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90th Annual Meeting Abstracts
Pediatric Procidentia Prevented by Following Physics Principle
*Sarah J McPartland, MD, MS1, *Carl-Christian Jackson, MD1, *Alex Flores, MD1, *Andrew Levy2, Brian F Gilchrist, MD1
1Tufts Medical Center, Boston, MA;2Tufts Medical School, Boston, MA
Objective
Describe principles of physics that support our technique for repair of pediatric procidentia.
Design
Case series
Setting
Academic tertiary medical center
Patients
Seven children (ages 7 to 17) with procidentia who had failed maximal medical therapy for symptom control of their disease.
Interventions
Sigmoid resection with reconstruction of the hindgut was performed with an end of left colon to side of rectum anastamosis.
Main Outcome Measure
Clinical recurrence
Results
Patients were followed for a minimum of three years following hindgut reconstruction (range 3-6 years). At follow-up, none had recurrence of rectal prolapse. We were able to mathematically attribute the success of this geometric reconstruction to the following formula, which applies the principles of vector addition to motility in the hindgut:
Colonic force through side-to-side anastamosis
(limb lengths assigned a random value of 5 for calculation purposes; force magnitude is equal to N):
= vector A (left colon) + vector B (rectum) [intersecting at 90 degree angle]
= √ { (Ax+Bx)2 + (Ay+By)2 }
= √ { [(A cos (θA)) + (B cos (θB))] 2 + [(A sin (θA)) + (B sin (θB))] 2 }
= 7.07
Historically, according to the surgical literature, operative reconstructions of the hind gut have subscribed to the linear vector force, as outlined in this formula:
Colonic force through end-to-side anastamosis:
= vector A (left colon) + vector B (rectum)
= (lengthsegment A x magnitudesegment A) + (lengthsegment B x magnitudesegment B)
= 5N + 5N
= 10N
Conclusions
We have conclusively found that the geometry of our reconstruction adheres to a principle of physics, which leads to corrective operations in these unfortunate children with rectal prolapse.
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