单切口腹腔镜手术马龙顺行大陆灌肠：优化儿童肠道管理的结果。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-11-29 DOI:10.1016/j.jpedsurg.2024.162080

Ismael Elhalaby , Irene Isabel P. Lim , Elizaveta Bokova , Wendy E. Lewis , Christine N. Feira , Rebecca M. Rentea

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引用次数: 0

摘要

背景：马龙顺行性失禁灌肠（MACE）越来越多地被用于治疗儿童严重便秘和大便失禁。尽管微创儿科结直肠手术取得了进展，但单切口腹腔镜手术（SILS）用于MACE的创建仍然相对未被探索。这项研究是迄今为止规模最大的队列研究，评估了儿童SILS MACE制造的可行性、安全性和临床结果。方法：对2022年3月至2024年7月期间接受SILS MACE治疗严重便秘和/或大便失禁的儿科患者进行单机构回顾性研究。评估患者人口统计学、手术数据、术后并发症和大便模式。定量变量采用描述性统计方法进行分析。结果：18例患者（10例男性，56%）平均年龄为10岁（范围4-18岁），中位BMI为17.6 kg/m2 （IQR 16.8-19.6）。术前诊断包括肛肠畸形（n = 9,50 %）、功能性便秘（n = 4,22 %）、神经源性肠（n = 3,17 %）和先天性巨结肠病（n = 2,11 %）。中位手术时间51 min (IQR 38 ~ 67)，术后并发症包括通道脱垂（n = 3, 17%）和伤口感染（n = 2, 11%）。2例患者（11%）因Mini-ACE®钮扣脱位需要介入放射检查，1例患者（5%）因皮肤狭窄需要手术翻修。在中位随访13个月（IQR 7-18）时，16例（89%）患者通过顺行冲洗成功清除粪便。结论：SILS MACE是一种安全、可行、有效的微创治疗儿童严重便秘和大便失禁的方法。该技术在美容效果和可比较的手术结果方面具有潜在优势，为传统的多孔腹腔镜方法提供了可行的替代方案。研究类型：原创研究文章。证据水平：III。

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Single Incision Laparoscopic Surgery for Malone Antegrade Continent Enema: Optimizing Outcomes in Pediatric Bowel Management

Background

Malone antegrade continence enemas (MACE) are increasingly being used to manage severe constipation and fecal incontinence in children. Despite advances in minimally invasive pediatric colorectal surgery, single-incision laparoscopic surgery (SILS) for MACE creation remains relatively unexplored. This study, featuring the largest cohort to date, evaluates the feasibility, safety, and clinical outcomes of SILS MACE creation in children.

Methods

A single-institution, retrospective review of pediatric patients who underwent SILS MACE creation for severe constipation and/or fecal incontinence between March 2022 and July 2024. Patient demographics, operative data, postoperative complications, and stooling patterns were assessed. Quantitative variables were analyzed using descriptive statistical methods.

Results

Eighteen patients (10 males, 56 %) underwent SILS MACE creation at a mean age of 10 years (range 4–18) and a median BMI of 17.6 kg/m² (IQR 16.8–19.6). Preoperative diagnoses included anorectal malformation (n = 9, 50 %), functional constipation (n = 4, 22 %), neurogenic bowel (n = 3, 17 %), and Hirschsprung Disease (n = 2, 11 %). Median operative time was 51 min (IQR 38–67), Postoperative complications included channel prolapse (n = 3, 17 %) and wound infection (n = 2, 11 %). Two patients (11 %) required interventional radiology owing to Mini-ACE® button dislodgment and one patient (5 %) required operative revision for skin-level stenosis. At a median follow-up of 13 months (IQR 7–18), 16 patients (89 %) were clean for stool with successful management through antegrade flushes.

Conclusion

SILS MACE creation is a safe, feasible, and effective minimally invasive approach for managing severe constipation and fecal incontinence in children. The technique demonstrates potential advantages in cosmetic results and comparable surgical outcomes, offering a viable alternative to the traditional multiport laparoscopic approach.

Type of study

Original Research Article.

Level of evidence

III.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.