CONGENITAL POUCH COLON; OUR EXPERIENCE WITH SINGLE STAGE PROCEDURE.

Objectives: To review our experience with single-stage management of congenital pouch colon (CPC) as regard to complications and continence. Study Design: retrospective study. Setting: Paediatric Surgery Bahawal Victoria Hospital Bahawalpur. Period: July 2011 to July 2017. Methodology: All the patients of anorectal agenesis that were diagnosed as case of CPC on history, clinical examination and supported by x-ray (invertogrm) admitted during the study period 2011 to 2017 were included. A total of 35 cases were managed with single stage procedure. All the patients were assessed for complications, mortality, and continence with Kelly’s scoring. Results: We managed 35 patients with average age 2.8 days ranging from 12 hours to 5 days. 29 (82,8%) were males and 6 (17.2%) females. In 31 (85.7%) patients, the association was with high anorectal agenesis, whereas, in 4(14.3%) patients with low ARM. At operation, type 1 CPC was in 4 (11.4%) patients, type II in 9 (25.7%), type III in 5 (14.2%) patients, and type IV in 17 (48.5%) patients. There were 2 (5.7%) deaths in our study; the reason was associated anomaly and sepsis. Wound infection was seen in 5 (14.2%) pts. anal stenosis in 2 pts. and mucosal prolapse in 1 pt. Continence was evaluated by the Kelly’s scoring and it showed good results. Conclusions: The results of SSP for various types of CPC are good as regards continence and cosmetics, with decrease rate of morbidity and mortality and hence it is recommended.

The Risk Factors of Anorectal Malformation Patients Mortality in Palembang

Anorectal malformations are serious anal and rectal disorders ranging from stenosis to anorectal agenesis. The incidence of mortality in cases of anorectal malformations is influenced by many factors, including the type of anorectal malformation, associated congenital anomalies, sepsis, and prematurity as investigated in this study. The aim of this study was to identify the risk factor of mortality on anorectal malformation patients. This study is an observational analytic study with cross sectional study design. Secondary data collection was obtained from eighty-two medical records of anorectal malformation patients in Dr. Mohammad Hoesin Hospital Palembang from January 2015 to June 2017 that meets the inclusion criteria. From eighty-two cases of anorectal malformations found nineteen cases of mortality (23.2%). There were four risk factors identified, anorectal malformation type, associated congenital anomalies, sepsis, and prematurity. Two risk factors found significantly affect the mortality on anorectal malformation patients, anorectal malformation type (p value = 0.036) and sepsis (p value = 0.049) from four risk factors studied. Type of anorectal malformation and sepsis have a significant effect on the mortality of patients with anorectal malformations, but there is no effect on the mortality of the patients with assciated congenital anomalies and prematurity. Keywords: Anorectal malformation, congenital abnormalities, sepsis, prematurity

POSTOPERATIVE REHABILITATION OF CHILDREN WHO UNDERWENT A SURGERY ON THE COLON AND ANORECTAL AREA

Aim. The research was carried out to create and evaluate the effectiveness of the rehabilitation algorithm of children who underwent a surgery on the colon and anorectal area.Materials and methods. We have experience in rehabilitation of 245 patients aged from 8 months to 15 years with anorectal agenesis and Hirschsprung's disease. To assess the effectiveness of the proposed algorithm of rehabilitation measures we formed 2 identical groups according to age, sex and nosology indicators. The main group consisted of 136 children with abovementioned pathology. Rehabilitation measures were carried out according to the developed algorithm. It included early bougienage, general and local physiotherapy, correction of intestinal dysbiosis by selective decontamination, relief of water-electrolyte and metabolic disorders. The control group consisted of 109 patients. Rehabilitation was carried out according to the traditional methods. Results. When comparing the results of rehabilitation, the following data were obtained: therapeutic and preventive bougienage was carried out for 18.34±1.29 months in patients of the control group and for 9.56±0.94 months in children of the main group. The duration of anal sphincter insufficiency treatment in the control group was 23.48±1.95 months and only 11.29±1.07 months in the main group. The timing of the correction of dysbiosis in patients of the control group was 36.25±2.17 months and 14.36±1.14 months in children of the main group. The duration of electrolyte disorders and metabolic disorders correction in the control group was 14.16±0.57 months and 6.34±0.28 months in the main group.Conclusion. The application of the developed algorithm of rehabilitation measures made it possible to reduce their duration by more than 2 times according to all the studied criteria. It allows us to recommend the created rehabilitation algorithm for wide clinical application.

Total Anomalous Pulmonary Venous Connection in Children

Introduction: The aim of this study was to study the anatomical types of total anomalous pulmonary venous connection (TAPVC), the associated cardiac and extracardiac congenital malformations, clinical manifestations, and postoperative evolution. Materials and methods: Twenty-four patients with a mean age of 125 days, admitted to the Clinic of Pediatric Cardiology III between January 1, 2009 and December 31, 2015 and diagnosed with TAPVC were included in the study. The patients were evaluated clinically, electrocardiographically and echocardiographically, both pre- and postoperatively. Postoperative evolution was monitored at 1, 3, 6, 12 and 24 months. Results: The anatomical types of TAPVC were: supracardiac in 50% of cases (12 patients), cardiac in 37.5% (9 patients) and mixed type in 12.5% of cases (3 patients). The first clinical manifestation was cyanosis in 72.2% of cases. Surgical correction was performed at a mean age of 37 days in obstructive forms, and 254 days in non-obstructive forms. From the study lot, 8.4% of patients had associated extracardiac malformations (anorectal agenesis and Ivemark syndrome). Early postoperative complications included pulmonary hypertension crisis (60% of cases), supraventricular arrhythmias (35% of cases) and chylothorax (8.4% of cases). Late postoperative complications included: reintervention in 8% of patients with mixed type TAPVC. Conclusions: The most frequently encountered type was supracardiac TAPVC, which had a favorable postoperative evolution. Mixed type TAPVC had the highest rate of reintervention.