Colectomy Followed by J-Pouch Reconstruction to Correct Total Colonic Aganglionosis

Background: Patients suffering from complete colonic aganglionosis (TCA) require the best surgical care possible. Only a few studies reported J-Pouch repair as the primary reconstructive surgery in TCA patients. This study adds to the current literature a thorough clinical and functional outcomes group. Methods: Between 2011 and 2021, medical records of Hirschsprung disease (HD) patients who underwent J-Pouch reconstruction during infancy (n = 12) were reviewed. In close follow-up, bowel function and satisfaction with operation results were evaluated. The median age at the time of J-Pouch reconstruction was 16 months, and covering ileostomies were closed four months later. There were no postoperative problems. After the final repair, Pouch-related problems (PRP) occurred in 27% of the children and were treated conservatively. There was no histological evidence of pouchitis in any of the individuals. The median 24-h stooling frequency was 4–5 at the latest follow-up 51 months following enterostomy closure. Conclusions: The current study’s findings support the existing literature and advocate for J-pouch repair in TCA patients. However, more research will be needed to determine the best time to undergo pouch surgery and ileostomy closure in TCA patients.

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Treatment and Patient Reported Outcome in Children with Hirschsprung Disease and Concomitant Congenital Heart Disease

BioMed Research International ◽

10.1155/2017/1703483 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Johan Hasserius ◽

Josefine Hedbys ◽

Christina Graneli ◽

Kristine Hagelsteen ◽

Pernilla Stenström

Keyword(s):

Congenital Heart Disease ◽

Congenital Heart ◽

Hirschsprung Disease ◽

Failure To Thrive ◽

Bowel Function ◽

Patient Characteristics ◽

Patient Reported ◽

Long Term Follow Up

Purpose. Congenital heart disease (CHD) is reported to be associated with Hirschsprung disease (HD). The aim was to evaluate any differences between children with HD with and without CHD, respectively, with regard to patient characteristics, medical care, and patient reported bowel function. Method. This is a retrospective chart study and a cross-sectional long-term follow-up of patients older than 4 years old, including all children with HD operated on with transanal endorectal pull-through (TERPT) at a tertiary center of pediatric surgery. Information about patient characteristics, diagnostics, surgery, and medical care was compiled. At long-term follow-up, bowel function was assessed by Bowel Function Score. Results. Included were 53 HD-patients, 13 with CHD and 40 without CHD. Children with CHD more commonly presented with failure to thrive; 4 (23%) compared to those without CHD (0%) (p<0.01). In the long-term follow-up, including 32 patients (6 with CHD), constipation was more commonly reported by children with CHD 5 (83%) than by children without CHD 4 (27%) (p=0.01). No differences were shown in the other parameters such as fecal control and incontinence. Conclusion. HD-patients with CHD more commonly presented with failure to thrive and more frequently reported constipation than HD-patients without CHD. The findings indicate that HD-patients with CHD might need special consideration in their initial care and long-term follow-up.

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Colonic J-pouch reconstruction versus straight colorectal anastomosis after low anterior resection for rectal cancer: impact on anastomotic leak, bowel function and quality of life. A multicentre prospective randomised trial

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2010.06.049 ◽

2010 ◽

Vol 36 (10) ◽

pp. 1022-1023

Author(s):

Isacco Maretto ◽

Salvatore Pucciarelli ◽

Paola Del Bianco ◽

Giovanni Romano ◽

Milan Breberina ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Low Anterior Resection ◽

Randomised Trial ◽

Colorectal Anastomosis ◽

Bowel Function ◽

Prospective Randomised Trial ◽

J Pouch ◽

Pouch Reconstruction

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A Long-Term Follow-Up Result of Pouch Plasty for Severe Dysfunction of Jejunal Pouch Reconstruction After Total Gastrectomy: A Case Report

International Surgery ◽

10.9738/intsurg-d-14-00181.1 ◽

2015 ◽

Vol 100 (5) ◽

pp. 954-957 ◽

Cited By ~ 2

Author(s):

Takafumi Tamura ◽

Satoshi Inagawa ◽

Hideo Terashima ◽

Yoshimasa Akashi ◽

Katsuji Hisakura ◽

...

