606 International Abstracts of Pediatric Surgery

was Wilms' tumor 56 (19%), non–Hodgkin lymphoma 71 (24%),

Hodgkin's lymphoma 64 (22%), rhabdomyosarcoma 32 (11%) and

neuroblastoma 68 (24%). There were a total of 12 bowel obstructions in

11 patients (3.7%). Mean follow-up was 3.6 ± 2.7 years. Children with

SBO were more likely to be male (4.5 : 1, P0.061) and younger (4.2 years

vs. 8.1yrs; P 0.087), Wilms' tumor accounted for 45% of patients with

SBO, but made up only 19% of the study population. The incidence of

SBO in patients with Wilms' tumor was 8.9% compared to 3.8% overall

incidence (P 0.043).

It is concluded that SBO is relatively uncommon after intra-abdominal

malignancies. Wilms' tumor, Burkitt's lymphoma, and rhabdomyosarcoma

appear to be associated with the highest risk of SBO.—

Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2010.11.054

Transanal endorectal vs. Duhamel pull-through forHirachsprung's diseaseGunnarsdottir A, Larsson L-T, Ambjörnsson E. Eur J Pediatr Surg 2010

(August);20/4:242-6

The aim of this study was to test the hypothesis that the early functional

outcome for patients with rectosigmoid Hirschsprung' s disease (HD) is

comparable for the Duhamel pull-through procedure and the transanal pull-

through (TERPT) procedure, with less discomfort for the patient

postoperatively after the TERPT technique. Eleven patients operated on

with the TERPT technique (T-group) were prospectively registered and

compared retrospectively with 18 patients operated on with the Duhamel

pull-through (D-group). Data recorded included patient demographics,

operative treatment, complications, hospital stay and bowel functions.

Follow-up time was limited to 24 months.

The T-group started oral feeding sooner, their bowel movement started

sooner, they had less need for analgesics postoperatively and a significantly

shorter hospital stay. Seventy one percent of the patients in the D-group

needed re-intervention as compared to only 18% of the T-group.

Enterocolitis was seen in two patients in both groups. At the last clinical

control ten patients had constipation (59%) and three had soiling (18%) in the

D-group. Three patients in the T-group had constipation (27%) and one had

soiling (9%).

In conclusion, the results support the use of the TERPT method rather than

the Duhamel pull-through for rectosigmoid HD.—

Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2010.11.055

Laparoscopic mesh rectopexy for complete rectal prolapse in children:a new simplified techniqueShalaby R, Ismail M, Abdelaziz M. Pediatr Surg Int 2010;26:807-13

Rectal prolapse in children without underlying conditions is usually a self-

limiting problem and requires no surgical treatment. For children with

persistent rectal prolapse, a variety of surgical procedures have been

described. This paper presents a novel simplified laparoscopic technique for

management of those patients. The aim of this study is to evaluate the results

that can be achieved by using this technique in management of persistent

complete rectal prolapse in children.

The authors reviewed the reports of 680 patients with primary complete and

partial rectal prolapse over the period from August 2000 to August 2008.

Fifty-two patients with complete primary rectal prolapse refractory to

medical treatment for 2 years underwent a novel simplified technique for

laparoscopic mesh rectopexy. The technique involves laparoscopic posterior

rectal mobilization, retroperitoneal presacral mesh placement, and fixation

of the redundant sigmoid to the mesh.

Nonoperative management was successful with no recurrences in 628

patients (92.4%), whereas 52 (7.6%) patients did not respond to non-

operative management at a median follow-up period of 2 years. They

were 35 males and 17 females. Their ages ranged from 2 to 14 years

(mean 6). All patients were successfully subjected to laparoscopic mesh

rectopexy without any conversion. The mean duration of surgery was

40 min. No intraoperative complications were reported, but one patient

developed postoperative constipation that responded well to conservative

treatment. The mean postoperative hospitalization was 2 days. Two cases

were lost to follow-up, while the others were available for 36 months.

There was no recurrence. The authors conclude that laparoscopic mesh

rectopexy is a safe, rapid, effective technique. It improved functional

outcome without recurrence. It is associated with minimal postoperative

pain and short hospital stay with excellent cosmetic result.—

Federico G. Seifarth

doi:10.1016/j.jpedsurg.2010.11.056

The efficacy of external neuromyogenic stimulation on neuromuscularanorectal incontinenceErgun O, Tatlisu R, Pehlivan M, et al. Ezr J Pediatr Surg 2010 (August);

20/4:230-3

This study presents the preliminary results of external neuromyogenic

electrostimulation (EMS) for the treatment of anorectal continence problems.

A total of 17 patients with anorectal malformations (n = 11), Hirsch-

sprung's disease (n = 5) or pelvi-perineal trauma (n = 1) were included in

the study. All patients were evaluated using clinical, radiological and

manometric methods prior to ENS. The Holschneider Continence Scale and

the Quality of Life (QOL) score were used for clinical assessment. The

ENS stimulator is a two channel ambulatory device providing a pulse

current. ENS was performed by parents in a home setting twice daily, using

a skin electrodes attached to the sides of the anus. ENS was continued for

6 weeks. Clinical and manometric variables were reevaluated following the

6-week program.

Mean age of the patients was 9.7 years (range 5-22 years) . The

Holschneider Continence Score increased from a mean value of 5.3 ± 3.2

to 12.4 ± 1.7 significantly (P = .002) and mean QOL stores from 5.6 ± 2.3

to 11.6 ± 1.8 (P = .01) following ENS. Mean anal resting pressures

prior to ENS were 20.3 ± 6 cm H2 and increased to 28.7 ± 14.7 cm H2

after 6 weeks (P = .05). Maximum voluntary squeeze pressures before an

after ENS were 56.1 ± 16.7 cm H2 and 100.7 ± 16.9 cm H2O, respectively

(P = .001). Preliminary results of ENS thus have shown that patients

achieved higher maximum voluntary squeeze pressures, and showed a

marked improvement in their continence and QOL scores. Given the

advantage of ambulatory use in a home setting, the ENS seems promising

in terms of achieving improved anorectal continence in selected

patients.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2010.11.057