Surgical Treatment of Colorectal Problems in Children

This superbly illustrated book on the surgical treatment of pediatric colorectal problems
focuses in particular on the specific technical maneuvers that may be considered key to
successful results. The presented management concepts are based on a database comprising over
5000 patients, more than 2300 of whom have been operated on by one of the authors as lead
surgeon over the past 30 years. The full range of colorectal disorders in children is thus
covered, from cloaca and fistulas to rare presentations. In addition, chapters are included on
topics such as prenatal diagnosis, minimally invasive techniques, recent advances in imaging,
and a bowel management program for fecal incontinence. Surgical Treatment of Colorectal
Problems in Children is eminently a practical book. Clarity, simplicity and applicability are
emphasized throughout. The excellence of the illustrations and photographs is a crucial
feature and the reader will also have access to instructive videos of procedures.


Contents
1: History of the Treatment of Anorectal Malformations
1.1 Introduction
1.2 The Early Times
References
2: Basic Anatomy and Physiology of Bowel Control
2.1 Internal Sphincter
2.2 General Anatomic Principles in Anorectal Malformations
2.3 Nerves
2.4 Blood Supply
2.5 Basic Physiology Principles of Bowel Control
References
3: Prenatal Diagnosis
3.1 Male Fetuses
3.1.1 Abnormal Sacrum (Fig. 3.3)
3.1.2 Tethered Cord
3.1.3 Absent Kidney (Fig. 3.5)
3.1.4 Vertebral Anomalies
3.1.5 Hydronephrosis (Fig. 3.6)
3.2 Female Fetuses
3.2.1 Dilated Bowel and Intraluminal Calcifications
3.2.2 Pelvic Cystic Mass
3.2.3 Cloacal Exstrophy
References
4: Neonatal Management
4.1 Introduction
4.2 Most Common Scenario
4.3 Answering the Two Most Important Questions
4.4 Physical Examination
4.4.1 Male Patients
4.5 Female Babies
4.6 Neonatal Management
4.7 Cloacal Exstrophy
References
5: Colostomy
5.1 Introduction
5.2 Stoma Locations
5.3 Ileostomies
5.4 To Divert or Not to Divert, That Is the Question
5.5 Recommended Types of Colostomies
5.5.1 Newborn Babies with Anorectal Malformations
5.6 Left Transverse Colostomy
5.7 Cecostomies
5.8 Creation of a Colostomy
5.8.1 Surgical Technique
5.9 Colostomy in Cases of Cloaca with Hydrocolpos
5.10 Other Types of Colostomies
5.11 Colostomy Care
5.12 Colostomy Closure
5.13 Surgical Technique
5.14 Errors and Complications in Colostomies
5.15 The Case of Upper Sigmoidostomy
5.16 Prolapse
5.17 Surgical Treatment for Prolapse
5.18 Malposition of the Stomas
References
6: Imaging
6.1 Introduction
6.2 Prenatal Diagnosis
6.3 Neonatal Imaging
6.4 Determination of the Fistula Location Prior to the Colostomy
6.4.1 Anatomic Facts and Timing
6.5 The Old Invertogram
6.6 High-Pressure Distal Colostogram
6.7 Technique
6.8 Most Common Errors
6.9 Not Showing the Coccyx and the Sacrum During the Fluoroscopy Studies
6.10 Distal Colostogram in Female Patients
6.11 Distal Colostogram in Cloacas
6.12 Monitoring Constipation
6.13 Radiology During the Bowel Management Program
6.14 Monitoring the Urinary Tract
References
