scholarly journals A novel Lugol’s iodine staining technique to visualize the upper margin of the surgical anal canal intraoperatively for Hirschsprung disease: a case series

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kazuki Yokota ◽  
Hizuru Amano ◽  
Toyoki Kudo ◽  
Takeshi Yamamura ◽  
Yujiro Tanaka ◽  
...  
Keyword(s):  
Anal Canal ◽  
Case Series ◽  
Hirschsprung Disease ◽  
Staining Technique ◽  
Bowel Function ◽  
Practical Method ◽  
Bowel Dysfunction ◽  
Lugol’S Iodine ◽  
Iodine Staining ◽  
Pull Through

Abstract Background In cases of Hirschsprung disease, complete and reproducible resection of the aganglionic bowel is ideal to achieve good postoperative bowel function. Reliable identification of the upper margin of the surgical anal canal, which is the squamous-columnar junction, is necessary during transanal pull-through. Here, we describe a novel staining technique using Lugol’s iodine stain to visualize the upper margin of the surgical anal canal. Methods Lugol’s iodine staining was performed in five patients with Hirschsprung disease treated using a single-stage laparoscopic transanal pull-through modified Swenson procedure. In two of these patients, endocytoscopic observation with ultra-high magnification was performed using methylene blue and crystal violet to mark the border of the squamous epithelium at 1 week before surgery. The alignment between the incisional line, which was revealed using Lugol’s iodine staining and endocytoscopic marking, was evaluated. Complications, including postoperative bowel dysfunction, were evaluated. Results In all cases, Lugol’s iodine staining produced a well-demarcated line. The endocytoscopic marking of the upper margin of the surgical anal canal was aligned with the line revealed by Lugol’s iodine staining. There were no complications associated with the transanal pull-through procedure, including postoperative bowel dysfunction. Conclusions Lugol’s iodine staining could be a safe and practical method to visualize the upper margin of the surgical anal canal intraoperatively. This finding may be useful for surgeons to make a consistent removal of the aganglionic bowel during surgery for Hirschsprung disease.

scholarly journals A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease

2017 ◽  
Vol 52 (9) ◽  
pp. 1458-1464 ◽  
Author(s):  
Kristin Bjørnland ◽  
Mikko P. Pakarinen ◽  
Pernilla Stenstrøm ◽  
Kjetil J. Stensrud ◽  
Malla Neuvonen ◽  
...  
Keyword(s):  
Hirschsprung Disease ◽  
Bowel Function ◽  
Multicenter Survey ◽  
Pull Through

scholarly journals Redo surgery with longitudinal resection for dilated bowel in Hirschsprung disease: an illustrative case series

2019 ◽  
Vol 34 (11) ◽  
pp. 1983-1987 ◽  
Author(s):  
Daniëlle Roorda ◽  
Tessa J. Surridge ◽  
Ruben G. J. Visschers ◽  
Joep P. M. Derikx ◽  
L. W. Ernest van Heurn
Keyword(s):  
Case Series ◽  
Hirschsprung Disease ◽  
Bowel Function ◽  
Uneventful Recovery ◽  
Illustrative Case ◽  
Redo Surgery ◽  
Short Term ◽  
Novel Technique ◽  
Primary Surgery ◽  
Distended Bowel

Abstract Purpose Patients with Hirschsprung disease (HD) can have persistent obstructive symptoms after resection of the aganglionic segment. If obstructive symptoms are treated inadequately, this may lead to recurrent faecal stasis and impaction, and may result in severe distension of the bowel. A permanently distended bowel which not responds to conservative treatment may be an indication for redo surgery. The aim of this study is to describe our experiences and the short-term results of a novel technique: longitudinal antimesenteric resection with a longitudinal anastomosis. Methods We reviewed the medical records of our three patients who underwent longitudinal resection of severe distended bowel. This technique aims to improve defecation by improving faecal passage and is characterized by resection of the antimesenteric side of the distended intestinal segment, followed by plication with a longitudinal anastomosis. In this paper, this novel technique is described in detail, as well as short-term outcomes. Results All patients had an uneventful recovery after longitudinal antimesenteric resection. During follow-up, the functional outcomes were excellent, with a large improvement of bowel function. All patients were continent for faeces, and treated with low-dose laxatives or occasional preventive irrigation in one patient. There were no more complaints of persistent constipation or soiling. Conclusion Longitudinal resection is a surgical redo-procedure offering large benefits for patients with Hirschsprung disease with distended bowel after primary surgery.

