Optimal Timing for Soave Primary Pull-through in Short-Segment Hirschsprung Disease: A Meta-Analysis

Abstract Background Transanal endorectal pull-through (TEPT) is considered the most preferable treatment method for Hirschsprung disease (HSCR) since it is less invasive and has fewer morbidities than transabdominal pull-through. Here, functional outcomes in short-segment HSCR patients after TEPT were assessed and associated with the prognostic factors. Methods Krickenbeck classification was used to assess the functional outcomes in patients with HSCR after TEPT surgery at our institution from 2012 to 2020. Results Fifty patients were involved in this study. Voluntary bowel movement (VBM) was achieved in 82% of subjects. Nine (18%) subjects had soiling grade 1, while two (4%) and two (4%) patients suffered constipation that was manageable with diet and laxative agents, respectively. Patients who underwent TEPT at ≥ 4 years old tended to have soiling more than patients who underwent TEPT at < 4 years old (OR = 16.47 [95% CI 0.9–301.61]; p = 0.06), whereas patients with post-operative complications had 10.5-fold higher risk for constipation than patients without post-operative complications (p = 0.037; 95% CI 1.15–95.92). Multivariate analysis showed male sex was significantly associated with VBM (OR = 9.25 [95% CI 1.34–63.77]; p = 0.024), while post-operative complications were strongly correlated with constipation (OR = 10 [95% CI 1.09–91.44]; p = 0.04). Conclusions The functional outcomes of HSCR patients after TEPT in our institution are considered relatively good. Moreover, the VBM, soiling, and constipation risk after TEPT might be affected by sex, age at TEPT performed, and post-operative complications, respectively, while the age at TEPT performed might not be associated with functional outcomes. Further multicenter studies with a larger sample size are necessary to clarify and confirm our findings.

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Duhamel and Transanal Endorectal Pull-throughs for Hirschsprung' Disease: A Systematic Review and Meta-analysis

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1607061 ◽

2017 ◽

Vol 28 (01) ◽

pp. 081-088 ◽

Cited By ~ 7

Author(s):

Hiromu Miyake ◽

Alison Hock ◽

Yuhki Koike ◽

Chen Yong ◽

Carol Lee ◽

...

Keyword(s):

Anastomotic Stricture ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Hirschsprung Disease ◽

Continuous Variables ◽

Postoperative Constipation ◽

Dichotomous Variables ◽

Pull Through

Aim The Duhamel pull-through and transanal endorectal pull-through (TEPT) are commonly used for the treatment of Hirschsprung's disease (HD). To date, there has been no meta-analysis evaluating postoperative outcomes following Duhamel pull-through and TEPT. The purpose of this meta-analysis was to compare patient outcome after Duhamel pull-through and TEPT for HD. Materials and Methods Original articles published between 1998 and 2016 were identified using the MEDLINE database. Studies comparing Duhamel pull-through and TEPT were included. Outcomes evaluated included incidence of postoperative constipation, incontinence/soiling, enterocolitis, anastomotic stricture, and leak. We analyzed dichotomous variables by estimating odds ratios (OR) with 95% confidence intervals (CI) and continuous variables using the weighted mean difference with 95% CI. The meta-analysis was done using RevMan 5.3. Result There were no randomized controlled trials. Seven observational clinical studies were included, comprising 260 cases of Duhamel pull-through and 170 cases of TEPT. Anastomotic stricture (OR = 0.10; 95%CI 0.02–0.48; p = 0.004) was lower following Duhamel pull-through than TEPT. There were no significant differences in the incidence of postoperative incontinence/soiling and anastomotic leak. After TEPT, postoperative constipation seems to be lower and enterocolitis higher compared with those after Duhamel pull-through; however, these differences are not significant when the follow-up period is equal between groups. Conclusion The Duhamel pull-through seems to be associated with lower incidence of anastomotic stricture compared with TEPT. The effects of the two analyzed operative techniques on constipation and enterocolitis remain unclear. The quality of evidence supporting the above findings is suboptimal, indicating the need for prospective studies.

