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Experience with the straight endorectal pullthrough for the management of ulcerative colitis and familial polyposis in children and adults
INTERNATIONAL ABSTRACTS
showed no difference among the three groups. Although the numbers are small, there appear to be no psychosocial problems after stoma formation if there has been proper preparation and followup.--C.M. Doig Physiologic Assessment of the Four Commonly Performed Endorectal Pullthroughs. D.K. Stoller, A.G. Coran, R.A. Drongowski, et al. Ann Surg 206:586-594, (November), 1987.
Endorectal pullthrough has become the treatment of choice for ulcerative colitis, familial polyposis, and total colonic Hirschprung's disease. Several variations of the pullthrough have emerged (Parks S-shaped reservoir, J-pouch, lateral isoperistaltic pouch, and straight ileoanal). Reservoir proponents claim pouches improve stool frequency and continence. Four month old Beagle puppies were randomly assigned to four groups, underwent pullthrough construction (four animals each), and were compared. Parameters studied included general health, stool consistency, perineal irritation, soiling, body temperature, hydration, body weight, stool frequency, intestinal transit time, stool cultures, platelet count, hemoglobin concentration, hematocrit, white and red blood cell counts, water absorption, electrolyte absorption, rectal manometrics, and barium enemas. Animals were studied to 6 months. No differences were found between groups regarding hematocrit, mean corpuscular red cell volume, and platelet count. All groups developed an initial leukocytosis. Weight, appearance, behavior, and posturing all remained similar. Perineal irritation was found in over 50% (S-pouch 50%, J-pouch 75%, lateral and straight groups 100%). Mean water absorption and manometric data was similar between groups preoperatively and at 6 months. The four groups uniformly achieved 80% to 85% of control values for maximum volume or rectal capacitance. Intestinal transit time deereased in all groups at 1 month, with a gradual rise to similar levels at 6 months (approximately 1/2of the preoperative value). Stool frequency showed variation between groups and did not correlate with transit time. Consistency of stools did not correlate with frequency or transit time. Postoperative stool cultures were normal in all groups. The investigators discuss the advantages and disadvantages of straight v reservoir endorectal pullthroughs. In this series of evaluations no difference was found between groups, and their conclusions suggest that there is no clinical or physiologic advantage to the addition of a reservoir to the endorectal pullthrough. -Edward G. Ford Experience With the Straight Endorectal Pullthrough for the Management of Ulcerative Colitis and Familial Polyposis in Children and Adults. R.A. Morgan, P.B. Manning and A.G. Coran. Ann
Surg 206:595-599, (November), 1987. Seventy-two children and adults underwent endorectal pullthrough with straight ileoanal anastomosis from 1977 to 1986 for ulcerative colitis (61) or familial polyposis (11). Sixty patients have had ileostomy closure and are reported here. The investigators discuss preoperative preparation, operative technique, and followup. Mean age at operation was 22.7 years with follow-up from 3 months to 9 years (average, 12 months). Operative mortality was 1.5%, and complications included adhesive bowel obstruction (11), pelvic abscess (2) pelvic phlegmon (1), rectovaginal fistulas (2), and minor wound infections (2). There were no anastomotic leaks. Six patients required revision to a standard Brooke ileostomy, and one patient with familial polyposis was found to have anaplastic carcinoma of the anal margin requiring abdominal perineal resection. Daytime continence was achieved in all patients at 1 year (all but two at 3 months). No patients had had major soiling. Mean stool
681
frequency declined progressively to eight semiformed stools per day at 3 years. A concise comparison of the straightforward ileoanal anastomosis v pouch type reconstruction is provided. Current experience suggests the straight anastomosis offers advantages of a shorter operation, complete spontaneous evacuation, absence of pouchitis, and a lower incidence of pelvic sepsis.--Edward G. Ford Bleeding Rectal Varices Following Injection Sclerotherapy of O e s o p h a g e a l V a r i c e s in a Child. A.A. Azmy. Z Kinderchir 42:252,
(August), 1987. Bleeding from esophageal varices accounts for most upper gastrointestinal bleeding in children. Repeat injection sclerotherapy has proven to be a practical and effective method to control the bleeding and to obliterate the varices. This report describes a 13-year-old girl with portal hypertension who developed massive rectal variceal bleeding after repeat injection sclerotherapy of esophageal varices. Injection sclerotherapy of the rectal varices and the residual varices was performed.-- Thomas A. Angerpointner Simple Help for Spina Bifida Children With Anal Incontinence A,
Pompino, H.J. Pompino, and B. Waidmann. Z. Kinderchir 42:4345, (December), 1987 (suppl 1). The search for an effective means of helping children with anal incontinence has been facilitated by tissue-compatible material which has already been in use for a long time in proctology. Polyvinyl alcohol foam is characterized by its elasticity, malleability under the influence of liquids, and its good tissue compatibility. Anal plugs manufactured in the shape of hourglasses were used. These are available in various sizes and can be adapted individually. The investigators consider their application to be indicated in about one third of myelomeningocele children who have either partial or complete fecal incontinence. The plugs were also tested in healthy children. Experience is available in eight children operated on for high anal atresia and 15 children with spina bifida. Results are thus far encouraging. Management is described in detaiL--Thomas A. Angerpointner ABDOMEN Biliary Calculi Caused by Hemobilia. F. Luzuy, O. Reinberg, D.
