Combined laparoscopic and modified posterior sagittal approach saving the external sphincter for rectourethral fistula: an easier and more physiologic approach.

AIM: To present surgical technique and results of combined laparoscopic and modified posterior sagittal approach (PSAP) saving the external sphincter in the management of rectourethral fistula. METHODS: The operation was started by a laparoscopic approach to dissect around the rectal pouch and separate the rectal pouch from the upper urethra. The PSAP saving the external sphincter was added to completely separate the rectal pouch from the urethra. The fistula was divided and closed. The rectal pouch was then pulled through a tunnel created at the center of the external sphincter and an anoplasty was performed. RESULTS: From September 2011 to September 2012, 19 patients were operated on using the same technique. Mean age of patients was 4.0 ± 1.8 months. Rectourethral fistula was located in the prostatic urethra in 15 patients and in the bulbar urethra in 4 patients. The mean operative time was 82 ± 13 min. There were no intraoperative complications. Postoperative perforation of the posterior wall of the rectum happened in one patient and required a second laparoscopic operation. Follow-up after closure of colostomy from 1 month to 7 months revealed all patients were able to pass stool spontaneously. All patients could urinate easily. No urethral fistula or diverticulum was detected on voiding cysto-urethrography. CONCLUSIONS: Combined laparoscopic and PSAP saving the external sphincter is the easier and more physiologic approach to manage rectourethral fistula with fewer complications.

Single trocar laparoscopic-assisted colostomy in newborns.

To present the technique and outcomes of single trocar laparoscopic-assisted colostomy in newborns. A rectangular skin flap was developed at the left subcostal area and detached from the fascia. Then the fascia and peritoneum were opened longitudinally around 11 mm, and then a 10-mm trocar was inserted into the abdominal cavity. The 10-mm operating laparoscope (Stema, Germany) was inserted through the trocar. The left transverse colon was inspected, grasped and brought outside the abdominal cavity with a Babcock grasper. The skin flap was inserted through a window created at the colon mesentery and secured to the opposite side to elevate the colon. A loop colostomy was performed. From August 2009 to December 2011, single trocar laparoscopic-assisted colostomy was performed for 39 newborns with anorectal malformations, including 26 boys and 13 girls. Mean operative time was 24 ± 4 min (range 20-30 min). There were no perioperative deaths or complications. Mean postoperative stay was 3 ± 0.6 days. Single trocar laparoscopic-assisted colostomy is a feasible and safe procedure in newborns.

Single trocar retroperitoneoscopic assisted ipsilateral ureteroureterostomy for ureteral duplication.

The aim of this study is to present the technique and early outcomes of single trocar retroperitoneoscopic assisted ureteroureterostomy for ureteral duplication. The patient was placed in a lateral decubitus position. A skin incision of 11 mm width was made above the iliac crest. The operation was performed through single trocar with operating laparoscope. The two ureters were encircled with a vessel loop and exteriorized outside the retroperitoneal space via trocar incision. The pathologic ureter was divided as low as possible. The recipient ureter was opened longitudinally. End-to-side ureteroureterostomy anastomosis was performed extracorporeally with two running 6/0 PDS sutures. From December 2010 to July 2011, nine patients were operated on using the same technique. Patient's ages ranged from 2 to 72 months. Mean operative time was 78 ± 21 min. There were no intra or postoperative complications. Postoperative stay was 2.6 ± 1.0 days. Follow-up revealed that two renal moieties preserved their functions in all patients. The diameter of involved ureters and pelvises was significantly reduced in all patients. Single trocar retroperitoneoscopic assisted ureteroureterostomy is safe and effective procedure for ureteral duplication.

Single trocar retroperitoneoscopic nephrectomy for unilateral multicystic dysplastic kidney in children.

The author presents the first report in performing single trocar nephrectomy for five patients with multicystic dysplastic kidney (MCDK). The mean operative time was 66 min and mean postoperative hospital stay was 36 h. There were no perioperative complications. The one-trocar nephrectomy is a feasible and safe procedure for patients with MCDK.

Long-term follow-up results of the treatment of high and intermediate anorectal malformations using a modified technique of posterior sagittal anorectoplasty.

The aim of this study was to evaluate the long-term follow-up result of a modified technique in the operation for high and intermediate anorectal malformations. The operation was performed by a posterior sagittal approach with three modifications: The external sphincter complex was not opened on the posterior side, the rectal pouch was not tapered, the dissection was performed outside the rectal pouch. From January 1984 to December 1992, 70 cases were operated on including 55 boys and 15 girls. There was one postoperative death during the first 48 hours due to malignant hyperthermia and one late death due to an unrelated disease. A follow-up result was obtained in 48 of 68 survivors (71 %) with follow-up ranging from 13 months to 10 years 11 months (mean: 72 months). According to the modified Wingspread criteria, 2 patients (4 %) had very good anorectal function, 26 children (54 %) had good anorectal function, 18 children (38 %) had fair anorectal function, and only two children (4 %) had poor anorectal function. All children had urinary continence and all boys had a normal erection. The long-term follow-up result was satisfactory. Two important factors affecting the anorectal function were the type of malformations and the thickness of the external sphincter complex.

The long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease in Vietnamese children.

The aim of this prospective study was to evaluate the long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease in Vietnamese children. The surgical intervention was performed in three stages. Swenson's operation was performed by the same surgical team. Hirschsprung's disease was confirmed by an operative rectal biopsy. Regular out-patient attendances were made for follow-up. From January 1987 to January 1990, 69 patients including 61 boys and eight girls underwent Swenson's operation at a mean age of two years and five months (range from seven months to 14 years). There were two postoperative deaths during first 48 hours due to sepsis and two other late deaths due to severe enterocolitis (four months and six months after closure of colostomy respectively). Complications such as anastomotic leakage, anastomotic stenosis, perianal abcess, pelvic abcess did not occur. A follow-up result was obtained in 54 of 65 survivors (83%) with follow-up ranging from two to five years (mean: three years and six months). 51 of 54 children (94%) had a normal evacuation. Constipation persisted in three children (6%). Fecal soiling occurred in four children (8%) and stress urinary incontinence in one child (2%). All boys (47 children) had a normal erection. 53 patients (98%) had a normal weight growth, whereas 48 patients (89%) had a normal height growth. In conclusion, the long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease was satisfactory.