Comparison of clinical results of Transanal Endorectal Pull-Through of the colon with and without laparoscopic assistance in children with Hirschsprung’s disease
Keywords:Hirschsprung’s disease, children, miniinvasive methods, results
Introduction. Techniques of Transanal Endorectal Pull-Through (TEPT) with and without laparoscopic assistance have been widely used in pediatric surgery for correction of Hirschsprung’s disease (HD) in children with. Many clinics in their studies have noted the positive features of this approach compared to classical methods, but the long-term results after such operations in children are still debated.
Purpose - to study and compare the clinical results of TEPT with and without laparoscopic assistance in children with HD.
Materials and methods. We analyzed the experience of TEPT approach with laparoscopy (n=65 (29.41%)) and without laparoscopic assistance (n=144 (70.59%)) in childreb for correction of HD. For confirmation diagnosis we used the results of general clinical and special procedures (barium enema, anomanometry, histological, determination of acetylcholesterase activity).
Results. Overall, among 55 (26.32%) of 209 patients who underwent TEPT, postoperative in long term follow up we found intestinal problems like - moderate stenosis of the colo-anal anastomosis without incontinence 4 (1.91%), constipation 9 (4.31%), partial faecal incontinence 20 (9.57%) and enterocolitis (EC) 22 (10.53%). There was no significant difference in the clinical results of TEPT with laparoscopy and without laparoscopic assistance in our patients. After TEPT without laparoscopic assistance, 6 (4.17%) of 144 patients had constipation, 11 (7.64%) had partial fecal incontinence, and 16 (11.11%) had enterocolitis (EC). And among 65 children after TEPT with laparoscopy, 3 (4.62%) patients were diagnosed with constipation, 9 (13.85%) with partial fecal incontinence and 6 (9.23%) with EC. All children with postoperative intestinal problems were treated conservatively. There was no need for redo surgical interventions in these patients.
Conclusions. The technique of TEPT with laparoscopy and without laparoscopic assistance is a modern method of surgical correction of HD, which has significant technical advantages compared to other existing methods. In 26.32% of children with HD who were operated by the TEPT method, persistent intestinal problems continue in the long term follow-up period.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the children’s parents was obtained for the research.
No conflict of interests was declared by the authors.
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
Dickie BH, Webb KM, Eradi B, Levitt MA. (2014). The problematic Soave cuff in Hirschsprung disease: manifestations and treatment. J Pediatr Surg. 49 (1): 77-80; discussion 80-81. https://doi.org/10.1016/j.jpedsurg.2013.09.034; PMid:24439585
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
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
Kawaguchi AL, Guner YS, Sømme S, Quesenberry AC, Arthur LG, Sola JE, Downard CD, Rentea RM, Valusek PA, Smith CA, Slidell MB, Ricca RL, Dasgupta R, Renaud E, Miniati D, McAteer J, Beres AL, Grabowski J, Peter SDS, Gosain A. (2021). Management and outcomes for long-segment Hirschsprung disease: A systematic review from the APSA Outcomes and Evidence Based Practice Committee. J Pediatr Surg. 56 (9):1513-1523. https://doi.org/10.1016/j.jpedsurg.2021.03.046; PMid:33993978 PMCid:PMC8552809
Kim AC, Langer JC, Pastor AC, Zhang L, Sloots CEJ, Hamilton NA, et al. (2010). Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. J Pediatr Surg. 45 (6):1213-1220. https://doi.org/10.1016/j.jpedsurg.2010.02.087; PMid:20620323
Li AW, Zhang WT, Li FH, Cui XH, Duan XS. (2006). A new modification of transanal Soave pull-through procedure for Hirschsprung's disease. Chin Med J (Engl). 119 (1):37-42. https://doi.org/10.1097/00029330-200601010-00007; PMid:16454980
Negash S, Getachew H, Tamirat D, Mammo TN. (2022). Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section. BMC Surg. 22 (1): 89. https://doi.org/10.1186/s12893-022-01536-9; PMid:35260130 PMCid:PMC8905736
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 30 years 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, Kurtash OO, Hussaini SF, Rusak PS. (2022). Comparative characteristics of the results of surgical treatment of Hirschsprung's disease in children depending on the method of surgical correction. Paediatric Surgery (Ukraine). 4: 40-49. https://doi.org/10.15574/PS.2022.77.40
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
Tang ST, Wang GB, Cao GQ, Wang Y, Mao YZ, Li SW, Li S, Yang Y, Yang J, Yang L. (2012). 10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung's disease in China. J Laparoendosc Adv Surg Tech A. 22 (3): 280-284. https://doi.org/10.1089/lap.2011.0081; PMid:22449115
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
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
Yokota K, Uchida H, Tainaka T, Tanaka Y, Shirota C, Hinoki A, et al. (2018). Single-stage laparoscopic transanal pull-through modified Swenson procedure without leaving a muscular cuff for short- and long-type Hirschsprung disease: a comparative study. Pediatr Surg Int. 34 (10):1105-1110. https://doi.org/10.1007/s00383-018-4318-1; PMid:30073481
Zhang JS, Li L, Hou WY, Liu SL, Diao M, Zhang J et al. (2014). Transanal rectal mucosectomy and partial internal anal sphincterectomy for Hirschsprung's disease. J Pediatr Surg. 49 (5): 831-834. https://doi.org/10.1016/j.jpedsurg.2014.02.042; PMid:24851780
Zheng Z, Jin Z, Gao M, Tang C, Huang L, Gong Y, Liu Y. (2022). Laparoscopic Complete Excision of the Posterior Muscular Cuff: Technique Refinements and Comparison With Stepwise Gradient Muscular Cuff Cutting for Hirschsprung Disease. Front Pediatr. Apr 5. https://doi.org/10.3389/fped.2022.578843
: 578843. doi: 10.3389/fped.2022.578843. eCollection 2022. https://doi.org/10.3389/fped.2022.578843; PMid:35450109 PMCid:PMC9016161
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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