Technique and long-term results of coloplasty for congenital short colon.

PURPOSE

This paper aims to present the modified technique of coloplasty for congenital short colon (CSC) and analyse the long-term results of this operative procedure.

METHODS

A total of 310 patients of CSC have been admitted to out department between 1975 and 2007; 138 have been treated by the modified technique of coloplasty. Seven patients expired after coloplasty and nine are awaiting ileostomy closure. One hundred and twenty-two have completed all stages of surgery (study group). In these patients, three-stage surgical management (window colostomy, coloplasty with ileostomy and ileostomy closure) was performed. The range of follow-up is from 2 months to 18 years. The patients have been observed for: quality of muscle at the time of PSARP, Kelly's continence score, growth and development, schooling and social interactions and complications. Contrast study of the coloplasty tube has been done at different stages during follow-up with observation of colon diameter, evidence of peristalsis and colon emptying.

RESULTS

Ninety-seven patients from the study group have good quality of life, normal growth and development, where appropriate, they go to school and have normal social interactions. Using Kelly's scoring system, the results are good in 97 (stool frequency up to 3/day, no perineal excoriation, no soiling), fair in 9 (stool frequency 3-5/day, occasional perineal excoriation and occasional soiling) and poor in 16 (continuous stooling, soiling, perineal excoriation or complications). Complications include perineal dehiscence needing permanent colostomy (n=1), closure of the distal end of the coloplasty tube requiring revision (n=2), adhesive intestinal obstruction requiring re-exploration (n=2). Additionally intractable perineal excoriation (n=8), colonic dilatation requiring pouch excision and conversion to ileal 'S' pouch (n=2) and failure to thrive (n=4) were also seen.

CONCLUSIONS

Congenital short colon is the most severe colonic malformation barring cloacal exstrophy; however, good quality of life can be offered to these patients by coloplasty. The important technical step is to make the colonic tube long and small in diameter, so that it can propel stools and resist dilatation. These steps have been highlighted in the paper.