Anorectal malformations: definitive surgery during adulthood.

BACKGROUND: Anorectal malformations (ARMs) are rarely seen in adults, since majority of cases are corrected in infancy or childhood. The aim of this study was to describe the profile of patients who underwent definitive surgery to correct their ARM in adulthood, and to discuss the outcomes of surgery (morbidity, mortality, and function). METHODS: This retrospective study included patients 18 years old and above, managed surgically by the Division of Colorectal Surgery at the Philippine General Hospital, University of the Philippines, Manila, from January 1, 2004, to December 31, 2012. Data from the Integrated Surgical Information System and the patients' hospital records were used to fill out a Data Collection Form. Frequencies and percentages were then computed. RESULTS: Eight patients were included in the study. The most common reason for consult was recurrent urinary tract infection (UTI, 25%). One patient had an imperforate anus (IA) without a fistula, and 1 patient had IA with rectal atresia, and the 6 had an IA with a fistula. All but one (87.5%) of the patients had undergone a prior diversion in infancy or childhood. Definitive surgical procedures included posterior sagittal anorectoplasty (PSARP) in 3 patients, anal transposition in 2 patients, laparotomy with colocutaneous anastomosis in two patients, and laparotomy and PSARP in 1 patient. There were 3 cases (37.5%) of postoperative complications. These complications included ureteral injury, enterocutaneous fistula, anal stricture, rectal stricture, rectovesical fistula, and recurrent rectourethral fistula. There was no reported mortality. Five patients already had their stomas reversed at the time of this writing. CONCLUSION: Our results showed that the rarity of the disease, limited surgical experience, and a technically challenging anatomy make the management of ARMs that persist into adulthood a formidable undertaking.

A randomized controlled clinical trial comparing the outcomes of circumferential subcuticular wound approximation (CSWA) with conventional wound closure after stoma reversal.

BACKGROUND: The creation of a stoma is commonplace in colorectal surgery. Circumferential subcuticular wound approximation (CSWA) is a method of wound closure following stoma reversal that has been reported to result in decreased wound infection rates and more desirable aesthetic outcomes. The aim of the present study was to determine the effectiveness of the CSWA method, in terms of wound infection and cosmesis by comparing the technique to the conventional method of wound closure. METHODS: All adult patients who presented for stoma reversal at the outpatient clinic of the Division of Colorectal Surgery at the Philippine General Hospital were randomized into two groups, CSWA and conventional. Patients were followed up for up to 30 days postoperatively, photographic documentation of wound appearance was obtained, and wound infections and complications were documented. Patients were asked to complete a satisfaction survey at the end of the follow-up period. RESULTS: A total of 121 patients were included in the study. One (1.6%) patient in the CSWA group developed wound infection, while six (10%) patients in the conventional group had a wound infection (p = 0.061). The CSWA group had a higher total satisfaction score than the conventional group (25 and 24, respectively, p = 0.012). CONCLUSIONS: With regard to wound infection rates, the CSWA method was better than the conventional method, although this was found to be borderline significant. With regard to patient satisfaction, the CSWA method proved to be superior to the conventional method, and this was found to be statistically significant. In addition, the technique is applicable to all forms of stoma regardless of the bowel segment involved, trephine size, and indication for diversion.