Reconstruction of intestinal tract after total colectomy in children with agangliosis

Abstract

Surgical treatment of agangliosis in children with total colectomy requires complex reconstructive plastic surgeries. In the absence of the colon, such patients experience metabolic disorders, without adequate correction of which may lead to adverse effects which complicates the postoperative period, worsens the process of rehabilitation and quality of life. Many options for reconstructive surgery have been suggested to restore adequate function of the intestinal tract after total colectomy in children with agangliosis. The reconstruction of intestinal tract requires selection and improvement of particular type of operation for the patients individually, taking into account the features of course of the disease, the advantages and disadvantages of the reliability of each of these operations.
Aim – to develop optimal reconstructive functional reservoir in treatment of children with agangliosis after total colectomy.
Materials and methods. Our experience since 1980 to 2020 in treatment 53 children with total colectomy with agangliosis, aged from neonatal to 3 years, using optimal reconstructive surgery, formation of functional intestinal reservoir.
Results. Colostomy was performed as first stage of surgical treatment in these children. The effective ways to restoration integrity of intestinal tract after total colectomy were presented formation of functionally advantageous reservoir’s variant of operation such ways as «J»-reservoir (n=2); ileotransplantant with side-by-side ileo-ileo anastomosis (n=34); ileotransplantant with side-by-side ileo-colo anastomosis (n=7); ileorectal primary anastomosis (n=1) or entero-entero anastomosis with invaginated valve (n=8) or implantation of ileocecal valve (n=1). Colostomy was closed after 3–4 month. There weren’t any complications in postoperative period. First 3 months of stool frequency was 10–15 times and after 1 year – 2–4 times a day. All children survived. Functional results of treatment in them is good. Bowel function is satisfactory. At X-ray – formed rectum became of sufficient reservoir, expressed as the colonization of reservoir.
Conclusions. Restoring integrity of intestinal tract with formation of functionally useful reservoir in form of ileotransplant with side-to-side anastomosis is best option for reconstructive surgery after total colectomy in children. Modernized surgical approach with the formation of different types of functionally beneficial reservoir for eliminating the effects of absence of colon in children, contributes to facilitating the postoperative period, accelerating rehabilitation, improving social adaptation and quality of life for patients.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.