Long-Term Results of One-Stage Laparoscopic-Assisted Endorectal Pull-Through for Rectosigmoid Hirschsprung's Disease in Patients Aged Above 5 Years

2020 ◽  
Author(s):  
Kin Wai Edwin Chan ◽  
Kim Hung Lee ◽  
Hei Yi Vicky Wong ◽  
Siu Yan Bess Tsui ◽  
Jennifer Wai Cheung Mou ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Long Term Results ◽  
One Stage ◽  
Pull Through ◽  
Laparoscopic Assisted

scholarly journals One stage transanal full thickness pull-through operation for rectosigmoid Hirschsprung's disease

2016 ◽  
Vol 9 (3) ◽  
pp. 135
Author(s):  
A. K. M. Zahid Hossain ◽  
Gazi Zahirul Hasan ◽  
Susankar Kumar Mandal ◽  
Md. Nooruzzaman ◽  
A. Shahinoor ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Bowel Movement ◽  
Long Term Results ◽  
Full Thickness ◽  
Urinary Function ◽  
One Stage ◽  
Pull Through

<p>The surgical management of Hirschsprung's disease (HD) has changed from the original staged operations to the latest introduced minimally invasive one stage techniques. One stage transanal full thickness Swenson-like procedure is a new concept of single stage procedure for HD. We reviewed the early outcome of one stage transanal Swenson-like pull-through operation for rectosigmoid HD. By using the transanal concept we choose to apply Swenson's principle in transanal dissection for the primary treatment of HD and describe technical aspects and impact on fecal and urinary function. We reviewed our series of HD patient who underwent one-stage transanal full thickness, Swenson-like rectosigmoid dissection, assessing for postoperative stricture or stenosis, anastomotic leak, enterocolitis, obstruction and long-term results for bowel and urinary function. Of 15 patients all had the transanal resection, the age of the patients ranged from 6 months to 5 years. The average length of resection was 20 ± 5 cm. Mean follow-up was 24 months. 10 patients were at least three years old at follow-up and were assessed for urinary and fecal continence. All had the voluntary bowel movement and urinary continence. Three patients had episodes of postoperative enterocolitis and two patients developed stenosis at the anastomotic site. Postoperative frequent bowel movement was present in all patients and continued for 2-8 weeks. In conclusion, our data support the fact that a modification of Swenson's original transabdominal dissection concept using the recently describe transanal approach is an excellent technique for HD and produces excellent long-term outcome for fecal and urinary function.</p><p> </p>

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

2017 ◽  
Vol 28 (05) ◽  
pp. 445-454 ◽  
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.

Single stage laparoscopic treatment of Hirschprungs disease for childrend under 6 month old in Viet Duc hospital

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Việt Hoa Nguyễn
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Operating Time ◽  
Single Stage ◽  
Average Hospital ◽  
Conversion To Open Surgery ◽  
Stay Time ◽  
Average Operating Time ◽  
Pull Through ◽  
Laparoscopic Assisted

Tóm tắt Đặt vấn đề: Ứng dụng phẫu thuật nội soi ổ bụng kết hợp với đường qua hậu môn cắt đoạn đại trực tràng vô hạch ở trẻ 2 - 6 tháng tuổi tại khoa Nhi bệnh viện Việt Đức Phương pháp nghiên cứu: Nghiên cứu hồi cứu cho trẻ 2 - 6 tháng tuổi được chẩn đoán phình đại tràng bẩm sinh dựa vào lâm sàng, chụp đại tràng có thuốc cản quang và sinh thiết tức thì trong mổ. Phẫu thuật 1 thì, nội soi ổ bụng sử dụng 3 trocars phẫu tích đoạn đại tràng cần cắt bỏ, kết hợp đường qua hậu môn sử dụng van Lonestar bóc đoạn trực tràng trên đường lược khỏi thanh cơ phương pháp Soave, kéo đoạn đại tràng vô hạch ra ngoài qua hậu môn, cắt và nối đại tràng lành với ống hậu môn. Đánh giá kết quả theo tiêu chuẩn Wingspread 1984 Kết quả: Trong thời gian từ tháng 6/2014 đến tháng 6/2017 có 32 người bệnh được phẫu thuật nội soi, tuổi trung bình 3,5 tháng. Thời gian phẫu thuật trung bình 150 ± 40 phút. Thời gian nằm viện trung bình 7,4 ± 2,2 ngày. Đại tràng vô hạch vị trí xích ma 1/3 dưới 19 người bệnh (59,37%), xích ma 1/3 giữa 11 người bệnh (34,38%), xích ma 1/3 trên 2 người bệnh (6,25%). Không có trường hợp nào chuyển mổ mở. chảy máu nặng hay bục rò miệng nối sau mổ. Theo dõi sau mổ từ 3 tháng - 4 năm: Viêm quanh hậu môn 6 người bệnh (18,75%); viêm ruột 8 người bệnh (25%); són phân 5 người bệnh (15,62%); táo bón 1 người bệnh (3,12%). Đánh giá chức năng đại tiện rất tốt 68,75%, tốt 21,88%, trung bình 9,37%. Chưa có trường hợp mổ lại, Kết luận: Phẫu thuật nội soi ổ bụng kết hợp đường qua hậu môn cắt đoạn đại trực tràng vô hạch một thì ở trẻ nhỏ là phương pháp phẫu thuật an toàn, mang lại chức năng đại tiện tốt, đảm bảo thẩm mỹ. Abstract Introduction: Laparoscopic assisted endorectal colon pull-through for Hirschsprung's disease have been applied for children under 6 month old in Viet Duc hospital Material and Methods: Restrospective. Children from 2 to 6 month with diagnosis of Hirschsprung's disease by clinical, radiological symptoms and biopsy during operation. Laparoscopic assisted endorectal colon pull- through by using Lonestar valve for resection of colon and coloanal anastomosis. Functional defecation is assessed according to the standard of Wingspread 1984. Results: 32 patients during from 6/2014 to 6/2017. Mean age: 3,5 months old, average operating time: 150 ± 40 minutes, average hospital stay time: 7,4 ± 2,2 days. The aganglionics lower sigmoid segment in 19 patiens (59,37%), 1/3 middle sigmoid segment in 11 patiens (34,38%), sigmoid segment in 2 patiens (6,25%). Non bleeding during the operation, no conversion to open surgery, no anastomotic fistula. Follow – up postoperative from 3 months to 4 years peri-anal: infection 6 patients (18,75%), enterocolitis 8 patients (25%), fecal incontinence 5 patients (15,62%), constipation 1 patient (4,45%). Functional defecation assessement: very good 68,75; good 21,88; average 9,37%. No re- operation. Conclusion: Single stage laparoscopic assisted endorectal colon pull- through for Hirschsprung's disease in children under 6 month old is safe with good functional defecation assessement. Keyword: Hirschprung ‘s desease, laparoscopic, endorectal colon pull- through

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