Robotic Swenson Pull-Through for Hirschsprung's Disease in Infants

2011 ◽  
Vol 77 (7) ◽  
pp. 937-941 ◽  
Author(s):  
André Hebra ◽  
Valerie A. Smith ◽  
Aaron P. Lesher
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Average Length ◽  
Robotic Technology ◽  
Average Length Of Stay ◽  
Young Infants ◽  
Bowel Movements ◽  
Da Vinci Robotic System ◽  
Average Operative Time ◽  
Pull Through

It has been demonstrated that infants with Hirschsprung's disease can be treated with a one-stage laparoscopic resection and coloanal pull-through. However, the feasibility and benefits of performing this operation using robotic technology have not yet been evaluated. We reviewed our experience with 12 infants diagnosed with Hirschsprung's disease and treated with laparoscopic-robotic assisted colonic resection with proctectomy and pull-through using the da Vinci robotic system. Patients were treated at a mean age/weight of 16 weeks/5.5 kg. The average operative time for the robotic procedure was 230 minutes, and average length of stay was 3 days. At discharge, all patients were having regular bowel movements and tolerating a completely oral diet. All patients received early postoperative anorectal dilation and six patients required dilations for an average of 12 weeks after surgery for management of minor rectal strictures. Only two patients developed postoperative enterocolitis with a mean follow-up of 36 months. A robotic approach for performing a Swenson-type resection and pull-through procedure can be performed safely and successfully in young infants. Robotic technology provided superior dexterity and visualization, essential in performing a more complete rectal dissection, thus allowing for a complete proctectomy and eliminating the risk of leaving a segment of aganglionic rectum behind.

Total Colonic Hirschsprung's Disease: The Hypermotility and Skin Rash Protocol

2019 ◽  
Vol 30 (04) ◽  
pp. 309-316 ◽  
Author(s):  
Alejandra Vilanova-Sanchez ◽  
Monica Ivanov ◽  
Devin R. Halleran ◽  
Andrea Wagner ◽  
Carlos Albert Reck-Burneo ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Failure To Thrive ◽  
Toilet Training ◽  
Bowel Management ◽  
High Incidence ◽  
Before And After ◽  
Perineal Skin ◽  
Bowel Movements ◽  
Pull Through

Introduction Total colonic Hirschsprung's disease (TCHD) presents a postoperative challenge due to multiple stools and perineal rash. We propose a protocol developed by pediatric surgeons and ostomy nurses to help prevent and treat hypermotility and severe perineal rash, especially in younger children who are not toilet trained. Materials and Methods We retrospectively reviewed our TCHD patients' charts from 2014 to 2017. All patients received a prescribed protocol for the treatment of hypermotility and perineal rash. We describe patients who underwent their pull through before and after the age of urine toilet training, and assessed the number of bowel movements, the perineal skin status, and growth. Results We treated 25 patients. Out of 25, 9 patients received a straight ileoanal pull through before the age of 18 months. Nine of 25 patients presented for a second opinion and had redo pull through. The remaining seven presented for bowel management after having a pull through at another institution. All these were treated following the hypermotility protocol. In total, 19 of 25 patients were not toilet trained. The mean number of bowel movements in all groups was 4 (3–5). All had a resolution of perineal rash and liquid stools after 3 months. Eleven of the 25 patients presented with failure to thrive. Two older patients experienced severe proctalgia requiring replacement of the ileostomy. Conclusion TCHD patients who underwent definitive pull through had nine high incidence of multiple stool, perineal rash, and low growth. With the implementation of bowel management care to slow the stools and a perineal skin protocol to treat the skin, we believe that these symptoms can be minimized even in patients who are not toilet trained. Since the implementation of this protocol, we have changed our practice to perform the pull through in such patients between the age of 6 and 18 months.

scholarly journals PRESENTATION AND MANAGEMENT OF HIRSCHSPRUNG'S DISEASE IN INFANTS AT A TERTIARY CARE CENTRE AND OUTCOME OF PRIMARY PULL-THROUGH IN THESE PATIENTS.

2021 ◽  
pp. 1-4
Author(s):  
Magray Mudasir A ◽  
Mufti, Gowhar N ◽  
Quyoom Nazia ◽  
Bhat, Nisar A. ◽  
Baba, Aejaz A
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Frozen Section ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
Rectal Biopsy ◽  
Water Soluble ◽  
Tertiary Care Centre ◽  
Young Infants ◽  
Pull Through

Hirschsprung's disease is a common cause of neonatal intestinal obstruction. The treatment of Hirschsprung's disease has evolved to a single stage pull-through. . The aim of study was to evaluate the feasibility of performing the primary pull-through surgery and to develop an optimum treatment protocol for patients of Hirschsprung's disease (HD) presenting to our institution. It was a prospective cohort study of newborn and young infants with features of Hirschsprung's disease conducted in our department from Oct. 2014, till Oct. 2018. The diagnosis was based on history, clinical examination, water soluble contrast enema and a definitive rectal biopsy. Transition zone was confirmed by intra-operative frozen section. Patients with weight of more than 5kgs and absence of features of concurrent enterocolitis, were taken for surgery. Patients included in the study underwent primary pull-through by different methods were put on strict follow-up protocol for 24 months and results were evaluated. Out of 40 patients of Hirschsprung's disease presented to SKIMS from Oct. 2014 till Oct. 2017,only 25 patients underwent primary pull-through. Mean age of patients at the time of pull-through was6.9±7.12 months and mean weight was 8.76 ±2.67kg. Delayed passage of meconium was seen in23 patients (92%). Preoperative rectal biopsy was done for confirmation of diagnosis and intra-operative frozen section for delineation level of aganglionosis. Laparoscopic transanal pull-through was most common operation done in 13 (52%) patients. Anastomotic leak was seen in 2(8%) patients, wound infection occurred 2(8%) patients, enterocolitis in1(4%) and constipation in 2 (8%) patients. One patient who had undergone trans-anal pull-through underwent a redo for a retained cuff. Primary pull-through is feasible and safe option with excellent results in neonates and infants with Hirschsprungs disease.

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

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.

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.

Repeat pull-through for Hirschsprung's disease

1998 ◽  
Vol 33 (10) ◽  
pp. 1507-1509 ◽  
Author(s):  
Duncan T Wilcox ◽  
Edward M Kiely
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pull Through

Enterocolitis risk factors after pull-through for hirschsprung's disease

2000 ◽  
Vol 35 (1) ◽  
pp. 153 ◽  
Author(s):  
J. Estevão-Costa ◽  
J.L. Carvalho ◽  
M. Soares-Oliveira
Keyword(s):  
Risk Factors ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pull Through
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