Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.
Male ; Humans ; Aged ; Anal Canal/surgery* ; Colon/surgery* ; Colectomy ; Anus Diseases/surgery* ; Adenocarcinoma/surgery* ; Digestive System Abnormalities/surgery*

Adult presentation of a rectocutaneous fistula with imperforate anus is rare. We report the case of a 22-year-old man who presented with an anorectal malformation and a rectocutaneous fistula. The patient complained of faecal matter passing through the external orifis of a fistula located at the distal part of his scrotum. He was continent for solid faeces, but had leakage of flatus and faecal soiling. He had no other associated anomaly. The patient subsequently underwent a surgical procedure where anal transposition was done. Postoperative recovery was uneventful, and the patient was fully continent at control examination.
Anal Canal ; abnormalities ; Anorectal Malformations ; Anus, Imperforate ; diagnosis ; surgery ; Digestive System Surgical Procedures ; Humans ; Male ; Rectal Fistula ; diagnosis ; surgery ; Scrotum ; surgery ; Young Adult

OBJECTIVETo investigate the relationship between the morphological features of different types of neuronal intestinal malformations (NIM) and their postoperative complications.

METHODSThe data of morphological and clinical features of 324 cases with NIM were analyzed retrospectively.

RESULTSIn all 324 patients, 210 cases were Hirschsprung's disease (HD), 38 intestinal neuronal dysplasia (IND), 45 mixed HD/IND, 8 hypoganglionosis, 22 combined HD/hypoganglionosis and 1 immaturity of ganglion cells. The percentages of normal neuron in bowel of different NIM were 88.1%, 24.4%, 18.4%, 4/8, 27.7% and 0/1 in HD, HD/IND, IND, hypoganglionosis, HD/hypoganglionosis and immaturity of ganglion cells respectively. There were totally 46 cases complicated with recurrent postoperative enterocolitis (EC). Incidence of recurrent postoperative EC in HD patients was 6.7% while in IND/HD and IND patients was 35.6% and 28.9%, respectively. Incidences of EC in cases with the residual IND margins and with the normal margins were 38.2% and 8.7%, respectively. Incidence of EC in cases with transanal endorectal pull-through procedure and with transabdominal procedure was 18.0% and 8.3%, respectively. Nine cases underwent another procedure because of severe persistent constipation or EC after operation, including 4 cases HD/IND, 1 case IND, 3 cases HD and 1 case HD/hypoganglionosis.

CONCLUSIONSNeuron distribution is inconsistent with pathology of NIM. Postoperative EC are rare in the patients only with isolated HD. Furthermore, margins with residual IND and transanal endorectal pull-through procedure are risk factors to recurrent EC. However, the extension of excision about IND is uncertain and need further study.

Adolescent ; Child ; Child, Preschool ; Digestive System Abnormalities ; complications ; pathology ; surgery ; Enteric Nervous System ; abnormalities ; pathology ; Female ; Hirschsprung Disease ; complications ; pathology ; surgery ; Humans ; Infant ; Male ; Postoperative Complications ; etiology ; Retrospective Studies

OBJECTIVETo evaluate the efficacy of bowel plication combined with early enteral nutrition (EEN) in the enhanced recovery after surgery(ERAS) of jejunal atresia (JA) neonates.

METHODSBetween January 2005 and January 2014, 58 neonates with JA underwent surgical treatment in Children's Hospital of Nanjing Medical University. Their clinical data, including operation procedures, ages, birth weight, concomitant diseases, age at surgery, hospital stay, total parenteral nutrition (TPN), postoperative intestinal function recovery (the time to the first oral feeding and the time to oral feeding volume reaching 150 ml·kg·d), complications and reoperation, were retrospectively analyzed.

RESULTSAccording to the surgical procedures, the 58 neonates were divided into three groups: control group(18 cases, undergoing atretic segments resection and primary anastomosis), bowel plication group(19 cases, undergoing bowel plication after atretic segments resection and primary anastomosis) and bowel plication combined with EEN group (21 cases, undergoing bowel plication combined with EEN). No significant differences of ages, birth weight, age at operation, and concomitant diseases were found among 3 groups (all P>0.05). The time of hospital stay, the time to the first oral feeding, the time to oral feeding volume reaching 150 ml·kg·d, and the time of TPN in bowel plication group were significantly shorter than those of control group [(19.3±4.4) d vs. (22.7±3.1) d, t=2.696, P=0.011; (9.8±3.3) d vs. (12.5±3.0) d, t=2.630, P=0.013; (18.5±4.1) d vs. (21.5±2.5) d, t=2.726, P=0.011; (13.1±2.9) d vs. (15.0±2.3) d, t=2.219, P=0.033]. However, above parameters of bowel plication combined with EEN group were significantly shorter than those of bowel plication group [(15.3±3.5) d vs. (19.3±4.4), t=4.120, P=0.003; (7.7±2.2) d vs. (9.8±3.3) d, t=2.428, P=0.020; (14.8±2.5) d vs. (18.5±4.1) d, t=3.752, P=0.001; (9.5±3.0) vs. (13.1±2.9) d, t=4.370, P=0.000].

CONCLUSIONThe bowel plication combined with EEN contributes to the early use of intestinal function, shorten the time to the first oral feeding, and reduces the use of TPN, which can improve the recovery of jejunal atresia neonates.

Anastomosis, Surgical ; Comparative Effectiveness Research ; Defecation ; Digestive System Surgical Procedures ; methods ; Enteral Nutrition ; methods ; Humans ; Infant, Newborn ; Intestinal Atresia ; rehabilitation ; surgery ; Jejunum ; abnormalities ; surgery ; Length of Stay ; Parenteral Nutrition, Total ; Postoperative Period ; Retrospective Studies

INTRODUCTIONPreoperative prognostic predictors are important for surgeons and parents to estimate the survival of patients with esophageal atresia (EA). The aim of this study was to update the clinical outcomes of EA treatment by comparing between the Waterston and the Spitz classification.

MATERIALS AND METHODSMedical records of the patients with EA treated at Queen Sirikit National Institute of Child Heath from 2003 to 2010 were reviewed. All of the patients were categorised into 3 groups of the Waterston and 3 groups of the Spitz risk factor criteria for comparing of the differences in each group and each classification.

RESULTSOne hundred and thirty-two patients (81 males and 61 females) were treated for EA during the study period. Applying the Waterston classification, survival rate was 100% in group A, 91.5% in group B and 48.8% in group C. There was no statistical difference between the survival rate in group A and group B (P = 0.119) but significant difference between group B and group C (P = 0.000). Using the Spitz classification, survival rate was 97.4% in group I, 64.4% in group II and 27.3% in group III. There was obviously statistical difference of the survival rate between each group (group I vs group II, P = 0.000; group II vs group III, P = 0.041).

CONCLUSIONComparing with the prognostic predictors, the Spitz classification was more valid than the Waterston criteria. The Spitz classification is suitable to use for preoperative predictor to parental counselling and comparing of treatment outcomes of EA among paediatric tertiary care centres.

Abnormalities, Multiple ; Digestive System Surgical Procedures ; methods ; Esophageal Atresia ; classification ; mortality ; surgery ; Female ; Humans ; Infant, Newborn ; Male ; Preoperative Period ; Prognosis ; Risk Factors ; Survival Rate ; trends ; Thailand ; epidemiology ; Tracheoesophageal Fistula ; classification ; mortality ; surgery