scholarly journals Early Experience With Single-Stage Transanal Endorectal Pull Through For Rectosigmoid Hirschsprung’s Disease

2015 ◽  
Vol 34 (3) ◽  
pp. 188-194
Author(s):  
MK Shrestha ◽  
M Sherchan ◽  
BK Dhoubhadel ◽  
RB Basnet
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Anastomotic Stricture ◽  
Operating Time ◽  
Single Stage ◽  
Invasive Technique ◽  
Older Children ◽  
Recent Trends ◽  
Pull Through ◽  
Adhesive Obstruction

On 24th August 2015, the spelling of the third author's name was changed from Dhaubhadel TO Dhoubhadel - Editor.Introduction: Recent trends in surgery for Hirschsprung’s disease (HD) have been towards earlier operation and fewer surgical stages. A single-stage transanal endorectal pull through (TEPT) is the latest development and minimally invasive technique for HD. This observational prospective study was designed to evaluate the safety and efficacy of single-stage TEPT technique in the management of rectosigmoid HD.Materials and Methods: Infants and children with biopsy-proved aganglionosis and barium enema (BE) documented rectosigmoid HD were included for single stage TEPT. Twenty children aged 22 days to 7 years (17 boys and 3 girls) underwent one stage TEPT over 5 year period. Median follow up was 18 months (range 6-36 months). These patients were evaluated with regard to age, sex, intraoperative details, postoperative functional outcome and complications and need for secondary surgical procedure.Results: The operating time was 105-180 minutes (mean 120 minutes). The length of resected bowel was 18-30 cm (mean 25 cm). Intraoperative blood loss was 5-40 ml, less in infants compared to older children. Blood transfusion was needed in none out of 12 infants and 2 out of 8 older children. Transient perianal excoriation occurred in 16 patients. Postoperative enterocolitis occurred in one patient. One patient developed constipation with encopresis following anastomotic stricture. None had adhesive obstruction and prolapse of pulled through colon, one required colostomy for anastomotic leakage and peritonitis while another had retained aganglionic segment and re-do pull through was required.Conclusion: Single-stage TEPT can be performed successfully in all age of children. The technique is safe, easily learned and has good clinical results.DOI: http://dx.doi.org/10.3126/jnps.v34i3.11617  J Nepal Paediatr Soc 2014;34(3):188-194

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

scholarly journals Single Stage Transanal Pull-Through for Hirschsprung’s Disease in Neonates: Our Early Experience

2013 ◽  
Vol 2 (4) ◽  
pp. 39 ◽  
Author(s):  
Pradeep Bhatia ◽  
Rakesh S Joshi ◽  
Jaishri Ramji ◽  
Mitesh Bachani ◽  
Amit Uttarwar
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Operating Time ◽  
Early Experience ◽  
Oral Feeding ◽  
Single Stage ◽  
Urethral Injury ◽  
Anastomotic Site ◽  
Early Results ◽  
Pull Through

Objective: Hirschsprung’s disease is one of the common causes of intestinal obstruction in neonates. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung’s disease. In this study, we present our early experience with single stage transanal pull through in neonates. Design: Retrospective study of neonates with single stage transanal pull-through done for Hirschsprung’s disease in our institute from January 2011 to January 2013. Material and Method: Five newborn boys who presented with Hirschsprung’s disease were studied. The selection criteria included radiological transition zone at rectosigmoid or mid-sigmoid region, weight more than 2 kg, no evidence of enterocolitis or sepsis and no associated major anomaly. Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years. Results: Five patients with a mean age of 26.4 days (range 15-45 days) and a mean weight of 2.6 Kg (range 2.2 to 3.7 Kg) underwent transanal endorectal pull through. The mean operating time was 68 min (range 60 to 120 min). The average intra-operative blood loss was 20 ml (range – 10 to 30 ml) and the average length of bowel resected was 12.8 cm (range – 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic site. Three patients developed perianal excoriation and one patient had post-operative enterocolitis. No mortality occurred in the series. Conclusion: Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in pre-operative and post-operative management and nursing care has made single stage transanal pull-through in neonates a feasible option. The early results are comparable to single stage or multistage surgery in older children.

