DOCSLIB.ORG

AO1-K1 Intelligence, Capabilities and Autonomy in Future Surgical Techniques and Technologies Children’S National Health System, George Washington University, USA

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
AO1-K1 Intelligence, Capabilities and Autonomy in Future Surgical Techniques and Technologies Children’S National Health System, George Washington University, USA 日小外会誌 第52巻 3 号 2016年 5 月 767 First Day (May 24, Tuesday) 10:00–12:00 AO1 Esophagus & Thoracic Keynote Lecture AO1-K1 Intelligence, Capabilities and Autonomy in Future Surgical Techniques and Technologies Children’s National Health System, George Washington University, USA Peter CW Kim Background: Surgery has remained an exclusive domain of each individual surgeon’s vision, dexterity and cognition to date. Future surgical techniques and technologies will complement and supplement current surgeon’s or human capacity and capability. Herein, we report the first example of such intelligent collaborative technology for commonly performed complex soft tissue surgery. Methods: We developed the next generation of robot, Smart Tissue Autonomy Robot (STAR) that consists of unique vision system combining 3-dimensional plenoptic and near infrared imaging, 7-degrees of freedom positioning platform (KUKA robots) and modified Endo360 end effector tool for suturing. We Oral Session (AO1) compared standard metrics and functional outcomes of anastomoses done by STAR to those done by Oral Session OPEN, MIS and da Vinci. Results: Extensive comparisons of semi-autonomous and autonomous anastomoses done by STAR to OPEN, MIS and da Vinci demonstrated that this first generation of intelligent robot can perform such complex surgical task as an anastomosis comparable to experienced surgeons. Conclusion: This proof-of-concept demonstration illustrates that autonomous surgical task can be accomplished even for a complex soft tissue surgical task such as intestinal anastomosis for the first time. Surprisingly, additional intelligence and autonomy promise improving technical safety, functional outcome and potential access to optimized surgical techniques for all surgeons. Dr. Kim is Vice President of the Sheikh Zayed Institute for Pediatric Surgical Innovation, and serves as Associate Surgeon-in-Chief of the Joseph E. Robert, Jr., Center for Surgical Care at Children’s National. Dr. Kim’s research focuses on the development of new paradigm and technologies such as intelligence and autonomy for future surgical technology; smarter simulation technologies; and the potential of imaging technologies such as high intensity-focused ultrasound (HIFU) as non-invasive alternatives to conventional surgery. He is the lead for FDA funded National Capital Consortium for Pediatric Device Innovation (NCC-PDI) (www.innovate4kids.org). His research is supported by several NIH grants. 768 日小外会誌 第52巻 3 号 2016年 5 月 First Day (May 24, Tuesday) 10:00–12:00 AO1 Esophagus & Thoracic Keynote Lecture AO1-K2 Current thoughts about thoracoscopic repair of esophageal atresia Surgeon-In-Chief/Senior Vice President, Children’s Mercy Hospital Kansas City, Missouri, USA George W Holcomb III In 1941, Dr. Cameron Haight successfully performed an open repair of an infant with esophageal atresia (EA) and tracheoesophageal fistula (TEF). The first thoracoscopic repair of EA was reported in a three month old infant in 1999 and the first thoracoscopic repair of EA and TEF was reported by Dr. Steve Rothenberg in 2002. Thus, the thoracoscopic repair is a relatively new approach when compared with the open operation. The thoracoscopic repair has several advantages over the open operation which primarily center on improvement of the potential musculoskeletal sequelae that develop after a thoracotomy. In addition, there is superior visualization of the anatomy and it is usually easy to identify the TEF for ligation. However, the thoracoscopic approach can be a technically demanding operation, especially suturing the two esophageal ends together without significant complications. In addition, optimal anesthetic management is becoming increasingly valued by surgeons as visualization and lung deflation are very important when using this approach. This lecture will discuss the evolution of the thoracoscopic technique over the past 15 years as well as a discussion about current advantages and problems with this approach. Dr. George W. Holcomb, III was born in Osaka, Japan in 1953. He attended the University of Virginia for college and then Vanderbilt University School of Medicine. His general surgery training was at Vanderbilt Medical Center and his pediatric surgery training was at the Children’s Hospital of Philadelphia. He began his pediatric surgery practice in 1988 as an Assistant and subsequently Associate Professor of Surgery in the Department of Pediatric Surgery at Vanderbilt University School of Medicine. In 1999, he was recruited to replace Dr. Keith Ashcraft as Surgeon-in-Chief at Children’s Mercy Hospital in Kansas City, Missouri. In addition to being the Surgeon-in-Chief, he is also Senior Vice-President and Director of the Center for Minimally Invasive Surgery Dr. Holcomb is best known for his interest in minimally invasive surgery in infants and children and his emphasis on evidence-based medicine. He is the author of over 240 peer-reviewed publications and 50 book chapters, and has been the editor of 5 textbooks. In addition, he is a member of numerous professional and surgical societies including the American Surgical Association, the American Pediatric Surgical Association, the European Pediatric Surgical Association, the British Association of Pediatric Surgeons and the World Organization of Federations of Associations of Pediatric Surgeons (WOFAPS). In addition, he is a past president of the International Pediatric Endosurgical Group (IPEG). 日小外会誌 第52巻 3 号 2016年 5 月 769 First Day (May 24, Tuesday) 10:00–12:00 AO1 Esophagus & Thoracic Keynote Lecture AO1-K3 Surgical technique for esophageal replacement All India Institute of Medical Sciences, New Delhi, India Devendra Kumar Gupta, Shilpa Sharma, Vishesh Jain Surgical techniques for replacing the esophagus in children include Colon interposition, Gastric tube, Gastric transposition and jejunal interposition. Surgery is usually a well planned procedure performed under general anesthesia except rarely in emergency. Replacement is indicated for long gap esophageal atresia, following major leaks after surgery for TEF/OA, esophageal strictures, and rarely after major trauma, scleroderma, candiasis. • Colon Interposition is the time tested procedure based on middle colic or the left upper colic Vessels, passing behind the stomach, with a colo gastric in the abdomen and the esophago-colic anastomosis in the neck. Being no suture line in the chest, postoperative complication are less common and less serious. However, long term complications include colo-gastric reflux, fetid smell, colonic segment dilation, Oral Session (AO1) stricture, and might requiring re-do procedures. Oral Session • Gastric tube with pyloric or fundal base (iso or reverse) though matches with the size of the lumen of the esophagus, is technically more demanding and associated with quite serious immediate and early postoperative complications eg. Leak in the neck, mediastinitis, necrosis and stricture of the tube. Long term results are good. • In Gastric transposition, fundus is the highest point and can be brought in the neck for primary anstomosis via hiatal or substernal route based on right gastric vessels, gastroepiploic vessel and the gastroepiploic arcade. Duodenum is mobilized. Spleen is preserved. Pyloromyotomy or pyloroplasty is always performed as vagotomy is invariably is done. Post operative complications include leak in the neck, gastric stasis and respiratory distress due bulky stomach. Neonates require dedicated ICU and postoperative ventilator support. However, there is only one anastomosis in neck. • There is little experience reported with the use of jejunum to replace the esophagus due to the shortened mesentery, with 60-90% success reported from Italy and Japan. Since 1980, of 118 esophageal replacements included; gastric pull up – 53 (including 32 in newborns), colon interposition – 48, and gastric tube – 17. Stomach was the only option in Newborns with 85% success. Authors prefer to use gastric transposition in infants upto 1 year age and thereafter colon interposition. Mediastinal route is preferred unless inaccessible. Being major, surgery should be done in tertiary care level hospitals by the experienced team of surgeons familiar with various replacement techniques and able to follow them up for long to detect and manage the specific post operative complications, if any Devendra Gupta, Professor and Head, Department of pediatric Surgery from the autonomous All India Institute of Medical Sciences, New Delhi, has trained 68 pediatric surgeons, published 12 books, 266 peer- reviewed articles and 203 book-chapters during the past 35 years. His areas of interest include teaching, Neonatal surgery, pediatric urology and stem cell research. He has been the President of the Indian Association, the SAARC Association, Asian Association and currently the President of the World Federation of Associations of Pediatric Surgeons. He has also been the Vice Chancellor of King George’s Medical University. He had been the Editor-in-Chief of the Journal of Indian Association of Pediatric Surgeons and the Journal of Pediatric Surgical Specialties and now on the Editorial-Board of 15 Journals. He has organized 58 CME- Programs, Workshops, and Congresses including the Asian Congress and the World Congress in Pediatric surgery. He has been invited to over 70 countries as visiting Professor and deliver over 360 guest- lectures, Orations, Key Note Address including the one at the Parliament Hill, Canada. He has received the Life-time Achievement awards, the RK Gandhi
Load more

Recommended publications
  • A Study of Incidence of Congenital Cardiac Anomalies in the New- Borns with Ano-Rectal Malformation: Our Hospital Experience
    Original Research Article Indian Journal of Anesthesia and Analgesia1973 2018; 5(12): 1973­76 DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51218.1 A Study of Incidence of Congenital Cardiac Anomalies in the New- Borns with Ano-Rectal Malformation: Our Hospital Experience Y.V.S. Ravi Nagaprasad1, Aavula Muralidhar2 1,2Associate Professor, Department of Anesthesiology, Niloufer Hospital for Women and Child, Osmania Medical Collage, Hyderabad, Telangana 500095, India. Abstract Background: Ano­rectal malformation is a common anomaly seen in newborns and is associated with multiple anomalies like renal, vertebral, muscular and cardiac. Associated cardiac anomalies determine the morbidity and mortality of newborn. It is mandatory to properly evaluate the child for cardiac anomalies in children with ARM. Objective: The aim of the study is to evaluate the incidence of associated cardiac anomalies in thenew­borns with Ano­rectal malformation admitted ina tertiary care centre. Method: Total number of Ano­rectal Malformation admitted from June 2017 to May 2018 in our hospital was recorded. All cases after examination and evaluation were classified into Low ARM and High ARM. All cases after preoperative evaluations and basic haematological tests were taken for emergency colostomy or cut back anoplasty. Patients during postoperative period were performed echocardiogram for cardiac evaluation. Total number newborns with ARM having associated cardiac anomalies were determined. The incidence of cardiac anomalies in two types of ARM was determined. Results: Total number of newborns with ARM admitted for sugery in the period of June 2017 to May 2018 were 182. Out of which 21 cases were having congenital cardiac anomalies (11.53%).
    [Show full text]
  • A Study on Etiology and Incidence of Formation of Types of Anorectal Malformation
    International Journal of Surgery Science 2019; 3(4): 100-103 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science A study on Etiology and incidence of formation of types www.surgeryscience.com 2019; 3(4): 100-103 of Anorectal malformation: A prospective study Received: 18-08-2019 Accepted: 22-09-2019 Dr. Mohd Zakir Mohiuddin Owais, Dr. T Vinodh Kumar, Dr. Hasanthi, Dr. Mohd Zakir Mohiuddin Owais Assistant Professor, Department of R Suman and A Madhu Paediatric Surgery, Niloufer Hospital, Hyderabad, Telangana, DOI: https://doi.org/10.33545/surgery.2019.v3.i4b.225 India Abstract Dr. T Vinodh Kumar Background: Anorectal malformations are one of the most common congenital defects. This study was Assistant Professor, Department of undertaken to study the hospital incidence of anorectal malformations (ARM), frequency of various types Paediatric Surgery, Sri Venkateswara Medical College, of defects, their sex distribution and the spectrum of anomalies associated with ARM. Tirupati, Andhra Pradesh, India Materials and Methods: Ninety consecutive children attending the paediatric surgery department were included in this study. A detailed history was taken, and examination was performed for the primary as Dr. Hasanthi well as the associated defects. Appropriate investigations like invertogram, cologram were done wherever Assistant Professor, Department of indicated. Management was as per the standard protocol. The data was recorded and analyzed. Paediatric Surgery, Guntur Results: Out of the 90 patients, 52(57.77%) male patients and 38(42.22%) female patients. Most of our Medical College & Govt General patients presented within first 24 hours of life. Patients who presented after 72 hours were either female Hospital, Guntur, Andhra Pradesh, patients with anovestibular malformation or male patients with anocutaneous fistula.
    [Show full text]
  • Anorectal Malformations
    Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1065 Anorectal Malformations Long-term outcome and aspects of secondary treatment JOHAN DANIELSON ACTA UNIVERSITATIS UPSALIENSIS ISSN 1651-6206 ISBN 978-91-554-9140-6 UPPSALA urn:nbn:se:uu:diva-241243 2015 Dissertation presented at Uppsala University to be publicly examined in Rosénsalen, Entrance 95/96, ground floor, Uppsala University Children’s Hospital, Uppsala, Friday, 27 February 2015 at 13:15 for the degree of Doctor of Philosophy (Faculty of Medicine). The examination will be conducted in English. Faculty examiner: Adjungerad Professor Olof Hallböök (Linköpings universitet ). Abstract Danielson, J. 2015. Anorectal Malformations. Long-term outcome and aspects of secondary treatment. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1065. 109 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-554-9140-6. Faecal incontinence (FI) is defined as the inability to control bowel movements. The causes of FI are many and diverse. One of the more uncommon reasons for FI is Anorectal Malformations (ARMs). An ARM is a congenital anomaly that affects somewhere between 1/2500 and 1/5000 live born babies. Many ARM patients have persistent FI. Several different procedures have been utilised to address this issue. This thesis aims to evaluate (1) the long-term outcome in adulthood of ARMs in relation to the modern Krickenbeck classification, and (2) scope for treating FI with transanal injection with dextranomer in non-animal stabilised hyaluronic acid (NASHA/Dx), in patients both with and without ARMs. All patients treated for ARMs in Uppsala up to 1993 were invited to participate in a questionnaire study of quality of life and function.
    [Show full text]
  • Subject Index
    SUBJECT INDEX SUBJECT INDEX Abbe flap, vermilion submucosal pedicle, for upper lip Accurate platelet counts for platelet rich plasma, validation reconstruction (Special Section: Cancer), 17:1259– of hematology analyzer and preparation techniques 1262 for counting and (Scientific Foundation), 16:749– Abbé island flap (Original Articles), 18:766–768 759 Abducens nerve, microanatomic and endoscopic study Acellular cadaveric dermis, experimental study of (Scientific (Literature Scan), 19:546 Foundations), 18:551–558 Abortive subtype of frontoethmoidal encephalocele (Case Acellular human dermis (alloderm), exposed skull with, one- Report), 10:149–154 stage skin grafting of (Technical Experience), Abraxane, for treatment of metastatic breast cancer (Special 19:1660–1662 Editorial), 17:3–7 Acetylic resin, in conjunction with silicon for maxillofacial Abrikossoff’s tumor (Clinical Note), 12:78–81 rehabilitation (Brief Clinical Notes), 17:152–162 Abscess, brain, from cranio-orbital foreign body (Clinical Achondroplasia and Pfeiffer syndrome, genetic relationship Note), 7:311–314 between (Clinical Note), 9:477–480 Absent ear, bone-anchored implants for (Scientific Acoustic evoked potentials in neurophysiological Foundation), 19:744–747 evaluation in craniostenosis and craniofacial Absorbable. See also under Bioabsorbable stenosis, 8:286–289 Absorbable biomaterial in craniofacial skeleton fixation, Acquired orbital deformity, reconstruction of (Clinical 10:491 Note), 19:1092–1097 Absorbable fixation Acrocephalosyndactyly, 7:23–30, 8:279–283 for
    [Show full text]
  • Dynamic Testing
    CHAPTER 11 Committee 7 Dynamic Testing Chair D. GRIFFITHS (USA) Co-chair A. KONDO (JAPAN) Members S. BAUER (USA), N. DIAMANT (CANADA), LIMIN LIAO (CHINA), G. LOSE (DENMARK), W. SCHÄFER (USA), N. YOSHIMURA (USA) Consultant H. PALMTAG (GERMANY) 585 CONTENTS A. INTRODUCTION ABBREVIATIONS BOO bladder outlet obstruction BOOI bladder outlet obstruction index, previously known as AG number B. MECHANISMS OF URINARY BPE benign prostatic enlargement CONTINENCE AND BPO benign prostatic obstruction DHIC detrusor hyperactivity with impaired INCONTINENCE contractile function DO detrusor overactivity DOI detrusor overactivity incontinence C. URODYNAMICS: NORMAL EMG electromyogram/electromyography VALUES, RELIABILITY, AND FDV first desire to void FSF first sensation of filling DIAGNOSTIC AND ICS International Continence Society THERAPEUTIC IPSS International Prostate Symptom Score ISD intrinsic sphincter deficiency PERFORMANCE LPP leak point pressure LUT lower urinary tract LUTS lower urinary tract symptoms D. CLINICAL APPLICATIONS Max Cap maximum cystometric capacity OF URODYNAMIC STUDIES MRI magnetic resonance imaging MUP maximum urethral closure pressure NDV normal desire to void NPV negative predictive value (see section C.IV.1) E. DYNAMIC TESTING FOR OAB overactive bladder syndrome/symptoms FAECAL INCONTINENCE POP pelvic organ prolapse PPV positive predictive value (see section C.IV.1) PVR post-void residual urine (volume) SD standard deviation SDV strong desire to void F. CONCLUSION SEM standard error of the mean SPECT single photon emission computed tomography SPT specificity (see section C.IV.1) STV sensitivity (see section C.IV.1) TURP transurethral resection of the prostate REFERENCES TVT tension-free vaginal tape USI urodynamic stress incontinence VLPP Valsalva leak point pressure 586 Dynamic Testing D.
    [Show full text]
  • Vitamin D in Health and Disease
    ? EDITORIAL Vitamin D in health and disease As medical graduates we were taught, VitD as an anti rachitic vitamin, Prof T U Sukumaran later it was termed as a hormone – Vithormone with its target mainly in bone and kidney. Vitamin D is mostly synthesized in human body under the skin from 7 dehydrocholesterol using UV–B 290–315 nm energy and a minor quantity is obtained from dietary sources. Vitamin D thus obtained is converted to active forms 25 OH cholecalciferol and 1, 25 dihydroxy cholecalciferol by enzymes 25–hydroxylase and l alpha hydroxylase in liver and kidney respectively. 25 OH From: cholecalciferol is considered as the best indicator for assaying vitamin D status of Pushpagiri Institute of the community. Classic functions of vitamin D include absorption of calcium and Medical Sciences phosphate from the intestine, mineralization of bone and reuptake of calcium in & Research Centre Tiruvalla, India - 689 101 the renal tubules. The deficiency will manifest as rickets in growing bone and osteomalacia in adults. Now we are more aware of the extra skeletal functions of vitamin D, its immunomodulatory role and hormone regulation. Vitamin D Receptors (VDR), Calcitriol receptors (NR 111) and l alpha hydroxylase receptors are present in bone, skeletal muscle, Prostate, Breast, Colon, Pancreas, Lungs and immune cells indicating its role in various other functions. There is evidence of the extraskeletal effects of vitamin D, but most derive from observational studies; more clinical trials are required to determine the therapeutic role of vitamin D. Muscular system: Hypovitaminosis D is associated with myopathy, sarcopenia, muscular strength reduction and increased risk of falls.
    [Show full text]
  • Division of Pediatric Surgery
    Division of Pediatric Surgery Division of Pediatric Surgery The Division of Pediatric Surgery at Children’s Hospital Los 4650 Sunset Blvd., #100 Los Angeles, CA 90027 Angeles brings together specialized pediatric knowledge Phone: 323-361-2322 in one of the country’s finest, most comprehensive pediatric Fax: 323-361-4775 surgical programs. The Division’s surgeons are international Referrals: Phone: 888-631-2452 leaders with extensive experience in a wide array of Fax: 323-361-8988 Email: [email protected] complex procedures, from chest wall reconstructions to myCHLA Physician Portal: https://myCHLA.CHLA.org pulmonary, gastrointestinal and oncologic procedures, to CHLA.org/GPSurgery the correction of congenital anomalies. Providers Our surgeons care for newborns to young adults and utilize laparoscopy and thoracoscopy to perform minimally Kasper Wang, MD invasive surgical procedures. Interim Chief, Division of Pediatric Surgery; Associate Director, Pediatric Surgery Fellowship Program; Treated disorders include: Attending Surgeon, Children’s Hospital Los Angeles • Anorectal anomalies Professor of Surgery and Clinical Scholar, • Breast masses Keck School of Medicine of USC • Congenital lesions of the head, neck Specialty: Pediatric surgery and thyroid • Esophageal anomalies • Gastroesophageal reflux disease (GERD) Dean Anselmo, MD • Gastrointestinal anomalies Co-Director, Vascular Anomalies Center; Attending Surgeon, Division of Pediatric Surgery, • Head and neck lesions Children’s Hospital Los Angeles • Hepatobiliary anomalies Associate
    [Show full text]
  • Anorectal Malformation (ARM) Imperforate Anus Worldwide, More Than a Million Children Are Born Each Year with Anorectal Malformation Or Imperforate Anus
    Anorectal Malformation (ARM) Imperforate Anus Worldwide, more than a million children are born each year with anorectal malformation or imperforate anus. The Colorectal Center for Children at Children’s Hospital of Pittsburgh of UPMC offers a comprehensive approach to treatment for children born with this anomaly. What is anorectal malformation (ARM) and imperforate anus? When a baby is born without an anus, the rectum may end in various abnormal forms, a generic name for these alterations is ARM or imperforate anus. Both names refer to the same condition. Is anorecal malformation the same in all patients? No. Anorectal malformation is a group of anorectal anomalies with different anatomical characteristics. For a better understanding, please view the anatomical illustrations of the pelvic anatomy of a boy and a girl provided below. These represent the most common anorectal malformations that are present in children. PELVIC ANATOMY OF A BOY Observe that the rectum ends in the center of the anal sphincter forming the anus. ARM with recto-perineal fistula Perineum is the limited area between the anal sphincter and the scrotum. When a baby does not have an anus and the rectum ends in the perineum, this is called an ARM with recto-perineal fistula. ARM with recto-urinary fistula Urethra and bladder form the lower urinary tract. When a baby does not have an anus and the rectum ends in any part of the lower urinary tract is an ARM with Recto-Urinary Fistula. A Recto-Urethral fistula is shown in this illustration. ARM without fistula In some boys the rectum ends in a blind pouch and it does not have any communication.
    [Show full text]
  • Congenital Anomalies of the Anus and Rectum* ANDREW W
    Arch Dis Child: first published as 10.1136/adc.47.256.960 on 1 December 1972. Downloaded from Personal Practice Archives of Disease in Childhood, 1972, 47, 960. Congenital Anomalies of the Anus and Rectum* ANDREW W. WILKINSON From the Institute of Child Health, University of London, and The Hospitalfor Sick Children, Great Ormond Street, London There is confusion in the minds ofmany clinicians inspected the abnormal source of meconium may about the exact anatomical features of the individual not always be noticed. Finally, in the rare atresia lesions of anorectal anomalies and therefore about of the middle third of the rectum, the normal anus, the way in which they should be treated. This anal canal, and lower rectum may give the impression arises partly because some, like the covered anus, that the whole anorectal region is normal and that are visible in the perineum, whereas in others part the cause of the obstruction lies much higher in of the anomaly is visible, for example, in a low the bowel. vaginal fistula, but the more important part, the Congenital anomalies of the anus and rectum blind end of the rectum, lies deep in the pelvis were classified by Ladd and Gross (1934) into 4 separated from the skin by the levator ani sheet main groups (Types I to IV). The advantage of of muscle. The indiscriminate use of the term their classification is that it is based on the normal 'imperforate anus' adds to the confusion because it and pathological anatomy and is simple. I use a implies that only the anus is abnormal and that the modification of it (Table I).
    [Show full text]
  • 17 Urological Problems in Children with Anorectal Malformations
    269 17 Urological Problems in Children with Anorectal Malformations Duncan T. Wilcox and Stephanie A. Warne Contents is a known feature of both the VATER (acronym of Vertebral and vascular anomalies, Anal atresia, Tra- 17.1 Introduction . 269 cheoesophageal fistula, Esophageal atresia, and Renal 17.2 Renal Anomalies . 270 anomalies, Radial dysplasia) and VACTERL (acro- 17.2.1 Structural . 270 nym of Vertebral abnormalities, Anal atresia, Cardiac 17.2.1.1 Position . 270 defects, Tracheoesophageal fistula with Esophageal 17.2.1.2 Duplication . 270 atresia, Radial and renal defects, and Lower-limb ab- 17.1.2.3 Hydronephrosis . 270 normalities) associations [40,56]. These children can 17.2.1.4 Renal Dysplasia . 271 17.2.1.5 Renal Agenesis . 271 have both structural and functional abnormalities of 17.2.2 Functional . 271 the upper and lower urinary tract as well as significant 17.3 Ureteric Anomalies . 272 genital anomalies [37]. Anomalies of the genitouri- 17.3.1 Vesicoureteric Reflux . 272 nary tract can have a dramatic impact on the length 17.3.2 Megaureters . 272 and quality of these children’s lives [27]. 17.3.3 Ureteric Ectopia . 272 Genitourinary anomalies occur frequently in pa- 17.4 Bladder Anomalies . 273 tients with ARM and previous retrospective reviews 17.4.1 Structural . 273 report incidences from 20 to 50% [27,28,36,41,54,55]. 17.4.2 Functional . 273 In one large series from Japan consisting of 1,992 17.4.2.1 Preoperative . 273 patients, 425 had genitourinary problems [16]. This 17.4.2.2 Postoperative Urinary Continence . 274 association is easily understood when one considers 17.4.2.3 Bladder Physiology .