Keyword(s):

Total Gastrectomy ◽

Jejunal Pouch ◽

J Pouch ◽

Long Term Follow Up ◽

Pouch Reconstruction ◽

Epigastric Distress ◽

Jejunal Pouch Reconstruction ◽

To Receive

A 78-year-old woman with malignant lymphoma of the stomach underwent total gastrectomy with a jejunal-pouch (J-pouch) reconstruction in 1994. Twelve years after surgery the patient began to suffer epigastric distress and reflux symptoms. Eventually, she was unable to take anything by mouth. A series of diagnostic images seemed to indicate that the main cause of the dysfunction was flaccidity of the J-pouch and deformity of the outflow route induced by chronic excessive dilatation of the pouch wall. Because all conservative managements only led to temporary improvement and ended in failure, she hoped to receive the operation. We designed “pouch plasty” capable of ameliorating the pouch dysfunction. The aim of pouch plasty was to improve uneven tension of the pouch wall and repair deformity of the outflow route of the food. After the operation, the J-pouch resumed adequate drainage and had good reservoir function. More than 7 years later, the patient had no further complications.

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Redo Transanal Soave Pull Through with or without Assistance in Hirschsprung Disease: An Experience in 46 Patients

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1710028 ◽

2020 ◽

Author(s):

Chunhui Peng ◽

Yajun Chen ◽

Wenbo Pang ◽

Tingchong Zhang ◽

Zengmeng Wang ◽

...

Keyword(s):

Associated Factors ◽

Hirschsprung Disease ◽

Bowel Function ◽

Distal Segment ◽

Anastomotic Complication ◽

Early Postoperative Complication ◽

Redo Procedure ◽

Pull Through ◽

Postoperative Problem

Abstract Introduction Transanal Soave pull through (PT) with or without assistance can be performed as a redo procedure for Hirschsprung disease (HD). In this study, we reviewed the indications and clinical outcomes of redo transanal Soave with or without assistance. Materials and Methods A retrospective analysis was performed on patients who underwent redo transanal Soave with or without assistance in our hospital from 2004 to 2016, and did not have rectourethral fistula or rectovaginal fistula. The Krickenbeck classification system was used to evaluate postoperative bowel function. We analyzed the associated factors of the two main indications. Results In this study, 46 patients were included, representing 5.6% of all HD PTs; 42 patients were initially operated elsewhere and 4 at our hospital. Primary PT surgeries included 38 transanal Soave, 2 Rehbein, 1 Martin, and 5 unknown procedures. The indications for redo PT were residual aganglionosis/transition zone PT (RA/TZPT) (27, 58.7%), anastomotic complication (14, 30.4%), and dilated distal segment (5, 10.9%). The median age of these 46 patients at primary and redo PT was 7.0 months (range, 0.4–137 months) and 45.5 months (range, 7–172 months), respectively. All 46 patients underwent redo transanal Soave PT; 43 patients (93.5%) underwent transanal Soave with laparotomy (n = 42) or laparoscopy (n = 1), and another 3 patients underwent transanal Soave PT. Six patients (13%) experienced complications within 30 days after redo surgery. A total of 43 patients were followed up, and the median follow-up period was 100 months (range, 35–180 months). Two patients could not hold back defecation in some inconvenient conditions. Sixteen patients (37.2%) had soiling, and 8 (18.6%) of 16 patients complained frequent soiling occurrence (more than 1/week). Only one patient complained of constipation (grade 1). Patients with anastomotic complication had more early postoperative complication and higher rate of soiling than patients with RA/TZPT, but there was no statistical difference (p = 0.672 and p = 0.105). Conclusion Transanal Soave PT with or without assistance was effective in resolving different problems after initial PT, while soiling was the most common postoperative problem, especially patients with anastomotic complication.

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CASE REPORT: RARE FORM OF HIRSCHPRUNG’S DISEASE

10.35988/sm-hs.2020.118 ◽

2020 ◽

Vol 30 (5) ◽

pp. 82-84

Author(s):

Ilja Skalskis

Keyword(s):

Down Syndrome ◽

Case Report ◽

Clinical Symptoms ◽

Hirschsprung Disease ◽

Distal Colon ◽

Total Colonic Aganglionosis ◽

Sphincter Function ◽

Anal Sphincter Function ◽

History Of ◽

High Index Of Suspicion

Hirschsprung disease (HD) is a developmental disorder characterized by the absence of ganglia in the distal colon, resulting in a functional obstruction. Incidence of total colonic aganglionosis (TCA) is 1 in 500 000 and it accounts for 5-10% of all cases of HD. HD should be suspected in patients with typical clinical symptoms and a high index of suspicion is appropriate for infants with a predisposing condition such as Down Syndrome (DS), or for those with a family history of HD. The treatment of choice for HD is surgical, such as Swenson, Soave, and Duhamel procedures. The goals are to resect the affected segment of the colon, bring the normal ganglionic bowel down close to the anus, and preserve internal anal sphincter function. We present a clinical case report of TCA in a child with Down syndrome (DS) and review of literature.

