scholarly journals Early results of different types of anorectoplasty for anorectal malformations

Mediscope ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 75-79
Author(s):  
Mizanur Rahman ◽  
Tarikul Islam ◽  
Zafor Sharif ◽  
Most Dalia Akhter
Keyword(s):  
Anorectal Malformations ◽  
Mucosal Prolapse ◽  
The Other ◽  
Anal Stenosis ◽  
Redo Surgery ◽  
Perineal Fistula ◽  
Anal Stricture ◽  
Early Results ◽  
Good Cosmetic ◽  
Rectourinary Fistula

Objective: To document our experience with the technique of surgical repair in anorectal malformations (ARM) and the short term anatomical and functional outcomes. Methods: This study included total 31 babies. Fourteen were perineal fistula cases with age range between 1 to 4 days. Ten patients had vestibular fistula and seven had rectourinary fistula. Primary diverting colostomy was done for vestibular and rectourinary fistula patients. On the other hand low imperforate anus with anoperineal fistula without associated major anomalies had undergone fistulectomy and simple anoplasty. Results: Simple anoplasty was done for fourteen perineal fistula cases. Anterior sagittal anorectoplasty (ASARP) was done for 10 vestibular fistulae and posterior sagittal anorectoplasty (PSARP) was done in 10 recto-urinary fistula cases. Simple anoplasty and vestibular anus scored good (5-6) in 70% to 71% while PSARP scored fair in 58% of the cases. Postoperative mucosal prolapse, anal stenosis and retraction occurred in two, six and one patient respectively. Redo surgery was done in mucosal prolapse and retraction cases. Four responded to anal dilation and the other needed redo surgery by a simple cutback technique for anal stricture. Continence was assessed in 23 patients whose follow-up periods were longer than 3 years. Twenty one patients had a good score and two had a fair score. No patients had a poor score. Conclusion: Our approach has the following advantages: (i) The operative technique is simple and easy to perform. (ii) Minimal complication rate with good cosmetic results. Mediscope 2021;8(2): 75-79

scholarly journals The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Naima Zamir ◽  
Naima Rasool
Keyword(s):  
Hospital Stay ◽  
Anorectal Malformations ◽  
Anal Stenosis ◽  
Perineal Fistula ◽  
Early Outcome ◽  
Female Patients ◽  
Surgery Outcome ◽  
Primary Surgery ◽  
Operative Complications ◽  
Post Operative Complications

Objective: To document our experience of the primary anterior sagittal anorectoplasty (ASARP) in female patients with lower and wide fistula in term of the early post operative outcome. Methods: A retrospective descriptive study was conducted in one surgical unit of the National Institute of Child Health Karachi, from January 2010 to April 2018. The study included female patients with diagnosis of imperforate anus with wide Vestibular or Perineal fistula with minimal or no straining during defecation and no excoriation of perineum. All patients underwent primary ASARP. Data regarding the age of the patients, site of fistula, the difficulties in dissection, post operative complications, stoma and re-do ASARP needed, were documented. Wound assessment was done during hospital stay, at two weeks and then at three months after surgery. Outcome was documented in terms of complications of surgery and cosmetic appearance of perineum. Data was analyzed on SPSS version 20. Results: A total of 70 patients underwent primary surgery, 48(68.57%) females had perineal fistula while 22(31.42%) had vestibular fistula. Age ranges between three months to 276 months with median of 6±39.73 months. No major injury to the rectal or vaginal wall occurred during surgical procedure. In early post-operative period, 12(17.14%) patients had wound infection with or without various extent of disruption. A total of seven (10.11%) patients underwent stoma formation, six (8.57%) patients because of wound disruption with in a week of primary surgery and in one patient due to severe anal stenosis and retraction of anal segment within three month follow up. Median hospital stay was 5±1.52 days. In 38(54.28%) paients complete wound healing occurred with no per or post operative complications. In 25(35.71%) patients, minor complications were noted and treated accordingly and results were labelled satisfactory with acceptable perineal appearance. Conclusion: The single stage procedure can be a good choice for both vestibular and perineal fisula. In majority of cases wound heals completely with minimal or no scaring and give good cosmetic results. doi: https://doi.org/10.12669/pjms.36.3.1503 How to cite this:Zamir N, Rasool N. The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1503 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Candy-Plug Generation II for False Lumen Occlusion in Chronic Aortic Dissection: Feasibility and Early Results

2019 ◽  
Vol 26 (6) ◽  
pp. 782-786 ◽  
Author(s):  
Ahmed Eleshra ◽  
Tilo Kölbel ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Martin Scheerbaum ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Success ◽  
False Lumen ◽  
The Other ◽  
Type I ◽  
Technical Success ◽  
Chronic Aortic Dissection ◽  
Early Results ◽  
Aortic Remodeling

