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Menon R, Saxena R, Jayakumar TK, Sinha A. Minimally Invasive Strategies in Rectal Atresia and Anal Stenosis: A Report of Two Cases. J Indian Assoc Pediatr Surg 2025; 30:394-397. [PMID: 40406334 PMCID: PMC12094603 DOI: 10.4103/jiaps.jiaps_251_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 12/13/2024] [Accepted: 12/20/2024] [Indexed: 05/26/2025] Open
Abstract
This study discusses our experience with rectal atresia and anal stenosis, utilizing a combined laparoscopic and transanal approach. A laparoscopic-assisted pull-through was performed successfully in both cases. Laparoscopic-assisted surgery is done when preserving the anal canal and sphincter complex and avoiding the complete posterior sagittal incision.
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Affiliation(s)
- Revathy Menon
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - T. K. Jayakumar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Liu SQ, Zhang HK, Lv Y, Xu XH, Li YF, Quan DW. Magnamosis for rectal reconstruction in canines. World J Gastrointest Surg 2025; 17:97862. [DOI: 10.4240/wjgs.v17.i2.97862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 10/25/2024] [Accepted: 12/03/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND The magnamosis, a minimal invasive, suture-free procedure, has been used for digestive tract or vessel reconstruction, such as gastrointestinal anastomosis, bilioenteric anastomosis, and coronary artery bypass. Although some case reports have demonstrated the potential of magnamosis for the treatment of congenital rectal atresia (RA), they cannot provide strong evidence for its widespread application.
AIM To assess the feasibility and safety of magnamosis in treating RA in dogs as compared to suturing anastomosis. The findings of this study can be beneficial in guiding the clinical application of magnamosis.
METHODS Thirty-six dogs were randomly assigned to the magnamosis group (n =18) and the suturing anastomosis group (n =18). The rectum was freed laparoscopically in all dogs. In the magnamosis group, rectal anastomosis was performed using a pair of magnetic rings, while the suturing anastomosis group underwent a straight-sighted end-to-end rectal anastomosis with 4-0 absorbable sutures. The anastomosis time was recorded, and abdominal plain film examination was performed to locate the magnets until they were expelled postoperatively. Specimens of the anastomosis were evaluated at one month, three months, and six months after surgery.
RESULTS The mean time for rectal anastomosis was significantly shorter in the magnamosis group (12.22 ± 2.78 minutes) than the suturing anastomosis group (18.11 ± 1.68 minutes). There was one incidence of anastomotic bleeding in the suturing anastomosis group, whereas no complication was recorded in the magnamosis group. The magnets were discharged post-surgery in 7.17 ± 1.30 days in all the dogs. The histopathological examination revealed a smoother healing of anastomotic mucosa in the magnamosis group as compared to that in the suturing anastomosis group. Moreover, the fiber alignment was also more natural in the magnamosis group with minimal inflammation.
CONCLUSION Rectal reconstruction using magnamosis is a feasible, safe, and effective alternative to suturing anastomosis in dogs, with the added benefit of faster and more natural healing of the anastomosis.
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Affiliation(s)
- Shi-Qi Liu
- Medical College, Xijing University, Xi’an 710123, Shaanxi Province, China
| | - Hong-Ke Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi’an 710061, Shaanxi Province, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xiang-Hua Xu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi’an 710061, Shaanxi Province, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yu-Feng Li
- Department of Pediatric Surgery, Guilin Maternal and Child Health Hospital, Guilin 541001, Guangxi Zhuang Autonomous Region, China
| | - Dong-Wen Quan
- The Second Clinical Medical School, Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi Province, China
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Jiang G, Wu L, Ruan W, Zhu J. Congenital rectal atresia: a case report. Asian J Surg 2024; 47:3796-3797. [PMID: 38719639 DOI: 10.1016/j.asjsur.2024.04.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/18/2024] [Indexed: 10/25/2024] Open
Affiliation(s)
- Guoping Jiang
- Ningbo University Affiliated Women and Children's Hospital, Ningbo, Zhejiang, China.
