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52 papers 25 to 100 followers
J Zimmer, C Tomuschat, P Puri
INTRODUCTION: Several operative techniques have been developed for the treatment of Hirschsprung's disease (HD) in the past decades. Since one-stage transanal pull-through (TAPT) was first performed in 1998, multiple studies have shown favourable short-and midterm results compared to other techniques with shorter operation length, shorter hospital stay and lower complication rates. The aim of this meta-analysis was to determine the longterm results following TAPT for HD. METHODS: A systematic literature search for relevant articles was performed in four databases using the following terms "Hirschsprung/Hirschsprung's disease", "aganglionosis", "transanal", "pullthrough/pull-through", "longterm/long-term" "results", "follow-up" and "outcome"...
August 2016: Pediatric Surgery International
Kevin M Garrett, Marc A Levitt, Alberto Peña, Steven J Kraus
BACKGROUND: The radiologic evaluation of Hirschsprung disease is well described in the literature. However, there is a paucity of literature describing the appearance of the neo-rectum and colon after repair, specifically describing findings in patients with poor functional outcome, which would suggest the need for reoperation. OBJECTIVE: We describe findings on contrast enema and correlate them with surgical findings at reoperation in children with poor functional outcome after primary repair for Hirschsprung disease who suffer from bowel dysfunction that can manifest with either soiling or obstructive symptoms such as enterocolitis...
September 2012: Pediatric Radiology
Marc A Levitt, Belinda Dickie, Alberto Peña
Ideally, after operative management of Hirschsprung disease, a child should thrive, avoid recurrent episodes of abdominal distention and enterocolitis, and be fecally continent. However, there is a small group of patients that do not do well after their pull-through procedure. The purpose of this article is to describe our algorithm for the work-up and management of the post pull-through patient with Hirschsprung disease who is not doing well. These children can be categorized into 2 distinct groups: (1) those who are soiling, and (2) those who suffer from distention and enterocolitis...
May 2010: Seminars in Pediatric Surgery
Marc A Levitt, Belinda Dickie, Alberto Peña
After surgery for Hirschsprungs disease, most children thrive, have few if any episodes of abdominal distention and enterocolitis, and are fecally continent. However, there exists a small group of patients who do not do well. Either they suffer from persistent distension and enterocolitis or they experience soiling after their pull-through procedure. These patients can be systematically evaluated and successfully treated with a combination of bowel management, dietary changes, and laxatives, and, in certain circumstances, a reoperation...
November 2012: Seminars in Pediatric Surgery
Marc A Levitt, Alberto Peña
In this review we describe lessons learned from the authors' series of patients born with the most complex of congenital anorectal problems, cloacal malformations, with the hope to convey the improved understanding and surgical treatment of the condition's wide spectrum of complexity learned from patients cared for over the last 25 years. This includes a series of 490 patients, 397 of whom underwent primary operations, and 93 who underwent reoperations after attempted repairs at other institutions. With regard to the newborn, we have learned that the clinician must make an accurate neonatal diagnosis, drain a hydrocolpos when present, and create an adequate, totally diverting colostomy, leaving enough distal colon available for the pull-through, and a vaginal replacement if needed...
May 2010: Seminars in Pediatric Surgery
Andrea Bischoff, Jason Frischer, Jennifer Leslie Knod, Belinda Dickie, Marc A Levitt, Monica Holder, Lyndsey Jackson, Alberto Peña
INTRODUCTION: Fecal incontinence after the surgical repair of Hirschsprung disease is a potentially preventable complication that carries a negative impact on patient's quality of life. METHODS: Patients that were previously operated for Hirschsprung disease and presented to our bowel management clinic with the complaint of fecal incontinence were retrospectively reviewed. All patients underwent a rectal examination under anesthesia looking for anatomic explanations for their incontinence...
April 2017: Journal of Pediatric Surgery
Inbal Samuk, Andrea Bischoff, Jennifer Hall, Marc Levitt, Alberto Peña
BACKGROUND: Rectobladder neck fistula is the highest and most complex anorectal malformation in boys and the only one that requires an abdominal approach, open or laparoscopic, for repair. The aim of this study was to describe the unique characteristics of rectobladder neck fistulas that warrant special attention and to describe the associated anatomic variants in the genitourinary tract. METHODS: The database of a tertiary medical center was retrospectively reviewed for all patients treated for rectobladder neck fistula, by our team in 1980-2011...
