Children with VACTERL association (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula with atresia, renal defects/radial limb dysplasia) often progress to ESRD, many of them with a colostomy that cannot be displaced. How should the surgeon proceed to prepare these patients for kidney transplantation? There are very few reports in the literature. How have you dealt with these patients?
My rare experiences with transplants in these children did not differ very significantly from the standard. If there has been extensive abdominal surgery, of course, the retroperitoneal plane may not be so easily developed. This is particularly the case in those who have had lower GI or pelvic procedures. A midline incision may be necessary.. Regardless of the approach, the side opposite the colostomy has clear advantages. In cases where bladder surgery has occurred, or if there is significant lower abdominal scarring, inflating the bladder when preparing for the ureterocytostomy is best done with saline containing methylene blue. This way, there is little doubt about the identity of bladder mucosa. In terms of medical/respiratory management, these issues are clearly best dealt with by the ICU/respirology team.
Thnak you for your answer. I will forward it to my team's surgeon.
Best regards
Marcelo
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