Transanal Rectosigmoidian Resection in Children. Comments upon the Surgical Technique

Purpose. This paper intends to expose and discuss the technical aspects of the transanal endorectal rectosigmoidian resection in children. Colic resection and coloanal anastomosis technique may be performed by totally endoanal or combined endoanal and laparoscopic approach for the mobilization and devascularization of the colon. Both techniques have, as a common surgical stage, the suprasphincteric endorectal dissection and transanal coloanal anastomosis. This paper analyses the indications, contraindications, technical details and surgical complications which strictly depends on the transanal endorectal surgical stage. Materials and methods This study was conducted on a number of 42 patients with rectosigmoidian resection. In 6 cases the resection was performed using exclusively the transanal endorectal approach and in the other 36 cases we used videoassisted technique. The patients were aged between 13 days and 17 years (mean 3y 2m). Five of these patients were admitted as an emergency case and were operated on as a single stage procedure, without performing a colostomy. There were 37 cases admitted as a chronic constipation syndrome with, or without aganglionosis. We used exclusively the endoanal technique in children with certified low type of aganglionosis. We practiced laparoscopic devascularization and mobilization of the colon in cases with resection above the rectosigmoid junction. Results and Discussions about operative results take into account only endoanal stage of the surgery, underlining the technical aspects with obvious impact over the postoperative results. There were 9 postoperative difficult outcomes: 2 anastomotic fistulas, 1 anastomotic stenosis, 1 insufficient resection and 4 cases with episodic soiling.