Purpose: To present the early results of false lumen (FL) occlusion in chronic aortic dissection using the Candy-Plug generation II (CP II), which has a self-closing fabric channel that obviates the need for separate occlusion of its center. Materials and Methods: Fourteen consecutive patients (mean age 60±11 years; 10 men) with persistent FL backflow and aneurysm formation at the thoracic segment in chronic aortic dissection underwent thoracic endovascular aortic repair (TEVAR) with FL occlusion using the refined CP II. Primary endpoints were technical success (successful deployment) and clinical success (no FL backflow at the CP II level). Secondary endpoints included 30-day mortality and morbidity and aortic remodeling during follow-up. Results: Technical success was 100%. One patient required additional intraprocedural FL embolization at the CP II level due to persistent FL backflow on final angiography (clinical success 93%), though there was no flow through the CP II center. There were no intraprocedural complications. Immediate complete FL occlusion was achieved in 12 patients; the other 2 required reintervention. One had contrast enhancement in the distal FL proximal to the CP II and was treated with coil embolization. The other patient had persistent type I endoleak at the level of the left subclavian artery (LSA) and underwent left carotid–LSA bypass and proximal stent-graft extension. One patient died due to retrograde type A aortic dissection that was not related to CP II placement. Over a mean 8-month follow-up (range 3–12), 9 patients had computed tomography angiography; 8 patients had evidence of aortic remodeling, while 1 aneurysm sac was stable. Conclusion: The CP II reduces the number of procedural steps and offers good seal, with minimal morbidity and mortality and a high rate of aortic remodeling.

“Virtual” Atmospheric and Oceanic Circulation in the Earth Simulator

2007 ◽  
Vol 88 (6) ◽  
pp. 861-866 ◽  
Author(s):  
Wataru Ohfuchi ◽  
Hideharu Sasaki ◽  
Yukio Masumoto ◽  
Hisashi Nakamura
Keyword(s):  
High Resolution ◽  
The Other ◽  
Educational Community ◽  
Oceanic Circulation ◽  
Close Collaboration ◽  
Simulation Research ◽  
The Earth ◽  
Other Hand ◽  
Early Results

High-resolution simulations of the atmospheric and oceanic general circulations on the Earth Simulator are briefly introduced to a wider research and educational community. Some early results have been published and are reviewed in this article. The high-resolution simulations may have more information in certain aspects than observations while the simulations need to be validated. On the other hand, high-resolution observations in which uncertainties are unavoidable are now available. Possible close collaboration between observational and simulation research is proposed.

Long-term follow-up results of selective VIM-thalamotomy

1986 ◽  
Vol 65 (3) ◽  
pp. 296-302 ◽  
Author(s):  
Yoshishige Nagaseki ◽  
Tohru Shibazaki ◽  
Tatsuo Hirai ◽  
Yasuhiro Kawashima ◽  
Masafumi Hirato ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Essential Tremor ◽  
The Other ◽  
Content Type ◽  
Early Results ◽  
Initial Surgery ◽  
Long Term Follow Up

✓ The authors report the results of a long-term follow-up study of the effects of the physiologically defined selective VIM (nucleus ventralis intermedius)-thalamotomy on tremor of Parkinson's disease in 27 patients and essential tremor in 16 patients. The follow-up period ranged from 3.25 to 10 years (mean 6.58 years). In 43 patients a total of 50 operations (including four bilateral operations and three reoperations) were carried out. The early (2 to 4 weeks after surgery) and late effects on the tremors were determined clinically and electromyographically. Fourteen parkinsonian cases were treated with minimal lesions (about 40 cu mm). Their late results were very similar to the early results: in 10, the tremors were completely abolished, three had a slight residual tremor, and one underwent reoperation 3 months after the first surgery. Eleven essential tremor cases were treated with minimal lesions. Six of these tremors were completely abolished, four patients had slight residual tremors, and one patient with a recurrence underwent reoperation 2 years after the initial surgery. In these 23 successful operations with minimal lesions (excluding two cases with reoperation), the tremor was abolished without discernible long-lasting side effects. The other 23 operations on 16 patients with Parkinson's disease (including one reoperation) and on seven with essential tremor (one of whom also had a minimal lesion on the other side) involved relatively large lesions. In this group, the surgery was successful in almost every case. It was concluded that radiographically and physiologically monitored selective VIM-thalamotomy for parkinsonian and essential tremor is effective even when lesioning is minimal. Moreover, the beneficial effect is maintained over a long period of time.

scholarly journals Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Kenji Okumura ◽  
Tadao Kubota ◽  
Kazuhiro Nishida ◽  
Alan Kawarai Lefor ◽  
Ken Mizokami
Keyword(s):  
Soft Tissues ◽  
Fournier’S Gangrene ◽  
Colostomy Closure ◽  
Anal Stenosis ◽  
Fournier's Gangrene ◽  
Anal Stricture ◽  
Internal Hemorrhoids ◽  
Old Japanese ◽  
History Of ◽  
Diverting Colostomy

Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier’s gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure.

scholarly journals Laparoscopic Diagnosis and Laparoscopic Hyperthermic Intraoperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei Detected by CT Examination

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Masamitsu Hirano ◽  
Yutaka Yonemura ◽  
Emel Canbay ◽  
Masumi Ichinose ◽  
Tuyoshi Togawa ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Pseudomyxoma Peritonei ◽  
Early Stage ◽  
Treatment Plan ◽  
Operation Time ◽  
Tumor Burden ◽  
The Other ◽  
Intraoperative Complication ◽  
Peritoneal Carcinomatosis Index ◽  
Early Results

Background. Patients with early stage of pseudomyxoma peritonei (PMP) are sometimes difficult to diagnose the primary sites and intraperitoneal spread of tumor and to perform a cytological study.Methods. Patients without a definitive diagnosis and with unknown extent of peritoneal spread of tumor underwent laparoscopy. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) was administered as part of the same intervention. The results of treatment were evaluated at the time of second-look laparotomy (SLL) as a subsequent intervention.Results. Eleven patients were managed by diagnostic laparoscopy followed by laparoscopic HIPEC (LHIPEC). The operation time of laparoscopic examination and LHIPEC was 177 ± 26 min (range 124–261 min). No intraoperative complication was experienced. The peritoneal carcinomatosis index (PCI) score by laparoscopic observation was 16.5 ± 6.4 (range 0–30). One patient with localized pseudomyxoma peritonei (PMP) mucocele did not received LHIPEC; the other 10 patients with peritoneal metastases (PM) were treated with LHIPEC. After LHIPEC, ascites disappeared in 2 cases and decreased in the amount in the other 8 cases. Nine patients underwent SLL and cytoreductive surgery (CRS) combined with HIPEC. The duration between LHIPEC and SLL ranged from 40 to 207 days (97 ± 40 days). The PCI at the SLL ranged from 4 to 27 (12.9 ± 7.1). The PCI at the time of SLL decreased as compared to PCI at the time of diagnostic laparotomy in 7 of 9 patients. Median follow-up period is 22 months (range 7–35). All 11 patients are alive.Conclusion. The early results suggest that laparoscopic diagnosis combined with LHIPEC is useful to determine the surgical treatment plan and reduce the tumor burden before definitive CRS at SLL.

scholarly journals Surgical Management of Gastroschisis With the Use of Primary and Staged Closure on the Basis of the Department's 20-Year Experience

2021 ◽  
Author(s):  
Patrycja Sosnowska-Sienkiewicz ◽  
Dominika Skinder ◽  
Przemysław Mankowski
Keyword(s):  
Surgical Management ◽  
Primary Closure ◽  
Abdominal Cavity ◽  
Treatment Method ◽  
The Other ◽  
Associated Anomalies ◽  
Postoperative Course ◽  
Factors Influencing ◽  
Early Results ◽  
History Of

Abstract BACKGROUND: Gastroschisis belongs to common developmental anomalies. The aim of surgical management is to restore the integrity of the abdominal wall and to insert the bowel into the abdominal cavity with the use of the primary or staged closure technique.The objective of this paper is to analyze our 20-year experience with surgical treatment of gastroschisis with primary and staged closure, to compare the postoperative course for the said techniques as well as to identify factors influencing the course and early results of treatment.METHODS: The research materials comprise of a retrospective analysis of medical history of patients treated at the Surgery Clinic in Poznan in the years 2000-2019. 59 patients were operated on: 30 girls and 29 boys.Surgical treatment was performed with the use of primary closure in 33% of the cases, whereas the staged silo closure was performed in 67% of the cases. RESULTS: Postoperative analgosedation was used for 6 days on average after primary closures, and for 13 days on average after staged closures. Incidence frequency of generalized bacterial infection was 21% for primary closures and 37% for staged closures. Infants treated with staged closure began enteral feeding considerably later (day 22) than those treated with primary closure (day 12). CONCLUSIONS: It is not possible to indicate clearly which surgical technique is superior to the other on the basis of the results obtained. When choosing the treatment method, the patient's clinical condition, associated anomalies and the medical team's experience must be taken into consideration.

scholarly journals The analysis of continence after posterosagital anorectoplasty in anorectal malformation patients in Wahidin Sudirohusodo hospital of Makassar

2019 ◽  
Vol 7 (6) ◽  
pp. 2022
Author(s):  
Alwi Lawile ◽  
Farid Nur Mantu ◽  
Nita Mariana ◽  
Arifin Seweng
Keyword(s):  
Gender Differences ◽  
Medical Records ◽  
Anorectal Malformation ◽  
Anorectal Malformations ◽  
Posterior Sagittal Anorectoplasty ◽  
Perineal Fistula ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
The One

