Single-stage management of all pouch colon (anorectal malformation) in newborns

Gangopadhyay, A. N.; V.S., Shilpa; Mohan, T. Vittal; Gopal, S. C.

doi:10.1016/j.jpedsurg.2005.03.050

Cited by 34 publications

(39 citation statements)

References 18 publications

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“…In SSP, the definitive procedure was done very early, so that anorectal continuity could be achieved early, which led to better continence results. Similar continence results were shown in a study by Gangopadhyay et al 11 The Quality of life, including somatic, social, participation in group activities, relationship with siblings and psychological, is terrible, owing to poor fecal continence after surgery. 14,15 The children will have problems in peer relationships, school absentees and behavioral problems.…”

Section: Discussionsupporting

confidence: 87%

“…In our study, the incidence was much higher at 30.6% and 44.1% of all high-ARM cases whereas in a study by Gangopadhyay et al it was 15.1% and 19.5% respectively. 11 Male predominance was noted in all the series (2.25:1) and even in our series it was 9:1. Associated malformations commonly involve gastrointestinal and genitourinary system in the form of double appendix, hydronephrosis and vesicoureteric reflux; in our series it was more of cardiac ( VSD, ASD, TOF) with rest same gastrointestinal and genitourinary anomalies but incidence being slightly less.…”

Section: Discussionsupporting

confidence: 43%

“…Associated malformations commonly involve gastrointestinal and genitourinary system in the form of double appendix, hydronephrosis and vesicoureteric reflux; in our series it was more of cardiac ( VSD, ASD, TOF) with rest same gastrointestinal and genitourinary anomalies but incidence being slightly less. Gatrointestinal and genitourinary complications were seen more frequently in study by Gangopadhyay et al 11 The diagnosis of pouch colon clinically requires high grade of suspicion and experience on the part of the surgeon and should be suspected in cases of disproportionate tense abdominal distension of the abdomen, especially on the left side, within 24 hours.…”

Section: Discussionmentioning

confidence: 95%

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Primary single stage repair of newborn babies with pouch colon (anorectal malformation) in a tertiary setup

Aggarwal

2017

Int Surg J

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Background: The standard procedure in the management of pouch colon is the staged procedure (SP), which has well-known disadvantages. We believe that staged procedure is unnecessary and single-stage procedure (SSP) can be done in the congenital pouch colon cases. Methods: Patients with pouch colon who underwent SSP (90 cases from 2008 to 2013) and SP (100 cases from 2003 to 2008), 65 and 55 of whom, respectively, were in regular follow-up for more than 3 years, were evaluated. Results: In SSP, male/female ratio was 87:3; in SP-94:6. Mean age of patient in SSP was 3.7 days and in SP 15 months. The distribution of cases into types I, II, III, and IV was 7,16,18, and 24 in SSP,and 6,14,15,and 20 in SP, respectively. The ratio of PSSP/SP for partial pouch colon (I and II) was 23:20 and for complete pouch colon (III and IV) was 42:35. The ratio of SSP/SP in terms of continence, mortality, and cost was 81:60, 17:53, and 1:6, respectively. Conclusions: Primary single-stage procedure gives better continence and cosmesis, with low morbidity and mortality at a low cost, and hence is recommended. Aggarwal S et al. Int Surg J. 2017 Apr;4(4):1158-1162 International Surgery Journal | April 2017 | Vol 4 | Issue 4 Page 1159 All the cases of pouch colon diagnosed clinically supported by radiological evidence (babygram, invertogram, cross-table prone lateral view, ultrasonogram) admitted at S.G.R.D. Hospital, Department of Paediatric Surgery, Amritsar, during the period 2003 to 2013 were included in the study. During this period, 100 cases were managed before 2008 with standard SP, and 90 cases were managed with SSP after 1997. Of these, 55 cases of SP and 65 cases of SSP who were in regular follow-up of more than 3 years were studied. All the patients were evaluated for associated congenital anomalies with X-ray abdomen, ultrasonography abdomen, micturating cystourethrogram, and echocardiogram whenever possible. After exploratory laparotomy with left lumbar hockeystick incision, the type of pouch colon was assessed according to the classification of Narasimharao et al, and decision was made accordingly. 1 In the follow-up period, all the cases were evaluated for continence with Kelly's scoring, mortality, and cost of treatment. Keywords METHODSThe SSP includes laparotomy, ligation of the fistula, followed by primary abdominoperineal pull-through/ abdomino-PSARP after pouch excision (partial/total pouch colon). Abdomino PSARP includes initial posterior sagittal approach and placement of tube stent, followed by change of posture for abdominal approach with dissection and division of fistula, followed by anoplasty with the pulled-down colon. The distribution of various operative procedures performed in both groups (SP and SSP) ( Table 1). RESULTSIn our study, pouch colon accounted for 30.64 % of all ARM (total ARM cases during the period 2003 -2013 was 620) and 44.1 % of all high ARMs (high ARM cases were 430). Male predominance was noted in our series (9:1).All the patients with congenital pouch colon had a high vari...

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 95%

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Primary single stage repair of newborn babies with pouch colon (anorectal malformation) in a tertiary setup

Aggarwal

2017

Int Surg J

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“…All patients underwent single stage anterior sagittal anorectovaginoplasty (ASARVP) without diverting colostomy. Most of the patients (about 95%) suffering with anorectal malformation either low or high were treated with single stage surgery at our center [15,16] as reported earlier the continence result of single stage repair in neonatal age group is safe, good results and minimal complications. The results were good in present study and we observed only one major complication.…”

Section: Discussionmentioning

confidence: 87%

“…Aluwihare [16] favored primary perineal rectovaginoplasty for supralevator imperforate anus in female neonates and concluded that operation is easier than other available procedures, with minimal complications. Single stage repair for anorectal malformations had been advocated by few studies [15][16][17][18] with good results and concluded that single stage repair in neonate is safe with minimal complications.…”

Section: Discussionmentioning

confidence: 99%

Single stage repair of anovestibular fistula in neonate

et al. 2007

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Anorectal malformations are one of the most common congenital defects. This study is conducted to evaluate the result of single stage anterior sagittal anorectovaginoplasty (ASARVP) in cases of vestibular anus (AVF) in neonatal age group without thorough gut preparation. All the patients of AVF admitted during 2003-2006 were included in this study. Single stage ASARVP was done in these patients without preparing the bowel in the lithotomy position, the fistula was freed and sufficient length of anorectum was dissected and vagina was separated. Midline incision at the proposed anal site was made, then a plane was dissected between the muscle complex going anteriorly. The mobilized anorectum was pulled to the proposed anal site and proper anoplasty was done. The results were evaluated for duration of surgery, need of bowel preparation, commencement of feed and hospital stay and follow-up (assessment of continence and anal dilatation). A total of 27 patients were included in our study. All patients were less than 1-month-old. Operative time ranges from 50 to 70 min. Bowel preparation was not needed. Per oral feed was started after 48 h in all patients and average duration of hospital stay was 3- 4 days. Postoperative regular anal dilatation was commenced after 1 week of operation. Continence results according to Kelly's method were good in 70%, fair in 21% and poor 9%. Single-stage anorectovaginoplasty in neonates has a good result in cases of AVF and avoids the need of bowel preparation.

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