Application of Yang-Monti's Principle as Part of Reconstructive Procedures for Complex Pediatric Surgical Cases: A...

Reconstructive surgery in pediatric patients often presents unique challenges due to anatomical and physiological differences compared to adults. The Yang-Monti principle, first described for urological reconstruction, has gained widespread recognition as a versatile technique for creating conduits and tubular structures in complex pediatric cases.

This is a retrospective study from January 2023 to December 2023, 9 cases aged 7-15 years with 5 females and 4 males. The conditions managed included variant posterior cloaca, traumatic urethral injury, Mayer-Rokitansky-Küster-Hauser syndrome, neurogenic bladder due to tethered cord and anorectal malformation, aphallia, common cloaca, both long and short channel, left ureteric stricture, and malone antegrade continence enema in operated cases of anorectal malformations with incontinence each. All patients were evaluated preoperatively and underwent staged procedures for correction of primary pathology. Previously and at present were operated for final reconstructive procedures. Monti's procedure was performed by isolating a segment of sigmoid colon or ileum, which is detubularized along the mesentery, folded, and retubularized longitudinally, and then anastomosed to the proposed anatomical site.

All nine cases had no postoperative surgical complications. Follow-up up to 1 year showed satisfactory outcomes with no hindrance in any daily activity.

Yang-Monti's principle provides a reliable, adaptable, and effective solution for complex pediatric reconstructive surgeries. Though Yang-Monti's principle is commonly used as a conduit, our institution recommends using the same principle for reconstructive procedures involving neourethral, neoureteral, and neovaginal construction, ensuring improved quality of life for paediatric patients.