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Duhamel operation vs. transanal endorectal pull-through procedure for Hirschsprung disease: A systematic review and meta-analysis

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2017.10.047 ◽

2018 ◽

Vol 53 (9) ◽

pp. 1710-1715 ◽

Cited By ~ 5

Author(s):

Yong-zhong Mao ◽

Shao-tao Tang ◽

Shuai Li

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Hirschsprung Disease ◽

Pull Through

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Optimal time for single-stage pull-through colectomy in infants with short-segment Hirschsprung disease

International Journal of Colorectal Disease ◽

10.1007/s00384-018-3179-3 ◽

2018 ◽

Vol 34 (2) ◽

pp. 255-259 ◽

Cited By ~ 1

Author(s):

Tianqi Zhu ◽

Xiaoyi Sun ◽

Mingfa Wei ◽

Bin Yi ◽

Xiang Zhao ◽

...

Keyword(s):

Hirschsprung Disease ◽

Single Stage ◽

Optimal Time ◽

Short Segment ◽

Pull Through

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Characterization of the Transition Zone in Short Segment Hirschsprung Disease Using Calretinin Immunostaining

Pediatric and Developmental Pathology ◽

10.1177/10935266211053973 ◽

2021 ◽

pp. 109352662110539

Author(s):

Franziska Righini-Grunder ◽

Dorothée Bouron-Dal Soglio ◽

Lara Hart ◽

Ann Aspirot ◽

Christophe Faure ◽

...

Keyword(s):

Transition Zone ◽

Ganglion Cells ◽

Short Form ◽

Hirschsprung Disease ◽

Nerve Fibers ◽

Normal Density ◽

Short Segment ◽

Pull Through ◽

Distal Border ◽

Proximal Border

Introduction: The detailed expression pattern of calretinin immunohistochemistry in the transition zone (TZ) of Hirschsprung disease (HSCR) has not yet been reported. This study aims to examine the value of calretinin immunohistochemistry for more accurately determining the distal and proximal border of the TZ in short segment HSCR. Methods: Specimens of pull-through surgery from 51 patients with short form of HSCR were analyzed on two longitudinal strips using hematoxylin and eosin (H&E) staining and calretinin immunohistochemistry. Results: In all but two patients, the first appearance of calretinin expression was seen on mucosal nerve fibers before the appearance of any ganglion cells, indicating the distal border of the TZ. The maximum distance between the distal border of the TZ and the proximal border of the TZ, defined by ganglion cells in a normal density on H&E stained sections, a strong calretinin expression on mucosal nerve fibers and in >80% of submucosal and myenteric ganglion cells, with no nerve hypertrophy and absence of ganglionitis was 60 mm. Conclusion: The distal border of the TZ is characterized by calretinin positive intramucosal neurites in nearly all of short form of HSCR and not by calretinin expression on ganglion cells.

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Paediatrician’s Suspicion and Radiologist’s Precision in Diagnosing Hirschprung’s Disease in a Child: Case Report

Nepalese Journal of Radiology ◽

10.3126/njr.v10i2.35975 ◽

2020 ◽

Vol 10 (2) ◽

pp. 38-41

Author(s):

Shashi Sharma ◽

Tanu Singh ◽

Rohit Sharma ◽

Vinod Bende ◽

Praveen Gulia ◽

...

Keyword(s):

Case Report ◽

Early Diagnosis ◽

Delayed Diagnosis ◽

Hirschsprung Disease ◽

Abdominal Distension ◽

Plain Radiography ◽

Motor Disorders ◽

Short Segment ◽

Pull Through ◽

Hirschprung's Disease

Hirschprung’s disease (HD) is also called as aganglionic megacolon. The entity falls in the group of congenital motor disorders. The usual presentation is in the form of not passing of meconium, abdominal distension with or without vomiting. We present a 2-years old child who was brought with complaints of constipation and difficulty in passing stool. The child was evaluated radiologically by plain radiography, ultrasonography (USG) and barium enema and was diagnosed as a case of short segment type of Hirschsprung disease. The parents had been counselled and advised for pull-through surgery for the child. It is a dilemma for the paediatrician to confirm the diagnosis of Hirschprung’s disease until a radiologically confirmed diagnosis is made. Many cases are delayed for the treatment because of non-diagnosis or delayed diagnosis. The importance lies in the early diagnosis for further surgical management.

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