スエヨシ　リヨウ   末吉　亮    所属   医学部 医学科（東京女子医科大学病院）    職種   講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Laparoscopy-Assisted Duhamel-Z Anastomosis for Total Colonic Aganglionosis: Outcome Assessed by Fecal Continence Evaluation.
掲載誌名	正式名：Journal of laparoendoscopic & advanced surgical techniques. Part A 略　 称：J Laparoendosc Adv Surg Tech A ISSNコード：15579034/10926429
掲載区分	国外
巻・号・頁	27(3),pp.302-305
著者・共著者	Miyano Go, Nakamura Hiroki, Seo Shogo, Sueyoshi Ryo, Okawada Manabu, Doi Takashi, Koga Hiroyuki, Lane Geoffrey J, Okazaki Tadaharu, Yamataka Atsuyuki
発行年月	2017/03
概要	BACKGROUND:A Z-shaped colorectal side-to-side anastomosis was introduced to improve the Duhamel procedure by eliminating the rectal blind pouch. We retrospectively reviewed all total colonic aganglionosis patients treated by laparoscopy-assisted Duhamel-Z (LapDZ) between 2009 and 2014 focusing on annual fecal continence evaluation scores (CES) as an indicator of outcome.METHODS:LapDZ was performed conventionally. Postoperatively, defecation was regulated with medications and enemas according to our standard protocol. Stool frequency, stool consistency, fecal soiling/incontinence, growth, and severity of enterocolitis were each scored (0-2) to give a total CES (maximum: 10).RESULTS:Eleven subjects (6 males and 5 females) were reviewed. Mean age and mean weight at LapDZ were 10.2 months and 8.4 kg, respectively. Mean length of the aganglionic ileum resected was 19.5 cm. Mean operative time was 6.2 hours. Postoperative recommencement of oral intake took 5.7 days on average. There were no intraoperative complications, no anastomotic leaks or strictures, and no intestinal obstruction. Postoperative blood transfusion was required in 1 case complicated by chronic bleeding. No subject has been constipated postoperatively. Follow-up was for 5 years. The number of subjects who had CES assessments each year was: after 1 year (n = 11), after 2 years (n = 10), after 3 years (n = 10), after 4 years (n = 8), and after 5 years (n = 5). Average annual CES during follow-up were 4.5, 6.1, 7.7, 8.1, and 8.4, respectively.CONCLUSION:LapDZ and strict management of postoperative bowel function may have contributed to improving CES over time.
DOI	10.1089/lap.2016.0216
PMID	28080215