Posterior caudal myectomy

Posterior posterior muscle resection for surgical treatment of congenital megacolon. Congenital megacolon is a common malformation of the digestive tract. It is caused by the lack of ganglion cells in the distal segment of the colon, resulting in intestinal fistula, normal peristalsis of the intestine segment disappearing, forming functional intestinal obstruction, obstructing proximal intestinal dilatation. Fat. The length of the intestines varies from a few centimeters, sometimes to the entire colon, and even to the small intestine. The latter has serious clinical symptoms and is complicated to treat. The most common type is the sigmoid colon below the sacral segment, and the proximal intestine near the sacral segment gradually expands until the dilated segment is called the transition segment. There is also a lack of ganglion cells in this segment of the intestine. In the dilated segment of the intestine muscle layer hypertrophy, chronic inflammation of the mucosa, and even ulceration, degeneration and spasm of the intermuscular plexus and submucosal ganglion cells. The length of the dilatation segment is also inconsistent with the age of the visit, and then gradually transitions to the normal intestine. The main point of congenital megacolon surgery is to remove the sacral segment, the transitional segment and some of the dilated bowel segments that cannot restore normal function according to the characteristics of the above pathological changes. Treatment of diseases: congenital megacolon in children with congenital megacolon Indication Posterior posterior muscle resection is not an abdominal cavity, no bowel resection and anastomosis, and less damage, only suitable for short megacolon, or as an auxiliary treatment for residual internal sphincter symptoms after other radical surgery. For some patients after this operation, some children can not resume spontaneous bowel movements. Therefore, some scholars believe that radical surgery should be performed after the diagnosis of ganglion cell megacolon, but this point is still controversial. Contraindications Congenital megacolon disease When the intestine segment is long, simply cutting the internal sphincter and partially removing the smooth muscle of the posterior wall of the rectum does not achieve a radical effect, so it is not applicable. This procedure is also not suitable for temporary treatment before radical surgery, because once it fails, severe adhesions in the anterior tibial space will bring great difficulties to the rectum. Surgical procedure 1. The sick child takes the prone position, and the pubic symphysis is raised below. The median incision in the back of the anus. 2. Separate the external sphincter subcutaneous fibers and the anal tail fascia to expose the puborectalis muscle ring and the external sphincter deep fibers. The operator's left hand shows the finger into the rectum, touches the internal sphincter, and marks with the finger to prevent the rectal mucosa from being cut. 3. Retract the anal external sphincter fibers, expose the anal internal sphincter, and cut the anal internal sphincter into a width of 2 cm. The incision continues to extend to the rectal muscle layer. According to the height of the sacral segment before surgery, the rectal muscle layer can be removed from 4 to 10 cm. If the length of the posterior wall of the rectum is to be 5 cm or more, it is often necessary to remove the coccyx and separate the anterior ankle space for good exposure. When removing the rectal muscle layer, carefully separate the mucosal layer to avoid damage to prevent postoperative infection. If the rectal mucosa is inadvertently damaged, it should be properly repaired. The anal external sphincter is placed back in place, the anal fascia and part of the external sphincter subcutaneous layer are sutured, and the subcutaneous and skin are sutured layer by layer. A rubber sheet was placed in the wound for drainage and removed after 24 hours. complication Incision infection Especially in the case of intraoperative injury of the rectal mucosa, the intraoperative incision of the rectal mucosa should be carefully sutured, the wound is rinsed with saline and the drainage strip is placed, and the antibiotic is treated with fasting after surgery. 2. Recurrent symptom group It is reported that due to the intraoperative resection of the posterior rectal muscle layer and the anal internal sphincter range is difficult to grasp, postoperative local adhesions, resulting in some cases of postoperative constipation symptoms recurrence, should be timely anal sphincter treatment, if the effect is not good Switch to radical surgery.

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