The serial transverse enteroplasty (STEP) has been shown to improve nutritional indices in an animal model of short bowel syndrome. The aim of this study was to review short-term surgical and nutritional outcomes in t...The serial transverse enteroplasty (STEP) has been shown to improve nutritional indices in an animal model of short bowel syndrome. The aim of this study was to review short-term surgical and nutritional outcomes in the first cohort of infants to undergo the STEP procedure at our institution. Methods: All patients who underwent the STEP procedure during a 26- month period from February 2002 to March 2004 were reviewed. Paired t tests were used for comparisons between values pre-STEP and post-STEP (P < . 05 deemed significant). Data are expressed as mean and range. Results: The STEP was performed on 5 patients, including 1 newborn. The STEP was used as a primary lengthening operation in 4 patients. Intestinal length was significantly increased in all patients with 18 (10- 26) stapler applications. There were no perioperative complications and no evidence of intestinal leak or obstruction on routine postoperative contrast study. Nutritional follow-up was available on 3 subjects at 17 (11- 26) months post-STEP. Percentage of enteral nutrition was significantly increased in these subjects (P <. 05). One subject was fully weaned from total parenteral nutrition 6 weeks after the STEP, and bilirubin in another patient with profound cholestasis who had been listed for liver-small bowel transplant normalized after the STEP. An additional patient, with established cirrhosis before operation, underwent successful liver-small bowel transplantation 8 months after intestinal lengthening. Conclusion: The STEP procedure is a simple bowel-lengthening procedure with promising early surgical and nutritional outcomes. Further data from a multicenter registry are needed to demonstrate its longterm efficacy.展开更多
Background/Aim: Imperforate anus without fistula consists of a spectrum of defects with variable distance between the rectal pouch and the perineum. We have developed a novel surgical approach for individual man ageme...Background/Aim: Imperforate anus without fistula consists of a spectrum of defects with variable distance between the rectal pouch and the perineum. We have developed a novel surgical approach for individual man agement of these patients based on precise knowledge of the level of the anomaly. Methods: All consecutive patients with imperforate anus without fistula between 2002 and 2004 had sigmoidostomy performed after having failed to pass meconium in the first 24 hours. The upper pouch was intraluminally visualized using retrograde endoscopy through the sigmoidmucous fistula. The distal termination of the rectum was clearly identified as by convergence of the anal columns. Bright translumination of the endoscope light from the rectum to the anal dimple within the external sphincter indicated a low malformation amenable to transanal proctoplasty. The rectum was incised from below under endoscopic visual control. Poor translumination indicated a higher defect,in which case,the operation was converted to standard posterior sagittal anorectoplasty. Results: Seven patients (6 boys) were identified. Four patients (3 boys) completed transanal endoscopic-assisted proctoplasty. In all cases,the convergence of anal columns indicating rectal termination was right above the anal pit at the site of the maximal external sphincter squeeze. In 3 patients,the operation was converted to posterior sagittal anorectoplasty after verification of a higher anomaly by endoscopy. There were no operative complications. The median follow-up was 3 months (range,1-26 months). All patients have an appropriate size anus and regular bowel actions. Conclusions: Transanal endoscopic-assisted proctoplasty allows safe and anatomical reconstruction of the anorectum,as well as contemporaneous closure of the sigmoidostomy in a significant proportion of patients with imperforate anus without fistula,avoiding the potential complications associated with the open posterior sagittal approach.展开更多
Small bowel atresia is associated with a large size discrepancy between the proximal and distal segments of bowel that has traditionally been managed by resection of the dilated segment, tape ring enteroplasty, or pli...Small bowel atresia is associated with a large size discrepancy between the proximal and distal segments of bowel that has traditionally been managed by resection of the dilated segment, tape ring enteroplasty, or plication. Longitudinal intestinal lengthening is rarely p erformed at the time of the initial operation. Many patients with small bowel at resia also have a short length of residual small intestine secondary to in utero resorption. The authors present the clinical application of the novel intestina l lengthening procedure, the serial transverse enteroplasty, in a neonate with p roximal jejunal atresia and suggest that it become part of the armamentarium for surgeons treating patients with this anomaly.展开更多