Kauszlaric, et aL Surgery 102:886-889, (November), 1987. The researchers describe two cases of their own and two collected from the literature of gall stones occurring 6 to 12 months following traumatic hemobilia. Three were children and one was a young adult. In three of the four patients, symptoms of gall bladder disease and/or common duct obstruction developed. In three cases operation confirmed the presence of gall stones which were of various types. Significant GI hemorrhage secondary to hemobilia occurred in two patients, while the other two had ultrasound evidence of blood filling the gall bladder and biliary tree. This study indicates that patients with known hemobilia, especially when there are clots noted in the gall bladder, should be followed closely for subsequent development of calculi.--Eugene S. Wiener Jejunal Interposition Hepaticoduodenostomy for Choledochal Cyst. K.L. Narasimha Rao, S.K. Mitra, R. Kochher, et al. Am J
Gastroenterol 82:1042-1045, (October), 1987. Four patients, aged 4 years, 13 years, 11 months, and 8 years, had excision of choledochal cysts and biliary tract reconstruction using a jejunal interposition limb between the common hepatic duct and duodenum, similar to the method described by Raffensperger in 1980. The authors did not favor the use of the intussusception valve
showed no difference among the three groups. Although the numbers are small, there appear to be no psychosocial problems after stoma formation if there has been proper preparation and followup.--C.M. Doig Physiologic Assessment of the Four Commonly Performed Endorectal Pullthroughs. D.K. Stoller, A.G. Coran, R.A. Drongowski, et al. Ann Surg 206:586-594, (November), 1987.
Endorectal pullthrough has become the treatment of choice for ulcerative colitis, familial polyposis, and total colonic Hirschprung's disease. Several variations of the pullthrough have emerged (Parks S-shaped reservoir, J-pouch, lateral isoperistaltic pouch, and straight ileoanal). Reservoir proponents claim pouches improve stool frequency and continence. Four month old Beagle puppies were randomly assigned to four groups, underwent pullthrough construction (four animals each), and were compared. Parameters studied included general health, stool consistency, perineal irritation, soiling, body temperature, hydration, body weight, stool frequency, intestinal transit time, stool cultures, platelet count, hemoglobin concentration, hematocrit, white and red blood cell counts, water absorption, electrolyte absorption, rectal manometrics, and barium enemas. Animals were studied to 6 months. No differences were found between groups regarding hematocrit, mean corpuscular red cell volume, and platelet count. All groups developed an initial leukocytosis. Weight, appearance, behavior, and posturing all remained similar. Perineal irritation was found in over 50% (S-pouch 50%, J-pouch 75%, lateral and straight groups 100%). Mean water absorption and manometric data was similar between groups preoperatively and at 6 months. The four groups uniformly achieved 80% to 85% of control values for maximum volume or rectal capacitance. Intestinal transit time deereased in all groups at 1 month, with a gradual rise to similar levels at 6 months (approximately 1/2of the preoperative value). Stool frequency showed variation between groups and did not correlate with transit time. Consistency of stools did not correlate with frequency or transit time. Postoperative stool cultures were normal in all groups. The investigators discuss the advantages and disadvantages of straight v reservoir endorectal pullthroughs. In this series of evaluations no difference was found between groups, and their conclusions suggest that there is no clinical or physiologic advantage to the addition of a reservoir to the endorectal pullthrough. -Edward G. Ford Experience With the Straight Endorectal Pullthrough for the Management of Ulcerative Colitis and Familial Polyposis in Children and Adults. R.A. Morgan, P.B. Manning and A.G. Coran. Ann
