2009, Number 4
Use of staplers in pediatric colorectal surgery Report of eight cases
Santos-Jasso KA, Herrera-García WE, Melgoza-Montañez D, Asz-Sigall J
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Language: Spanish
References: 7
Page: 162-169
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ABSTRACT
Introduction: The use of surgical staplers (mechanical sutures) has allowed the creation of safe and functional intestinal anastomoses in difficult-access regions of the body. Mechanical sutures are useful to anastomose intestinal segments of different caliber in the pelvic cavity with less contamination and reduced surgical time, and therefore, it is routinely used in adult colorectal surgery. We report our experience with the use of staplers for pediatric colorectal surgery.Material and methods: Observational retrospective study with review of all medical records of patients operated with staplers for colorectal surgery. Demographic data, morbidity, mortality, as well as intraoperative and postoperative complications were analyzed.
Results: Eight patients were operated with staplers during a 43 month period, three girls and five boys with ages ranging between one and sixteen years (mean 6.1 years). The most frequent diagnosis was Hirschsprung´s disease (50%), followed by ulcerative colitis (12.5%), colonic polyps (12.5%), megasigmoid (12.5%) and vascular malformation of the colon (12.5%). Thirteen staplers were used, being the most used one the 55 mm linear-cutting. Three circular end to end anastomosis staplers were used (one 25 mm and two 29 mm).
The procedures performed were: a J-pouch ileo-rectal anastomosis, two J-pouches in which the ileo-rectal anastomosis was performed manually, a tapering of the sigmoid in Hirshsprung´s disease, a Duhamel pull-trough, an enlarging of a short Duhamel common wall, and two colorectal anastomoses (one for resection of megasigmoid and one for resection of a colonic vascular malformation). There was one leak of an ileo-rectal anastomosis that was detected and repair during the original procedure.
The case where the 25 mm circular stapler was used presented stenosis of the anastomosis that required progressive dilatations. In all cases air was insufflated to corroborate absence of leakage. There were no postoperative leaks. There were no deaths.
Conclusions: Mechanical suture is a good alternative for pediatric colorectal surgery and is specially useful to perform rectal anastomoses because it makes the procedure easier and faster. Because the commercially available staplers are designed for adult surgery, the size of the instruments is a major obstacle for their use in small children. We do not recommend the use of circular staplers less than 29 mm for colorectal anastomoses because the risk of stricture formation.
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