scholarly journals Is Single-stage Primary Transanal Endorectal Pull through (TEP) feasible for Short Segment Hirschsprung's Disease in Neonates?- Our Experience in a Tertiary Hospital

2019 ◽  
Vol 18 (2) ◽  
pp. 45-50
Author(s):  
Md Shahjahan ◽  
Kazi Md Noor ul Ferdous ◽  
M Kabirul Lslam
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Anastomotic Stricture ◽  
Pediatric Anesthesia ◽  
Rectal Biopsy ◽  
Tertiary Hospital ◽  
Single Stage ◽  
Short Segment ◽  
Pull Through

Background: The surgical management of Hirschsprung's Disease (HD) includes so many procedures. TransanalEndorectal Pull through (TEP) represents the latest development in the concept of the minimally invasive surgery for HD. The purpose of this study was to evaluate the out come of the procedure in neonates. Methods: This retrospective study was carried out in a tertiary pediatric hospital during the period from January 2007 to December 2012 (5 years). The study included neonates of both sex, weight more than 2 kg, who were clinically suspected HD, radiologically transition zone at rectosigmoid and midsigmoid region and rectal biopsy proven HD and no evidence of sepsis or entrocolitis. Short segment HD with associated anomalies, and operated cases with less than 6 months' or irregular follow up were excluded. Results: During study period, single-stage transanalendorectal pull through (TEP) operation was done for short segment HD in 63 neonates, 9 patients were excluded from the study for irregular follow up. The mean operative time, mean blood loss, postoperative hospital stay, follow up period were 113 minutes, 20ml, 6.8 days and 19.6 months respectively. Transverse colostomy was needed in 6 patients for anastomotic leakage, thereafter developed anastomotic stricture, managed with regular anastomotic dilatation. Conclusion: Advancement in pediatric anesthesia, improvement of pediatric surgical expertise, perioperative management and nursing care has made single-stage primary transanalendorectal pull-through a feasible and safe surgical procedure for the treatment of short segment Hirschsprung's disease in neonate. Journal of Surgical Sciences (2014) Vol. 18 (2) : 45-50

scholarly journals A comparative study between the single-stage transanal and Soave-Boley pull-through for short segment Hirschsprung's Disease

1970 ◽  
Vol 22 (1) ◽  
pp. 20-24
Author(s):  
Md Momtazul Hoque ◽  
Md Akbar Husain Bhuiyan ◽  
Md Nur Hossain Bhuiyan ◽  
Shah Alam Talukder ◽  
Tahmina Banu
Keyword(s):  
Comparative Study ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Single Stage ◽  
Short Segment ◽  
Pull Through

Keywords: Soave-Boley Pull; entercolitis; hirschsprung's diseaseDOI: http://dx.doi.org/10.3329/jcmcta.v22i1.9107 JCMCTA 2011; 22(1): 20-24

TREATMENT OF CONGENITAL MEGACOLON IN 50 INFANTS

PEDIATRICS ◽  
1966 ◽  
Vol 38 (2) ◽  
pp. 185-193
Author(s):  
Walton K. T. Shim ◽  
Orvar Swenson
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Average Weight ◽  
Older Children ◽  
The Past ◽  
History Of ◽  
Pull Through ◽  
Definitive Surgery ◽  
Criteria For Selection ◽  
Selection Of

Fifty infants less than 1 year old with Hirschsprung's disease were treated at Children's Memorial Hospital in the past 6 years. Thirty-two of the 35 barium enema studies yielded "diagnostic" roentgenographic studies, and 3 were "negative" for Hirschsprung's disease. Fourteen of the 50 infants had a history of diarrhea. Enterocolitis in infants may be extremely rapid in onset and progression. It should be vigorously treated with rectal irrigations and intravenous fluids. Nineteen patients (38%) had aganglionic segments extending above the rectosigmoid colon, and eight (16%) were aganglionic proximal to the splenic flexure. This includes three patients with aganglionosis of the entire colon and one that was aganglionic from the jejunum to anus. Emphasis is placed on an aggressive combined attack by pediatrician, radiologist, pathologist, and surgeon to diagnose and prepare the sick infant as early as possible for colostomy or definitive abdominal-perineal pull-through operation. Twelve infants with an average weight of 12.5 lb were operated on primarily with no deaths or complications. It is our belief that definitive surgery can be done with greater ease in an infant than in older children, but careful selection and preparation of the patient and meticulous operative technique must be exercised. The important criteria for selection of infants for immediate resection are the absence of emaciation and enterocolitis, although the infant may be small. Twenty-six infants had colostomy and resection with no deaths or complications. Our raw mortality figures show 10 deaths in 50 patients (20%). There were 7 deaths in 47 surgical patients (15%).

