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Transanal Irrigation System For The Treatment Of Neuropathic Bowel Dysfunction
ESPU Programme 2009
S87
# S14-10 (DP) MACE-STOMA BY CAECAL FLAP PLASTY Lennart H. HOMRIGHAUSEN, Uta ZEEH and Thomas M. BOEMERS Children’s Hospital Cologne, Departement of pediatric surgery and pediatric urology, Cologne, GERMANY
In patients with chronic constipation or fecal incontinence due to anorectal malformations, Hirschsprung’s Disease, MMC and other causes, different techniques of ACE exist, depending on wheter there is an appendix or not. We describe our new technique of a stapeled caecal flap plasty in detail.
by stapeled caecal flap plasty. The mean age was 15 years (6.5-19.0). In 7 patients no appendix was present after earlier surgery. In 2 patients earlier appendicocaecostomies showed stenosis and in 1 patient the appendix was obliterated. All patients underwent stapeled caecal flap plasty and intraabdominal antirefluxive fixation. In 7 patients the ACE was fixed in the right midabdomen and in 3 in the umbilicus.
MATERIAL AND METHODS
RESULTS
During a 2 year period (2006-2008) 10 out of 30 patients underwent MACE-construction
During the follow-up period 5 patients showed no problems at all. 2 had initial
PURPOSE
problems in catheterization of the MACE, 1 showed stenosis of the MACE, requiring surgical dilatation. 2 patients still show problems in the self-organisation of catheterization with delayed defecation while the stoma works well.
CONCLUSIONS Our new technique of stapeled caecal flap plasty is a good alternative procedure to construct a continent catheterizable ACEstoma in patients without appendix.
# S14-11 (DP) TRANSANAL IRRIGATION SYSTEM FOR THE TREATMENT OF NEUROPATHIC BOWEL DYSFUNCTION Pedro LOPEZ PEREIRA1, S BARRENA DELFA1, Mj MARTINEZ URRUTIA1, R LOBATO ROMERA1, O PEREZ SALVADOR1, J ALONSO ARCAS1 and E JAUREGUIZAR2 1
University Hospital La Paz, Pediatric Urology, Madrid, SPAIN, 2University Hospital La Paz, Madrid, SPAIN
PURPOSE Fecal incontinence is a major problem in children with myelomeningocele affecting their quality of life. We evaluate the effects of¨Peristeen ¨ transanal irrigation system on these children and in their quality of life.
MATERIAL AND METHODS We prospectively review 40 children suffering spina bifida with constipation and fecal incontinence who did not respond satisfactorily to conservative bowel management and were treated with the Persiteen ¨ transanal irrigation system. Lesion ¨ level, ambulatory status, and urinary
continence were determined. Constipation, fecal incontinence and quality of life were analysed before and after treatment using a specific questionare.
RESULTS Fourty children were enrolled and 35 (17F, 18M) completed the study. Mean patient age and follow-up were 12.5 yrs (6-25) and 12 months (4-18), respectively. The average of irrigation frequency was once every 3 days and mean instillation volume was 530 ml (250-1.500). Time necessary for evacuation was 26 minutes (20-60). At the beginning, three patients had abdominal pain during irrigation and other 3 some handling
problems. None children used pharmaceutical products during the treatment and fecal pseudo-continence was achieved in all. The degree of general satisfaction with the¨Peristeen ¨ transanal irrigation was high in the 97% of children.
CONCLUSIONS Peristeen ¨ transanal irrigation is a simple and ¨ effective therapeutic method for treatment constipation and fecal incontinence in children with neuropathic bowel dysfunction that could avoid in many cases the need for antegrade continence enema procedure (ACE).
S15: ONCOLOGY # S15-1 (O) EXPERIENCE WITH LAPAROSCOPIC RADICAL NEPHRECTOMY IN WILMS’ TUMOR ´NES2, Lilian CRISTOFANI3, Vicente ODONE FILHO4 and Miguel SROUGI1 Ricardo DUARTE1, Francisco DE 1 Sa~o Paulo University, Urology, Sa~o Paulo, BRAZIL, 2Sa~o Paulo, University, Sa~o Paulo, BRAZIL, 3Sa~o Paulo University, Pediatrics, Sa~o Paulo, BRAZIL, 4Sa~o Paulo Universiy, Pediatrics, Sa~o Paulo, BRAZIL
S87
# S14-10 (DP) MACE-STOMA BY CAECAL FLAP PLASTY Lennart H. HOMRIGHAUSEN, Uta ZEEH and Thomas M. BOEMERS Children’s Hospital Cologne, Departement of pediatric surgery and pediatric urology, Cologne, GERMANY
In patients with chronic constipation or fecal incontinence due to anorectal malformations, Hirschsprung’s Disease, MMC and other causes, different techniques of ACE exist, depending on wheter there is an appendix or not. We describe our new technique of a stapeled caecal flap plasty in detail.
by stapeled caecal flap plasty. The mean age was 15 years (6.5-19.0). In 7 patients no appendix was present after earlier surgery. In 2 patients earlier appendicocaecostomies showed stenosis and in 1 patient the appendix was obliterated. All patients underwent stapeled caecal flap plasty and intraabdominal antirefluxive fixation. In 7 patients the ACE was fixed in the right midabdomen and in 3 in the umbilicus.
MATERIAL AND METHODS
RESULTS
During a 2 year period (2006-2008) 10 out of 30 patients underwent MACE-construction
During the follow-up period 5 patients showed no problems at all. 2 had initial
PURPOSE
problems in catheterization of the MACE, 1 showed stenosis of the MACE, requiring surgical dilatation. 2 patients still show problems in the self-organisation of catheterization with delayed defecation while the stoma works well.
CONCLUSIONS Our new technique of stapeled caecal flap plasty is a good alternative procedure to construct a continent catheterizable ACEstoma in patients without appendix.
# S14-11 (DP) TRANSANAL IRRIGATION SYSTEM FOR THE TREATMENT OF NEUROPATHIC BOWEL DYSFUNCTION Pedro LOPEZ PEREIRA1, S BARRENA DELFA1, Mj MARTINEZ URRUTIA1, R LOBATO ROMERA1, O PEREZ SALVADOR1, J ALONSO ARCAS1 and E JAUREGUIZAR2 1
University Hospital La Paz, Pediatric Urology, Madrid, SPAIN, 2University Hospital La Paz, Madrid, SPAIN
PURPOSE Fecal incontinence is a major problem in children with myelomeningocele affecting their quality of life. We evaluate the effects of¨Peristeen ¨ transanal irrigation system on these children and in their quality of life.
MATERIAL AND METHODS We prospectively review 40 children suffering spina bifida with constipation and fecal incontinence who did not respond satisfactorily to conservative bowel management and were treated with the Persiteen ¨ transanal irrigation system. Lesion ¨ level, ambulatory status, and urinary
continence were determined. Constipation, fecal incontinence and quality of life were analysed before and after treatment using a specific questionare.
RESULTS Fourty children were enrolled and 35 (17F, 18M) completed the study. Mean patient age and follow-up were 12.5 yrs (6-25) and 12 months (4-18), respectively. The average of irrigation frequency was once every 3 days and mean instillation volume was 530 ml (250-1.500). Time necessary for evacuation was 26 minutes (20-60). At the beginning, three patients had abdominal pain during irrigation and other 3 some handling
problems. None children used pharmaceutical products during the treatment and fecal pseudo-continence was achieved in all. The degree of general satisfaction with the¨Peristeen ¨ transanal irrigation was high in the 97% of children.
CONCLUSIONS Peristeen ¨ transanal irrigation is a simple and ¨ effective therapeutic method for treatment constipation and fecal incontinence in children with neuropathic bowel dysfunction that could avoid in many cases the need for antegrade continence enema procedure (ACE).
S15: ONCOLOGY # S15-1 (O) EXPERIENCE WITH LAPAROSCOPIC RADICAL NEPHRECTOMY IN WILMS’ TUMOR ´NES2, Lilian CRISTOFANI3, Vicente ODONE FILHO4 and Miguel SROUGI1 Ricardo DUARTE1, Francisco DE 1 Sa~o Paulo University, Urology, Sa~o Paulo, BRAZIL, 2Sa~o Paulo, University, Sa~o Paulo, BRAZIL, 3Sa~o Paulo University, Pediatrics, Sa~o Paulo, BRAZIL, 4Sa~o Paulo Universiy, Pediatrics, Sa~o Paulo, BRAZIL