Intraoperative Sonographic Guided Pull-through Anorectoplasty: A Novel Procedure for Imperforate Anus and Rectourethral Fistula: A Clinical Trial Study

نویسندگان

  • Aghigh Ziaee-mehr Surgical Oncology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Ahmad Mohammad-pour Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Ali Azadmand Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Alireza Keshtgar Department of Pediatric Surgery, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK.
  • Alireza Sabzevari Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Farideh Jamali-Behnam Surgical Oncology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Khalil Alizadeh Surgical Oncology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Marjan Joudi Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mehdi Fathi Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Reza Nazarzadeh Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Saeed Vaziri Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Seyed Ali Alamdaran Division of Radiology, Department of Pediatrics, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده مقاله:

Background and objectives: Optimal surgical management of the neonate with imperforate anus (IA) depends on determining accurate location of muscle complex, pouch of rectum and urethral fistula. The aim of this study was to investigate a novel minimally invasive technique of anorectoplasty assisted by intraoperative sonography pull-through for repair of anorectal malformation and rectourinary fistula.Patients and methods: Eight male patients with imperforate anus aged under 48 h had undergone colostomy. Any associated anomalies were evaluated in cases. After 5-8 weeks, neonates were prepared for anoplasty. After catheterization, sonography of perinea was carried out. Patients were placed in lithotomy position. The accurate position of each required point was determined by this procedure.Results: In all cases, the pouch of rectum to skin distance was in range 1.5-1.8 mm and entrance distance of wire to fistula was maximally 6 mm, just in one patient this value was 7 mm. Anomalies associated with some patients were Down Syndrome, cardiac anomalies, kidney disease .6 out of 8 patients removed urinary catheter after two days and discharged home. Colostomy of all patients was closed after sonography of prinea. After one week and one month follow- up, all patients had an acceptable fecal frequency about 3- 5 times a day.Conclusion:Intra-operative sonography is an applicable procedure to determine correct location of muscle complex, pouch of rectum and uretral fistula to treat IA patients non- invasively. Another interesting point of this study is the ability of non invasive surgery and novel procedure with perfect result.

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عنوان ژورنال

دوره 5  شماره 12

صفحات  6195- 6200

تاریخ انتشار 2017-12-01

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