Comparative characteristics of the results of surgical treatment of Hirschsprung’s disease in children depending on the method of surgical correction
DOI:
https://doi.org/10.15574/PS.2022.77.40Keywords:
Hirschsprung’s disease, children, surgical treatment, results, complicationAbstract
For the Treatment of Hirschsprung’s disease (HD) in children’s, different methods of open and minimally invasive surgical correction are used. However, up to 40.4% of operated patients get complications that require secondary correction or repeated radical interventions, regardless of the primary method of correction.
Purpose - to compare the results of surgical treatment of HD in children depending on the method of surgical correction.
Materials and methods. An analysis of the surgical treatment of 1,187 children with various forms of HD aged from birth till 18 years old was conducted from 1980 to the end of 2021. The rectal form of HD was seen in 386 (32.52%) patients, 598 (50.38%) rectosigmoid., subtotal - 162 (13.65%) and 41 (3.45%) patients had a total form of aganglionosis. All patients were operated by either «classical» open approach or minimally invasive radical methods. Early and long-term complications after various methods of surgical correction of HD, their cause and options for appropriate correction were studied.
Results. In the early postoperative period, 51 (4.30%) of 1187 operated patients were diagnosed with such complications as intestinal obstruction (n=7 (0.59%)), intestinal intussusception (n=3 (0.25%)), suppuration of the postoperative wound at the place of removal of the intestinal stoma (n=5 (0.42%)), hematoma of the inter-cuff space (n=3 (0.25%)), abscess of the inter-cuff space (n=9 (0.76%)), retraction of pull through colon (n=2 (0.17%)), anastomotic leak (n=7 (0.59%)) and anastomotic stenosis (n=15 (1.26%)). In 9 (0.76%) children we noted stenosis of the colo-anal anastomosis, and in 6 (0.51%) patients - stenosis of the ileo-anal anastomosis. Long-term postoperative complications were noted in 48 (4.04%) patients: anastomotic stenosis (n=16 (1.35%)), «Duhamel pouch» (n=2 (0.17%)), residual aganglionosis (n=23 (1.94%)), colonoptosis (n=1 (0.08%)) and adhesive intestinal obstruction (n=6 (0.51%)). All complications were detected in a timely manner and corrected accordingly.
Conclusions. When treating HD in children, complications may occur in the early and long-term postoperative periods after using any approach open or minimally invasive methods of radical correction. The Soave-Boley operation and minimally invasive techniques are the safest methods of radical correction of HD in children. Timely detection and appropriate correction of early or long term postoperative complications improves the functional results of surgical treatment of HD in children.
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 interests was declared by the authors.
References
Allin BSR, Bradnock T, Kenny S, Kurinczuk JJ, Walker G, Knight M. (2017). NETS1HD study: development of a Hirschsprung's disease core outcome set. Arch Dis Child. 102: 1143-1151. https://doi.org/10.1136/archdischild-2017-312901; PMid:28784616 PMCid:PMC5754863
Avansino JR, Levitt MA. (2017). Hirschsprung disease. In Fundamentals of pediatric surgery, 2, Mattei P. et al (eds.). - Springer International Publishing, Cham.: 513-524. https://doi.org/10.1007/978-3-319-27443-0_62
Bjørnland K, Pakarinen MP, Stenstrøm P, Stensrud KJ, Neuvonen M, Granström AL et al. (2017). A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease. J. Pediatr. Surg. 52: 1458-1464. https://doi.org/10.1016/j.jpedsurg.2017.01.001; PMid:28094015
Byström C, Östlund S, Hoff N, Wester T, Granström AL. (2020). Evaluation of bowel function, urinary tract function, and quality of life after transanal endorectal pull-through surgery for Hirschsprung's Disease. Eur J Pediatr Surg. 31 (1): 40-48. https://doi.org/10.1055/s-0040-1715612; PMid:32877942
Chhabra S, Kenny SE. (2016). Hirschsprung's disease. Surgery (Oxford). 34 (12): 628-632. https://doi.org/10.1016/j.mpsur.2016.10.002
Chun-Hui P, Ya-Jun C, Wen-Bo P, Ting-Chong Zh et al. (2018). STROBE-anastomotic leakage after pull-through procedure for Hirschsprung disease. Medicine. 97; 46 (e13140): 1-5. https://doi.org/10.1097/MD.0000000000013140; PMid:30431584 PMCid:PMC6257430