October 2016: Journal of Pediatric Surgery
Charlotte Holbrook, Devesh Misra, Indre Zaparackaite, Stewart Cleeve
AIM: For decades, paediatric surgeons have employed the standard posterior sagittal anorectoplasty (PSARP) approach to deal with patients with anorectal malformations (ARM). In recent years, we noted an apparent increase in the incidence of anal stricture after surgical repair of ARM following the introduction of laparoscopic pull-through and techniques aiming to preserve the internal sphincter-the internal sphincter sparing approach (ISSA). We decided to analyse our data to find out if these new trends had added to the problem of post-operative strictures...
August 2017: Pediatric Surgery International
T J Bradnock, M Knight, S Kenny, M Nair, G M Walker
BACKGROUND/PURPOSE: Primary pull-through without a stoma has become preferred practice in managing Hirschsprung's disease (HD). The aims of this study were to establish stoma rate and identify factors associated with stoma formation in a population-based cohort in the UK and Ireland. METHODS: Live-born infants with HD were prospectively identified in all 28 specialist pediatric surgical units in the UK and Ireland between October 2010 to September 2012. Method of colonic decompression was recorded and multivariable logistic regression was used to identify factors associated with stoma formation...
May 11, 2017: Journal of Pediatric Surgery
Fouad Youssef, Ghaidaa Arbash, Pramod S Puligandla, Robert J Baird
BACKGROUND: The ideal colostomy type for patients with anorectal malformations (ARM) is undetermined. We performed a systematic review and meta-analysis of short-term complications comparing loop and divided colostomies. METHODS: After review registration (PROSPERO: CRD42016036481), multiple databases were searched for comparative studies without language or date restrictions. Gray literature was sought. Complications investigated included stomal prolapse/hernia/retraction, wound infections, and urinary tract infections (UTIs)...
May 2017: Journal of Pediatric Surgery
Xuyong Chen, Wu Xiaojuan, Hongyi Zhang, Chunlei Jiao, Kechi Yu, Tianqi Zhu, Jiexiong Feng
BACKGROUND AND OBJECTIVE: The cardinal diagnostic sign of congenital aganglionic megacolon, or Hirschsprung's disease (HD), is an aganglionic segment of the distal colon or rectum. To determine the surgical planning of a radiological transition zone (TZ) in HD, this study investigated the association between a radiological TZ and the bowel resection length. METHODS: A prospective observational study was conducted in children (n = 192) with suspected HD determined by radiological TZ on contrast barium enema, and who underwent pull-through operations...
May 2017: Pediatric Surgery International
J C Langer, M D Rollins, M Levitt, A Gosain, L de la Torre, R P Kapur, R A Cowles, J Horton, D H Rothstein, A M Goldstein
Although most children with Hirschsprung disease ultimately do well, many experience a variety of ongoing problems after pull-through surgery. The most common include obstructive symptoms, soiling, enterocolitis and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative obstructive symptoms in children with Hirschsprung disease. The American Pediatric Surgical Association Board of Governors established a Hirschsprung Disease Interest Group. Group discussions, literature review and expert consensus were then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with obstructive symptoms following pull-through for Hirschsprung disease...
May 2017: Pediatric Surgery International
Ankush Gosain, Philip K Frykman, Robert A Cowles, John Horton, Marc Levitt, David H Rothstein, Jacob C Langer, Allan M Goldstein
BACKGROUND: Patients with Hirschsprung disease are at risk for Hirschsprung-associated enterocolitis (HAEC), an inflammatory disorder of the bowel that represents the leading cause of serious morbidity and death in these patients. The diagnosis of HAEC is made based on clinical signs and symptoms which are often non-specific, making it difficult to establish a definitive diagnosis in many patients. The purpose of this guideline is to present a rational, expert-based approach to the diagnosis and management of HAEC...
May 2017: Pediatric Surgery International
Ana Cristina Aoun Tannuri, Mariana Aparecida Elisei Ferreira, Arthur Loguetti Mathias, Uenis Tannuri
BACKGROUND/PURPOSE: The Duhamel and transanal pull-through (TAPT) techniques have been commonly used for the treatment of children with Hirschsprung disease (HD). However, despite adequate treatment, some patients present with fecal incontinence that severely affects the quality of life (QoL) and lead to psychiatric disorders. The objectives of the present study were to evaluate, through previously adapted questionnaires, the incidence of fecal incontinence and the quality of life (QoL) of children with HD who underwent Duhamel or TAPT techniques...
