کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
6217454 | 1273762 | 2013 | 5 صفحه PDF | دانلود رایگان |
PurposeSurgical options previously described by us as part of a bowel management program for the treatment of soiling and fecal incontinence include (1) resection of a megarectosigmoid to reduce a patient's laxative requirement or (2) a Malone appendicostomy in patients who require enemas. We have found that some patients may benefit from both procedures.MethodsWe reviewed 18 fecally incontinent patients with structural or functional disorders of the anorectosigmoid (16 ARM, 1 spina bifida, and 1 SCT) who underwent both procedures.ResultsOf 18 patients, the enema regimen prior to resection had an average volume of 681Â ml of saline (Range 400-1000Â ml) and 60Â ml (Range 48-117Â ml) of additives (glycerine, castile soap and/or phosphate). Following the colon resection, the average volume of saline and additives was 335Â ml (Range 130-650Â ml) and 25Â ml (Range 0-60Â ml), respectively, a 50% reduction for both (PÂ <Â 0.01). The time for enema administration and evacuation was reduced by 25%, and the enemas were more effective, rendering the patients clean in 18 of 18 cases (follow-up was 3Â months to 21Â years). 2 patients later demonstrated that they could be managed with laxatives alone.ConclusionIn patients with poor continence potential and a megarectosigmoid, combining a colon resection with a Malone appendicostomy can make the enema more effective. In some rare cases we found the resection may allow for a better response to laxatives.
Journal: Journal of Pediatric Surgery - Volume 48, Issue 11, November 2013, Pages 2296-2300