Effect of surgical techniques on long-term outcome in congenital pouch colon: A tertiary care centre experience

Abstract

Background: The objective of the following study is to assess effect of a novel surgical technique on long-term outcome in operated cases of congenital pouch colon (CPC).

Patients and Methods: We retrospectively analysed our surgical neonatal records from June 2002 to May 2012. Out of 477 cases of anorectal malformations, CPC was found in 73 (15%) cases. Out of 73 cases of CPC, 39 (53.4%) were complete pouch and 34 (46.6%) were incomplete. In addition to invertogram, an erect skiagram was done in all cases to confi rm diagnosis. Patients were operated either by single stage pullthrough or by staged procedure using conventional abdominoperineal (AP) pull-through or by our new hanging bowel technique. All patients were put on bowel management programme starting 1 month post-surgery until 5 years of life.

Results: Children presented to us at median age of 2.1 days. Mean weight at time of presentation was 2.74 kg. In our study, group median age at time of initial procedure was 2.7 days. In staged procedures defi nitive surgery was done after 6 months. Hospital stay in single stage procedure using the hanging bowel technique was 9.7 days while 17.4 days in conventional AP pull-through. Complication rate were high in conventional pullthrough when compared to hanging bowel technique as shown by the signifi cant P < 0.05.

Conclusion: Our novel surgical technique for pull-through is suitable for both single stage as well as staged pullthrough. Bowel enema programme should be an integral part of management of CPC.

Key words: Bowel training programme, congenital pouch colon, hanging bowel technique, pull-through