Reconstructive-plastic operations for restoring patency at different levels of subtotal resection of the colon in children with intestinal agangliosis
DOI:
https://doi.org/10.15574/PS.2022.74.45Keywords:
agangliosis, intestine, children, surgical treatment, resultsAbstract
Subtotal resection of the colon in intestinal agangliosis depends on the level of lesion and secondary decompensatory changes in the intestinal wall. Rational choice of reconstructive plastic surgery in such pathology is necessary to restore patency, normalize functional changes in the intestine and stabilize the general condition of patients.
Purpose - to evaluate the results of reconstructive-plastic surgery to restore patency at different levels of subtotal resection of the colon in children with intestinal agangliosis.
Materials and methods. We analyzed the surgical treatment of 182 children with intestinal agangliosis aged from 1 month to 8 years, who underwent reconstructive-plastic surgery to restore patency at different levels of subtotal resection of the colon.
Results. In 58 (31.86%) patients after subtotal resection of the colon performed the pullthrough of the remaining segment of the colon on the left mesenteric sinus (lateral canal), in 51 (28.02%) - pullthrough of the remaining segment of the colon on the right mesenteric sinus in front of the terminal ileum, in 63 (34.62%) - pullthrough of the ascending colon or caecum on the right flank with a rotation of 180° and in 10 (5.50%) children - replacement of the left half of the colon with an ileograft with intrarectal pullthrough. In 161 (88.46%) cases good results were obtained, and in 21 (11.54%) patients - satisfactory functional results in the long term follow up.
Conclusions. Restoration of intestinal patency after subtotal resection of the colon in children with intestinal agangliosis should be aimed at providing favorable conditions for anastomosis between the remaining part of the colon and rectum. If it is impossible to directly anastomose the remaining segments of the colon and rectum, it is advisable to replace the left half of the colon with an ileograft with its intrarectal pullthrough. Differential approach in the choice of reconstructive plastic surgery for subtotal resection of the colon allows to normalize functional changes in the intestine and stabilize the general condition of patients.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
References
Amerstorfer EE, Fasching G, Till H, Huber-Zeyringer A, Hollwarth ME. (2015). Long-term results of total colonic agangliosis patients treated by preservation of the aganglionic right hemicolon and the ileo-cecal valve. Pediatr Surg Int. 31 (8): 773-780. https://doi.org/10.1007/s00383-015-3743-7; PMid:26160361
Bischoff A, Frischer J, Knod JL et al. (2017). Damaged anal canal as a cause of fecal incontinence after surgical repair for Hirschsprung disease - a preventable and under-reported complication. J Pediatr Surg. 52 (4): 549-553. https://doi.org/10.1016/j.jpedsurg.2016.08.027; PMid:27624566
Chen F, Wei X, Chen X, Xiang L, Feng J. (2021). Laparoscopic vs. Transabdominal Treatment for Overflow Fecal Incontinence Due to Residual Aganglionosis or Transition Zone Pathology in Hirschsprung's Disease Reoperation. Front. Pediatr. 27 April 2021. https://doi.org/10.3389/fped.2021.600316; PMid:33987148 PMCid:PMC8111174
Chen X, Xiaojuan W, Zhang H, Jiao C, Yu K, Zhu T et al. (2017). Diagnostic value of the preoperatively detected radiological transition zone in Hirschsprung's disease. Pediatr Surg Int. 33: 581-586. https://doi.org/10.1007/s00383-017-4064-9; PMid:28154903
