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[Millard's flap for sequelae of high anorectal malformations. Apropos of 6 cases]
J M Babut1, A Akkouche, H Tekou
1Clinique Chirurgicale Infantile, CHU Pontchaillou, Rennes.
Abstract:
Mucosal prolapse is a frequent sequela after surgical treatment of the high type of anorectal malformation whatever was the technic used for the pull-through operation. The authors report six cases treated with the spiral flap described by Millard. The initial procedures had been a Romualdi-Rehbein pull through in three cases with secondary revision of anoplasty and a Stephan's operation in the three other cases. Before Millard's plasty, all the patients were continent and two of them had an associated stricture. The anatomical result was good in all the cases with reconstruction of a cutaneous anal funnel and no stricture. Improvement of continence was noted in two cases, uncertain in two. Incontinence remained unchanged in two other cases. The advantages of the Millard's plasty are analysed. The prevention of mucosal prolapse is possible in the initial pull through operation using the same plasty or whatever plasty which provides a cutaneous anal canal.
Insights
Mucosal prolapse is a common complication after anorectal malformation surgery. Millard
Area of Science:
- Pediatric Surgery
- Anorectal Malformations
- Surgical Techniques
Context:
- Mucosal prolapse frequently occurs after surgical correction of high-type anorectal malformation.
- Previous surgical techniques include Romualdi-Rehbein pull-through and Stephan's operation.
Purpose:
- To evaluate the efficacy of Millard's spiral flap plasty in treating mucosal prolapse after anorectal malformation surgery.
- To assess the impact of Millard's plasty on anal canal anatomy and continence.
Summary:
- Six cases of post-anorectal malformation surgery mucosal prolapse were treated with Millard's spiral flap.
- Anatomical success was achieved in all cases, with a reconstructed cutaneous anal funnel and no strictures.
- Continence showed improvement in two cases, remained uncertain in two, and unchanged in two.
Impact:
- Millard's spiral flap plasty offers a potential solution for mucosal prolapse following anorectal malformation repair.
- The technique reconstructs a functional cutaneous anal canal, potentially improving anatomical outcomes.
- Further investigation into optimizing continence outcomes with this technique is warranted.
