Perioperative Histologically Controlled Fistula Resection in Patients with Imperforate Anus and Perineal Fistula.

IF 1.5 3区医学 Q2 PEDIATRICS

European Journal of Pediatric Surgery Pub Date : 2024-10-01 Epub Date: 2023-11-28 DOI:10.1055/s-0043-1777101

Richard Skaba, Vojtech Dotlacil, Pavla Fuccillo, Blanka Rouskova, Lucie Pos, Michal Rygl

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引用次数: 0

Abstract

Introduction: Postoperative constipation (PC) in patients with imperforate anus and perineal fistula (PF) has been reported in up to 60%. Histological studies of PF revealed innervation anomalies which seem to be one of the reasons for PC. Perioperative histologically controlled fistula resection (PHCFR) allows appropriate resection of PF and pull-down normoganglionic rectum at the time of posterior sagittal anorectoplasty (PSARP).

Materials and methods: A total of 665 patients with anorectal malformations underwent surgery between 1991 and 2021. Of these, 364 presented PF; 92 out of them (41 F) were studied. Patients with sacral and spinal cord anomalies, neurological disorders, and cut-back anoplasty were excluded. PSARP was done on all patients. Hematoxylin-eosin staining and NADH Tetrazolium-reductase histochemical method were used. Four and more ganglion cells in the myenteric plexus represented a sufficient length of the resection. The continence was scored according to the modified Krickenbeck scoring system. Final scores ranged from 1 to 7 points. Values are given as median.

Results: A total of 65 (70.7%) patients presented an aganglionic segment in PF, and 27 patients presented hypoganglionosis. The median length of the resected fistula was 25 mm (interquartile range [IQR]: 20-30). The median total continence score was 7 (IQR: 6-7). Post-op constipation was observed in 6/92 (6.5%) patients.

Conclusion: PHCFR diminished PC to 6.5% of patients.

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肛门闭锁伴会阴瘘围手术期组织学控制的瘘管切除术。

导读:据报道，肛门闭锁和会阴瘘(PF)患者术后便秘(PC)的发生率高达60%。PF的组织学研究显示神经支配异常，这似乎是PC的原因之一。围手术期组织学控制瘘管切除术(PHCFR)允许在后矢状直肠成形术(PSARP)时适当切除PF和下拉正节直肠。材料和方法:1991年至2021年间，665例肛肠畸形患者接受了手术治疗。其中，364例为PF;其中92例(41例)进行了研究。排除了骶骨和脊髓异常、神经系统疾病和切口成形术的患者。所有患者均行PSARP检查。采用苏木精-伊红染色和NADH四唑还原酶组织化学方法。在肌肠丛中有四个或更多的神经节细胞代表了足够的切除长度。根据改良的Krickenbeck评分系统对尿失禁进行评分。最终得分从1到7分不等。数值以中位数给出。结果:PF中65例(70.7%)出现神经节节段，27例出现神经节减少症。切除瘘管的中位长度为25 mm(四分位数间距[IQR]: 20-30)。尿失禁总分中位数为7分(IQR: 6-7)。6/92(6.5%)患者出现术后便秘。结论:PHCFR降低了6.5%的患者PC。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pediatric Surgery 医学-外科

CiteScore

3.90

自引率

5.60%

发文量

审稿时长

6-12 weeks

期刊介绍： This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.