Laparoscopic Rectosigmoid Resection With Transanal Colonic Pull-Through and Delayed Coloanal Anastomosis: A New Approach to Adult Hirschsprung Disease

2011 ◽  
Vol 54 (10) ◽  
pp. 1313-1319 ◽  
Author(s):  
Julien Jarry ◽  
Jean-Luc Faucheron
Keyword(s):  
Coloanal Anastomosis ◽  
Hirschsprung Disease ◽  
New Approach ◽  
Rectosigmoid Resection ◽  
Pull Through

Laparoscopy-assisted transanal pull-through at the time of suction rectal biopsy: a new approach to treating selected cases of Hirschsprung disease

2006 ◽  
Vol 41 (12) ◽  
pp. 2052-2055 ◽  
Author(s):  
Atsuyuki Yamataka ◽  
Hiroyuki Kobayashi ◽  
Shu Hirai ◽  
Hiroyuki Koga ◽  
Go Miyano ◽  
...  
Keyword(s):  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
New Approach ◽  
Suction Rectal Biopsy ◽  
Pull Through

scholarly journals Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

2021 ◽  
Vol 73 (2) ◽  
pp. 495-502
Author(s):  
Francesco Bianco ◽  
Paola Incollingo ◽  
Armando Falato ◽  
Silvia De Franciscis ◽  
Andrea Belli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Coloanal Anastomosis ◽  
Functional Results ◽  
Anal Margin ◽  
Perioperative Mortality ◽  
The Mean ◽  
Pull Through ◽  
Protective Stoma

AbstractDespite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed ‘Short stump and High anastomosis Pull-through’ (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

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

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.

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

2007 ◽  
Vol 42 (11) ◽  
pp. 1869-1876 ◽  
Author(s):  
Akshay Pratap ◽  
Devendra Kumar Gupta ◽  
Vikal Chandra Shakya ◽  
Shailesh Adhikary ◽  
Awadhesh Tiwari ◽  
...  
Keyword(s):  
Hirschsprung Disease ◽  
Pull Through

Altered Cytoskeleton in Smooth Muscle of Aganglionic Bowel

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.

scholarly journals Comparison of the Results of Transanal Endorectal Pull-through and Martin-modified Duhamel Operations in Hirschsprung Disease

2020 ◽  
Vol 72 (3) ◽  
pp. 349-355
Author(s):  
Yasemin Dere Günal ◽  
Mustafa Kemal Aslan ◽  
Ayşe Karaman ◽  
İbrahim Karaman ◽  
Derya Erdoğan ◽  
...  
Keyword(s):  
Hirschsprung Disease ◽  
Pull Through ◽  
Comparison Of The Results

Results of the Surgical Treatment in Children with Hirschprung Disease: A 12-Year Experience

2021 ◽  
Author(s):  
Ceren Cesur ◽  
Ayşenur Celayir
Keyword(s):  
Surgical Treatment ◽  
Complication Rate ◽  
Operative Procedure ◽  
Surgical Techniques ◽  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
X Rays ◽  
Surgical Methods ◽  
Pull Through ◽  
Subacute Intestinal Obstruction

Objective: In the treatment of Hirschsprung’s disease, many surgical techniques have been developed and modified including laparotomy, resection of the affected colon segment, and pull-through of the functional bowel segment to the anus. Conventional surgical methods have many early and late postoperative complications, albeit at a reduced rate today. In this study, it was aimed to compare the treatment results of children with Hirschsprung Disease who were operated with single or two-stage techniques in our department. Method: Hospital records of the patients operated for Hirschsprung disease were retrospectively evaluated. Demografic characteristics, findings of physical and rectal examinations, X-rays findings, rectal biopsy results, surgical treatment methods and outcomes were analyzed. Results: Fifty-two children including 41-male (78.8%) and 11-female (21.2%) patients with age ranging from 1-day to 5-year and mean age of 6.8-day in neonates and 6.3-month in others were enrolled in the study. All patients presented with acute or subacute intestinal obstruction. Levels were observed on supine abdominal radiographs in all; transition zone and retention of opaque material were observed on opaque enema or retention radiographs.In patients whose rectal biopsies revealed aganglionic megacolon two staged procedures were performed including initial colostomy followed by definitive procedure of Duhamel with stapler in 30, and Soave in 12, and Swenson in 1 patient. Nine patients were operated with one-stage endorectal pull-through technique. The complication rate in 43 patients with Hirschsprung disease managed by two staged operative procedure was (78.8%), and it was 11.1% in 9 cases that underwent transanal endorectal pullthrough procedure. It was learned that effective anal dilatation was not performed in 22-patients who had postoperative enterocolitis attacks. Conclusion: In addition to the low complication rate, the morbidity rates in the transanal endorectal pull-through method, which achieved successful results with only one procedure, were very low compared to multiple-stage operations.

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