METHOD FOR SURGICAL MANAGEMENT OF RECTAL PROLAPSE IN CHILDREN OPERATED ON FOR ANORECTAL MALFORMATION Russian patent published in 2024 - IPC A61B17/00 

FIELD: medicine; pediatric surgery.

SUBSTANCE: surgical management of rectal prolapse is performed in children operated on for anorectal malformation. That is ensured by dissection of the rectal mucosa, separation of the mucous membrane from the muscular layer, application of longitudinal sutures on the muscular membrane. In case of circular prolapse, rectal mucosa is dissected circularly. A circular retractor is applied on the perianal skin at 5 mm from the mucocutaneous junction. Then the length and type of prolapse are determined with a swab from the intestinal lumen towards the mucocutaneous junction. In case of circular rectal prolapse, 20–30 interrupted sutures are applied on the rectal mucosa at distance of 7 mm from the mucocutaneous junction. Then an electric knife is used to perform a circular incision in the distal direction from the applied sutures-holders and demucosation is performed, wherein the demucosation depth corresponds to the double value of the prolapse, determined using the swab, plus 1.5–2 centimeters, which is determined using a measuring scale on a scalpel handle applied to the separated mucosa. Then retractor hooks are transferred from skin of perianal region to demucosated muscular wall of intestine, after completion of the intestinal mucosa separation from the muscular layer and providing hemostasis, the hooks are transferred back to the perianal region, then 4 radial sutures are applied on a muscular intestinal wall, dividing the circumference of the surgical field into equal sectors, each suture having 4–6 radial stitches. After that proximal and distal ends of sutures of each suture are tied in 4 knots, gathering muscular wall, after which the excess mucous membrane at 12 o'clock of the conditional clock face is dissected longitudinally from the distal end in the proximal direction and a mucous-mucous anastomosis is formed with interrupted absorbable sutures, then mucous membrane is longitudinally incised at 6, 3 and 9 o'clock of conditional clock face with application of interrupted sutures, excess of separated mucous membrane is cut off and mucous-mucous anastomosis is applied, after which the circular retractor is dismantled. Treatment of rectal prolapse in children operated on for anorectal malformation includes dissection of rectal mucosa, separation of mucous membrane from muscular layer, application of longitudinal sutures on muscular membrane. Segmental prolapse requires a semilunar incision of the rectal mucosa on the prolapse side. A circular retractor is applied on the perianal skin at 5 mm from the mucocutaneous junction. Then, from the intestinal lumen towards the mucocutaneous junction, the length of the prolapse is determined, 10–15 interrupted sutures are applied on the rectal mucosa on the prolapse side at distance of 7 mm from the mucocutaneous junction. Then, an electric knife is used to perform a semilunar incision of the rectal mucosa on the prolapse side in the distal direction from the applied sutures, and demucosation is performed. At that, demucosation depth corresponds to double value of prolapse, determined by means of swab, plus 1.5–2 centimeters, that is determined using a measuring scale on a scalpel handle, applied to the separated mucosa, then the retractor hooks are transferred from the skin of the perianal region to the demucosated muscular wall of the intestine, after the intestinal mucosa is separated from the muscular layer and haemostasis is provided, the hooks are placed back on the perianal region. 4 radially arranged interrupted sutures are applied on a muscular intestinal wall symmetrically dividing a demucosated semicircle. Each seam has 4–6 radial stitches with interval of 4–5 mm, after which proximal and distal ends of sutures of each suture are tied by 4 knots, gathering muscular wall. Thereafter, the excess mucous membrane of the mucosal semicircle is dissected longitudinally from the distal end in the proximal direction and a mucous-mucous anastomosis is formed with interrupted absorbable sutures. Then, an excess of the separated mucous membrane is cut off, and a mucous-mucosal anastomosis is applied, after which the circular retractor is dismantled.

EFFECT: method allows to avoid recurrent rectal prolapse and stenosis of anastomosis, to achieve consistency of muscular cuff assembled by interrupted sutures, preservation of blood flow in it.

4 cl, 10 dwg, 2 ex