Duhamel versus transanal endorectal pull through (TERPT) for the surgical treatment of Hirschsprung’s disease

Hirschsprung’s disease (HD) belongs to group of severe congenital malformations of the colon that can be only treated surgically. Various methods of radical correction HD have been evolutionarily improved. The Soave–Boley technique is considered to be the most successful, physiological and technically acceptable. Purpose – to evaluate the effectiveness of the use of stapler for primary colo-anal anastomosis as an element of Soave-Boley surgery in the surgical treatment of HD in children. Materials and methods. The analysis of surgical treatment of 125 children with various forms of HD aged from 6 months to 18 years, the formation of the primary colo-anal anastomosis was done using the Soave–Boley technique by mechanical (stapler) method. Results. In 20 patients (16.00%) among 125 with complicated course of HD, it was difficult to do radical single stage surgical treatment they required twostage treatment (stage 1) formation of the protective intestinal stoma and (stage 2) radical surgery. In the remaining 105 (84.00%) patients, single stageradical correction of HD was performed. In 1 (0.80%) of 125 patients operated by the Soave–Boley method with a primary colo-anal stapler anastomosis, in the early postoperative period was diagnosed with hematoma between pull through colon and sero-mascular pouch, which was treated conservatively. Andin one patient (0.80%) of 125 children in the remote postoperative period there was surgical complication – residual agangliosis, which was corrected by sphincteromyectomy by Lynn technique. Conclusions. Soave–Boley surgery with stapler colo-anal anastomosis is an effective method of radical correction of HD in children of different ages with one-stage or two-stage interventions. The use of a stapler for primary colo-anal anastomosis as an element of Soave–Boley surgery for the surgical treatment of HD in children with the consideration of necessary technical precautions has significant advantages over its classic methods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Hirschsprung’s disease, children, surgical treatment, results.

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Long-term outcomes in children with Hirschsprung’s disease and transition zone bowel pull-through: impact of surgical techniques and role for conservative approach

Pediatric Surgery International ◽

10.1007/s00383-021-04974-3 ◽

2021 ◽

Author(s):

Gowri Shankar ◽

J. G. Deepak ◽

Vinay Jadhav ◽

K. Venkatesh ◽

Usha Kini ◽

...

Keyword(s):

Transition Zone ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Surgical Techniques ◽

Conservative Approach ◽

Long Term Outcomes ◽

Pull Through

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The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

Journal of Robotic Surgery ◽

10.1007/s11701-021-01238-z ◽

2021 ◽

Author(s):

Tran Anh Quynh ◽

Pham Duy Hien ◽

Le Quang Du ◽

Le Hoang Long ◽

Nguyen Thi Ngoc Tran ◽

...

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Pediatric Patients ◽

Three Dimensional ◽

Dentate Line ◽

Robotic Arms ◽

Robotic Assisted ◽

The Mean ◽

Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

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Abnormal distribution of nerve terminals in the normoganglionic bowel of Hirschsprung's disease: a causative factor of failed pull-through operations?

Pediatric Surgery International ◽

10.1007/bf00832253 ◽

1994 ◽

Vol 9 (4) ◽

pp. 264-267 ◽

Cited By ~ 4

Author(s):

A. Yamataka ◽

T. Miyano ◽

T. Okazaki ◽

M. Urao ◽

T. Fujimoto ◽

...

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Causative Factor ◽

Nerve Terminals ◽

Abnormal Distribution ◽

Pull Through

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Long-Term Outcomes and Quality of Life in Patients after Soave Pull-Through Operation for Hirschsprung's Disease: An Observational Retrospective Study

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1604115 ◽

2017 ◽

Vol 28 (05) ◽

pp. 445-454 ◽

Cited By ~ 7

Author(s):

Tania Mahler ◽

Martine Dassonville ◽

Dinh Truong ◽

Annie Robert ◽

Philippe Goyens ◽

...

Keyword(s):

Quality Of Life ◽

Fecal Incontinence ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Bowel Function ◽

Long Term Outcomes ◽

Neurologic Impairment ◽

Pull Through

Introduction Patients after pull-through operation for Hirschsprung's disease (HD) are at high risk of defecation disorders. This study aimed at investigating their long-term outcomes and quality of life (QoL) in comparison with controls. Patients and Methods Patients older than 5 years operated on for HD were interviewed to complete detailed questionnaires on bowel function. Patients without neurologic impairment were enrolled in a QoL survey to compare with controls matched for sex and age and selected randomly from the general population using sampling set in a ratio of four controls to one case of HD. Results In total, 53 operated patients were enrolled. Mean age of the patients was 16 ± 8 years, with 68% boys. Rectosigmoid aganglionosis was the most seen form of HD in 38 (72%) cases. Open Soave was performed in 40 (75.5%) cases, and minimally invasive surgery Soave (MIS Soave) in 13 (24.5%) cases. At investigation, prevalence of fecal incontinence and constipation were 22.6 and 13.2%, respectively. Regarding QoL survey, 45 patients and 180 controls were enrolled, excluding 8 patients with neurologic impairment. Thirty-seven (82.2%) patients were classified as having a good QoL (score ≥ 9 points); whereas six had a fair QoL (5–8 points) and two had a poor QoL (< 5 points). QoL score in the cases and the controls were 10.2 ± 2.5 and 11.9 ± 0.4 points, respectively. Long aganglionosis form of HD was significantly associated with a low QoL (score < 8 points), adjusted odds ratio = 9, 95% confidence interval [1.3; 64.1] (p < 0.05). In subscales analyses, the prevalence of each dimension including fecal continence, school absenteeism, unhappiness or anxiety, food restriction, and peer rejection was significantly higher in operated patients than in controls (p <0.001). Conclusion Although the QoL of patients operated on for HD in general was with good outcomes, fecal incontinence and constipation still are problematic issues and challenges in a high percentage of patients. Therefore, a long-term and multidisciplinary follow-up is essentially required for these patients.

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