Alejandra Vilanova-Sanchez's research while affiliated with Nationwide Children's Hospital and other places

Publications (51)

Article
Laparoscopy has a major role in the treatment of anorectal malformations (ARM) since Georgeson et al. introduced the laparoscopic assisted anorectoplasty in 2000. The majority of ARM can be repaired through a posterior sagittal incision without the need to enter the abdomen. Some ARM types require an abdominal approach to detach the rectum from the...
Chapter
Surgical treatment of Hirschsprung disease (HD) evolved in the last decades with the introduction of new innovative minimally invasive techniques. Nowadays minimal access can be performed with two different approaches, total transanal endorectal pull-through and laparoscopic-assisted transanal pull-through. In this chapter we emphasize the indicati...
Chapter
Anorectal malformations (ARM) affect 1 in 5000 live births. The majority of ARM can be repaired through a posterior sagittal incision as the rectum is reachable from below. However there are some types of anorectal malformations which need an abdominal approach. This abdominal approach is ideally performed with minimal invasive surgery. In this cha...
Article
Full-text available
Background Many patients with anorectal malformations (ARM) need a bowel management program (BMP) to manage lifelong problems of fecal incontinence or severe constipation. We aimed to evaluate the sustainability of the results in such a program. Methods A single-institution retrospective review was performed in children with ARM who attended our B...
Article
Aim of the Study : For the past four decades, routine daily postoperative anal dilation by parents has been the standard treatment following a primary posterior sagittal anorectoplasty (PSARP). However, the clinical benefit of this practice has never been formally investigated. It is known that dilations can have a significant negative psychologica...
Article
Background Patients with anorectal malformations (ARM) commonly have associated urologic anomalies. Few large studies exist to accurately characterize the incidence or associations between severity of malformation and urologic diagnosis. The purpose of our study was to determine the incidence of urologic diagnoses in a large cohort of children with...
Article
Purpose Interactive courses play an important role in meeting the educational needs of pediatric surgical trainees. We investigated the impact of a multimodal pediatric colorectal and pelvic reconstruction course on pediatric surgery trainees. Methods A retrospective evaluation was performed of pre- and post-course surveys for an annual colorectal...
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Full-text available
Hirschsprung disease is the most common neurocristopathy in children, resulting in the congenital loss of enteric ganglia. Rare reports of skip lesions have previously been reported in the literature. We present a case of skip lesions known prior to surgery and managed by pull-through of the right colon that allowed the preservation of the colon.
Article
The treatment of patients with colorectal disorders and their associated urologic, gynecologic, gastrointestinal, spinal, and orthopedic anomalies requires care from various medical and surgical specialties over the course of their lifetime. This is ideally handled by a collaborative center which facilitates the assessment and development of a long...
Article
Chronic idiopathic constipation, also known as functional constipation, is defined as difficult and infrequent defecation without an identifiable organic cause. Medical management with laxatives is effective for the majority of constipated children. However there is a subset of patients who may need evaluation by a surgeon. As constipation progress...
Article
Background and Aim Patients with a previously repaired anorectal malformation (ARM) can suffer from complications which lead to incontinence. Reoperation can improve the anatomic result, but its impact on functional outcomes is unclear. Methods We performed a retrospective cohort study of patients with a previously repaired ARM who underwent redo...
Article
Introduction: Pilonidal sinus (PS) is a highly frequent condition in teenagers. There is no consensus on which type of closure should be carried out following surgical removal. Our objective is to compare primary closure (PC) results with secondary closure (SC) or deferred closure results. Materials and methods: Patients undergoing surgery for P...
Chapter
This chapter describes the surgical and nonsurgical management of ovarian, isolated fallopian tube, or adnexal torsion, via open and laparoscopic approach. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, and variations in technique for the procedure in question. This is followed by a template o...
Chapter
This chapter describes the endoscopic/surgical procedure for vaginoplasty and vaginal replacement as performed by the following approach: open. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, needed equipment, and variations in technique for the procedure in question. This is followed by a temp...
Chapter
This chapter describes the surgical procedure for incision and drainage of Bartholin gland duct cyst or abscess as performed by open approach. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, needed equipment, and variations in technique for the procedure in question. This is followed by a templ...
Chapter
This chapter describes how to perform a hymenectomy. Hymenectomy may be indicated in the presence of an imperforate hymen causing mucocolpos, hematocolpos, hematometrocolpos at menarche; or in the case of a septate, microperforate, or cribriform hymen – which prevents tampon insertion or penetrative vaginal intercourse. An imperforate hymen typical...
Chapter
This chapter describes the endoscopic/surgical procedure for ovarian cystectomy for benign ovarian masses as performed by the following approaches: open and laparoscopic. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, needed equipment, and variations in technique for the procedure in question....
Article
Background: A subset of patients with cloacal malformations requires vaginal replacement during their primary reconstruction, increasing the surgical complexity. Identifying factors which predict the need for vaginal replacement would facilitate operative planning. Methods: We retrospectively reviewed patients who underwent primary cloacal recon...
Chapter
Anorectal malformations (ARM) are relatively common in children, affecting 1/5000 live births. Since the description of the posterior sagittal anorectoplasty (PSARP), the rectum is most often easily reachable from a posterior sagittal approach [1]. However, there are some malformations in which the rectum is located high in the pelvis and can benef...
Article
Recto-urethral fistulae are the most common finding in males born with an anorectal malformation (ARM). A high pressure distal colostogram is an important tool in visualizing the fistula, although the precise level at which the fistula communicates with the urethra may be difficult to interpret and is not reported in a uniform manner. This anatomy...
Article
Purpose: A complication of the surgical management of anorectal malformations (ARMs) is a retained remnant of the original fistula (ROOF) formerly called a posterior urethral diverticulum (PUD). A ROOF may have multiple presentations or may be incidentally discovered during the work-up of ARM after previous surgery. We sought to define the entity...
Article
Background: Despite variability at presentation, presacral masses in patients with and without anorectal malformations (ARM) appear histologically similar. The purpose of this study was to identify differences in oncologic outcomes between these two groups. Methods: A retrospective review was performed utilizing our institutional cancer and colo...
Article
Aim of the Study The goals of urinary reconstruction in urogenital sinus and cloacal repair include: (1) positioning of the bladder neck above the urogenital diaphragm to maximize future urinary continence, and (2) creating a visible urethra that can be catheterized if needed. A recent algorithm in cloacal reconstruction proposed a urethral length...
Article
Full-text available
Aim of the study: Many patients with an anorectal malformation (ARM) or pelvic anomaly have associated urologic or gynecologic problems. We hypothesized that our multidisciplinary center, which integrates pediatric colorectal, urologic, gynecologic and GI motility services, could impact a patient's anesthetic exposures and hospital visits. Methods:...
Article
Patients born with complex anorectal malformations often have associated Müllerian anomalies, which might affect fertility and obstetrical outcomes. Other vertebral-anorectal-tracheoesophageal-renal-limb associations, such as renal or cardiac anomalies, could also affect pregnancy intention, fertility rates, and recommendations about mode of delive...
Article
Background Appendicostomy and cecostomy are two approaches for antegrade enema access for children with severe constipation or fecal incontinence as adjuncts to a mechanical bowel management program. Each technique is associated with a unique set of complications. The purpose of our study was to report the rates of various complications associated...
Article
Aim Hepatoblastoma is the most frequent hepatic tumor in children, and its initial presentation will affect treatment and prognosis. The aim of this study is to evaluate long-term results of liver transplantation in children with unresectable hepatoblastoma. Patients and Methods This is a retrospective review of patients with hepatoblastoma who und...
Article
Aim Extrahepatic portal vein obstruction (EHPVO) is a frequent cause of noncirrhotic portal hypertension in children. The aim of this study is to analyze long-term results after diversion surgery. Patients and Methods Retrospective review of EHPVO patients who underwent diversion surgery analyzing number of platelets, leukocytes, prothrombin activi...
Article
Introduction: Patients with neurogenic bladder frequently also have bowel dysfunction and a simultaneous urologic and colorectal reconstruction is possible. We present our experience with combined reconstructive procedures using robot-assisted laparoscopy, and demonstrate the utility of a minimally invasive approach that considers both the bowel a...
Article
Introduction: Most patients with a cloacal malformation have a Mullerian anomaly. We sought to examine our patients with a cloacal malformation to determine the proportion of them we felt we knew their Mullerian anatomy and which proportion we felt would most benefit from longitudinal assessment to define their anatomy, reproductive potential, and...
Article
Introduction Patients with anorectal malformations (ARM), Hirschsprung disease (HD), and colonic motility disorders often require care from specialists across a variety of fields, including colorectal surgery, urology, gynecology, and GI motility. We sought to describe the process of creating a collaborative process for the care of these complex pa...
Article
Introduction: We previously reported our surgical technique for functional constipation for patients who have failed medical management using a novel collaborative approach with gastroenterology input, pre-operative contrast enema, colonic manometry, and laxative protocol combined with a laparoscopic colonic resection with Malone appendicostomy. N...
Article
Background: Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs. Methods: At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and...
Article
Background and aim: The sacral ratio (SR) is a well-established tool to quantify sacral development in patients with anorectal malformations (ARM) and can be used as a predictor of fecal continence. We hypothesized that a lower SR correlated with the presence of urologic and renal malformations. Methods: We retrospectively reviewed the medical r...
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Full-text available
Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depress...
Article
Background and aim: Senna is a stimulant laxative commonly used by pediatricians, pediatric gastroenterologists, and pediatric surgeons. Many clinicians avoid Senna for reasons such as tolerance or side effects but this has little scientific justification. We recently found several patients we were caring for developed perineal blistering during t...
Article
Introduction Health literacy is low in an estimated one-third of the US population. Little is known about the health literacy of caregivers of children with colorectal conditions. The objective of this study was to investigate whether a timed health literacy intervention could improve health literacy in this population. Methods We used the BRIEF H...
