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

Abstract

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...

Congenital Pouch Colon

“…[ 14 15 ] However, Type IV variety is more frequently reported in recent studies. [ 12 16 17 18 ] Type IV anomaly was detected in 72% of our cases. Our study in combination with the current literatures suggests a changing scenario regarding the most common pathological type of the anomaly and the resultant decrease in severity.…”

“…Primary single-stage management in CPC was also practiced by some surgeons, and they found to have good/fair continence. [ 18 21 ] However, due to high risk of complications and mortality, single-stage surgical approach is not advised by many authors. [ 2 4 ] Again, definitive surgery at few month later is well tolerated and is associated with better result.…”

“…Faecal continence assessment was done by Kelly's method in both the groups and was found to be good/fair. [ 18 25 ]…”

Surgical treatment of congenital anorectal malformation with rectovesical fistula in boys

“…Тип III -здухвинна кишка з'єднана з нормальною сліпою, висхідною та поперечно-ободовою кишкою, яка відкривається в товстокишковий «мішок». Тип IV -ободова кишка є нормальною, а товстокишковий «мішок» формується із ректосигмоподібного відділу [1,19].…”