Das Neves Romaneli MT, Ribeiro AF, Bustorff-Silva JM, de Carvalho RB, Lomazi EA. (2016). Hirschsprung's disease - Postsurgical intestinal dysmotility. Rev Paul Pediatr. 34 (3): 388-392. https://doi.org/10.1016/j.rppede.2016.05.001; PMCid:PMC5178128
Ekenze SO, Ngaikedi C, Obasi AA. (2016). Problems and Outcome of Hirschsprung's Disease Presenting after 1 Year of Age in a Developing Country. World Journal of Surgery. 35 (1): 22-26. https://doi.org/10.1007/s00268-010-0828-2; PMid:20976451
Ergashev BB, Khamroev UA. (2021). Features of clinic, diagnosis and tactics of surgical treatment of Hirschsprung's disease in infants. Paediatric Surgery. Ukraine. 1 (70): 32-37. https://doi.org/10.15574/PS.2021.70.32
Fang Y, Bai J, Zhang B, Wu D, Lin Y, Liu M. (2020). Laparoscopic Soave procedure for long-segment Hirschsprung's disease single-center experience. Wideochir Inne Tech Maloinwazyjne. 15: 234-238. https://doi.org/10.5114/wiitm.2019.86807; PMid:32117510 PMCid:PMC7020730
Gupta DK, Khanna K, Sharma S. (2019). Experience with the redo pull-through for Hirschsprung's disease. Indian Assoc Pediatr Surg. 24: 45-51. https://doi.org/10.4103/jiaps.JIAPS_52_18; PMid:30686887 PMCid:PMC6322179
Jiang M, Li CL, Cao GQ, Tang ST. (2019). Laparoscopic redo pull-through for Hirschsprung disease due to innervation disorders. J Laparoendosc Adv Surg Tech A. 29: 424-429. https://doi.org/10.1089/lap.2018.0551; PMid:30461345
Jiao C, Yu D, Li D, Wang G, Feng J. (2018). A long-term follow-up of a new surgery method: laparoscope-assisted heart-shaped anastomosis for Hirschsprung's disease. J Laparoendosc Adv Surg Tech A. 28: 471-475. https://doi.org/10.1089/lap.2017.0275; PMid:29190183
Kapur RP, Smith C, Ambartsumyan L. (2020). Postoperative pullthrough obstruction in Hirschsprung disease: etiologies and diagnosis. Pediatr Dev Pathol. 23: 40-59. https://doi.org/10.1177/1093526619890735; PMid:31752599
Moore SW. (2015). Total colonic aganglionosis and Hirschsprung's disease: a review. Pediatr Surg Int. 31: 1-9. https://doi.org/10.1007/s00383-014-3634-3; PMid:25367097
Prytula VP, Silchenko MI, Kurtash OO, Hussaini SF. (2020). Reconstruction of intestinal tract after total colectomy in children with agangliosis. Paediatric Surgery. Ukraine. 1 (66): 51-57. https://doi.org/10.15574/PS.2020.66.51
Scholfield DW, Ram AD. (2016). Laparoscopic Duhamel procedure for Hirschsprung's disease: systematic review and meta analysis. J Laparoendosc Adv Surg Tech A. 26: 53-61. https://doi.org/10.1089/lap.2015.0121; PMid:26312541
Taguchi T, Matsufuji H, Ieiri S. (2019). Hirschsprung's Disease and the Allied Disorders. Status Quo and Future Prospects of Treatment. Springer Nature Singapore. Pte Ltd.: 59-63. https://doi.org/10.1007/978-981-13-3606-5
Taguchi T, Obata S, Ieiri S. (2017). Current status of Hirschsprung's disease: based on a nationwide survey of Japan. Pediatr Surg Int. 33 (4): 497-504. https://doi.org/10.1007/s00383-016-4054-3; PMid:28058486
Tomuschat C, Zimmer J, Puri P. (2016). Laparoscopic-assisted pull-through operation for Hirschsprung's disease: a systematic review and meta-analysis. Pediatr Surg Int. 32: 751-757. https://doi.org/10.1007/s00383-016-3910-5; PMid:27369964
Wong CW, Lau CT, Chung PH, Lam WM, Wong KK, Tam PK. (2015). The value of the 24-h delayed abdominal radiograph of barium enema in the diagnosis of Hirschsprung's disease. Pediatr Surg Int. 31: 11-15. https://doi.org/10.1007/s00383-014-3632-5; PMid:25348880
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