Surg 206:595-599, (November), 1987. Seventy-two children and adults underwent endorectal pullthrough with straight ileoanal anastomosis from 1977 to 1986 for ulcerative colitis (61) or familial polyposis (11). Sixty patients have had ileostomy closure and are reported here. The investigators discuss preoperative preparation, operative technique, and followup. Mean age at operation was 22.7 years with follow-up from 3 months to 9 years (average, 12 months). Operative mortality was 1.5%, and complications included adhesive bowel obstruction (11), pelvic abscess (2) pelvic phlegmon (1), rectovaginal fistulas (2), and minor wound infections (2). There were no anastomotic leaks. Six patients required revision to a standard Brooke ileostomy, and one patient with familial polyposis was found to have anaplastic carcinoma of the anal margin requiring abdominal perineal resection. Daytime continence was achieved in all patients at 1 year (all but two at 3 months). No patients had had major soiling. Mean stool
681
frequency declined progressively to eight semiformed stools per day at 3 years. A concise comparison of the straightforward ileoanal anastomosis v pouch type reconstruction is provided. Current experience suggests the straight anastomosis offers advantages of a shorter operation, complete spontaneous evacuation, absence of pouchitis, and a lower incidence of pelvic sepsis.--Edward G. Ford Bleeding Rectal Varices Following Injection Sclerotherapy of O e s o p h a g e a l V a r i c e s in a Child. A.A. Azmy. Z Kinderchir 42:252,
(August), 1987. Bleeding from esophageal varices accounts for most upper gastrointestinal bleeding in children. Repeat injection sclerotherapy has proven to be a practical and effective method to control the bleeding and to obliterate the varices. This report describes a 13-year-old girl with portal hypertension who developed massive rectal variceal bleeding after repeat injection sclerotherapy of esophageal varices. Injection sclerotherapy of the rectal varices and the residual varices was performed.-- Thomas A. Angerpointner Simple Help for Spina Bifida Children With Anal Incontinence A,
Pompino, H.J. Pompino, and B. Waidmann. Z. Kinderchir 42:4345, (December), 1987 (suppl 1). The search for an effective means of helping children with anal incontinence has been facilitated by tissue-compatible material which has already been in use for a long time in proctology. Polyvinyl alcohol foam is characterized by its elasticity, malleability under the influence of liquids, and its good tissue compatibility. Anal plugs manufactured in the shape of hourglasses were used. These are available in various sizes and can be adapted individually. The investigators consider their application to be indicated in about one third of myelomeningocele children who have either partial or complete fecal incontinence. The plugs were also tested in healthy children. Experience is available in eight children operated on for high anal atresia and 15 children with spina bifida. Results are thus far encouraging. Management is described in detaiL--Thomas A. Angerpointner ABDOMEN Biliary Calculi Caused by Hemobilia. F. Luzuy, O. Reinberg, D.
Kauszlaric, et aL Surgery 102:886-889, (November), 1987. The researchers describe two cases of their own and two collected from the literature of gall stones occurring 6 to 12 months following traumatic hemobilia. Three were children and one was a young adult. In three of the four patients, symptoms of gall bladder disease and/or common duct obstruction developed. In three cases operation confirmed the presence of gall stones which were of various types. Significant GI hemorrhage secondary to hemobilia occurred in two patients, while the other two had ultrasound evidence of blood filling the gall bladder and biliary tree. This study indicates that patients with known hemobilia, especially when there are clots noted in the gall bladder, should be followed closely for subsequent development of calculi.--Eugene S. Wiener Jejunal Interposition Hepaticoduodenostomy for Choledochal Cyst. K.L. Narasimha Rao, S.K. Mitra, R. Kochher, et al. Am J
Gastroenterol 82:1042-1045, (October), 1987. Four patients, aged 4 years, 13 years, 11 months, and 8 years, had excision of choledochal cysts and biliary tract reconstruction using a jejunal interposition limb between the common hepatic duct and duodenum, similar to the method described by Raffensperger in 1980. The authors did not favor the use of the intussusception valve