In an era where colostomy for HD is

In an era where colostomy for HD is being avoided because of its associated morbidity and even mortality, almost half of the patients required preliminary colostomy as part of staged management. The reason for this is due to late presentation in the patients which makes a primary pullthrough unsuitable because of the gross bowel distension. Also, many of the colostomies were done as a life-saving procedure in some of them as the conditions of the patients precluded any attempt at a primary extensive surgery. The advantages of a preliminary colostomy are numerous and include relief of obstruction, time for dilated colon to regain caliber and tone, making for easy colo-anal anastomosis as well as easy bowel washout prior to the pull-through. It may also help to reduce the incidence of postoperative
enterocolitis. Planning a two-staged procedure requires that the stoma be well sited in a biopsy-proven normal bowel. This facility was not constantly available during the study period due to cost constraints, mechanical failures of the frozen section machine as well as the emergency nature of the colostomy. Reliance had to be made in some cases on visual identification of the transition zone as well as presence of peristalsis on stimulation in order to site the stoma. One patient required resiting of the stoma because it was sited in the aganglionic portion. In a previous study we have shown that primary pull-through is feasible and desirable in our children even in infants less than four months old.[16] The patients, however, need to be carefully selected in addition to adequate bowel preparations. We were able to accomplish these in 54.5% of the children. The authors did not find a high incidence of postoperative enterocolitis in our patients following Swenson’s PT. One of our patients had suspected enterocolitis based on clinical presentation which responded to intravenous fluids and antibiotics.

Hasil (Bahasa Indonesia) 1:

Dalam era dimana elektronik untuk HD adalah dihindari karena terkait morbiditas dan mortalitas bahkan, hampir setengah dari pasien diperlukan awal elektronik sebagai bagian dari manajemen bertahap. Alasan untuk ini adalah karena akhir presentasi di pasien yang membuat pullthrough utama tidak cocok karena distension usus yang kotor. Juga, banyak dari colostomies yang dilakukan sebagai prosedur hidup hemat dalam beberapa dari mereka sebagai kondisi pasien menghalangi setiap usaha di operasi luas utama. Keuntungan dari awal elektronik banyak dan termasuk menghilangkan penyumbatan, waktu untuk membesar usus untuk mendapatkan kembali kaliber dan nada, membuat untuk membantu pembentukan anastomosis colo-anal mudah serta mudah usus Penghanyutan sebelum tarik-melalui. Itu juga dapat membantu untuk mengurangi timbulnya pasca bedahenterocolitis. Planning a two-staged procedure requires that the stoma be well sited in a biopsy-proven normal bowel. This facility was not constantly available during the study period due to cost constraints, mechanical failures of the frozen section machine as well as the emergency nature of the colostomy. Reliance had to be made in some cases on visual identification of the transition zone as well as presence of peristalsis on stimulation in order to site the stoma. One patient required resiting of the stoma because it was sited in the aganglionic portion. In a previous study we have shown that primary pull-through is feasible and desirable in our children even in infants less than four months old.[16] The patients, however, need to be carefully selected in addition to adequate bowel preparations. We were able to accomplish these in 54.5% of the children. The authors did not find a high incidence of postoperative enterocolitis in our patients following Swenson’s PT. One of our patients had suspected enterocolitis based on clinical presentation which responded to intravenous fluids and antibiotics.