Simple antireflux technique for the cologastric anastomosis: complementary step in retrosternal colon interposition procedure.

Gastrocolic reflux is a troublesome symptom causing repeated aspiration or chocking in patients underwent retrosternal colon interposition. Various techniques were described to avoid such complication, however, they entail complicated technique that may jeopardize the viability of the graft or cause obstructing symptoms. A simple antireflux procedure is described here alleviating this problem. Over the last 7 years, 87 patients had gastrocolic antireflux procedure for cologastric anastomosis; 75 patients as a primary procedure (group 1) and 12 patients as a secondary procedure treating symptomatic reflux (group 2). The technique entails the creation of cologastric angle after finishing the cologastric anastomosis by applying three stitches between the colon and the stomach, thus tucking the colon to the stomach for 3-4 cm. Gastrocolic reflux was evaluated clinically and radiologically 3 months postoperatively. In group 1, three cases (4%) suffered symptomatic gastrocolic reflux, and seven cases (9.3%) had radiological asymptomatic mild reflux, while all patients in group 2 had complete alleviation of their symptoms with gastrogram showing no reflux. Gastrocolic reflux can be treated simply by creation of cologastric angle; however, controlled trial is needed to confirm its effectiveness in comparison to other described techniques.

Urothelial ingrowth over demucosalized gastrocystoplasty: an experimental study.

OBJECTIVE: To evaluate histopathologically the ingrowth of urothelium over a demucosalized gastric flap used for augmentation, as such flaps increase the capacity of the bladder if the urothelium can cover the seromuscular patch. MATERIALS AND METHODS: The study included eight male dogs; the urinary bladder was widely divided at its dome anteroposteriorly to receive a seromuscular gastric flap, sutured to the edges of the urinary bladder. Before and 1 month after surgery the changes in bladder capacity and pressure were recorded, and urothelial ingrowth assessed histopathologically. RESULTS: Two of the eight dogs died; the increase in mean bladder capacity in the remaining dogs was 20% and the decrease in mean intravesical pressure 34%. Gross pathological examination of the urinary bladder showed good 'take' of the gastric flap by the urinary bladder. Histopathologically, there was good healing of the flap, active ingrowth of urothelium, and no mucosal re-growth. CONCLUSION: Bladder augmentation with a demucosalized gastrocystoplasty allows the creation of a large compliant urinary bladder with few complications caused by the incorporation of the enteric or gastric epithelium into the urinary bladder. The stomach has a rich blood supply, allowing the harvesting of a well-vascularized flap, and urothelial ingrowth over this flap in the present study was significant.

Total urogenital sinus mobilization in the repair of cloacal anomalies and congenital adrenal hyperplasia.

PURPOSE: Urogenital sinus mobilization has facilitated markedly the vaginal reconstruction in cases of cloacal anomalies. Application of the same technique in cases of congenital adrenal hyperplasia has resulted in cosmetic and functional improvement. METHODS: Total urogenital sinus mobilization was used as a part of the repair in 9 patients: 6 with congenital adrenal hyperplasia (4 high and 2 mid vaginal confluence), and 3 with cloacal anomalies; sinus mobilization to the level of the symphesis pubis allowed the vagina to reach the perineum in all cases. Their age ranged from 6 to 8 months, and follow-up ranged from 6 months to 2 years. In the former group, the mobilized sinus was split dorsally and used as an anterior vaginal flap. Cases of cloaca needed weekly dilatation early postoperatively. RESULTS: All patients are below 3 years of age, so urinary control assessment is not yet objective; however, all mothers reported dry intervals. Examination 6 months postoperatively showed wide vagina and excellent cosmetic appearance in all cases. CONCLUSIONS: Total urogenital mobilization provides an easier way for vaginal reconstruction. The improved cosmetic appearance and the absence of vaginal stenosis provided by this technique is a major advantage in the management of these difficult surgical situations.