Redo Transanal Soave Pull Through with or without Assistance in Hirschsprung Disease: An Experience in 46 Patients

2020 ◽  
Author(s):  
Chunhui Peng ◽  
Yajun Chen ◽  
Wenbo Pang ◽  
Tingchong Zhang ◽  
Zengmeng Wang ◽  
...  
Keyword(s):  
Associated Factors ◽  
Hirschsprung Disease ◽  
Bowel Function ◽  
Distal Segment ◽  
Anastomotic Complication ◽  
Early Postoperative Complication ◽  
Redo Procedure ◽  
Pull Through ◽  
Postoperative Problem

Abstract Introduction Transanal Soave pull through (PT) with or without assistance can be performed as a redo procedure for Hirschsprung disease (HD). In this study, we reviewed the indications and clinical outcomes of redo transanal Soave with or without assistance. Materials and Methods A retrospective analysis was performed on patients who underwent redo transanal Soave with or without assistance in our hospital from 2004 to 2016, and did not have rectourethral fistula or rectovaginal fistula. The Krickenbeck classification system was used to evaluate postoperative bowel function. We analyzed the associated factors of the two main indications. Results In this study, 46 patients were included, representing 5.6% of all HD PTs; 42 patients were initially operated elsewhere and 4 at our hospital. Primary PT surgeries included 38 transanal Soave, 2 Rehbein, 1 Martin, and 5 unknown procedures. The indications for redo PT were residual aganglionosis/transition zone PT (RA/TZPT) (27, 58.7%), anastomotic complication (14, 30.4%), and dilated distal segment (5, 10.9%). The median age of these 46 patients at primary and redo PT was 7.0 months (range, 0.4–137 months) and 45.5 months (range, 7–172 months), respectively. All 46 patients underwent redo transanal Soave PT; 43 patients (93.5%) underwent transanal Soave with laparotomy (n = 42) or laparoscopy (n = 1), and another 3 patients underwent transanal Soave PT. Six patients (13%) experienced complications within 30 days after redo surgery. A total of 43 patients were followed up, and the median follow-up period was 100 months (range, 35–180 months). Two patients could not hold back defecation in some inconvenient conditions. Sixteen patients (37.2%) had soiling, and 8 (18.6%) of 16 patients complained frequent soiling occurrence (more than 1/week). Only one patient complained of constipation (grade 1). Patients with anastomotic complication had more early postoperative complication and higher rate of soiling than patients with RA/TZPT, but there was no statistical difference (p = 0.672 and p = 0.105). Conclusion Transanal Soave PT with or without assistance was effective in resolving different problems after initial PT, while soiling was the most common postoperative problem, especially patients with anastomotic complication.

The anal canal is the fine line between “fecal incontinence and colitis” after a pull-through for Hirschsprung disease

2017 ◽  
Vol 52 (12) ◽  
pp. 2011-2017 ◽  
Author(s):  
Luis De la Torre ◽  
Kimberly Cogley ◽  
Karla Santos ◽  
Otto Morales ◽  
Juan Calisto
Keyword(s):  
Fecal Incontinence ◽  
Anal Canal ◽  
Hirschsprung Disease ◽  
Fine Line ◽  
Pull Through

scholarly journals Bowel function after transanal endorectal pull-through for Hirschsprung disease – does outcome improve over time?

2020 ◽  
Vol 55 (11) ◽  
pp. 2375-2378
Author(s):  
Marianne V. Fosby ◽  
Kjetil J. Stensrud ◽  
Kristin Bjørnland
Keyword(s):  
Hirschsprung Disease ◽  
Bowel Function ◽  
Pull Through ◽  
Over Time

Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease

2017 ◽  
Vol 265 (3) ◽  
pp. 622-629 ◽  
Author(s):  
Malla I. Neuvonen ◽  
Kristiina Kyrklund ◽  
Risto J. Rintala ◽  
Mikko P. Pakarinen
Keyword(s):  
Quality Of Life ◽  
Hirschsprung Disease ◽  
Bowel Function ◽  
Pull Through

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.

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