Comparison of clinical outcomes after total transanal and laparoscopic assisted endorectal pull-through in patients with rectosigmoid Hirschsprung disease

Abstract Background Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. Methods A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. Results A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000). Conclusion General anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.

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Laparoscopic-Assisted Transanal Pull-Through in Hirschsprung Disease: Does Laparoscopic Dissection Minimize Anal Overstretching?

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2019.0524 ◽

2020 ◽

Vol 30 (3) ◽

pp. 338-343 ◽

Cited By ~ 1

Author(s):

Osama A. Bawazir

Keyword(s):

Hirschsprung Disease ◽

Pull Through ◽

Laparoscopic Assisted

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Suspension sutures facilitate single-incision laparoscopic-assisted rectal pull-through for Hirschsprung disease

BMC Surgery ◽

10.1186/s12893-021-01260-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Liem Thanh Nguyen ◽

Anh Tho Nguyen ◽

Quang Thanh Nguyen ◽

Quynh Anh Tran ◽

Hau Duc Bui ◽

...

Keyword(s):

Abdominal Wall ◽

Single Incision ◽

Hirschsprung Disease ◽

Conventional Instruments ◽

Long Term Follow Up ◽

Pull Through ◽

Laparoscopic Assisted ◽

Suspension Suture

Abstract Background To present a surgical technique of single-incision laparoscopic-assisted endorectal pull-through (SILEP) with suspension sutures using conventional instruments for Hirschsprung disease (HD) and its long-term follow-up outcomes. Methods The procedure began with a 1 cm transumbilical skin incision. Three separate punctures were made in the fascia with a 5 mm scope in the middle and 5 mm and 3 mm ports for working instruments on the left and right, respectively. The first suspension suture was placed to secure the sigmoid colon to the abdominal wall. A window was created through the rectal mesentery, and dissection around the rectum was carried out. The second suspension suture was performed to suspend the rectovesical peritoneal fold or the rectovaginal peritoneal fold to the abdominal wall. Dissection around the rectum was continued downward to approximately 1 cm below the peritoneal fold. Then, the operation was completed by a transanal approach. Results Forty patients underwent SILEP from March 2013 to April 2015. The median age was 2.7 months (ranging from 1 to 17 months). The mean operative time was 96 ± 23 min. No conversion to an open operation was required. The average hospitalization time was 4.5 ± 2 days. There were no intraoperative or perioperative complications. Long-term follow-up results were obtained from 38 patients. A frequency of defecation from every other day to twice a day was noted for 33 patients (86.8%) and more often for 5 patients (13.2%). Two patients had enterocolitis (5.2%). Conclusion Single-incision laparoscopic rectal pull-through with suspension sutures using conventional instruments is feasible and safe for HD with good long-term outcomes.

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Suspension Sutures Facilitate Single Incision Laparoscopic-Assisted Rectal Pull-Through for Hirschsprung Disease

10.21203/rs.3.rs-107785/v1 ◽

2020 ◽

Author(s):

Liem Thanh Nguyen ◽

Anh Nguyen Tho ◽

Quang Nguyen Thanh ◽

Quynh Tran Anh ◽

Hau Bui Duc ◽

...

Keyword(s):

Abdominal Wall ◽

Single Incision ◽

Hirschsprung Disease ◽

Conventional Instruments ◽

Long Term Follow Up ◽

Pull Through ◽

Laparoscopic Assisted ◽

Suspension Suture

Abstract BackgroundTo present the surgical technique and long-term follow-up outcomes of single incision laparoscopic-assisted endorectal pull-through (SILEP) with suspension sutures using conventional instruments for Hirschsprung disease. MethodsThe procedure began with a 1cm transumbilical skin incision. Three separate punctures were made onto the fascia for a 5mm scope in the middle, a 5mm and 3mm ports for working instruments on the left and right, respectively. The first suspension suture was performed to secure the sigmoid colon to the abdominal wall. A window was created through the rectal mesentery, and dissection around the rectum was carried out. The second suspension suture was performed to suspense the rectovesical peritoneal fold or the rectovaginal peritoneal fold to the abdominal wall. Dissection around the rectum was continued downward to approximately 1cm below the peritoneal fold. The operation was completed by a transanal approach. Results40 patients underwent SILEP from March 2013 to April 2015. The median age was 2.7 months (ranged from 14 days to17 months). The mean operative time was 94.7 ± 20 minutes. No conversion to open operation was required. Mean hospital stay was 4.1±1.3 days. There were no intraoperative or perioperative complications. Long term follow-up results were obtained in 38 patients. The number of defecation from 1-2 times per day was noted in 36 patients (94.7%) and from 3-4 times per day in 2 patients (5.2%). Two patients had enterocolitis (5.2%).ConclusionSingle site laparoscopic rectal pull-through with suspension sutures using conventional instruments is feasible and safe for Hirschsprung disease with good long-term outcomes.