March 2017: Journal of Pediatric Surgery
Victoria A Lane, Kristine M Nacion, Jennifer N Cooper, Marc A Levitt, Katherine J Deans, Peter C Minneci
BACKGROUND: Health related Quality of Life (HRQoL) is an important outcome in medical care. The aim of our study was to identify characteristics associated with lower HRQoL scores in children with anorectal malformation (ARM) and Hirschsprung disease (HD). METHODS: Patients younger than 18years, with HD or ARM, who were evaluated at our center from April 2014 to August 2015, were identified. The results of comprehensive questionnaires regarding diagnosis, symptoms, comorbidities and previous medical/surgical history, and validated tools to assess urinary status, stooling status and HRQoL were evaluated...
November 2016: Journal of Pediatric Surgery
Christina Feng, Feroze Sidhwa, Danielle B Cameron, Charity Glass, Shawn J Rangel
PURPOSE: The purpose of this study was to characterize the rates of surgical site infections (SSI) associated with colorectal procedures in children and the relative burden of these events within the scope of pediatric surgical practice. METHODS: The NSQIP-Pediatric Public Use File was queried for all pediatric surgery procedures captured from 50 hospitals during 2012-2013. Rates of incisional and deep organ/space SSIs (ISSI and OSI, respectively) were calculated for all procedures, and the relative burden of SSIs from the entire dataset attributable to colorectal procedures was determined...
June 2016: Journal of Pediatric Surgery
Andrea Bischoff
Similar to other anorectal malformations, cloaca also represents a spectrum of defects that goes from "benign" cloaca with a good functional prognosis that can be repaired with a relatively simple surgical technique, to very complex malformations with many anatomic variations that require different surgical maneuvers to be able to successfully reconstruct those patients. The group of patients born with a "benign" type of cloaca will have bowel and urinary control, will become sexually active and may get pregnant and deliver by cesarean section...
April 2016: Seminars in Pediatric Surgery
Carlos Gine, Saioa Santiago, Alba Lara, Ana Laín, Victoria Alison Lane, Richard J Wood, Marc Levitt
Introduction We describe a two-port laparoscopic technique to create a colostomy in the descending colon with separated stomas for newborns with anorectal malformations. Material and Methods Six patients with an anorectal malformation underwent this procedure in the early-neonatal period. The surgical technique was performed with two ports, which allows for an accurate inspection of the abdominal contents. The first loop of the sigmoid colon is grasped through the first port and exteriorized while the attachments to the left retroperitoneum and direction of the loop are checked with the scope introduced in the second port...
October 2016: European Journal of Pediatric Surgery
Go Miyano, Hiroyuki Koga, Manabu Okawada, Takashi Doi, Ryo Sueyoshi, Hiroki Nakamura, Shogo Seo, Takanori Ochi, Susumu Yamada, Takaaki Imaizumi, Geoffrey J Lane, Tadaharu Okazaki, Masahiko Urao, Atsuyuki Yamataka
BACKGROUND: In 2007, we began using the anorectal line (ARL) as the landmark for commencing rectal mucosal dissection (RMD) instead of the dentate line (DL) during laparoscopy-assisted transanal pull-through (L-TAPT) for Hirschsprung's disease (HD). We conducted a medium-term prospective comparison of postoperative fecal continence (POFC) between DL and ARL cases to follow our short-term study. METHODS: POFC is assessed by scoring frequency of motions, severity of staining, severity of perianal erosions, anal shape, requirement for medications, sensation of rectal fullness, and ability to distinguish flatus from stool on a scale of 0 to 2 (maximum: 14)...
December 2015: Journal of Pediatric Surgery
Chen Wang, Long Li, Shuli Liu, Zheng Chen, Mei Diao, Xu Li, Guoliang Qiao, Wei Cheng
PURPOSE: This study aimed to evaluate the mid-term outcomes of single-stage modified anterior sagittal anorectoplasty (ASARP) for anorectal malformation with vestibular fistula. METHOD: Twenty-six patients with congenital imperforate anus and vestibular fistula underwent single-stage modified sphincter-saving ASARP between January 2008 and December 2012. The ages of the patients at the time of operation ranged from 1 month to 5.1 years. Standard ASARP procedure was modified to avoid the incision of the external sphincter complex...
September 2015: Pediatric Surgery International
2015-07-21 00:50:34
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