7: Bowel Preparation in Pediatric Colorectal Surgery
7.1 Major Procedures
7.2 Primary Procedures for the Treatment of Anorectal Malformation During the Newborn Period
7.3 Primary Pull-Through in Newborn Patients with Hirschsprung뭩 Disease
7.4 Patients with Hirschsprung뭩 Disease with Enterocolitis After the Neonatal Period
7.5 Patients with Hirschsprung뭩 Disease Beyond the Neonatal Period, Without Enterocolitis
7.6 Colostomy Closures
7.7 Patients with a Colostomy Who Will Have a Repair of an Anorectal Malformation
References
8: Recto-perineal Fistula
8.1 Definition, Frequency, and Prognosis
8.2 Associated Defects
8.3 Diagnosis
8.3.1 Female Patients
8.3.2 Male Patients
8.4 Management
8.5 Dilatations
8.6 Cutback Operation
8.7 Minimal Posterior Sagittal Anoplasty
8.7.1 Male Patients
8.7.2 Surgical Technique
8.7.3 Female Patients
8.8 Postoperative Care
References
9: Rectourethral Bulbar Fistula
Introduction
Associated Defects
Posterior Sagittal Anorectoplasty
Surgical Technique
Functional Results
References
10: Rectourethral Prostatic Fistula
10.1 Introduction
10.2 Associated Defects
10.3 Surgical Repair
10.4 Posterior Sagittal Anorectoplasty (Animation 10.2)
10.5 Postoperative Care and Functional Results
References
11: Recto-bladder Neck Fistula
11.1 Definition and Frequency
11.2 Associated Defects
11.2.1 Sacral Defects
11.2.2 Spinal-Associated Defects
11.2.3 Urologic-Associated Defects
11.2.4 Gastrointestinal-Associated Defects
11.2.5 Neurosurgical-Associated Defects
11.2.6 Cardiovascular-Associated Defects
11.2.7 Other Associated Defects
11.3 Diagnosis
11.4 Treatment
11.4.1 Colostomy
11.4.2 Main Repair
11.4.3 Laparotomy
11.4.4 Laparoscopy
11.5 Special Problems
11.5.1 Dealing with Inadequate Colostomies (Too Distal)
11.6 Functional Results
11.6.1 Fecal Control
11.6.2 Urinary Control
References
12: Imperforate Anus Without Fistula in Males and Females
12.1 Introduction
12.2 Anatomic Characteristics
12.3 Main Repair
12.4 Function and Results
References
13: Minimally Invasive Approach to Anorectal Malformations
13.1 Introduction
13.2 Males
13.3 Females
References
14: Rectal Atresia
14.1 Treatment
14.2 Surgical Repair
References
15: Rectovestibular Fistula
15.1 Definition/Frequency
15.2 Associated Defects
15.2.1 Sacral
15.2.2 Spinal
15.2.3 Urologic
15.2.4 Gynecologic
15.2.5 Gastrointestinal
15.2.6 Tethered Cord
15.2.7 Cardiovascular
15.3 Diagnosis
15.4 Treatment
15.4.1 Colostomy or No Colostomy
15.5 Main Repair (Animation 15.1)
15.6 Complications
15.7 Functional Results
15.8 Reoperations in Patients with Vestibular Fistula
15.9 Surgical Technique
15.10 Rectovestibular Fistula with Normal Anus
References
16: Cloaca, Posterior Cloaca and Absent Penis Spectrum
16.1 Cloaca
16.1.1 Definition and Management
16.1.1.1 Associated Defects
16.1.1.2 Goals of Treatment
16.1.1.3 Neonatal Management
16.1.1.4 Main Repair
Cloacas with a Common Channel of Less Than 1 cm
Cloacas with a 1? cm Common Channel
Cloacas with a 3- to 5-cm Common Channel (Animation 16.3)
Carving of the Pubic Cartilage Maneuver
Separations of Vagina(s) from the Urinary Tract (Animation 16.3)
