RESUMEN
OBJECTIVE: To evaluate the long-term results of surgical correction of H-type fistula in girls with a normal anus. MATERIAL AND METHODS: There were 7 patients with rectovestibular fistula and 3 patients with rectovaginal fistula with a normal anus were observed from 2014 to 2019 in the Surgical Department No. 1 of the Russian Children's Clinical Hospital. Upon admission, all patients underwent genital examination, vaginoscopy, rectal examination and probing the fistulous canal, irrigography, abdominal and retroperitoneal ultrasound. They were also examined by a gynecologist and genital smears were obtained. Surgical treatment was determined depending on the height and diameter of the fistula for each child. One patient underwent perineal fistulectomy, three patients - anterior anorectoplasty. Invaginated fistula extirpation, abdominoperineal proctoplasty and perineal fistulectomy using a pad flap between the defects were used in two cases, respectively. Patients were followed-up for the period from 6 months to 1 year after the last recurrence. Follow-up examination, irrigography and functional examination of sphincter were performed. RESULTS: Two (20%) patients did not require redo surgery. In 6 (60%) cases, recurrences didn't occur within a year after the second surgery, in 2 (20%) cases - after 3 operations. Recurrent H-type fistula appeared after 3 of 4 perineal fistulectomy procedures, 3 of 9 anterior anorectoplasty, 2 of 2 abdominoperineal proctoplasty and 2 of 3 invaginated fistula extirpation. Hypotension of internal anal sphincter and neo-rectal ampulla, recurrent vulvovaginitis were diagnosed in 2 patients in 6 months after anterior anorectoplasty. CONCLUSION: We recommend anterior anorectoplasty and perineal fistulectomy using a pad flap between the defects for the treatment of H-type fistula to minimize the risk of recurrence.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Procedimientos Quirúrgicos Ginecológicos/métodos , Fístula Rectovaginal , Canal Anal/cirugía , Niño , Femenino , Humanos , Perineo/cirugía , Procedimientos de Cirugía Plástica/métodos , Fístula Rectal/diagnóstico , Fístula Rectal/etiología , Fístula Rectal/cirugía , Fístula Rectovaginal/diagnóstico , Fístula Rectovaginal/etiología , Fístula Rectovaginal/cirugía , Recto/cirugía , Colgajos Quirúrgicos , Resultado del TratamientoRESUMEN
For assessment of the incidence and characteristics of urination disorders and erectile dysfunction after radical surgical treatment of anorectal congenital defects in children, 60 patients (12 girls, 48 boys) without urination disorders before operation, who have undergone 1-4 proctoplasties were examined. Their was Hirschsprung's disease in 20 patients, anorectal atresia in 40 patients. Iatrogenic urination disorders and erectile dysfunction were revealed in 38 (63.3%) patients, majority of them (24) underwent repeated proctoplasty. The main urination disorders were urinary incontinence (30 patients), infravesical obstruction (10), hyporeflexion of urinary bladder. Erectile dysfunction after operation was in 11 (34.4%) patients from 32. The combination of disorders was revealed in 17 (44.7%) patients. Primary radical operations in children with anorectal defects often cause iatrogenic urination disorders and erectile dysfunction. The number of complications increases progressively after repeated proctoplasty. It is necessary to improve the treatment and the methods of surgical correction bearing in mind the risk of iatrogenic disorders of genitourinary apparatus.
Asunto(s)
Canal Anal/anomalías , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Disfunción Eréctil/etiología , Enfermedad de Hirschsprung/cirugía , Atresia Intestinal/cirugía , Recto/anomalías , Recto/cirugía , Trastornos Urinarios/etiología , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Enfermedad Iatrogénica , Lactante , Masculino , ReoperaciónRESUMEN
During the first three days after trauma a pronounced hypotonia of muscles independent of the localization of the vertebral column was observed. Two patients of mathematical estimation of the clinoid form of the vertebra were proposed aimed at objectivization of the roentgenological information. In 90% of cases the methods proved to be effective. Gamma scintigraphic examination of the vertebral column was carried out in 101 patients. The results obtained have shown the method to be highly sensitive and objective and to distinguish the normal state, disease and trauma of the vertebral column