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Two-staged management for all types of congenital pouch colon
Rajendra K Ghritlaharey1, K S Budhwani
1Department of Paediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India.
Insights
Two-staged management for congenital pouch colon (CPC) is safe and effective, yielding good functional outcomes. This approach avoids the need for a protective stoma, simplifying treatment and reducing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Malformations
Background:
- Congenital pouch colon (CPC) is a rare anorectal malformation.
- Previous management strategies for CPC have varied.
- Evaluating two-staged management for all CPC types is crucial.
Purpose of the Study:
- To review the experience with two-staged management for all congenital pouch colon (CPC) types.
- To assess the safety and efficacy of this surgical approach.
- To analyze functional outcomes and complications.
Main Methods:
- Retrospective study of 11 CPC cases managed with two-staged procedures over 12 years.
- Classification of CPC types (I-IV) based on Narsimha Rao et al.
- Analysis of initial and definitive operative procedures, including pouch excision with abdomino-perineal pull-through (APPT).
Main Results:
- CPC represented 13.71% of all anorectal malformations (ARM) and 28.19% of high ARM.
- Eleven male cases underwent two-staged procedures.
- Good fecal continence was achieved in 6/11 cases; no mortality was observed.
Conclusions:
- Two-staged procedures for all CPC types are safe and yield good results.
- This approach eliminates the need for a protective stoma, avoiding associated complications and costs.
- Definitive procedures without protective stomas simplify management and improve patient outcomes.
Background:
The aim of this study was to review our experience with two-staged management for all types of congenital pouch colon (CPC).
Patients And Methods:
This retrospective study included CPC cases that were managed with two-staged procedures in the Department of Paediatric Surgery, over a period of 12 years from 1 January 2000 to 31 December 2011.
Results:
CPC comprised of 13.71% (97 of 707) of all anorectal malformations (ARM) and 28.19% (97 of 344) of high ARM. Eleven CPC cases (all males) were managed with two-staged procedures. Distribution of cases (Narsimha Rao et al.'s classification) into types I, II, III, and IV were 1, 2, 6, and 2, respectively. Initial operative procedures performed were window colostomy (n = 6), colostomy proximal to pouch (n = 4), and ligation of colovesical fistula and end colostomy (n = 1). As definitive procedures, pouch excision with abdomino-perineal pull through (APPT) of colon in eight, and pouch excision with APPT of ileum in three were performed. The mean age at the time of definitive procedures was 15.6 months (ranges from 3 to 53 months) and the mean weight was 7.5 kg (ranges from 4 to 11 kg). Good fecal continence was observed in six and fair in two cases in follow-up periods, while three of our cases lost to follow up. There was no mortality following definitive procedures amongst above 11 cases.
Conclusions:
Two-staged procedures for all types of CPC can also be performed safely with good results. The most important fact that the definitive procedure is being done without protective stoma and therefore, it avoids stoma closure, stoma-related complications, related cost of stoma closure and hospital stay.
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