| | - Lixu Wu
- Ningbo University Affiliated Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Weiwei Ruan
- Ningbo University Affiliated Women and Children's Hospital, Ningbo, Zhejiang, China
| | - JianMing Zhu
- Ningbo University Affiliated Women and Children's Hospital, Ningbo, Zhejiang, China
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Nasr, Eric W. Etchill IW. Congenital Anorectal Malformations and Hirschsprung Disease in the Neonate. PRINCIPLES OF NEONATOLOGY 2024:738-744. [DOI: 10.1016/b978-0-323-69415-5.00085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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de Beaufort CMC, Derikx JPM, de Jong JR, Burchell GL, Bosscha SRJ, de Beer SA, van Heurn LWE, Gorter RR. Outcomes after Surgical Treatment for Rectal Atresia in Children: Is There a Preferred Approach? A Systematic Review. Eur J Pediatr Surg 2023; 33:345-353. [PMID: 36516962 PMCID: PMC10564564 DOI: 10.1055/s-0042-1758152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/26/2022] [Indexed: 12/23/2022]
Abstract
Rectal atresia (RA) affects only 1 to 2% of all children with anorectal malformations. No consensus on optimal treatment strategy is yet achieved. Therefore, the aim of this systematic review is to summarize all surgical interventions for RA and outcomes described in the current literature. A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library on January 24, 2022. All studies describing treatment for RA in children (< 18 years) were included. Operation technique and postoperative complications were listed. Only descriptive analysis was anticipated. Quality of the studies was assessed using Johanna Briggs Institute critical appraisal checklist for case reports and series. The search yielded 6,716 studies of which, after duplicate removal, 4,028 were excluded based on title and abstract screening. After full-text assessment, 22 of 90 studies were included, yielding 70 patients. Posterior sagittal anorectoplasty (PSARP) and pull-through were most performed (43/70 and 18/70 patients, respectively). Four patients experienced postoperative complications: anal stenosis (n = 1), anastomotic stenosis (n = 2), and death due to a pulmonary complication (n = 1). In the low-quality literature available, most patients with RA are treated with PSARP or pull-through technique. A low complication rate of both has been described but follow-up was often not mentioned. Larger well-designed studies should be performed to determine optimal treatment strategy for children with RA. This study reflects level of evidence V.
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Affiliation(s)
- Cunera M. C. de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Joep P. M. Derikx
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Justin R. de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - George L. Burchell
- Department of Medical Library, Amsterdam University Medical Center, Vrije Universiteit of Amsterdam, Medical Library, Amsterdam, the Netherlands
| | - Sterre R. J. Bosscha
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sjoerd A. de Beer
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lodewijk W. Ernest van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Ramon R. Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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de Beaufort CMC, Gorter RR, Iacobelli BD, Midrio P, Sloots CEJ, Samuk I, van Rooij IALM, Lisi G. Rectal atresia and rectal stenosis: the ARM-Net Consortium experience. Pediatr Surg Int 2023; 39:242. [PMID: 37507508 PMCID: PMC10382331 DOI: 10.1007/s00383-023-05518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To assess the number, characteristics, and functional short-, and midterm outcomes of patients with rectal atresia (RA) and stenosis (RS) in the ARM-Net registry. METHODS Patients with RA/RS were retrieved from the ARM-Net registry. Patient characteristics, associated anomalies, surgical approach, and functional bowel outcomes at 1 and 5-year follow-up were assessed. RESULTS The ARM-Net registry included 2619 patients, of whom 36 (1.3%) had RA/RS. Median age at follow-up was 7.0 years (IQR 2.3-9.0). Twenty-three patients (63.9%, RA n = 13, RS n = 10) had additional anomalies. PSARP was the most performed reconstructive surgery for both RA (n = 9) and RS (n = 6) patients. At 1-year follow-up, 11/24 patients with known data (45.8%, RA n = 5, RS n = 6) were constipated, of whom 9 required stool softeners and/or laxatives. At 5-year follow-up, 8/9 patients with known data (88.9%, RA n = 4, RS n = 4) were constipated, all requiring laxatives and/or enema. CONCLUSION RA and RS are rare types of ARM, representing 1.3% of patients in the ARM-Net registry. Additional anomalies were present in majority of patients. Different surgical approaches were performed as reconstructive treatment, with constipation occurring in 46% and 89% of the patients at 1 and 5-year follow-up. However, accurate evaluation of long-term functional outcomes remains challenging.
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Affiliation(s)
- Cunera M C de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Barbara D Iacobelli
- Neonatal Surgery Unit, Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Childrens Hospital, IRCCS, Rome, Italy
| | - Paola Midrio
- Department of Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | - Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Iris A L M van Rooij
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gabriele Lisi
- Department of Pediatric Surgery, Spirito Santo Hospital, Pescara, G. d'Annunzio University, Chieti-Pescara, Italy
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Kurashima M, Joshi S, Sobrino J, Blewett C. Rectal Atresia Treated Via a Transanal and Posterior Sagittal Approach: A Report of Two Cases. Cureus 2023; 15:e38694. [PMID: 37292545 PMCID: PMC10245193 DOI: 10.7759/cureus.38694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
Rectal atresia is a rare cause of bowel obstruction in neonates with a normal-appearing anus. We present two different types of rectal atresia requiring different surgical management. Case one was a one-day-old term male with web-type rectal atresia diagnosed preoperatively with bedside obliteration of the web. Subsequent transanal web resection was performed. Case two was a one-day-old male born at 28 weeks weighing 980 g with significant cardiac defects including aortic atresia. The patient underwent initial colostomy creation and delayed rectal anastomosis via posterior sagittal anorectoplasty. We review the published literature, discuss the surgical strategy, and highlight the decision-making of diverting ostomy creation and approach of definitive anorectal anastomosis.
