Dewan P A, Hrabovszky Z, Mathew M
Department of Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.
P N G Med J. 2000 Mar-Jun;43(1-2):105-9.
The posterior sagittal anorectoplasty (PSARP) procedure for the definitive repair of children with imperforate anus was described in 1982. Unfortunately, surgeons in Papua New Guinea (PNG) have until recently not had the opportunity of being trained in the technique. Through the Medical Officer, Nursing and Allied Health Sciences Training Project (MONAHP) and Pacific Islands Project (PIP) of the Royal Australasian College of Surgeons, 65 Papua New Guinean children with an anorectal anomaly have undergone a repair, in conjunction with training of the surgical staff and medical students. A new technique for the management of a prolapsed colostomy has been developed and a protocol for management of PSARP patients postoperatively has been formulated. Patients referred to the paediatric surgical visiting teams were diagnosed and treated according to the stage their management had reached. Patients with a low anomaly were treated by a cutback procedure, those with a colostomy and a high lesion were managed by a PSARP and those with failed previous surgery were managed with a redo anorectoplasty, often without a covering colostomy. Data were collected on the patients treated and, where possible, the patients were followed during subsequent visits. 65 patients with an anorectal anomaly were treated, of whom 6 were treated with a cutback and 43 had a primary repair of a major anomaly. 5 of these 43 involved an abdominoperineal procedure. 19 children had redo surgery, 3 of whom had a second operation by the senior author, due to failure of initial postoperative management; 1 of these was for a failure to carry out the postoperative dilatations and 2 were due to poorly controlled constipation in the early postoperative period. A protocol for the postoperative dilatations was developed using shaped candles. Major complications were uncommon, in particular infections were rare despite the relative lack of facilities. However, difficulties with outpatient follow-up resulted in problems that could have been avoided. A large number of anorectal anomalies have been successfully treated as part of the MONAHP and PIP projects with local surgeons learning the technique. A protocol for follow-up and a technique for the management of colostomy prolapse have been developed.
1982年描述了用于肛门闭锁患儿确定性修复的后矢状位肛门直肠成形术（PSARP）。不幸的是，巴布亚新几内亚（PNG）的外科医生直到最近才有机会接受该技术的培训。通过皇家澳大利亚外科学院的医务人员、护理及相关健康科学培训项目（MONAHP）和太平洋岛屿项目（PIP），65名患有肛门直肠畸形的巴布亚新几内亚儿童接受了修复手术，同时对手术人员和医学生进行了培训。已开发出一种处理脱垂结肠造口术的新技术，并制定了PSARP患者术后管理方案。转诊至小儿外科巡回医疗队的患者根据其治疗阶段进行诊断和治疗。低位畸形患者采用缩减手术治疗；有结肠造口术和高位病变的患者采用PSARP治疗；既往手术失败的患者采用再次肛门直肠成形术治疗，通常不进行保护性结肠造口术。收集了接受治疗患者的数据，并在可能的情况下，在后续随访中对患者进行跟踪。65名患有肛门直肠畸形的患者接受了治疗，其中6名采用缩减手术治疗，43名对主要畸形进行了一期修复。这43例中有5例涉及腹会阴手术。19名儿童接受了再次手术，其中3名因术后初始管理失败由资深作者进行了二次手术；其中1例是由于未进行术后扩张，2例是由于术后早期便秘控制不佳。使用成形蜡烛制定了术后扩张方案。主要并发症并不常见，特别是尽管设施相对匮乏，但感染很少见。然而，门诊随访困难导致了一些本可避免的问题。作为MONAHP和PIP项目的一部分，大量肛门直肠畸形已成功治疗，当地外科医生也学会了该技术。已制定了随访方案和结肠造口脱垂处理技术。
