Anatomical derangements after failed PSARP: correlating MRI and operative findings

Background Redo surgery for anorectal anomalies (ARA) may be considered a special category of reconstructive surgery with less predictable outcomes. In this report, we studied anatomical derangements in a group of boys following a previously complicated PSARP procedure, in addition to the effect of reoperation on rectifying this distorted anatomy. Results The study included 27 boys who were re-operated after a previous complicated PSARP. Included cases were divided into two groups: group A (14 cases) was referred before colostomy closure with an obviously complicated primary operation, and group B (13 cases) was referred with delayed complications after colostomy closure. Pelvic MRI examinations were performed before reoperation in 19 cases. In nine of these cases, a repeat MRI examination was performed at follow-up after reoperation to study the effect of redo surgery on rectifying the distorted anatomy. Abnormal wide anorectal angle and wide pelvic hiatus were common anatomical derangements after a previously complicated PSARP. An important goal of reoperation was reconstruction of the levator ani behind the anorectum trying to create a more acute anorectal angle and a narrower pelvic hiatus. The success of this corrective step was evaluated by MRI comparing pre- and postoperative measurements that showed a favourable decrease in the values of anorectal angle and hiatal/PC ratio. Improvement of faecal continence was documented after reoperation in 8 out of 10 cases in group B. Conclusion A wide pelvic hiatus was a frequently encountered postsurgical complication after failed PSARP that has most probably resulted from poor reconstruction of the pelvic floor at time of the primary repair. Re-approximation of the split halves of levator ani in the midline behind the anorectum at reoperation can help to correct the distorted internal anatomy and improve bowel control in these cases.

Synchronous Hartmann reversal and incisional hernia repair is associated with higher complication rate compared to a staged procedure

Post operative ventral hernias are common following Hartmann's procedure. There is a debate whether hernia repair is safe when performed concomitantly with colostomy closure. In this study we aimed to evaluate the outcomes of synchronous Hartmann reversal (HR) with a hernia repair, compared to a staged procedure. A retrospective multi-center study was conducted, including all patients who underwent Hartmann’s procedure from January 2004 to July 2017 in 5 medical centers. Patient data included demographics, surgical data and post-operative outcome. Two hundred and seventy-four patients underwent colostomy reversal following Hartmann's procedure. In 107 patients (39%) a concomitant ventral hernia was reported during the Hartmann's reversal. Out of this cohort, 62 patients (58%) underwent hernia repair during follow-up. Thirty two patients (52%) underwent a synchronous hernia repair and 30 patients (48%) underwent hernia repair as a separate procedure. Post operative complication rate was significantly higher in the colostomy reversal with synchronous hernia repair group when compared to HR alone group (53% vs. 20%; p < 0.01; OR 4.5). In addition, severe complication rate (Clavien–Dindo score ≥ 3) was higher in the synchronous hernia repair group (25% vs. 7%). A tendency for higher hernia recurrence rate was noted in the synchronous group (56% vs. 40%). Median follow up time was 2.53 years (range 1–13.3 years). Synchronous colostomy closure and ventral hernia repair following Hartmann's procedure carries a significant risk for post operative complications, indicating that a staged procedure might be preferable.

Compare outcome in patients of ileostomy and colostomy closure with surgical stapler versus ileostomy and colostomy closure with hand sewn anastomosis: a prospective study

Background: Diverting temporary stoma is created to protect the primary bowel pathology and distal anastomosis. Once that primary pathology has been overcome or distal anastomosis gets healed, closure of temporary stomas can be carried out. Invention of stapling devices for intestinal anastomosis provided another dimension than hand sewn method to the stoma closure techniques. In this study, we have compared two methods of loop stoma closure-hand sewn method versus stapler method.Methods: This is prospective comparative study in which 50 cases of loop ileostomy/colostomy were taken. 25 patients underwent ileostomy/colostomy closure by hand sewn anastomosis (group A). Another 25 patients underwent ileostomy/colostomy closure by stapler anastomosis (group B). Time taken for operation, initiation of oral intake, anastomotic leak, post-operative wound infection and total hospital stay duration were compared between these two groups to conclude about which method is superior and in the best interest of patient and surgeon.Results: Mean operation time 105.96 minutes (group A) and 72.84 minutes (group B). Mean time to start oral intake 5.36 days (group A), 3.6 days (group B). 16% patients (4/25) group A and 4% patients (1/25) group B developed anastomotic leak. 28% patients (7/25) group A and 8% patients (2/25) group B had post-operative wound infection. Mean hospital stay 10.4 days in group A and 7.84 days in group B.Conclusions: Stapler method provides significant benefits in terms of less operative time, early oral intake and less hospital stay. Overall stapler method for stoma closure is more efficient and cost effective.

MORBI-MORTALITY RELATED TO ILEOSTOMY AND COLOSTOMY CLOSURE AT TERTIARY CARE HOSPITAL BIKANER

Background: To study the morbi-mortality related to ileostomy or colostomy closure at tertiary care hospital Bikaner Material and Method: prospective hospital based study. 30 patients reporting to the General Surgery dept. within study duration and eligible as per inclusion criteria will be included in the study. Results: Out of 30 Cases ,(30.00%) patients had hypertension ,6(20.00%) had diabetes, 5 (16.67%) had renal dysfunction and 2(6.67%) cases had COPD. 11 (36.67%) patients developed complications post closure of ileostomy or colostomy. Medical complications accounted for a large proportion of complications (n=5), while major (n=4) and minor complications (n=2) were present. Conclusion: ileostomy is effective and feasible as a diversion procedure and has reduced morbidity and complication rates. Keywords: Ileostomy, Colostomy. Complications.

Anorectal Malformations at a University Teaching Hospital in Southern Nigeria

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.

Anorectal Malformations at a University Teaching Hospital in Southern Nigeria

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.