Background: Persistent or recurrent idiopathic rectal prolapse in children requires surgical intervention. Several techniques have been used to repair this problem. However, recurrence and complications continue to be a challenge in the management of this condition. Here we report our experience in using the modified Delorme's procedure to treat such patients. Methods: We conducted a retrospective observational study of patients with idiopathic rectal prolapse who underwent the modified Delorme's procedure during 2013-2017. We analyzed the clinical characteristics of the patients and the recurrence and complication rates during a follow-up of 15-68 months. Results: We included 14 patients. The age at operation ranged from 2 to 17 years, and the length of the prolapse was 3-15 cm. There were no intraoperative or postoperative complications. All patients achieved postoperative fecal control, and there were no recurrences. Conclusion: The modified Delorme's procedure was effective for the treatment of idiopathic rectal prolapse. There were no recurrences or complications. Because it is a perineal technique, the procedure avoids the risk of nerve injury that exists for transabdominal methods.
OBJETIVO: exponer y describir una técnica de realimentación en niños con ileostomía que permite aumentar la curva de crecimiento y disminuir las dehiscencias anastomóticas y dermatitis posoperatoria.MATERIAL Y MÉTODOS: estudio retrospectivo de serie de casos de pacientes con ileostomía tratados con la técnica de realimentación de estoma distal, previa a la restitución del tránsito intestinal, atendidos durante el año 2014. Se revisó el padecimiento que condicionó la derivación, la edad y peso al inicio de la realimentación, ganancia ponderal, duración de la realimentación, hallazgos macroscópicos en el cierre de ileostomía y repercusiones posoperatorias.RESULTADOS: se estudiaron siete pacientes, cuatro de ellos tuvieron atresia intestinal, uno sospecha de enfermedad de Hirschsprung, otro enterocolitis y otro sufrimiento intestinal postinvaginación. La realimentación se inició a una edad media de 5 meses de vida y peso medio de 4.4 kg. La ganancia ponderal fue de 0.7 kg al mes, en promedio, (rango 0.36-1.4 kg al mes). No se encontró desproporción entre los cabos. No hubo ninguna dehiscencia anastomótica ni dermatitis perianal posoperatoria. Luego del seguimiento durante dos años, seis pacientes tienen curva ponderal y talla normal para su edad.CONCLUSIONES: la realimentación es una técnica fácil, segura y barata que permite aumentar la ganancia ponderal del paciente, evitar la atrofia del segmento intestinal, disminuir la pérdida de líquidos y electrólitos y preparar el intestino distal para la futura anastomosis.PALABRAS CLAVE: realimentación; estoma; ileostomía; cierre de la ileostomía; atresia intestinal; intestino. Abstract OBJECTIVE: To present and describe a feedback technique in children with ileostomy that allows to increase the growth curve and decrease anastomotic dehiscence and postoperative dermatitis.MATERIAL AND METHODS: We present 7 patients with ileostomy, treated with the refeeding technique during 2014 in the ColorectalCenter. We review why the derivation was performed, the age and the weight when the refeeding was begun, the weight gained, how long the refeeding was carried out, the macroscopic findings during the ileostomy closure and the outcome.RESULTS: Four patients had intestinal atresia, 1 patient was suspected of Hirschsprung's disease, one had necrotizing enterocolitis and another had an intestinal intussusception with intestinal damage. The refeeding was begun at 5 months old on average and with 4.4kg on average. The weight gain was 0.7kg per month on average (range 0.36- 1.4kg per month). We found no disproportion between the bowel segments. There was neither anastomotic dehiscence nor postoperative perianal dermatitis. After 2 years of follow-up, 6 patients have normal weight curve and normal height curve for their age.CONCLUSIONS: The refeeding is an easy, safe and inexpensive technique to increase the patient weight gain, to prevent the atrophy of the intestinal segment, to reduce fluid and electrolyte loss and to prepare the bowel for the future intestinal anastomosis.KEY WORDS: refeeding; stoma; intestinal; ileostomy; ileostomy closure; intestinal atresia, bowel.
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