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
Davidson JR, Kyrklund K, Eaton S, Blackburn SC, De Coppi P, Curry J. (2021). Long-term surgical and patient-reported outcomes of Hirschsprung Disease. J. Pediatr. Surg. 13: 1502-1511. https://doi.org/10.1016/j.jpedsurg.2021.01.043; PMid:33706942
Dingemans A, van der Steeg H, Rassouli-Kirchmeier R, Linssen MW, van Rooij I, de Blaauw I. (2017). Redo pull-through surgery in Hirschsprung's disease: short-term clinical outcome. J. Pediatr. Surg. 52: 1446-1450. https://doi.org/10.1016/j.jpedsurg.2016.09.059; PMid:27765267
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
Langer JC, Rollins MD, Levitt M, Gosain A, Torre L, Kapur RP et al. (2017). American Pediatric Surgical Association Hirschsprung Disease Interest Group. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr. Surg. Int. 33: 523-526. https://doi.org/10.1007/s00383-017-4066-7; PMid:28180937
Meinds RJ, van der Steeg AFW, Sloots CEJ, Witvliet MJ, de Blaauw I, van Gemert WG et al. (2019). Long-term functional outcomes and quality of life in patients with Hirschsprung's disease. Br J Surg. 106: 499-507. https://doi.org/10.1002/bjs.11059; PMid:30653654 PMCid:PMC6590339
Neuvonen M, Kyrklund K, Taskinen S, Koivusalo A, Rintala RJ, Pakarinen MP. (2017). Lower urinary tract symptoms and sexual functions after endorectal pull-through for Hirschsprung disease: controlled long-term outcomes. J Pediatr Surg. 52: 1296-1301. https://doi.org/10.1016/j.jpedsurg.2017.02.013; PMid:28341232
Neuvonen MI, Kyrklund K, Rintala RJ, Pakarinen MP. (2017). Bowel function and quality of life after transanal endorectal pull-through for Hirschsprung disease: controlled outcomes up to adulthood. Ann Surg. 265 (3): 622-629. https://doi.org/10.1097/SLA.0000000000001695; PMid:28169931
Onishi S, Nakame K, Yamada K, Yamada W, Kawano T, Mukai M, Kaji T, Ieiri S. (2016). Long-term outcome of bowel function for 110 consecutive cases of Hirschsprung's disease: comparison of the abdominal approach with transanal approach more than 30years in a single institution - is the transanal approach truly beneficial for bowel function? J. Pediatr. Surg. 51: 2010-2014. https://doi.org/10.1016/j.jpedsurg.2016.09.029; PMid:27916192
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
Ralls MW, Coran AG, Teitelbaum DH. (2017). Redo pullthrough for Hirschsprung disease. Pediatr. Surg. Int. 33: 455-460. https://doi.org/10.1007/s00383-016-4045-4; PMid:28040830
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
Sun S, Chen G, Zheng S, Dong K, Xiao X. (2017). Usefulness of posterior sagittal anorectoplasty for redo pull-through in complicated and recurrent Hirschsprung disease: experience with a single surgical group. J. Pediatr. Surg. 52: 458-462. https://doi.org/10.1016/j.jpedsurg.2016.08.016; PMid:27712891
Tannuri AC, Ferreira MA, Mathias AL, Tannuri U. (2017). Long-term results of the Duhamel technique are superior to those of the transanal pullthrough: a study of fecal continence and quality of life. J Pediatr Surg. 52: 449-453. https://doi.org/10.1016/j.jpedsurg.2016.10.007; PMid:27836370
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
Tran VQ, Mahler T, Dassonville M, Truong DQ, Robert A, Goyens P, Steyaert H. (2018). Long-Term Outcomes and Quality of Life in Patients after Soave Pull-Through Operation for Hirschsprung's Disease: An Observational Retrospective Study. Eur. J. Pediatr. Surg. 28 (5): 445-454. https://doi.org/10.1055/s-0037-1604115; PMid:28738437
Urushihara N. (2019). Laparoscopic Modified Duhamel Procedure. In Hirschsprung's Disease and the Allied Disorders. Status Quo and Future Prospects of Treatment. Taguchi T, Matsufuji H, Ieiri S (eds.). Springer Nature Singapore. Pte Ltd.: 119-125. https://doi.org/10.1007/978-981-13-3606-5_18
Yasui Y, Nishida S, Shironomae T, Satomi M, Kuwahara T, Kohno M. (2017). Surgical approach for fecal incontinence with a patulous anus after transanal pull-through for Hirschsprung disease. J. Pediatr. Surg. 52: 1070-1075. https://doi.org/10.1016/j.jpedsurg.2017.02.004; PMid:28242026
Zimmer J, Tomuschat C, Puri P. (2016). Long-term results of transanal pullthrough for Hirschsprung's disease: a meta-analysis. Pediatr. Surg. Int. 32: 743-749. https://doi.org/10.1007/s00383-016-3908-z; PMid:27385111
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