Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
J Pediatr Surg. 2021 Apr;56(4):821-824. doi: 10.1016/j.jpedsurg.2020.12.010. Epub 2020 Dec 24.
The use of transanal proctectomy may have particular advantages for pediatric patients with small pelvic working space. We report short-term outcomes of transanal completion proctectomy (taCP) during surgery for inflammatory bowel disease.
All patients (age≤19) underwent taCP from January 1, 2018 to December 31, 2019. Prior total abdominal colectomy (TAC) was performed using a single-incision technique. At operation, patients underwent single-incision laparoscopy with taCP. Patient demographics, pre and perioperative details, and postoperative complications were abstracted.
Seven patients (n = 6) with a median age of 18 years [Range: 13-19] were included in this initial series. All patients had a prior TAC with end-ileostomy with taCP occurring a median of 6 [Range: 3-89] months after TAC. Six of 7 had a diagnosis of ulcerative colitis (UC) while 1 patient had Crohn's colitis. For patients with UC, taCP was part of an ileal pouch-anal anastomosis with the majority (n = 4) proceeding as a modified-two stage and the remaining (n = 2) a three-stage approach. Single-incision laparoscopy through the prior ileostomy site was used in all IPAA patients. Median operative time was 226 [Range: 150-264] minutes with no conversions to more invasive technique. Median hospital length of stay (LOS) was 5 [Range: 2-8] days. In-hospital complications occurred in two patients who had watery diarrhea that prolonged LOS but resolved postdischarge. One patient was readmitted for bowel obstruction that resolved with placement of red rubber catheter at the ileostomy site. Of the 4 patients with a functioning ileal pouch, 1 patient reported 6-10 bowel movements per day, while 3 others reported ≤5 bowel movements per day. Half (n = 2) reported 1-2 nocturnal bowel movements at their first postoperative visit. No patients reported soiling or leakage, though one patient had a single episode of incontinence.
In this pilot series, transanal proctectomy was effective and safe. Future work should compare traditional MIS completion proctectomy to taCP for applications in pediatric inflammatory bowel disease.
Case series.
IV.
经肛门直肠切除术在盆腔工作空间较小的儿科患者中可能具有特殊优势。我们报告了在炎症性肠病手术中进行经肛门完成直肠切除术（taCP）的短期结果。
所有患者（年龄≤19 岁）均于 2018 年 1 月 1 日至 2019 年 12 月 31 日期间接受 taCP。所有患者均采用单切口技术进行先前的全腹结肠切除术（TAC）。在手术中，患者接受单切口腹腔镜 taCP。提取患者的人口统计学、术前和围手术期细节以及术后并发症等数据。
该初始系列纳入了 7 名患者（n=6），中位年龄为 18 岁[范围：13-19]。所有患者均行先前的 TAC 加末端回肠造口术，taCP 中位时间为 TAC 后 6 个月[范围：3-89]。7 名患者中有 6 名诊断为溃疡性结肠炎（UC），1 名诊断为克罗恩病结肠炎。对于 UC 患者，taCP 是回肠袋肛管吻合术的一部分，其中大多数（n=4）采用改良两期法，其余（n=2）采用三期法。所有接受 IPAA 手术的患者均通过先前的回肠造口术部位进行单切口腹腔镜检查。中位手术时间为 226 分钟[范围：150-264]，无转为更具侵袭性技术的病例。中位住院时间（LOS）为 5 天[范围：2-8]。2 名患者出现腹泻延长 LOS 的院内并发症，但出院后得到缓解。1 名患者因肠梗阻再次入院，在回肠造口部位放置了红色橡胶导管后得到解决。在 4 名具有功能回肠袋的患者中，1 名患者报告每天有 6-10 次排便，而其他 3 名患者报告每天有≤5 次排便。一半（n=2）患者在第一次术后就诊时报告有 1-2 次夜间排便。无患者报告有污粪或渗漏，但有 1 名患者有单次失禁。
在这项初步系列研究中，经肛门直肠切除术是有效且安全的。未来的研究应比较传统的微创完成直肠切除术与 taCP 在儿科炎症性肠病中的应用。
病例系列。
IV。
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