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Objective:To investigate the clinical characteristics and therapeutic laparoscopy treatment for superior mesenteric artery syndrome(SMAS) in children.Methods:A retrospective study on 5 children with SMAS who failed to respond to the conservative treatment in the Second Hospital of Shandong University from March 2017 to March 2022 was carried out.All the patients underwent the laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure.The clinical data were analyzed and literature retrieved from Wanfang and PubMed databases were reviewed.Results:There were 3 boys and 2 girls in the 5 cases with SMAS.The average age was (12.4±1.4) years, and the preoperative body mass index was (15.2±0.8) kg/m 2.The patients were admitted to the hospital with vomiting, abdominal pain and emaciation symptoms, and the duration of symptoms was (8.4±7.8) months.Gastroscopy, laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure were performed successfully in all the patients, without conversions to open surgery.The average operation duration was (66.0±10.7) min.Food intake was allowed 1 day after surgery.Chylous fistula occurred 4 days after operation in one patient, whose symptom relieved after 11 days of conservative treatment.One patient still had nausea and vomiting symptoms 10 days after operation and was healed by knee-chest posture treatment.No other short-term complications were observed.The median postoperative duration of stay in the hospital was 7 (6-22) days.The patients were followed up for 9-56 (median: 21) months.All of them recovered well and gained weight.One patient had mild recurrent symptoms, and was cured after conservative treatment.A total of 15 literature on the treatment of SMAS by laparoscopic lysis of the ligament of Treitz was retrieved, and the cure rate was 40%-100%.Only one group of these cases had a cure rate below 75%. Conclusions:The laparoscopic lysis of the ligament of Treitz and duodenal lowering procedure is safe, effective, simple and minimally invasive treatment for children with SMAS.It can be used as the first choice for most pediatric patients.
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<p><b>OBJECTIVE</b>To evaluate the application of anal endosonography in the morphology of internal anal sphincter (IAS), external anal sphincter (EAS) and puborectalis (PR) in order to provide necessary information for analysis of the etiology of fecal incontinence and formulation of the therapeutic schedule.</p><p><b>METHODS</b>From December 2010 to November 2012, 18 children of anorectal malformation (n=14) or Hirschsprung's disease(n=4) with fecal incontinence received anal endosonography. The morphology of IAS, EAS and PR was observed. The damage of anal sphincter was classified according to Starck criteria. Anorectal mamometry and anal clinical score were measured simultaneously. Spearman analysis was performed to examine the correlation of anal sphincter damage with anorectal mamometric score and anal clinical score.</p><p><b>RESULTS</b>According to Starck criteria, anal sphincter damage was small in 11 children, moderate in 6, and severe in 1. PR damage was found in 4 cases. Starck score was positively correlated with manometric score(P<0.05), while not correlated with anal clinical score(P>0.05).</p><p><b>CONCLUSIONS</b>Anal endosonography can clearly display the morphology of IAS, EAS and PR, and their integrity and damage degree. It is a very valuable technique to evaluate the anal sphincter of the children with fecal incontinence, which however can not reflect the function of anal sphincter and anal continence thoroughly.</p>
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Child , Humans , Anal Canal , Diagnostic Imaging , Endosonography , Fecal Incontinence , Diagnostic Imaging , ManometryABSTRACT
Objective: To investigate the shortterm efficiency of overflow fecal incontinence treated by biofeedback and electrical stimulating therapy. Methods: Twenty children with overflow fecal incontinence were given combined therapy, biofeedback and electricalstimulating therapy,for four weeks. Every therapy cost 20 to 30 minutes. The grading of clinical incontinence degree ,measurement of pressure of the anus and rectum, electromyogram of muscles of solum plevis were done before and after the therapy. Results: Followup was done for a mean of 4.5 years (range 3 to 5), the subjective scores, maximum contractive pressure of anus, last contractive time, rectal volume at sensory threshold, contraction amplitude of external anal sphincter and pudenda neural latency were significantly different from the ones before treatment (P
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Objective To observe the effect of biofeedback therapy combined with electrical stimulation in patients with traumatic faecal incontinence.Methods Eishty-two patients with traumatic faecal incontinence were treated once daily with electric stimulation delivered via an intra-anal electrode.They also followed a biofeedback regimen including strengthening,sensory and coordination biofeedback.The whole progrtun consisted of 3 sessions of supervised treatment in hospital followed by 3 sessions of home therapy(10 days per session with an interval of 7days between the sessions).Clinical scores and anorectal function were assessed before and after the program.Results Before treatment,there were 9 patients with good clinical scores,and the general rate of fair and poor clinical scores Was 89%.After therapy,61 patients had good scores,and the general rate of fair and poor Was 26%.Anorectal squeeze pressure and sphincter electromyographic amplitude had improved significantly,the rectal sensory threshold Was decreased significantly,and 76%of the patients who had no external anal sphincter reflex recovered.At the two years follow-up,68% of the patients had maintained the clinical outcomes.Conclusion Biofeedback therapy in conjunction with electrical stimulation has significant therapeutic effects on patients with traumatic faecal incontinence.
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Objective: To evaluate the anal sphincter function of congenital anorectal malforotation retrospectively.Methods: With continuous pull through technique, the manometry of 22 congenital anorectal malforotation patients and 24 controls were studied and the results were analysed with their clinical scores. Results: Anal resting pressure in the children with neurogenic anorectum induced by myelodysplasia(21.3?3.4) mmHg was lower than that in normal children(66.7?24.0) mmHg.The maximum contractive pressure of anus in the patients(22.4?3.3) mmHg was lower than that in normal children(129.0?18.8) mmHg. The length of high pressure zone in the patients(12.3?4.6 mm) was lower than that in normal children(23.6?4.6 mm). Rectoanal inhibitory reflex was identified in both patients and normal children. Conclusion:Anorectal manometry might be an effective parameter to evaluate the anal sphincter function of congenital anorectal malformation.
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Objective:To study the influence of neurogenic anorectum induced by myelodysplasia on function of anorectum.Methods:Twenty-five patients with myelodysplasia were evaluated by anorectal manometry.The function of anal sphincter was evaluated by resting pressure,contractive pressure and the length of high pressure;The sensation of rectum was evaluated by rectal maximum volume threshold;The function of defecation reflex was evaluated by rectoanal inhibitory reflex.Results:Anal resting pressure in the children with neurogenic anorectum induced by myelodysplasia( 25.8?3.4)mmHg was lower than that in normal children(66.7?24)mmHg.The maximum contractive pressure of anus in patients (86.6?20.1)mmHg was lower than that in normal children(129.0?18.8)mmHg.The length of high pressure in patients (17.5?4.5)mm was lower than that in normal children(23.6?4.6)mm.The rectal volume at sensory threshold in patients(62.1?8.5)ml was higher than that in normal children(36.0?12.6)ml.Rectal maximum volume threshold in patients(141.4?22.6)ml was higher than that in normal children (109.5?12.2)ml.Rectoanal inhibitory reflex was identified in both patients and normal children.Conclusions:Anorectal manometry may provide objective assessment of the neurogenic damage of anorectum in myelodysplasia including the damage of sphincter and the decrease of the rectal sensation. Rectoanal inhibitory reflex was identified in both patients and normal children. The major objective of anorectal treatment for patients with myelodysplasia was to strengthen the function of external sphincter, internal sphincter and pelvis floor muscle and to repair the sensation of rectum.