In intestinal atresia, resection of the proximal dilated bowel segment, if long, might lead to bowel length compromise.Although tapering enteroplasty and plication are well described to avoid such a resection, the use...In intestinal atresia, resection of the proximal dilated bowel segment, if long, might lead to bowel length compromise.Although tapering enteroplasty and plication are well described to avoid such a resection, the use of serial transverse enteroplasty is proposed here as an alternative in this situation.展开更多
文摘The serial transverse enteroplasty (STEP) has been shown to improve nutritional indices in an animal model of short bowel syndrome. The aim of this study was to review short-term surgical and nutritional outcomes in the first cohort of infants to undergo the STEP procedure at our institution. Methods: All patients who underwent the STEP procedure during a 26- month period from February 2002 to March 2004 were reviewed. Paired t tests were used for comparisons between values pre-STEP and post-STEP (P < . 05 deemed significant). Data are expressed as mean and range. Results: The STEP was performed on 5 patients, including 1 newborn. The STEP was used as a primary lengthening operation in 4 patients. Intestinal length was significantly increased in all patients with 18 (10- 26) stapler applications. There were no perioperative complications and no evidence of intestinal leak or obstruction on routine postoperative contrast study. Nutritional follow-up was available on 3 subjects at 17 (11- 26) months post-STEP. Percentage of enteral nutrition was significantly increased in these subjects (P <. 05). One subject was fully weaned from total parenteral nutrition 6 weeks after the STEP, and bilirubin in another patient with profound cholestasis who had been listed for liver-small bowel transplant normalized after the STEP. An additional patient, with established cirrhosis before operation, underwent successful liver-small bowel transplantation 8 months after intestinal lengthening. Conclusion: The STEP procedure is a simple bowel-lengthening procedure with promising early surgical and nutritional outcomes. Further data from a multicenter registry are needed to demonstrate its longterm efficacy.
文摘Background/Aim: Imperforate anus without fistula consists of a spectrum of defects with variable distance between the rectal pouch and the perineum. We have developed a novel surgical approach for individual man agement of these patients based on precise knowledge of the level of the anomaly. Methods: All consecutive patients with imperforate anus without fistula between 2002 and 2004 had sigmoidostomy performed after having failed to pass meconium in the first 24 hours. The upper pouch was intraluminally visualized using retrograde endoscopy through the sigmoidmucous fistula. The distal termination of the rectum was clearly identified as by convergence of the anal columns. Bright translumination of the endoscope light from the rectum to the anal dimple within the external sphincter indicated a low malformation amenable to transanal proctoplasty. The rectum was incised from below under endoscopic visual control. Poor translumination indicated a higher defect,in which case,the operation was converted to standard posterior sagittal anorectoplasty. Results: Seven patients (6 boys) were identified. Four patients (3 boys) completed transanal endoscopic-assisted proctoplasty. In all cases,the convergence of anal columns indicating rectal termination was right above the anal pit at the site of the maximal external sphincter squeeze. In 3 patients,the operation was converted to posterior sagittal anorectoplasty after verification of a higher anomaly by endoscopy. There were no operative complications. The median follow-up was 3 months (range,1-26 months). All patients have an appropriate size anus and regular bowel actions. Conclusions: Transanal endoscopic-assisted proctoplasty allows safe and anatomical reconstruction of the anorectum,as well as contemporaneous closure of the sigmoidostomy in a significant proportion of patients with imperforate anus without fistula,avoiding the potential complications associated with the open posterior sagittal approach.
文摘Small bowel atresia is associated with a large size discrepancy between the proximal and distal segments of bowel that has traditionally been managed by resection of the dilated segment, tape ring enteroplasty, or plication. Longitudinal intestinal lengthening is rarely p erformed at the time of the initial operation. Many patients with small bowel at resia also have a short length of residual small intestine secondary to in utero resorption. The authors present the clinical application of the novel intestina l lengthening procedure, the serial transverse enteroplasty, in a neonate with p roximal jejunal atresia and suggest that it become part of the armamentarium for surgeons treating patients with this anomaly.
文摘In intestinal atresia, resection of the proximal dilated bowel segment, if long, might lead to bowel length compromise.Although tapering enteroplasty and plication are well described to avoid such a resection, the use of serial transverse enteroplasty is proposed here as an alternative in this situation.