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Functional outcomes of patients with short-segment Hirschsprung disease after transanal endorectal pull-through

BMC Gastroenterology ◽

10.1186/s12876-021-01668-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gunadi ◽

Gabriele Ivana ◽

Desyifa Annisa Mursalin ◽

Ririd Tri Pitaka ◽

Muhammad Wildan Zain ◽

...

Keyword(s):

Functional Outcomes ◽

Hirschsprung Disease ◽

Treatment Method ◽

Strongly Correlated ◽

Short Segment ◽

Multicenter Studies ◽

Operative Complications ◽

Pull Through ◽

Larger Sample ◽

Post Operative Complications

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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Analysis of problems, complications, avoidance and management with transanal pull-through for Hirschsprung disease

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2007.07.017 ◽

2007 ◽

Vol 42 (11) ◽

pp. 1869-1876 ◽

Cited By ~ 21

Author(s):

Akshay Pratap ◽

Devendra Kumar Gupta ◽

Vikal Chandra Shakya ◽

Shailesh Adhikary ◽

Awadhesh Tiwari ◽

...

Keyword(s):

Hirschsprung Disease ◽

Pull Through

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Perioperative and long-term functional outcomes of neonatal versus delayed primary endorectal pull-through for children with Hirschsprung disease: A Pediatric Colorectal and Pelvic Learning Consortium Study

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2021.04.024 ◽

2021 ◽

Author(s):

Zachary J. Kastenberg ◽

Mark A. Taylor ◽

Megan M. Durham ◽

Casey M. Calkins ◽

Rebecca M. Rentea ◽

...

Keyword(s):

Functional Outcomes ◽

Hirschsprung Disease ◽

Pull Through

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Altered Cytoskeleton in Smooth Muscle of Aganglionic Bowel

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-0692-acismo ◽

2002 ◽

Vol 126 (6) ◽

pp. 692-696

Author(s):

Laszlo Nemeth ◽

Udo Rolle ◽

Prem Puri

Keyword(s):

Smooth Muscle ◽

Smooth Muscle Cells ◽

Laser Scanning ◽

Hirschsprung Disease ◽

Muscle Cells ◽

Cytoskeletal Proteins ◽

Laser Scanning Microscopy ◽

Confocal Laser ◽

Normal Bowel ◽

Pull Through

Abstract Context.—Intestinal motility is under the control of smooth muscle cells, enteric plexus, and hormonal factors. In Hirschsprung disease (HD), the aganglionic colon remains spastic or tonically enhanced and unable to relax. The smooth muscle cell's cytoskeleton consists of proteins or structures whose primary function is to link or connect protein filaments to each other or to the anchoring sites. Dystrophin is a subsarcolemmal protein with a double adhesion property, one between the membrane elements and the contractile filaments of the cytoskeleton and the other between the cytoskeletal proteins and the extracellular matrix. Desmin and vinculin are functionally related proteins that are present in the membrane-associated dense bodies in the sarcolemma of the smooth muscle cells. Objective.—To examine the distribution of the cytoskeletal proteins in the smooth muscle of the aganglionic bowel. Design.—Bowel specimens from ganglionic and aganglionic sections of the colon were collected at the time of pull-through surgery from 8 patients with HD. Colon specimens collected from 4 patients at the time of bladder augmentation acted as controls. Anti-dystrophin, anti-desmin, and anti-vinculin antibodies were used for fluorescein immunostaining using confocal laser scanning microscopy. Results.—Moderate to strong dystrophin immunoreactivity was observed at the periphery of smooth muscle fibers in normal bowel and ganglionic bowel from patients with HD, whereas dystrophin immunoreactivity was either absent or weak in the smooth muscle of aganglionic colon. Moderate to strong cytoplasmic immunostaining for vinculin and desmin was seen in the smooth muscle of normal bowel and ganglionic bowel from patients with HD, whereas vinculin and desmin staining in the aganglionic colon was absent or weak. Conclusion.—This study demonstrates that the cytoskeletal proteins are abundant in the smooth muscle of normal bowel, but are absent or markedly reduced in the aganglionic bowel of HD. As cytoskeletal proteins are required for the coordinated contraction of muscle cells, their absence may be responsible for the motility dysfunction in the aganglionic segment.

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