Laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis without diverting ileostomy for total colonic and extensive aganglionosis is safe and feasible with combined Lugol's iodine staining technique and indocyanine green fluorescence angiography

被引：3

作者：

Nakagawa, Yoichi ^{[1
]}

Yokota, Kazuki ^{[2
,3
]}

Uchida, Hiroo ^{[1
]}

Hinoki, Akinari ^{[4
]}

Shirota, Chiyoe ^{[1
]}

Tainaka, Takahisa ^{[1
]}

Sumida, Wataru ^{[1
]}

Makita, Satoshi ^{[1
]}

Amano, Hizuru ^{[1
]}

Takimoto, Aitaro ^{[1
]}

Ogata, Seiya ^{[1
]}

Takada, Shunya ^{[1
]}

Maeda, Takuya ^{[1
]}

Gohda, Yousuke ^{[1
]}

机构：

[1] Nagoya Univ, Dept Pediat Surg, Grad Sch Med, Nagoya, Japan

[2] Mie Univ, Dept Gastrointestinal & Pediat Surg, Grad Sch Med, Mie, Japan

[3] Mie Univ, Fac Med, Mie, Japan

[4] Nagoya Univ, Dept Rare Intractable Canc Anal Res, Grad Sch Med, Nagoya, Japan

来源：

FRONTIERS IN PEDIATRICS | 2023年 / 10卷

关键词：

total colonic aganglionosis; extensive aganglionosis; laparoscopic restorative proctocolectomy; j pouch; diverting ileostomy; minimally invasive surgery; ILEOANAL ANASTOMOSIS; HIRSCHSPRUNG DISEASE; PULL-THROUGH; RISK-FACTORS; OUTCOMES; COMPLICATIONS; LEAKAGE;

D O I：

10.3389/fped.2022.1090336

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

BackgroundWe present the surgical technique and outcomes of reduced-port laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis (IPACA) without diverting ileostomy for total colonic and extensive aganglionosis (TCA+). MethodsWe retrospectively reviewed TCA+ cases between 2014 and 2022. Preoperative ileostomy was performed when transanal bowel irrigation was ineffective. Radical surgery for TCA+ was performed at approximately 6 kg. The surgery was performed using laparoscopy through a multi-channel trocar with or without an additional 3-mm trocar and IPACA reconstruction with indocyanine green fluorescence angiography (ICG) to assess anastomotic perfusion and Lugol's iodine staining to visualize the surgical anal canal. ResultsTen patients with TCA+ were included. Ileostomy was performed in seven cases. The median operation time and blood loss were 274.5 min and 20 ml, respectively. No significant postoperative complications were found. All patients experienced frequent liquid stools and perianal excoriation in the early postoperative period, requiring anti-flatulence or codeine. The median follow-up period was 3.5 years. Three patients required irrigation management 1 year postoperatively, and the others defecated a median of 3.5 times per day. The median Kelly's clinical score was 5 in 5 patients aged >4 years. ConclusionReduced-port surgery, combined with Lugol's iodine staining and ICG, was safe, feasible, and had cosmetically and clinically acceptable mid-term outcomes.

引用

页数：8