Pediatric Colonic Anastomosis: Can Method of Anastomosis and Wound Closure be of Help?

Autor:	Ghosh A; Department of Pediatric Surgery, IPGMER and SSKM Hospital, Kolkata, West Bengal, India., Biswas SK; Pediatric Surgery, ICH, Kolkata, West Bengal, India., Ghosh T; Department of Pediatric Surgery, NRS Medical College and Hospital NRS Medical College and Hospital, Kolkata, West Bengal, India., Basu KS; Department of Pediatric Surgery, NRS Medical College and Hospital NRS Medical College and Hospital, Kolkata, West Bengal, India., Biswas SK; Department of Pediatric Surgery, NRS Medical College and Hospital NRS Medical College and Hospital, Kolkata, West Bengal, India.
Jazyk:	angličtina
Zdroj:	Journal of Indian Association of Pediatric Surgeons [J Indian Assoc Pediatr Surg] 2023 May-Jun; Vol. 28 (3), pp. 245-249. Date of Electronic Publication: 2023 May 02.
DOI:	10.4103/jiaps.jiaps_129_22
Abstrakt:	Background: Enhanced recovery after surgery (ERAS) protocols after colorectal surgery focused on reduced bowel preparation, standardized feeding schedule, earlier return of bowel function, and earlier resumption of normal activities. ERAS in pediatric surgical practice is not well established. The present study aims to present the results of two colonic anastomosis techniques of interrupted single-layered closure: Halsted (Horizontal Mattress) and Matheson (serosubmucosal or appositional extramucosal) along with two different methods of colostomy wound closure and their influence on the adoption of ERAS protocol of early feeding and early discharge. Materials and Methods: This single institute-based randomized control study was conducted in a tertiary care facility in Kolkata for 2.4 years. Patients were chosen randomly for serosubmucosal (Group I) and full-thickness (Group II) anastomosis. Results: Among total of 91 patients (Group I-43 and Group II-48), Return of bowel sounds and passage of bowel averaged 1.51 ± 0.51 and 1.91 ± 0.55 days in Group I and 1.91 ± 0.57 and 3.9 ± 0.66 days in Group II, respectively. Postoperative hospital stay averaged 5.88 ± 1.12 days in Group I and 8.9 ± 1.17 days in Group II. Overall 15 (16.48%) patients had complications among which SSI (Suprficial surgical site infection) and minor leaks (Group I-3 and 1 and Group II-5 and 3, respectively) which were treated conservatively (Clavien-Dindo Grade-I) and three major leaks under Group II requiring surgical intervention (Clavien-Dindo Grade-III). Conclusion: This study concludes that the technique of colostomy closure in the form serosubmucosal closure helps in the implementation of ERAS protocol by producing early bowel movement, early initiation of food, and less postoperative complications. Competing Interests: There are no conflicts of interest. (Copyright: © 2023 Journal of Indian Association of Pediatric Surgeons.)
Databáze:	MEDLINE
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