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Surgical Treatment
of Colorectal Problems
in Children
Alberto Peña
Andrea Bischo
123
Surgical Treatment of Colorectal
Problems in Children
Alberto Peña • Andrea Bischoff
Surgical Treatment
of Colorectal Problems
in Children
Alberto Peña
Pediatric Surgery
Colorectal Center for Children
Cincinnati Children’s Hospital
Cincinnati, OH
USA
Andrea Bischoff
Pediatric Surgery
Colorectal Center for Children
Cincinnati Children’s Hospital
Cincinnati, OH
USA
ISBN 978-3-319-14988-2 ISBN 978-3-319-14989-9 (eBook)
DOI 10.1007/978-3-319-14989-9
Library of Congress Control Number: 2015937190
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2015
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specifi c statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made.
Printed on acid-free paper
Springer International Publishing AG Switzerland is part of Springer Science+Business Media
(www.springer.com)
To our parents
To our children
To all children born with congenital anomalies
Foreword I
The care of infants and children with anorectal malformations and disorders
has long been an important component of the pediatric surgeon’s practice.
Information concerning the recognition and management of these relatively
common conditions dates back hundreds of years. Progress during the past
half-century due to advances in imaging, both prenatal and postnatal anatomic and embryologic studies, improved detection of associated anomalies,
the availability of antibiotics, and improvements in overall care resulted in
survival of most of the patients, but the functional outcomes following
attempted surgical correction of these conditions were not optimal and
remained a challenge. While children’s surgeons worldwide recognized the
guarded outcomes particularly related to establishing continence, it was diffi cult to reach a consensus on classifi cation, type of procedure, and methods
to assess outcomes and compare results.
Following the early work of Douglas Stephens and Durham Smith, many
surgeons were successful in achieving good outcomes for most infants with
imperforate anus and a perineal fi stula and girls with a rectoforchette (vestibular) fi stula or those without a fi stula; however, in those defects where the
rectal atresia ended with a recto-urethral or bladder fi stula and in instances of
cloacal anomalies results were often poor. Interest in these cases peaked
when Peter de Vries and Alberto Peña fi rst described the posterior sagittal
anorectoplasty (PSARP) procedure in 1980. While there remains some honest differences of opinion regarding the operative approach to some cases and
the success rates, surgeons throughout the world have employed the PSARP
in many patients and there has been a cooperative international effort to modify the old Wingspread and Peña Classifi cations and adopt the Krickenbeck
consensus to identify and classify the various anomalies and assess
outcomes.
Dr. Peña has focused his career on caring for infants and children with
colorectal problems both here and abroad. He is clearly recognized as one of
the leading experts in the fi eld and has made major contributions to the care
of these children. This textbook Surgical Treatment of Colorectal Problems
in Children co-edited by Dr. Andrea Bischoff is truly a labor of love and
refl ects the vast personal experience of the authors. As noted by the authors
in their forwarding remarks, this is not a data-driven, evidenced-based textbook, but rather an observational personalized approach based on their
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considerable experience in the care of these children. The book contains 27
chapters that cover the broad spectrum of colorectal conditions from the complex to the mundane (fi stula-in-ano, fi ssure, hemorrhoids, bowel preparation)
as well as an historical background, imaging, the role of minimally invasive
surgery, motility disorders, and perhaps more importantly bowel management. To his credit Dr. Peña has been a strong advocate of establishing multidisciplinary centers for colorectal disorders to aid children with motility
disorders and those that require bowel management programs especially in
the postoperative period. The textbook also includes chapters on Hirschsprung
disease and reoperative surgery but excludes any information on infl ammatory bowel disease (IBD). While this might be viewed as a weakness of the
book, it is noted that the authors intentionally left out the IBD chapter as they
did not feel their experience in this area was adequate.
One of the strengths and more unique aspects of the textbook is its use of
animation and careful attention to details that illustrate the surgical techniques employed in the operative care of the patients. The illustrations in the
book are superior. Another important area of emphasis in the text is the thorough evaluation of the status of the sacrum and spinal cord in determining
outcomes.
The textbook by Peña and Bischoff is an extensive reference on colorectal
disorders in children that will be useful to those both in training and practice
and provides insights into these conditions based on their enormous experience with these cases. It will be an excellent resource and valuable addition
to a pediatric surgeon’s personal library.
Foreword I
Jay L. Grosfeld
Indiana University School of Medicine
Indianapolis , IN , USA
Foreword II
In 1982, Prof. Alberto Pena made an outstanding contribution to the management of anorectal malformations by introducing the procedure of posterior
sagittal anorectoplasty which in subsequent years has become the classic
approach for the treatment of anorectal malformations. The book Surgical
Treatment of Colorectal Problems in Children represents over 30 years of
Prof. Pena’s experience in dealing with colorectal disorders in children.
The pediatric surgical community will greatly appreciate the efforts of
Prof. Alberto Pena and Dr. Andrea Bischoff in putting together their vast
experience in a valuable and easily readable book. The authors provide a
comprehensive description of operative techniques for various colorectal
malformations in children. The text is organised in a systematic manner providing step-by-step detailed practical advice on operative approach on the
management of these congenital malformations. The strength of the book is
that it is based on the experience and best belief of the authors which goes on
to show that the successful correction of colorectal anomalies requires a thorough understanding of the problem and the pathological anatomy as well as
meticulous attention to surgical techniques.
An interesting and unique feature of this book is the generous use of high
quality colour illustrations to clarify and simplify various operating techniques. Another unique feature of the book which has not been used before in
a pediatric surgical text is the use of sophisticated computer animation for the
diagnostic accuracy required for the effective treatment of anorectal
malformations.
I congratulate the authors for producing the most comprehensive and welldocumented text ever written on the surgical treatment of colorectal problems
in children. This book provides an authoritative and complete account of various colorectal problems in children. I hope that the trainees as well as the
established pediatric surgeons, pediatric urologists and pediatricians will fi nd
this textbook useful as a guide when dealing with colorectal problems.
Dublin , Ireland Prem Puri
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