Ebook Surgical treatment of colorectal problems in children: Part 2
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Ebook Surgical treatment of colorectal problems in children: Part 2
Rectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2ses of anorectal malformations. In this defect, the anus seems to be completely normal, including the quality of the sphincter and the location of the anal orifice. However, deep inside the anus, just at the junction of the anal canal with the rectum, there is an atresia or narrowing (stenosis) (Fig Ebook Surgical treatment of colorectal problems in children: Part 2. 14.1). Occasionally, we see atresias or stenosis located at a different level. The space that separates the dilated blind rectum, from the anal canaEbook Surgical treatment of colorectal problems in children: Part 2
l, is represented by a septum that sometimes is extremely thin and can be perforated, and other times it is very thick. In some unusual cases, there iRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2There is one particular malformation similar to this one that is represented by a stricture or by atresia of the rectum, associated to a presacral mass and a sacral defect (see Chap. 8. Sect. 8.2). which is a completely different type of defect. The only thing they have in common is the fact that th Ebook Surgical treatment of colorectal problems in children: Part 2e rectum is narrow or atretic.We believe that rectal atresia with normal sacrum and no presacral mass is unique, because the sphincter mechanism is noEbook Surgical treatment of colorectal problems in children: Part 2
rmal and also because these patients do not have the typical association with all the defects that we see in other anorectal malformations. As a conseRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2ranceA. Pefia. A. Bischoff. Surgical Treatment of Colorectal Problems in Children.DOI 10.1007/978-3-319-14989-9_ 14. ©Springer International Publishing Switzerland 201520120214 Rectal Atresiasignificant tendency to suffer from severe constipation because they are born with a blind, very dilated rect Ebook Surgical treatment of colorectal problems in children: Part 2um. These malformations have been previously described in the literature [1-51-Rectal atresia has been traditionally described in the old textbooks. TEbook Surgical treatment of colorectal problems in children: Part 2
he baby is born with a normal-looking anus, and the nurse or the pediatrician tries to pass a thermometer through the anus and finds an obstruction. IRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2TreatmentIf one could think in an ideal indication fora posterior sagittal approach, this would be the malformation which seems to be more indicated. The defect is easily repaired through a posterior sagittal incision. In our initial cases, we simply remove the septum that separates the upper rectum Ebook Surgical treatment of colorectal problems in children: Part 2 from the anal canal and created an end-to-end anastomosis (Figs. 14.2 and 14.3). Subsequently, we found some cases in which the size discrepancy betwEbook Surgical treatment of colorectal problems in children: Part 2
een the upper blind rectum and the small anal canal was very' severe, and in order to expand the size of the anal canal, w e introduced a technical moRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2lostomy, one can perform a distal colostogram and simultaneously introduce a metallic dilator in the anal canal to have a lateral image of the atresia and estimate the distance between the upper pouch and the anal canal. If we could make the diagnosis early in an otherwise healthy newborn baby, we w Ebook Surgical treatment of colorectal problems in children: Part 2ould recommend to do the operation without a colostomy.14.2 Surgical RepairThe patient is placed in the prone position and we approach the malformatioEbook Surgical treatment of colorectal problems in children: Part 2
n posterior sagittally. We go through the skin, subcutaneous tissue, parasagittal fibers, ischiorectal fossa, and the entire sphincter mechanism to exRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2(Fig. 14.2a).Unfortunately, we still see some of these patients, previously operated in whom the surgeon considered that the little anal canal was useless and therefore decided to resect it and pulled down the dilated piece of rectum. That is ratherFig. 14.2 Repair of a Rectal Atresia, (a) Incision, Ebook Surgical treatment of colorectal problems in children: Part 2 exposed defect, open lipper rectum, and anal canal. I b) Anastomosis of the upper rectum to anal canal14.2 Surgical Repair203Fig. 14.3 Diagram showinEbook Surgical treatment of colorectal problems in children: Part 2
g the repair of rectal atresia, (a) Rectum repaired, Ib> Sagittal view of the finished operationregrettable, because the anal canal, as we know, repreRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2metimes the size of the anal canal is too small. For that, we introduced a technical modification |5]. consisting in mobilizing the posterior rectal wall, down to the skin of the anus (Fig. 14.4), enlarging the circumference of the anus. We realize that by doing that, the posterior aspect of the anu Ebook Surgical treatment of colorectal problems in children: Part 2s will no longer be a real anal canal, but rather a rectal wall. However we manage to presene most of the circumference of the original anal canal, whEbook Surgical treatment of colorectal problems in children: Part 2
ich will provide enough sensation to have bowel control. We must keep in mind that after we finish this procedure, the anastomosis that we created betRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2al closed all the time, except during defecation: therefore, these babies must tie subjected to the same protocol of anal dilatations that we already described.Some surgeons 14| went as far as to perform a "laparoscopic transanal approach'* to repair this malformation. To demonstrate that something Ebook Surgical treatment of colorectal problems in children: Part 2can be done does not mean that it must be done. We cannot justify to change a limited, painless, bloodless, quick, minimally invasive, non-laparoscopiEbook Surgical treatment of colorectal problems in children: Part 2
c procedure for a laparoscopic invasive operation that includes an unnecessary total rectal dissection.Our experience includes 11 cases and has been pRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all cas Ebook Surgical treatment of colorectal problems in children: Part 2Arrows show the portion of the rectum to be mobilized, (c) Sutures on one side of anal canal and rectum, (d) Sutures tied down.(e) Same maneuver, opposite side.Ebook Surgical treatment of colorectal problems in children: Part 2
ement. J Pediatr Suig 25(5):535-5373Kisra M. Alkadi H. Zcrhoni H. Ettayebi F. Benhammou M (2005) Rectal atresia. J PaediatrRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all casRectal Atresia14Rectal atresia is a very unique malformation that desenes a special description. It happens in our experience, in about I % of all casGọi ngay
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