The method of rectoplasty at cologenic constipations for children

Abstract

The aim of our work was to reduce postoperative complications by reconstructive repair of anatomic-functional features of rectum. This method provides realization of the main stage of operation according to one of the used methods. The conclusion of operation includes the reconstructive repair of anatomic feautures of rectum’s internal surface by creation of three pairs of transverse plicas o the rectum. After bringing down the healthy part of the descending colon at a distance 4-5cm from the internal anal sphincter along the lateral and medial surfaces, at the level of the interweaving of the muscle lifting the anus into rectum’s longitudinal muscle layer. On each side of the intestine, three serous-myorrhaphies are put at a diameter of 1 /3 (distance between stitches is 1.0±0.5 cm), in a way that two opposite duplications of rectum’s transverse plicas with depth-1,5 cm could be formed at tightening of the stitches. The next stage of reconstructive operation was to determine the distance from the upper edge of the internal sphincter to the parietal peritoneum. It is at this level that the second pair of duplicator of rectum’s transverse plicas (at 1 /3 dm of intestine) is formed, after bringing down of healthy intestine’s part. At the level of the symphysis projection in the region of sacral flexure, the third pair of duplicator of rectum’s transverse plicas is formed in a way one lip is located on the anterior- lateral surface and the second one is formed at 1cm above the first on the posterior- lateral surface. All three pairs of duplicator of rectum’s transverse plicas are formed spirally, relatively longitudinally to the axis of the intestine. The groups of children who were operated by the offered method didn’t have postoperative complications in any clinical observation. The method of this proposed pelvic rectoplasty at cologenic constipations for children gives an opportunity to form natural anatomic formations of the neorectum in the form of transverse plicas without additional dissection of the bowel wall. The repair of anatomic relief of mucous neorectum helps to save the natural and reserve functions of the rectum. As thus, we think that creation of “artificial” transverse plicas is an effective, technically and easily performed by the method of pelvic rectoplasty surgery.