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Safer postoperative dilatation in surgery for imperforate anus
MODERN OPERATIVE
TECHNICS
Safer Postoperative
Dilatation
for Imperforate MAJ.
HENRY
J. SCHMITT,
in Surgery
Anus
JR.,MC, USAF, USAF Academy, Co!orado
From the General Surgery Service, 7625th USAF Hospital, USAF Academy, Colorado 80840. The views expressed herein are those of the author and do not necessarily reeresent those of the USAF or the Department of Defense.
rather than stenosis at the mucocutaneous junction. The time recommended by the various authors for beginning dilatation ranges from four to twenty days. All agree that disruption at the suture line with retraction of the rectal segment is a serious complication requiring immediate treatment and that results after such a happening are poorer. If dilatation is thought necessary and if it is begun prior to firm healing, the insertion of the dilator from without inward may promote retraction of the rectal segment. A safer method using a Foley catheter is depicted in Figure 1. Insertion of a small enough catheter in the deflated state eliminates undue force on the suture line. The desired balloon size for effective dilatation can be determined prior to insertion. The problem of mucosal prolapse has not been encountered thus far in these patients. Dilatations carried out at home by the patients’ parents have also been performed well using this method when the parents were sufficiently motivated and intelligent.
UTBORITIES
are at variance regarding the need for dilatation after correction of imperforate anus. Although most believe that dilatation is necessary to insure a good longterm result 12-31, Gross [4] thinks it is not required in most cases, stressing that the formation of an opening approximately 50 per cent larger than normal will obviate their need. Recently, Swenson and Donnellon [5] have pointed out that dilatation is necessary because of the newly constructed puborectalis sling
A
REFERENCES
PIG. 1. Safer method of postoperative Foley catheter. Vol. 116. July 1968
1. FORSHALI., I. In: Surgery of Childhood, p. 934. Edited by Mason Brown, J. J. Baltimore, 1963. Williams & Wilkins Co. 2. LYNN, H. B. and ARCARI, F. :i. .4nal atresia: result\ of surgical treatment. Surgeiy, 51: 692, 1962. 3. SANTUI.LI,T. \‘. In: Pediatric Surgery, vol. 2, p. 834. Edited by Benson, C. D., Mustard, W. T., Ravitch, M. M, Snyder, W. H., and Welch, K. J. Chicago, 1962 Year Book Pnblishcrs, Inc. 4. CROSS, R. E. The Surgery of Infancy and Childhootl, p. 359. Philadelphia, 1953. W. B. Saunders Co 5. ST~ENSON,0. and DONNELLOS, W. Preservatioii (If the puborectalis sling in imp&orate anus repair. .C. C&z. North America, 47: 188, 1967
dilatation using a
137
TECHNICS
Safer Postoperative
Dilatation
for Imperforate MAJ.
HENRY
J. SCHMITT,
in Surgery
Anus
JR.,MC, USAF, USAF Academy, Co!orado
From the General Surgery Service, 7625th USAF Hospital, USAF Academy, Colorado 80840. The views expressed herein are those of the author and do not necessarily reeresent those of the USAF or the Department of Defense.
rather than stenosis at the mucocutaneous junction. The time recommended by the various authors for beginning dilatation ranges from four to twenty days. All agree that disruption at the suture line with retraction of the rectal segment is a serious complication requiring immediate treatment and that results after such a happening are poorer. If dilatation is thought necessary and if it is begun prior to firm healing, the insertion of the dilator from without inward may promote retraction of the rectal segment. A safer method using a Foley catheter is depicted in Figure 1. Insertion of a small enough catheter in the deflated state eliminates undue force on the suture line. The desired balloon size for effective dilatation can be determined prior to insertion. The problem of mucosal prolapse has not been encountered thus far in these patients. Dilatations carried out at home by the patients’ parents have also been performed well using this method when the parents were sufficiently motivated and intelligent.
UTBORITIES
are at variance regarding the need for dilatation after correction of imperforate anus. Although most believe that dilatation is necessary to insure a good longterm result 12-31, Gross [4] thinks it is not required in most cases, stressing that the formation of an opening approximately 50 per cent larger than normal will obviate their need. Recently, Swenson and Donnellon [5] have pointed out that dilatation is necessary because of the newly constructed puborectalis sling
A
REFERENCES
PIG. 1. Safer method of postoperative Foley catheter. Vol. 116. July 1968
1. FORSHALI., I. In: Surgery of Childhood, p. 934. Edited by Mason Brown, J. J. Baltimore, 1963. Williams & Wilkins Co. 2. LYNN, H. B. and ARCARI, F. :i. .4nal atresia: result\ of surgical treatment. Surgeiy, 51: 692, 1962. 3. SANTUI.LI,T. \‘. In: Pediatric Surgery, vol. 2, p. 834. Edited by Benson, C. D., Mustard, W. T., Ravitch, M. M, Snyder, W. H., and Welch, K. J. Chicago, 1962 Year Book Pnblishcrs, Inc. 4. CROSS, R. E. The Surgery of Infancy and Childhootl, p. 359. Philadelphia, 1953. W. B. Saunders Co 5. ST~ENSON,0. and DONNELLOS, W. Preservatioii (If the puborectalis sling in imp&orate anus repair. .C. C&z. North America, 47: 188, 1967
dilatation using a
137