PubMed · 13631966
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1959-01-24. SEX FUNCTION after rectal excision.. https://pubmed.ncbi.nlm.nih.gov/13631966/
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BACKGROUND: Since its first publication in 1986, the Tan-Bianchi procedure for treatment of infantile hypertrophic pyloric stenosis has displayed a growing consensus among pediatric surgeons. However, in up to 30% of cases, the supraumbilical skin fold incision does not allow a comfortable access. Delivery through this route, a large pyloric tumor into the wound to perform a pyloromyotomy, can be fairly difficult and time consuming and may damage the gastric or duodenal serosa by tearing. Other technical variants have been proposed to overcome these limitations, but some are more complicated, some are demanding, and some others can worsen the final cosmetic result. METHODS: The authors present a personal modification to the Tan-Bianchi procedure that they have successfully applied in the last 25 cases of infantile hypertrophic pyloric stenosis. A right semicircular umbilical skin fold incision is performed. The anterior rectus abdominis muscle (RAM) sheath is incised vertically all around the umbilicus, the muscle is laterally displaced, and its posterior sheath and the peritoneal cavity entered in the same line. Because all incisions lay in the same axis, the abdominal cavity is largely opened by 2 retractors without the need for excessive increased traction as it often happens with the supraumbilical approach. RESULTS: This technical variant was particularly useful to deliver a very large hypertrophic pyloric muscle into the wound. There were no complications and excellent cosmetic results were obtained in all patients. CONCLUSIONS: These observations suggest that a right semicircular umbilical skin fold incision is an attractive alternative for pyloromyotomy mostly when facing with a large pyloric tumor.
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OBJECTIVE: After sphincter-sparing core fistulectomy for deep anal fistula most surgeons advance a rectal mucosal flap to reinforce closure of the internal opening. Our own method having for many years been simple appositional closure the resulting series presented an opportunity for comparison. PATIENTS AND METHODS: From November 1987 to January 2001, 44 patients underwent 46 core fistulectomies with flap-less direct appositional closure in our unit. Records were kept prospectively. Twenty-six fistulae (in 28 patients) appeared healed at two to five months follow-up and the patients had been discharged. A full review was mounted in May 2001, when 16 of the healed patients could be contacted and questionnaires completed. Two patients were excluded from the study. RESULTS: The procedure failed in 16 patients initially and was found to have done so in two more at long-term follow-up (41% overall). Three patients had died and five could not be traced. CONCLUSION: Simple appositional closure after core fistulectomy for deep anal fistula seems inferior to methods using flap reinforcement.