caa a22 4500 465771629 CHVBK 20180323111930.0 cr unu---uuuuu 170327e19900101xx s 000 0 eng 10.1007/BF00179635 doi (NATIONALLICENCE)springer-10.1007/BF00179635 Improvements in the management of total colonic aganglionosis [Elektronische Daten] [B. Ratta, E. Kiely, L. Spitz, R. Brereton] Children with total colonic aganglionosis pass through three critical phases, the first extending from birth to the establishment of the correct diagnosis with construction of a ganglionic stoma. The second phase lasts from the raising of the stoma to its closure, including the definitive surgical procedure. The third phase begins with closure of the stoma and ends in a gradual decrease in the frequency of defaecation together with the acquisition of continence. The three phases have been analysed in two groups of patients; group I presented between 1978 and 1982 (n = 23) and group II between 1983 and 1987 (n = 17). In the first phase, 9 children in each group underwent inappropriate surgery. The mortality in the second phase was 26% in group I and 6% in group II and in the third phase 6% and 0% respectively. Lack of awareness of the condition and a reluctance to transfer neonates with intestinal obstruction to specialised centres led to delay in diagnosis and inappropriate treatment in both groups. In the second phase, improvements in results were due to increased use of parenteral nutrition, careful monitoring and replacement of stomal electrolyte losses, and improved management of enterocolitis. During the third phase, nocturnal incontinence remained a problem. Springer-Verlag, 1990 Hirschsprung's disease nationallicence Total colonic aganglionosis nationallicence Ratta B. The Hospitals for Sick Children, Great Ormond Street, London, UK aut Kiely E. The Hospitals for Sick Children, Great Ormond Street, London, UK aut Spitz L. The Hospitals for Sick Children, Great Ormond Street, London, UK aut Brereton R. The Hospitals for Sick Children, Great Ormond Street, London, UK aut Pediatric Surgery International Springer-Verlag 5/1(1990-01-01), 30-36 0179-0358 5:1<30 1990 5 383 https://doi.org/10.1007/BF00179635 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00179635 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ratta B. The Hospitals for Sick Children, Great Ormond Street, London, UK aut NATIONALLICENCE 700 1- Kiely E. The Hospitals for Sick Children, Great Ormond Street, London, UK aut NATIONALLICENCE 700 1- Spitz L. The Hospitals for Sick Children, Great Ormond Street, London, UK aut NATIONALLICENCE 700 1- Brereton R. The Hospitals for Sick Children, Great Ormond Street, London, UK aut NATIONALLICENCE 773 0- Pediatric Surgery International Springer-Verlag 5/1(1990-01-01), 30-36 0179-0358 5:1<30 1990 5 383 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer