We present our experience utilizing ileum to preserve the rectum and sigmoid. METHODS: We performed a retrospective study of eight patients with RVF and VA treated from May 2011 to June 2015 at two colorectal centers, at Pittsburgh and Mexico...
November 2016: Journal of Pediatric Surgery
Luis De La Torre, Kimberly Cogley, Juan Calisto, Gary Nace, Catalina Correa
PURPOSE: To present our experience in patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence who underwent a primary sigmoidectomy and appendicostomy. METHODS: We reviewed eight patients referred to the Colorectal Center from 2014 to 2016 with chronic idiopathic constipation and undergoing a sigmoidectomy and appendicostomy. We analyzed the previous medical treatment, indications for the surgical procedure, and outcomes...
August 2016: Pediatric Surgery International
Inbal Samuk, Andrea Bischoff, Jennifer Hall, Marc Levitt, Alberto Peña
BACKGROUND: Rectobladder neck fistula is the highest and most complex anorectal malformation in boys and the only one that requires an abdominal approach, open or laparoscopic, for repair. The aim of this study was to describe the unique characteristics of rectobladder neck fistulas that warrant special attention and to describe the associated anatomic variants in the genitourinary tract. METHODS: The database of a tertiary medical center was retrospectively reviewed for all patients treated for rectobladder neck fistula, by our team in 1980-2011...
October 2016: Journal of Pediatric Surgery
Christina Feng, Feroze Sidhwa, Danielle B Cameron, Charity Glass, Shawn J Rangel
PURPOSE: The purpose of this study was to characterize the rates of surgical site infections (SSI) associated with colorectal procedures in children and the relative burden of these events within the scope of pediatric surgical practice. METHODS: The NSQIP-Pediatric Public Use File was queried for all pediatric surgery procedures captured from 50 hospitals during 2012-2013. Rates of incisional and deep organ/space SSIs (ISSI and OSI, respectively) were calculated for all procedures, and the relative burden of SSIs from the entire dataset attributable to colorectal procedures was determined...
June 2016: Journal of Pediatric Surgery
Rajiv Chadha, Niyaz Ahmed Khan, Shalu Shah, Nitin Pant, Amit Gupta, Subhasis Roy Choudhury, Pinaki Ranjan Debnath, Archana Puri
AIMS: To discuss the assessment and management of genitourinary (GU) tract abnormalities in 21 girls with Types I-III congenital pouch colon (CPC), studied over a period of 10 years. MATERIALS AND METHODS: Assessment included clinical and radiological assessment, examination under anesthesia (EUA), endoscopy of the lower GU tract, and evaluation of the surgical findings, operative procedures for the GU anomalies, and the results of management. RESULTS: Initial examination of the external genitalia showed a "clover-leaf" appearance (n = 6) and a single perineal opening (n = 6)...
July 2015: Journal of Indian Association of Pediatric Surgeons
Julia Guerra, Carolyn Wayne, Tatenda Musambe, Ahmed Nasr
BACKGROUND: It is unclear whether laparoscopic-assisted transanal pull-through (LATP) or complete transanal pull-through (CTP) is superior for the surgical management of Hirschsprung's disease. We compared outcomes between approaches. METHODS: We retrospectively reviewed patients with Hirschsprung's disease who underwent LATP or CTP at our centre between 1995 and 2014. Patients were matched based on age, birth weight, and level of aganglionosis. A systematic literature review and meta-analysis were also performed...
May 2016: Journal of Pediatric Surgery
Yasuo Sakamoto, Ryuma Tokunaga, Yuji Miyamoto, Mayuko Ohuchi, Kenichi Nakamura, Keisuke Kosumi, Kazuto Harada, Hironobu Shigaki, Junji Kurashige, Masaaki Iwatsuki, Yoshifumi Baba, Naoya Yoshida, Hideo Baba
Tension-free anastomosis is often difficult to achieve after extended left hemicolectomy because the residual colon is too short to reach the rectal stump. Retroileal colorectal anastomosis is very simple and useful for obtaining tension-free anastomosis. We first applied this technique to laparoscopic operations. We herein describe the procedure of laparoscopic retroileal colorectal anastomosis.
December 2016: Surgery Today
Scott J Keckler, Jeannie C Yang, Jason D Fraser, Pablo Aguayo, Daniel J Ostlie, George W Holcomb, Shawn D St Peter
BACKGROUND: Many options exist in the surgical management of Hirschsprung's disease (HD). To gain insight into contemporary management, we queried pediatric surgeons listed in the American Pediatric Surgical Association Directory on their management for the typical baby with HD. METHODS: Surveys were sent electronically to the surgeons concerning a typical newborn diagnosed with HD. Questions included the preferred approach, number of stages, anastomotic technique, length of muscular rectal cuff, point of initiation of the anorectal dissection, and length of colonic resection...
June 2009: Journal of Pediatric Surgery
Clara Chong, Neil Featherstone, Shazia Sharif, Abraham Cherian, Peter Cuckow, Imran Mushtaq, Paolo De Coppi, Kate Cross, Joseph Curry
PURPOSE: Antegrade continence enema (ACE) revolutionised the lives of children with chronic constipation and soiling. Parents often ask how long the ACE will be required. We looked at our patients 5 years after ACE formation to answer the question. METHODS: We reviewed clinical notes of all patients undergoing ACE procedure during January 1990 to December 2010. Only patients with >5 years follow-up were included. Data are given as median (range). RESULTS: 133 patients were included with >5 years of follow-up...
April 2016: Pediatric Surgery International
Paul K H Tam
BACKGROUND/PURPOSE: Understanding the true nature of the disease provided the basis for appropriate surgery for Hirschsprung's disease some 60 years ago. Nevertheless, surgical outcome remains unsatisfactory. Advances in diagnosis and treatment will depend on the elucidation of the pathogenesis and disease heterogeneity. METHODS: This lecture outlines the author's attempt in the past 30 years to bridge some of the gaps of knowledge in Hirschsprung's disease. RESULTS: Studies of human fetal gut and aganglionic gut gave insight into the complexity of the human enteric nervous system, but the more fruitful studies came from genetic studies in which disease-causing genes were discovered, and the importance of noncoding mutations conferring disease susceptibility was unraveled...
January 2016: Journal of Pediatric Surgery
Xue Xia, Ning Li, Jia Wei, Wen Zhang, Donghai Yu, Tianqi Zhu, Jiexiong Feng
INTRODUCTION: This study aims to report medium-term outcomes of single-incision laparoscopic surgery (SILS) and compare its results with conventional laparoscopic surgery (CLS). PATIENTS AND METHODS: Seventy-five patients with Hirschsprung's disease (HD) underwent operations from January 2009 to December 2012 in our institution (SILS, n=40; CLS, n=35). SILS procedure is similar to CLS, but uses a single, 1.5-cm horizontal skin incision in the umbilicus for laparoscopic access...
March 2016: Journal of Pediatric Surgery
Orvar Swenson
No abstract text is available yet for this article.
October 2004: Journal of Pediatric Surgery
Clare Skerritt, Athanasios Tyraskis, Clare Rees, Iram Cockar, Edward Kiely
BACKGROUND: Straining at stool is an automatic reflex in babies and implies the presence of rectal sensation. We hypothesised that early reported rectal sensation would predict future continence in children with anorectal anomalies. AIM OF THE STUDY: The aim of this study is to determine if early straining at stool was a useful predictor of future continence in infants born with high anorectal malformations. METHODS: A retrospective case note review of prospectively collected clinical information was performed with institutional review board approval...
March 2016: Journal of Pediatric Surgery
2015-11-16 03:36:43
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