A New Pouch-tapering Technique for the Management of Congenital Pouch Colon.

AIM

The contemporary surgical management of congenital pouch colon (CPC) includes either excision or tapering of the pouch. The aim was to analyze the results of a new technique of pouch tapering by excising the lateral outpouching like a diverticulum and pull-through of the remaining tapered colon.

METHODS

In this retrospective study, patients with type 1 and 2 CPC who underwent a three-stage operation consisting of (a) sitting a stoma just proximal to the pouch preserving the ileocecal valve wherever possible, (b) pouch tapering with pull-through, and (c) stoma closure was analyzed. The terminal fistula was separated from the bladder in males and its lowest termination in females. Pouch tapering was done eliminating the lateral outpouching such as a diverticulum of the pouch and tubularization of the remaining colon. The tapered colon was pulled through the sphincter complex and anoplasty was completed. The postoperative results were analyzed for fecal continence, nutritional status, and any re-dilatation.

RESULTS

The study included eight patients with five males and five females over the period of the last 16 years. In three female patients, the residual lateral outpouching like a diverticulum with its vascular pedicle was retained with a small external stoma and two patients later underwent bladder augmentation using the same for management of urinary incontinence. During follow-up visits up to 4 years, the bowel continence was fair with minimum peri-anal excoriation and no re-dilatation with satisfactory nutritional status.

CONCLUSIONS

The outcome of this New tapering technique (NTT) for type 1 and 2 CPC by eliminating the lateral outpouching like a diverticulum and retaining the remaining tubular terminal bowel was satisfactory in terms of continence and nutrition. The excluded portion of the pouch is a potential source for bladder augmentation.