Evaluation of Perioperative Management of Augmentation Cystoplasty in Patients With Spina Bifida : Safety and Efficacy of Modified Management

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  • 二分脊椎患者に対する消化管利用膀胱拡大術の周術期管理 : 入院期間を短縮し患児のストレスを軽減するための工夫
  • 二分脊椎患者に対する消化管利用膀胱拡大術の周術期管理--入院期間を短縮し患者のストレスを軽減するための工夫
  • 2ブン セキツイ カンジャ ニ タイスル ショウカカン リヨウ ボウコウ カクダイジュツ ノ シュウジュツキ カンリ ニュウイン キカン オ タンシュクシ カンジャ ノ ストレス オ ケイゲンスル タメノ クフウ

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Abstract

Purpose: Augmentation cystoplasty is a widely accepted surgical procedure in patients with spina bifida. However, many patients likely feel stress due to the long hospital stay. We modified perioperative management to shorten the hospital stay and evaluated the safety and efficacy of the management. Methods: From June 2004 to March 2007, we performed 13 augmentation cystoplasties in patients with spina bifida. Surgical materials were ileum in 12, sigmoid colon in 1. Mean follow up period was 1y11m (8m-3y5m). According to the style of discharge, patients were divided into two groups: Group 1, discharge without catheter; Group 2, early discharge with catheter and later re-admission for catheter removal. In addition, Group 2 patients were divided into two subgroups: Group 2a, with retrograde colonic enema before admission; Group 2b, without retrograde colonic enema. In each group we retrospectively reviewed clinical records and evaluated the duration of hospital stay, time to oral fluid intake, wound infection and gastrointestinal complication. Results: The total hospital stay of Group 2 (17.7 days) was shorter than that of Group 1 (27 days). Time to oral fluid intake and total hospital stay in Group 2a and Group 2b were 2.25 days, 14.8 days and 3.25 days, 20.75 days respectively. There was no wound infection. Only 1 case had postoperative acute gastric mucosal lesion. We did not experience any case of leakage with anastomosis, ileus or V-P shunt infection. Conclusion: Postoperative early discharge with catheter and retrograde colonic enema before admission were safe and effective perioperative measures to shorten the hospital stay.

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