scholarly journals Single-stage versus multi-stage pull-through for Hirschsprung's disease: Practice trends and outcomes in infants

2014 ◽  
Vol 49 (11) ◽  
pp. 1619-1625 ◽  
Author(s):  
Jason P. Sulkowski ◽  
Jennifer N. Cooper ◽  
Anthony Congeni ◽  
Erik G. Pearson ◽  
Benedict C. Nwomeh ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Single Stage ◽  
Stage Versus ◽  
Multi Stage ◽  
Pull Through

scholarly journals OBLIQUE VS. CIRCULAR ANASTOMOSIS IN THE CHILDREN UNDERWENT SOAVE’S PULL-THROUGH SURGERY FOR THE TREATMENT OF HIRSCHSPRUNG’S DISEASE: WHICH IS THE BEST?

2020 ◽  
Vol 33 (3) ◽  
Author(s):  
Shahnam ASKARPOUR ◽  
Mehran PEYVASTEH ◽  
Gholamreza DROODCHI ◽  
Hazhir JAVAHERIZADEH
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Anastomotic Stricture ◽  
Wound Dehiscence ◽  
Common Complication ◽  
Different Types ◽  
Fecal Soiling ◽  
Pull Through ◽  
Circular Anastomosis

ABSTRACT Background: Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung’s disease. Aim: To compare circular and oblique anastomoses following Soave’s procedure for the treatment of Hirschsprung’s disease. Methods: Children who underwent Saove’s pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. Results: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). Conclusion: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave’s procedure.

scholarly journals Case Report: SECONDARY LAPAROSCOPIC ASSISSTED TRANSANAL ENDORECTAL PULL-THROUGH. A PRE-ELIMINARY STUDY

2017 ◽  
Vol 52 (1) ◽  
pp. 74
Author(s):  
Barmadisatrio Barmadisatrio ◽  
Hariono Hariono
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Minimal Invasive ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Anastomotic Site ◽  
Invasive Approach ◽  
Minimal Invasive Approach ◽  
Stoma Formation ◽  
Pull Through

The definitive treatment for Hirschsprung’s disease is pullthrough procedure, that can be done through conventional pullthrough approach or through minimal invasive approach. The benefit of minimal invasive technique compared to conventinal open procedure is shorter time to oral intake, shorter length of stay, and less postoperative pain. Secondary LATEP is a minimal invasive pull through technique in patients with preexisting colostomy. Primary pullthrough sometimes cannot be done because limitation of health facilities, uneven distribution of pediatric surgeons throughout the country and late diagnosis of Hirschsprung’s Disease. In dr Soetomo Hospital Surabaya, 7 secondary LATEP procedures were done in January to August 2014. The age range was 6 months to 8 years old. All patients survived, 1 patient had stenosis of anastomotic site 2 weeks postoperative, 3 had enterocolitis, 3 with no complication. Secondary LATEP is a minimal invasive approach for Hirschsprung’s Disease that can be adjusted with Indonesia’s social and economic condition, where most population was distant from an adequate health facility. As there is high incidence of malnutrition, enterocolitis and also the distance from appropriate health services, stoma formation is the first thing that can be done before definitive treatment.Secondary LATEP has never been done in Indonesia, and we still need more data and research to evaluate the benefit and disadvantage of this approach compared to conventional or minimal invasive primary pull through. In conclusion, secondary LATEP is an appropriate pullthrough alternative for Hirschsprung’s Disease and applicable in Indonesia, considering the social and economy condition. Further study must be done to develop this method.

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