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.

scholarly journals Tissue Engineering Strategies for Treating Avascular Necrosis of the Femoral Head

2021 ◽  
Vol 8 (12) ◽  
pp. 200
Author(s):  
Sumit Murab ◽  
Teresa Hawk ◽  
Alexander Snyder ◽  
Sydney Herold ◽  
Meghana Totapally ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Stem Cells ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Hip Replacement ◽  
Surgical Techniques ◽  
Significant Activity ◽  
X Rays ◽  
Early Stages ◽  
Surgical Methods

Avascular necrosis (AVN) of the femoral head commonly leads to symptomatic osteoarthritis of the hip. In older patients, hip replacement is a viable option that restores the hip biomechanics and improves pain but in pediatric, adolescent, and young adult patients hip replacements impose significant activity limitations and the need for multiple revision surgeries with increasing risk of complication. Early detection of AVN requires a high level of suspicion as diagnostic techniques such as X-rays are not sensitive in the early stages of the disease. There are multiple etiologies that can lead to this disease. In the pediatric and adolescent population, trauma is a commonly recognized cause of AVN. The understanding of the pathophysiology of the disease is limited, adding to the challenge of devising a clinically effective treatment strategy. Surgical techniques to prevent progression of the disease and avoid total hip replacement include core decompression, vascular grafts, and use of bone-marrow derived stem cells with or without adjuncts, such as bisphosphonates and bone morphogenetic protein (BMP), all of which are partially effective only in the very early stages of the disease. Further, these strategies often only improve pain and range of motion in the short-term in some patients and do not predictably prevent progression of the disease. Tissue engineering strategies with the combined use of biomaterials, stem cells and growth factors offer a potential strategy to avoid metallic implants and surgery. Structural, bioactive biomaterial platforms could help in stabilizing the femoral head while inducing osteogenic differentiation to regenerate bone and provide angiogenic cues to concomitantly recover vasculature in the femoral head. Moreover, injectable systems that can be delivered using a minimal invasive procedure and provide mechanical support the collapsing femoral head could potentially alleviate the need for surgical interventions in the future. The present review describes the limitations of existing surgical methods and the recent advances in tissue engineering that are leading in the direction of a clinically effective, translational solution for AVN in future.

scholarly journals Various surgical techniques for the treatment of inflammatory diseases of the periodontium

2014 ◽  
Vol 21 (1) ◽  
pp. 71-74 ◽  
Author(s):  
S. B. Ulitovskiy ◽  
O. V. Galibin ◽  
V. V. Tomson ◽  
A. V. Antipova ◽  
A. D. Vilesov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Present Article ◽  
Inflammatory Diseases ◽  
Periodontal Diseases ◽  
Surgical Techniques ◽  
Treatment And Prevention ◽  
Surgical Methods

The inflammatory periodontal diseases (IPD) take the second place after caries of teeth therefore the questions of treatment and prevention of IPD are especially actual. In the IPD treatment are the most effective, it is possible to allocate the surgical methods. In the present article questions of improvement of traditional techniques of surgical treatment, and also development and deployment of the new are considered.

scholarly journals Safety and Accuracy of Suction Rectal Biopsy in Preterm Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Yanan Zhang ◽  
Yongwei Chen ◽  
Shen Yang ◽  
Yichao Gu ◽  
Kaiyun Hua ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Clinical Characteristics ◽  
Ganglion Cells ◽  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
Late Preterm Infants ◽  
Suction Rectal Biopsy ◽  
Pull Through

Purpose: Most pediatric surgeons give little attention to the diagnosis of Hirschsprung disease (HD) in preterm infants. We aimed to explore the safety and accuracy of suction rectal biopsy (SRB) for diagnosing HD in preterm infants.Methods: A retrospective review was conducted of 45 preterm patients who underwent SRB from 2015 to 2019 in our hospital. We collected the clinical characteristics and pathology results of the patients and information on follow-up. The sensitivity and specificity of SRB for HD diagnosis were calculated.Results: The median gestational age of the patients was 35 weeks (range: 28.9–36.9 weeks), the median gestational age at biopsy was 38.6 weeks (range: 33.4–60.0 weeks), and the median weight was 2,790 g (range: 1,580–4,100 g). Fifteen patients (33.3%) were positive for HD, which was confirmed after pull-through surgery. Ganglion cells were present in 30 patients. The diagnosis of HD was excluded in 29 patients after discharge follow-up. The sensitivity of SRB ranged from 93.7 to 100%, and the specificity was 100%. No complications occurred after SRB among the patients whose biopsy age was <37 weeks (10 patients) or biopsy weight was <2,000 g (five patients).Conclusion: SRB is accurate and safe for diagnosing HD in late preterm infants.