Article
Full-text available
Cloacal exstrophy is the most severe type of anorectal malformations that belongs to the bladder–exstrophy–epispadias complex of genitourinary malformations. Interestingly, its variant, the covered cloacal exstrophy, is often missed. The clinical findings of this variant may include an imperforate anus, low lying umbilicus, thick pubic bone, and pu...
Article
Background/aim: Patients may present with gynecologic concerns after previous posterior sagittal anorectoplasty (PSARP) for repair of an anorectal malformation (ARM). Common findings include an inadequate or shortened perineal body, as well as introital stenosis, retained vaginal septum, and remnant rectovestibular fistula. An inadequate or shorte...
Article
Full-text available
Costello syndrome is caused by heterozygous de novo missense mutations in the protooncogene HRAS with tumor predisposition, especially rhabdomyosarcoma. We here report two pediatric patients with Costello syndrome and umbilical ligament rhabdomyosarcoma. A review of the literature published in English in MEDLINE from January 1971 to June 2016 using...
Article
Patients with recto vestibular fistula may have gynecological malformations that could be unnoticed at the initial examination. The aim of this paper is to demonstrate the incidence of these malformations and propose a study method to help diagnose these malformations, avoiding unnecessary surgeries. We reviewed the records of patients treated with...
Article
IntroductionGanglioneuroma (GN) is a benign, differentiated variety of neurogenic tumor. It is often asymptomatic and may be diagnosed by serendipity. Surgical removal is the treatment of choice. However, it has been suggested that postoperative complications and sequelae might outweigh the benefits of this approach. The purpose of the present stud...

Citations

... A recent study examining continence outcomes in patients with anorectal malformation was able to show that undergoing a BMP improved urinary symptoms in these patients with underlying anatomic abnormalities of the urologic system [15]. While not specific for improvement in BBD, the Baylor Continence Scale (BCS) and Cleveland Clinic Constipation Score (CCCS) are also PROMs that are used to assess changes in bowel and bladder symptoms after intervention, which the aforementioned study examined as well [16,17]. ...
... A thorough physical exam also evaluates the abdomen for distention and the presence of a palpable lower midline mass, which may represent a hydrocolpos. This should be confirmed with bedside US, along with a check for concurrent hydroureteronephrosis [31]. An abdominal X-ray may show a pelvic mass opacifying a large portion of the abdomen ( Figure 5). ...
... As a result, the patient's condition deteriorates, simple constipation becomes complicated, and the recovery will be longer and difficult. In addition, when the drug treatment is not ideal, surgical treatment is also needed, which affects the patient's body function [18]. ...
... It may improve with advancing age, whereas the ARM-related ARP does not [9]. Severe ARP cannot be left untreated, as it has a major negative impact on short and long-term outcomes including excessive mucous production, ulceration, bleeding, and bowel function disorders [10]. There are very few studies addressing the surgical techniques and their long-term effectiveness in the correction of ARM-related ARP. ...
... The sacral ratio was calculated from the first radiograph available as described by Peña [4]. ARM index was also calculated evaluating the ARM type, sacral and spinal abnormalities [7]. A questionnaire to evaluate the bladder and bowel function was used during the hospital visit for performing the MRI study. ...
... Among patients undergoing repair of a cloacal anomaly, those with a long common channel are typically more likely to require vaginal replacement. In a recent study, factors predictive of needing vaginal replacement were need for urogenital separation and shorter vaginal length [2]. Rectum, colon, and small bowel are options for vaginal replacement. ...
... Anorectal malformations (ARMs) consist of a wide spectrum of defects with an estimated incidence of 1:5,000 live births. 1 Management relies on the correct identification of the rectum's location and its relationships to the urinary tract and bony structures of the pelvis. 2 At present, the gold standard for diagnosis is the augmented-pressure distal Keywords ► anorectal malformations ► ultrasound ► diagnostics ► reconstructive surgery Abstract Introduction Anorectal malformations (ARM) affect 1 in 5,000 newborns with a wide range of defects. In the absence of a visible fistula, the diagnosis and classification of ARM require an augmented pressure distal colostogram. ...
... For example, anterior anal retraction is the most common complication after anterior sagittal anorecto-plasty (ASARP) [5], while lateral misplacement of anorectum [4] may be more common after abdominal pull-through procedures. Posterior urethral diverticulum used to be seen more frequently following the early attempts of laparoscopic repair of rectourethral fistula [6]. ...
... Similarly, in Fig. 3, the AP plane gives the impression that the patient has a dysmorphic sacrum in part a, although the lateral image in part b elucidates a moderately developed sacrum in the same patient. The AP radiograph is important for detection of hemisacrum, a typical feature of Currarino syndrome [17], even if it is only present in 25% of patients [18]. ...
... 25 Another study analyzing the benefits of a multidisciplinary CCC found that the number of operative interventions, anesthetic exposures, and clinic visits could be reduced by coordinating care with the multiple specialties involved in the long-term management of complex pediatric colorectal patients. 26 Thus, the development of a CCC can lead to improved quality of care, reduced burden on families, and potentially improve patient outcomes. 25 . ...