Vaginal Switch
Vaginal Replacement
Vaginal Replacement with Rectum
Vaginal Replacement with Colon
Vaginal Replacement with Small Bowel
Cloacas with Extremely Long Common Channels
16.1.1.5 Postoperative Care
16.1.2 Urologic Concerns
16.1.3 Gynecologic Concerns
16.1.4 Reoperations
16.1.4.1 Persistent Urogenital Sinus
16.1.4.2 Acquired Vaginal Atresia or Stricture
16.1.4.3 Acquired Urethral Atresia or Stricture
16.1.4.4 Sequelae from Catastrophic Complications
16.1.5 Transpubic Approach
16.2 Posterior Cloaca and Absent Penis Spectrum
16.2.1 Surgical Repair
16.2.1.1 Typical Cloaca with a Single Perineal Orifice in the Anal Location
16.2.2 Surgical Repair of the 2-Perineal-Orifice Variant of the Posterior Cloacal Spectrum
16.2.3 Posterior Cloaca and Absent Penis
References
17: Cloacal Exstrophy and Covered Cloacal Exstrophy
17.1 Neonatal Approach
17.2 Pull-Through or 밣ermanent Stoma?
17.3 Covered Cloacal Exstrophy
References
18: General Principles for the Postoperative Management of Patients with Anorectal Malformations
18.1 General Care
18.2 Local Care
18.3 Anal Dilatations
18.4 Avoiding Constipation
18.5 Toilet Training
19: Postoperative Evaluation
References
20: Bowel Management for the Treatment of Fecal Incontinence
20.1 Introduction
20.2 Goals of the Bowel Management Program
20.3 Evaluation of the Patient for Bowel Management
20.4 Individualization of the Management
20.5 Laxative Trial
20.6 About Our Program
20.7 Content of the Enema
20.8 Rationale to Change the Type of Enema
20.9 Bowel Management for the Treatment of Severe Diaper Rash
20.10 Bowel Management Through a Stoma
References
21: Operations for the Administration of Antegrade Enemas
21.1 Introduction
21.2 Our Preferred Technique
21.3 Surgical Technique: Continent Appendicostomy
21.4 Continent Neo-appendicostomy
References
22: Reoperations
22.1 Introduction
22.2 Reoperations to Improve Bowel Control
22.3 Reoperations Performed After Failed Attempted Repair (Catastrophes) Males
22.4 Reoperations for Postoperative Recto-춙rinary Fistula
22.4.1 Recurrent Fistula (17 Cases)
22.4.2 Persistent Rectourethral Fistula (24 Cases)
22.4.3 Acquired Fistula (9 Cases)
22.5 Posterior Urethral Diverticulum (32 Cases)
22.6 Acquired Rectal Atresia or Stenosis (83 Cases)
22.7 Presacral Masses
22.8 Reoperations in Female Patients
22.9 Prolapse
References
23: Urologic Problems in Anorectal Malformations
23.1 Introduction
23.2 Neonatal Approach
23.3 The Importance of the Colostomy Type from the Urologic Point of View
23.4 Most Common Urologic Abnormalities in Male Patients with Anorectal Malformations
23.4.1 Absent Kidney
23.4.2 Urethral Problems
23.5 Bifid Scrotum
23.6 Hypospadias
23.7 Ectopic Ureters in Males
23.8 Ectopic Ureters in Females
23.9 Ectopic Vas Deferens
23.10 Ectopic Verumontanum
23.11 Megalourethra
23.12 Ureterovesical and Ureteropelvic Obstruction
23.13 Neurogenic Bladder
23.14 Postoperative Problems
23.15 Posterior Urethral Diverticulum (Animation 13.2)
23.16 Sexual Problems
23.17 Tethered Cord
23.18 The Ultimate Concern, Kidney Function
References
24: Hirschsprung뭩 Disease
24.1 Introduction
24.2 Historical Review
24.3 Incidence, Inheritance, and Associated Anomalies
24.4 Pathogenesis
24.5 Genetics
24.6 Clinical Manifestations and Differential Diagnosis
24.7 Histologic Diagnosis
24.8 Differential Diagnosis
24.9 Early Management
24.10 Surgical Treatment
24.10.1 The Authors?Approach
24.10.2 Other Surgical Techniques for the Treatment of Hirschsprung뭩 Disease
24.11 Total Colonic Aganglionosis
24.12 Ultrashort-Segment Hirschsprung뭩 Disease
24.13 Problems, Complication, and Sequela Secondary to Operations for Hirschsprung뭩 Disease
24.13.1 Preventable Complications (Catastrophes)
24.13.1.1 Fecal Incontinence
24.13.2 Non-preventable Complications
24.13.3 Partially Preventable Complications
References
25: Idiopathic Constipation and Other Motility Disorders
25.1 Definition and Terminology
25.2 Incidence, Social Impact, and Relevance
25.3 Etiology
25.3.1 Ultrashort Segment Hirschsprung뭩 Disease
25.3.2 Rectal Manometry
25.3.3 Doubts and Questions About the Anatomy of the Internal Sphincter
25.3.4 Questions About Myectomy Technique
25.3.5 Botulinum Toxin Injection
25.4 Pathogenesis
25.5 Natural History and Clinical Manifestations
25.6 Diagnosis
25.6.1 Colonic Transit Time
25.6.2 The Evaluation of Severity: Search for Objective 밒nstruments?
25.7 Management
25.7.1 Fecal Disimpaction Protocol (Animation 20.4)
25.7.2 Determination of Laxative Requirements
25.7.3 Electric Stimulation
25.8 Surgical Treatment
25.8.1 Operations to Administer Antegrade Enemas (ACE Procedures)
25.8.2 Colonic Resection
References
26: Posterior Sagittal Approach for the Treatment of Other Conditions
26.1 The Kraske Operation
26.2 Urogenital Sinus with Normal Rectum
26.3 Urogenital Sinus with Normal Rectum and Adrenal Hyperplasia
26.4 Acquired Urethral Atresia
26.5 Acquired Rectourethral Fistula
26.6 Giant Seminal Vesicle
26.7 Urethral Tumors
26.8 Acquired Rectovaginal Fistula
26.9 Rectal Tumors
26.10 Presacral Masses
26.11 Surgical Technique
26.12 Posterior Sagittal Approach, Its Application in Cases with Hirschsprung뭩 Disease
26.13 Vaginal Atresia with Normal Rectum
References
27: Miscellaneous Conditions
27.1 Part I: Perianal Abscess and Fistula
27.1.1 Definition
27.1.2 Etiology
27.1.3 Natural History
27.1.4 Treatment
27.1.5 Fistulotomy
27.2 Part II: Perianal Fistula and Rectovestibular Fistula with Normal Anus in Females
27.2.1 Surgical Treatment
27.3 Part III: Other Conditions
27.3.1 Anal Fissure
27.3.2 Hemorrhoids
27.3.3 Idiopathic Rectal Prolapse
References