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Assessment of 3-Year Follow-up on Genitourinary and Bowel Function Quality of Life (QOL) in Prostate Cancer Patients Receiving Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2008.06.996 ◽

2008 ◽

Vol 72 (1) ◽

pp. S101

Author(s):

A.J. Calcaterra ◽

K. McPhee ◽

G. Boyea ◽

M. Balasubramaniam ◽

M. Wallace ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Radiation Therapy ◽

Cancer Patients ◽

Bowel Function

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LONG-TERM BOWEL FUNCTION IN CHILDREN WITH DOWN SYNDROME AND HIRSCHSPRUNG DISEASE

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-200610000-00164 ◽

2006 ◽

Vol 43 (4) ◽

pp. E56

Author(s):

Ajay Kaul ◽

Jason E. Dranove

Keyword(s):

Down Syndrome ◽

Hirschsprung Disease ◽

Bowel Function ◽

Children With Down Syndrome

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A two different chemoprophylaxis approaches after phacoemulsification surgery in one thousand patients in Iraq

International Eye Research ◽

10.18240/ier.2020.03.04 ◽

2020 ◽

Vol 1 (3) ◽

pp. 154-159

Author(s):

Suzan Amana Rattan ◽

◽

Mahir Kadhim Mutashar ◽

Keyword(s):

Treated Group ◽

The Other ◽

Eye Drops ◽

Topical Medication ◽

Group Methods ◽

Significant Difference ◽

Infection And Inflammation ◽

Group 2 ◽

Age Range

AIM: To evaluate the effectivity of the combination of intracameral moxifloxacin 0.1% with subconjunctival triamcinolone acetonide 4 mg as prophylaxis of infection and inflammation after phacoemulsification in comparison with topical medication treated group. METHODS: A total one thousand patients with age range from 38 to 70 years old who scheduled for phacoemulsification were divided into 2 groups of no statistically significant differences in age, preoperative intraocular pressure (IOP) and central macular thickness (CMT), P=0.6, 0.9 and 0.8 respectively. The surgeries were done by 2 surgeons each one planned to use one method of prophylaxis at Eye Speciality Private hospital, Baghdad, Iraq. For the 1st group of patients (500) a topical moxifloxacin hydrochloride 0.5% and dexamethasone 0.1% eye drops were prescribed four times a day for 1mo postoperatively. For the 2nd group intracameral (IC) diluted moxifloxacin at 0.1% with subconjunctival (SC) triamcinolone 4mg in 0.4 cc were administered at the conclusion of the surgery. Follow up visits were on the first postoperative day, 1wk, 1mo, and 3mo postoperatively. Anterior chamber (AC) reaction was examined during the 4 visits while IOP was measured during the last 3 and CMT was measured only in the last one. RESULTS: The current clinical trial study compared 2 samples with 2 different prophylaxis methods. No endophthalmitis case reported in both group. By a 2-Sample t-test, the IC-treated group (group 2) had statistically significant lower AC cells at the 1st day postoperative visit than the other group while there were no statistically significant differences at 1wk, 1 mo and 3mo visits between the 2 groups. There was no statistically significant difference at 3mo visits in IOP and CMT between the two groups. A breakthrough inflammation rate with the topical medication was (9.6%) while in the other group (IC treated ) was 4.0%. A significant IOP elevation ≥10 mm Hg at 1mo in 2.4% within the topical medication group which was higher than the rate in the other group (0.8%). CONCLUSION: In addition to the safety and effectivity of the combination of intracameral moxifloxacin and subconjunctival triamcinolone in preventing infection and inflammation after cataract surgery. The majority (480) of our included patients didn’t require any topical postoperative medication that is cost saving for the patient, helped patients who were unable to administer topical medication, and decreased chance of complication related to patient poor adherence to postoperative medication.

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Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared With the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001101 ◽

2017 ◽

Vol 27 (9) ◽

pp. 1990-1999 ◽

Cited By ~ 10

Author(s):

Ji-Chan Nie ◽

An-Qi Yan ◽

Xi-Shi Liu

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Surgical Outcomes ◽

Operating Time ◽

Bowel Function ◽

Lymph Node Yield ◽

Laparoscopic Radical Hysterectomy ◽

Function Recovery ◽

Node Yield

ObjectiveThe aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients.MethodsWe have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients.ResultsBoth groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups.ConclusionsThe results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.

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