Background: The management of anorectal malformations universally uses posterior sagittal anorectoplasty (PSARP) as standard surgery. The aim of this research was to determine continence in patients with anorectal malformation after PSARP action.Methods: This study was a descriptive analytical categorical research with cross sectional design. The data were obtained from patients’ medical records and questionnaire given to patients underwent PSARP in Wahidin Sudirohusodo Hospital and network hospitals from June 1 to December 1, 2018. The analysis was done to 60 children ranging from 5 to 8 years old. Most of them were male (56.7%) ranging from 5 to 6 years old (53.3%).Results: The results of the research indicated that based on malformation subtype, most of them suffered from rectourethra fistula (40.0%) with continence problem (61.7%). There was no significant correlation between sex and continence problem (p >0.05). However, it was seen that the percentage of continence subjects was higher in female (65.4%) than in male (58.8%), while the percentage of soiling and constipated subjects was higher in male than in female. Rectourethra fistula was found more frequently in male than in female (70.6%), while vestibuler fistula was found more frequently in female (69.2%). There was no significant correlation between age and defecation problem (p >0.05). However, the percentage of continence and soiling subjects was higher in 5-6 years children then the one for 7-8 year children, while the percentage of constipated subjects was higher in 7-8 year children (21.4%) than 5-8 year children (18.8%).Conclusions: Gender differences in the outcome of children with anorectal malformations must be considered. Men with perineal fistula were likely to experience continence and constipation than women with perineal fistulas. Women with perineal fistulas and vestibular fistulas had almost similar outcome.

scholarly journals ANTERIOR SAGGITAL ANORECTOPLASTY

2018 ◽  
Vol 21 (05) ◽  
pp. 845-850
Author(s):  
Naima Rasool ◽  
Mohammad Asghar Khan ◽  
Mushahid Aslam ◽  
Aqeel Safdar
Keyword(s):  
Rectal Mucosa ◽  
Anorectal Malformations ◽  
Vaginal Wall ◽  
Military Hospital ◽  
Intermediate Type ◽  
Female Children ◽  
Vestibular Fistula ◽  
Good Cosmetic ◽  
Set Protocol ◽  
The Common

… Anorectal malformation is the common congenital malformation. Ectopic anusand vestibular fistula are Intermediate types of anorectal malformations (ARM), which are themost common in female babies. Many surgical procedures have been described for the treatmentof ARM. Anterior Saggital Anorectoplasty (ASARP) is not only convenient for the anesthetist formaintenance of anesthesia but also gives better exposure of surgical structures during surgery.Objectives: To determine the technical suitability and outcome of ASARP in intermediate typesof ARM in female children. Design: This Descriptive study with prospective collection of dataaccording to a set protocol. Setting: The study was carried out at the department of PediatricSurgery, Military Hospital, Rawalpindi, Pakistan. Period: November 2010 to March 2014, overthe period of 3 years and 5 months. Patients and Methods: The data of all female patientspresenting with intermediate types of ARM and undergoing ASARP, during the study periodwere analyzed, with respect to age, type, associated anomalies, complications and cosmeticoutcome. Results: A total of 36 patients of intermediate variety underwent ASARP. Age rangedfrom 6 months to 22 years. All patients had colostomy prior to this procedure. During surgery,posterior vaginal wall tear occurred in 2 patients (5.5%). Postoperatively, 2 patients (5.5%) hadretention of urine, 2 patients (5.5%) developed wound infection with superficial disruption, analstenosis occurred in 2 patients (5.5%) and 1 patient (2.7%) had rectal mucosa prolapse. Noneof them required re_ do surgery. Cosmetic outcome was excellent in 31 patients (86.1%), while itwas satisfactory in 5 (13.8%) patients. Conclusions: Anorectoplasty through anterior approachis not only technically easy but has good cosmetic results in intermediate type of imperforateanus in female children.

Anus perinei ventralis in adulthood – case report

2020 ◽  
Vol 99 (12) ◽  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Congenital Malformations ◽  
Anorectal Malformations ◽  
Intermediate Type ◽  
Perineal Fistula ◽  
Sphincter Complex ◽  
Golden Standard ◽  
Anorectal Reconstruction ◽  
Anorectal Atresia

Anorectal malformations present a type of the most serious congenital malformations, either in terms of treatment or treatment outcomes. Anorectal atresia can be subdivided into three categories: the supralevator form, the intermediate type of atresia and the low translevator type. One of the clinical forms of low translevator type in girls is a perineal fistula opening just behind the vaginal entrance on the perineum, with a fully developed sphincter complex dorsally from the fistula (so called anus perinei ventralis). The golden standard of surgical treatment of anus perinei ventralis in children is Peña’s procedure, which was used as a guideline for anorectal reconstruction in our adult patient, as well.

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