    [Show full text]
  • Anorectal Malformations, Stone-Benson's Operation Modification, Perineal Proctoplasty, Early and Long-Term Results
    American Journal of Medicine and Medical Sciences 2018, 8(4): 66-70 DOI: 10.5923/j.ajmms.20180804.03 Modified Stone Benson’s Perineal Proctoplastics in Low Forms of Anorectal Malformation in Children TT Narbaev, UX Tilavov, NN Turaeva, BA Terebaev, MS Chuliev, MM Nasirov* Department of Pediatric Surgery, Tashkent Pediatric Medical Institute, Uzbekistan Abstract After Stone-Benson’s operation in early period 18,9% complications were occurred, after perineal proctoplasty by modification of TashPMI clinic (patent # IAP04799 17.12.2013y.) – 9,5%. In long-term period after Stone-Benson’s operations complications occurred in 22,8% of cases, after perineal proctoplasty by modification of TashPMI clinic – 12,3%. In recommended method of perineal proctoplasty by modification of TashPMI clinic successful results were noticed. Keywords Anorectal malformations, Stone-Benson’s operation modification, Perineal proctoplasty, Early and long-term results The disadvantages of the Stone-Benson operation were: 1. Introduction - Insufficient vision in the narrow and deep wound of the fissure, which made it difficult to isolate the walls of the The problem of surgical correction of anorectal anomalies rectum - often the wall of the rectum and vagina was remains relevant. Despite some successes in this field [2, 3, 6, damaged in the allocation of the latter; 13, 15] there is no method that would provide reliable - the inability to form an adequate rectal obturation; anatomical and functional results providing social adaptation - recurrence of fistula in the reproductive system, of patients, many of whom remain severely disabled. Studies secondary ectopia of the newly formed anal opening aimed to improve the tactics and methods of treatment of anteriorly (towards the vaginal vestibule); anorectal pathology in childhood are continuing.
    [Show full text]
  • Associated Anomalies with Anorectal Malformations in the Eastern Indian Population
    www.jpnim.com Open Access eISSN: 2281-0692 Journal of Pediatric and Neonatal Individualized Medicine 2019;8(2):e080214 doi: 10.7363/080214 Received: 2018 Oct 10; revised: 2018 Oct 21; rerevised: 2018 Dec 19; accepted: 2018 Dec 21; published online: 2019 Aug 12 Original article Associated anomalies with anorectal malformations in the Eastern Indian population Neha Sisodiya Shenoy1, Vikrant Kumbhar1, Kalyani Saha Basu2, Sumitra Kumar Biswas2, Yogesh Shenoy2, Charu Tiwari Sharma1 1Department of Paediatric Surgery, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India 2Department of Paediatric Surgery, NRSMC, Kolkata, West Bengal, India Abstract Aim: Anorectal malformations (ARMs) are often associated with other anomalies. At present, there is no comprehensive protocol to detect these associated anomalies. This study aims to study prevalence of associated anomalies in the Eastern Indian population. Materials and methods: All patients admitted with ARM in our institute (Department of Paediatric Surgery, NRS Medical College & Hospital, Kolkata, West Bengal, India) were studied from 2010 to 2012 (n = 182). Clinical examination and basic laboratory and radiological investigations were done in all patients. Advanced radiological investigations followed if abnormality was detected in the basic investigation. Incidence of associated anomalies was compared with known literature and correlation between level of ARM and other associated anomalies was studied. Results: 102 of 182 ARM patients studied had associated anomalies. More associated anomalies were present in high ARM than low ARM (59.65% vs 50%). Genitourinary anomalies were the most common associated anomaly, followed by spinal, cardiovascular, tracheo-esophageal, gastrointestinal tract, limbs and facial anomalies. Conclusion: In the Eastern Indian population, there is no significant sexual difference in patients who have associated anomalies with ARM.
    [Show full text]