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 Surgical techniques used for tonsil disease in children

2015 ◽  
Vol 62 (3) ◽  
pp. 294-297
Author(s):  
A. Zamfir-Chiru-Anton ◽  
◽  
D.C. Gheorghe ◽  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Surgical Techniques ◽  
The Other ◽  
Intraoperative Blood Loss ◽  
Advantages And Disadvantages ◽  
Surgical Methods ◽  
Surgical Options ◽  
The Difference

The authors review the techniques described for the surgical treatment of the tonsils. Each new method has its own advantages and disadvantages. The difference can be evaluated by studying the intraoperative blood loss and safety of the procedure. Also, the postoperative complications and quality of life can be used as an adjunct to objectively appreciate the different surgical techniques. There is no literature consensus about the superiority of one technique over the other. Multiple studies brought multiple significant results. It is also hard to evaluate the entire panel of surgical methods described concomitantly. The experience of one surgeon and his/her mastering of a certain technique is the actual cause of so many surgical options still in use for tonsil treatment in children.

Why Do the Patients with Hirschsprung Disease Get Redo Pull-Through Operation?

2018 ◽  
Vol 29 (05) ◽  
pp. 431-436 ◽  
Author(s):  
Ji-Won Han ◽  
Joong Kee Youn ◽  
Chaeyoun Oh ◽  
Hyun-Young Kim ◽  
Sung-Eun Jung ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Ganglion Cell ◽  
Transition Zone ◽  
Associated Factors ◽  
Operation Time ◽  
Hirschsprung Disease ◽  
Contrast Study ◽  
Pull Through

Introduction The treatment of Hirschsprung disease (HD) is pull-through (PT) surgery. Redo PT can be performed in 1 to 10% of patients after initial PT. In this study, we reviewed the causes and associated factors of redo PT. Materials and Methods We retrospectively reviewed medical charts of 657 patients with HD who underwent surgeries between September 1979 and January 2016. The indications for redo PT are as follows. First, there were persistent obstructive symptoms after the first operation, (1) with transition zone shown definitely on contrast study, (2) with anatomic problems, and (3) obstructive symptoms persist despite conservative or nonredo surgical treatment without (1) and (2). We analyzed the causes and associated factors of redo PT. Results A total of 49 (7.5%) patients underwent redo PT. Among them, 41 and 8 patients underwent PT twice and three times, respectively. Among 57 cases of redo, the causes of redo included pathologic problem (n = 28)—aganglionosis (n = 20), hypoganglionosis (n = 4), immature ganglion cell (n = 4)—or anatomic problem (n = 21)—stricture (n = 13), fistula and/or abscess (n = 8) at anastomosis. Comparing associated factors between the nonredo and redo groups, the redo group had longer initial PT operation time (p = 0.001), more postoperative complications (p < 0.001), and more transanal endorectal PT (TERPT) approach as initial PTs (p < 0.001). According to causes of redo, the anatomic problem group underwent more third PTs than the pathologic problem group (p = 0.010). Conclusion Approximately 7.5% of patients experienced redo PT. The cause of redo included pathologic (n = 28) or anatomic problem (n = 21). Longer operation time, more complications, and TERPT were associated with redo. The anatomic problem group underwent more third PTs than the pathologic problem group.

scholarly journals A Hirschsprung Pull-through, “with a Twist”

2020 ◽  
Vol 08 (01) ◽  
pp. e95-e98
Author(s):  
Hira Ahmad ◽  
Devin R. Halleran ◽  
Raquel Quintanilla ◽  
Alessandra C. Gasior ◽  
Richard J. Wood ◽  
...  
Keyword(s):  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
Contrast Enema ◽  
Good Outcome ◽  
Aganglionic Segment ◽  
Enteric Ganglia ◽  
Bowel Continuity ◽  
Pull Through ◽  
Multiple Episodes

AbstractHirschsprung disease is the most common neurocristopathy in children, resulting in the congenital loss of enteric ganglia. Surgery, which involves resecting the aganglionic segment and restoring bowel continuity, usually results in a good outcome; however, some patients suffer from multiple episodes of enterocolitis and other obstructive symptoms. A contrast enema, examination under anesthesia, and rectal biopsy can identify the cause of obstruction in many cases, including a rare explanation, a twist of the pull-through, a case of which we present here.

scholarly journals Minimally invasive treatment for Hirschsprung disease

2015 ◽  
Vol 62 (3) ◽  
pp. 289-293
Author(s):  
Simona-Gabriela Tudorache ◽  
◽  
Felix Negoiţescu ◽  
Laura Niculescu ◽  
◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Hirschsprung Disease ◽  
Minimally Invasive Techniques ◽  
Minimally Invasive Approach ◽  
Invasive Treatment ◽  
Invasive Approach ◽  
Duhamel Procedure ◽  
Pull Through ◽  
Invasive Techniques