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Affiliation(s)
- Maho Kurashima
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Samrudhi Joshi
- Pediatric Surgery, Saint Louis University School of Medicine, Saint Louis, USA
| | - Justin Sobrino
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Christopher Blewett
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
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Selection of operative approach in children with Currarino syndrome. Pediatr Surg Int 2023; 39:72. [PMID: 36607405 DOI: 10.1007/s00383-022-05345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To summarize the experience of surgical treatment of children diagnosed with Currarino syndrome, with an emphasis on the selection of an optimal operative approach. METHODS The clinical materials of patients diagnosed with Currarino syndrome were recorded. Special attention was given to the operative management, particularly the different routes for operation. The type of ARM was the critical point. The Rintala score was used for the evaluation of bowel function. RESULTS The medical records of 26 patients were reviewed. Seven were male, and 19 were female, with a mean age of 19.38 ± 13.80 months. The standard posterior sagittal approach (SPS) group included three perineal fistulae, one anal stenosis, one retraction of the rectum after anoplasty for vestibular fistula, one ARM with no fistula, one rectourethral fistula, and one cloaca. In the limited posterior sagittal approach (LPS) group, there were 13 perineal fistulae, one displacement of the rectum, and one retraction of the rectum after anoplasty for the vestibular fistula. In addition, the transanal approach (TA) and anterior sagittal approach (AS) were also used. The mean follow-up time was 39.48 ± 26.84 m. The Rintala score was 16.74 ± 2.93. CONCLUSION For a perineal fistula, SPS or LPS should be used to reach anoplasty and remove the presacral mass. For a vestibular fistula, the AS or LPS should be chosen. For anal stenosis, SPS or LPS should be used.
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de Beaufort CM, Derikx JP, Robben SG, van Rijn RR, Gorter RR, van Heurn LE. Ultrasonography guided puncture and dilatation in membranous rectal atresia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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10
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Tanaka A, Miyasaka EA. Colonic and rectal atresia. Semin Pediatr Surg 2022; 31:151143. [PMID: 35305803 DOI: 10.1016/j.sempedsurg.2022.151143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Tanaka
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Eiichi A Miyasaka
- Division of Pediatric Surgery, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
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Akkary R, Diab N, Zeidan S. Another indication for a transanal pull-through: surgical management of rectal atresia—a case report. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-021-00143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Rectal atresia is a very rare cause of neonatal intestinal obstruction. It has some distinctive anatomical and physiological specifications. The management is controversial with many described operative techniques. In this case report, we described our patient that we operated according to the transanal pull-through technique. We discussed the advantages and disadvantages of this technique and what makes it a suitable option for this population of patient.
Case presentation
A full-term male patient presented at 36 h of life for a pneumoperitoneum. Because of his well-placed, normally appearing anus, the diagnosis of rectal atresia was delayed. The patient was operated then according to the transanal pull-through technique with good follow-up results.
Conclusion
Transanal pull-through is a safe, easy. and a potentially reproducible option for managing rectal atresia. It should be considered for managing future cases. More cases should be done before drawing big conclusions.
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Chowdhury TK, Hoque MM, Kabir M, Banu T. Delayed presentation of congenital rectal stenosis associated with Down's syndrome and hypothyroidism: Case report. Clin Case Rep 2021; 9:e05083. [PMID: 34815875 PMCID: PMC8593885 DOI: 10.1002/ccr3.5083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 11/05/2022] Open
Abstract
Rectal stenosis is a rare variety of rectal atresia. A membrane separates the rectum from the anal canal in the presence of a normal anus. We report a case of rectal stenosis associated with Down's syndrome and hypothyroidism in whom rectal stenosis was diagnosed at the age of 17 years.
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Affiliation(s)
| | | | | | - Tahmina Banu
- Chittagong Research Institute for Children SurgeryChattogramBangladesh
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13
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Mehmetoğlu F. Rectal Atresia and Congenital Hypothyroidism: An Association or Coincidence? European J Pediatr Surg Rep 2018; 6:e7-e10. [PMID: 29326865 PMCID: PMC5762197 DOI: 10.1055/s-0037-1612610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/04/2017] [Indexed: 11/20/2022] Open
Abstract
Rectal atresia is a rare anorectal malformation, and its association with other anomalies is even more rare. This study presents a unique case of co-twin in which the surviving newborn male underwent surgery due to rectal atresia. Newborn screening tests identified congenital hypothyroidism. The surgical treatment consisted of three stages and thyroid hormones were replaced.
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Affiliation(s)
- Feride Mehmetoğlu
- Department of Pediatric Surgery, Dortcelik Children's Hospital, Bursa, Turkey
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