Introduction. Harold Hirschsprung, a physician at Queen Louise Children’s Hospital of Copenhagen, first described the disease that now bears his name, at the Pediatric Congress of Berlin in 1886. Since then there have been countless debates on the optimal surgical approach. This paper aims both to recap the main classical surgical techniques: Swenson, Duhamel and Soave, but the main focus is on minimally invasive techniques. Surgical techniques. In the last 25 years, the treatment for Hirschsprung disease has progressed. If classically the preferred treatment was in 2-3 stages, now the definitive intervention is per primam in most cases, thus avoiding the morbidity associated with stomas. In 1995, Georgeson describes the minimally invasive approach using laparoscopy, and then in 1998, De la Torre et al, describes the first transanal endorectal pull-through (TERPT), unattended laparoscopically. Discussions. The initial discussions were linked to comparing processes in a single stage with ones in 2 or 3 stages, finding similar results, it is now a question of comparing open techniques with minimally invasive and even minimally invasive techniques with each other, endeavoring to establish whether laparoscopically assisted approach is needed or if the transanal one is enough. Conclusion. Usually shorter forms of Hirschsprung disease are treated strictly using the transanal technique, for the forms involving the left and transverse colon laparoscopically assisted transanal pull-through is used, while for the ascending colon and for the total aganglionosis the laparoscopically assisted Duhamel procedure is preferred.

Safety and Accuracy of Suction Rectal Biopsy in Preterm Infants

2020 ◽  
Author(s):  
Yanan Zhang ◽  
Jinshi Huang ◽  
Yongwei Chen ◽  
Shen Yang ◽  
Yichao Gu ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Clinical Characteristics ◽  
Ganglion Cells ◽  
Hirschsprung Disease ◽  
Rectal Biopsy ◽  
Late Preterm Infants ◽  
Suction Rectal Biopsy ◽  
Pull Through

Abstract Purpose: Little attention were paid in the diagnosis of preterm infants with Hirschsprung disease (HD) in most pediatric surgeons. We aimed to explore the safety and accuracy of suction rectal biopsy (SRB) in preterm infants.Methods: A retrospective review was conducted on 45 preterm patients who underwent SRB from 2015 to 2019 in our hospital. We collected the clinical characteristics and pathology results of the patients, and followed up. The sensitivity and specificity of SRB for HD diagnosis were calculated.Results: The median gestational age of the patients was 35 weeks (range: 28.9 to 36.9 weeks) while the median gestational age at biopsy was 38.6 weeks (range: 33.4 to 60.0 weeks), and the median weight was 2790 g (range: 1580 to 4100 g). Fifteen cases (33.3%) were positive for HD which were confirmed after the pull-through surgery. The ganglion cells presented on 30 cases. And the diagnosis of HD was excluded in 29 patients after discharge follow-up. The sensitivity was supposed to be 93.7%-100% and specificity was 100%. Among the patients whose biopsy age is < 37 weeks (10 cases) or biopsy weight is < 2000 g (5 cases), no complications occurred after SRB.Conclusion: SRB is safe and accurate in late preterm infants.

Surgical treatment of Ebstein's malformation—the ‘Hôpital Broussais’ experience

1996 ◽  
Vol 6 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Sylvain M. Chauvaud ◽  
Serban A. Mihaileanu ◽  
Julian A.R. Gaer ◽  
Alain C. Carpentier
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Tricuspid Valve ◽  
Operative Procedure ◽  
Surgical Techniques ◽  
Ventricular Contractility ◽  
Actuarial Survival ◽  
Surgical Methods ◽  
The Mean ◽  
The Right

AbstractEbstein's malformation is usually treated by replacing the tricuspid valve, albeit with controversial results. The “Carpentier technique,” introduced in 1980, offers both a new classification and new surgical methods for treatment of this lesion. The classification is based on the severity of the displacement of the septal and posteroinferior leaflets, with four grades of increasing severity. The surgical techniques involve mobilization of the anterosuperior leaflet, reduction of the diameter of the annulus, and longitudinal plication of the atrialized part of the right ventricle. Following this approach, 64 patients underwent consecutive surgical evaluation, with only one valvar replacement. The mean age was 26±15 years. The hospital mortality was nine percent. The mean follow-up is now 5.18±3.25 years. The actuarial survival rate was 87% at one year and 82% at five and 10 years. Of the patients, 90% were in postoperative functional class I or II. Control echocardiography revealed either no insufficiency, or minimal regurgitation in 80%. A second operation was needed in six patients because of right ventricular failure (two patients) or recurrence of valvar insufficiency (four patients). Sinus rhythm was present in 44 (88%) of the surviving patients. We conclude that repair of the malformed tricuspid valve, associated with longitudinal plication of the right ventricle, is safe and efficient. The prognosis depends on right ventricular contractility, which should be evaluated carefully before and after the operative procedure.

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