Long-term results of miniinvasive methods of treatment of hirshprung’s disease in children
Keywords:Hirschsprung’s disease, children, mini-invasive methods of treatment, results
The mini-invasive methods of treating Hirshprung’s disease (HD), namely, the Transanal Endorectal Pull-Through (TEPT) of the colon with or without laparoscopic assistance, have been widely used in pediatric surgery. Many clinics in their studies have noted the positive features of the mini invasive approach to HD treatment compared to classical methods, but long-term results after such operations in children are quite debatable.
Aim to study: the remote results of mini-invasive methods of treating HD in children.
Materials and methods. We analyzed the experience of using mini invasive method of surgical correction of HD in 187 children from 1 month to 8 years. Among them, 122 patients were operated using the TEPT method and 65 children by the method of laparoscopically-assisted TEPT. All children were operated in single step, without conversion, there were no intra-operative complications. In the early postoperative period, 2 (3.74%) out of 187 children had colo-anal anastomosis failure.
Results and discussion. In 4 children aged 1 to 12 months after TEPT, during the first 2-4 months after the operation, moderate stenosis of colo-anal anastomosis was seen, which was corrected without any complications. After TEPT, out of 122 in 6 (4.92%) patients, constipation was noted, in 11 (9.01%) – partial incontinence of feces and in 15 (12.29%) – enterocolitis (EC). Out of 65 children after laparoscopically-assisted TEPT in 3 (4.62%) patients, constipation was noted, in 9 (13.85%) – partial incontinence of feces and in 6 (9.23%) – EC. All children with postoperative bowel problems have been successfully treated conservatively. There was no need for repeated surgical interventions in these patients.
Conclusions. The nature of complications in the long-term post operative period after the correction of HD depends on the age of the patient at the time of operation, following carefully all the technical features of the method, taking into consideration the anatomical features of the disease, the presence and type of accompanying pathology. In 28.88% of children with HD, which were operated by mini-invasive methods, persistent intestinal problems continue in the long term post operative period. The earlier the correction of HD, the better the functional results in the long term post operative period. The children aged under 1 year are optimal for correction of HD with mini-invasive technique. In time detected and adequately corrected complication in the long term postoperative period promotes faster normalization of functional results and improving quality of life of patient’s.
Prytula VP, Silchenko MI, Khusseiny SF, Kuzyk AS, Kurtash OO, Iskov AP. (2014). Transanalne endorektalne zvedennia ta rezektsiia tovstoi kyshky, yak suchasnyi pidkhid khirurhichnoho likuvannia ditei z khvoroboiu Hirshprunha. Arkhiv klinichnoi medytsyny. 2: 93–94.
Burkardt DD, Graham JrJM, Short SS, Frykman PK. (2014). Advances in Hirschsprung disease genetics and treatment strategies: an update for the primary care pediatrician. Clin Pediatr (Phila). 53 (01):71–81. https://doi.org/10.1177/0009922813500846; PMid:24002048
Chun-Hui P, Ya-Jun C, Wen-Bo P, Ting-Chong Zh, Zeng-Meng W, Dong-Yang W, Kai W. (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
Clermidi P, Podevin G, Cretolle C, Sarnacki S, Hardouin JB. (2013). The challenge of measuring quality of life in children with Hirschsprung’s disease or anorectal malformation. J Pediatr Surg. 48(10): 2118–2127. https://doi.org/10.1016/j.jpedsurg.2013.03.071; PMid:24094967
Fernandez Ibieta M, Sanchez Morote JM, Martinez Castano I et al. (2014). Quality of life and long term results in Hirschsprung’s disease (in Spanish). Cir Pediatr. 27 (03): 117–124.
Gosemann JH, Friedmacher F, Ure B, Lacher M. (2013). Open versus transanal pull-through for Hirschsprung disease: a systematic review of long-term outcome. Eur J Pediatr Surg. 23(02): 94–102. https://doi.org/10.1055/s-0033-1343085; PMid:23572464
Han-Geurts IJ, Hendrix VC, de Blaauw I, Wijnen MH, van Heurn EL. (2014). Outcome after anal intrasphincteric Botox injection in children with surgically treated Hirschsprung disease. J Pediatr Gastroenterol Nutr. 59 (05):604–607. https://doi.org/10.1097/MPG.0000000000000483; PMid:25000353
Khazdouz M, Sezavar M, Imani B, Akhavan H, Babapour A, Khademi G. (2015). Clinical outcome and bowel function after surgical treatment in Hirschsprung’s disease. African Journal of Paediatric Surgery. 12 (2): 143–147. https://doi.org/10.4103/0189-6725.160403; PMid:26168755 PMCid:PMC4955413
Kyrklund K, Koivusalo A, Rintala RJ, Pakarinen MP. (2012). Evaluation of bowel function and fecal continence in 594 Finnish individuals aged 4 to 26 years. Dis. Colon Rectum. 55 (06):671–676. https://doi.org/10.1097/DCR.0b013e31824c77e4; PMid:22595847
Langer JC. (2013). Hirschsprung’s disease. Curr Opin Pediatr. 25 (03):368–374. https://doi.org/10.1097/MOP.0b013e328360c2a0; PMid:23615177
Li Y, Shao-tao T, Guo-qing C, Ying Y, Shuai L, Shi-wang L, Yong W, Yong-zhong M, Qing-lan R, Guo-bin W. (2012). Transanal endorectal pull-through for Hirschsprung’s disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes. Pediatr Surg Int. 28:515–521. https://doi.org/10.1007/s00383-012-3071-0; PMid:22426598
Meinds RJ, Eggink MC, Heineman E, Broens PM. (2014). Dyssynergic defecation may play an important role in postoperative Hirschsprung’s disease patients with severe persistent constipation: analysis of a case series. J Pediatr Surg. 49 (10):1488–1492. https://doi.org/10.1016/j.jpedsurg.2014.05.001; PMid:25280652
Neuvonen MI, Kyrklund K, Rintala RJ, Pakarinen MP. (2017). Bowel function and quality of life after transanal endorectal pullthrough for Hirschsprung disease: controlled outcomes up to adulthood. Ann Surg. 265 (03): 622–629. https://doi.org/10.1097/SLA.0000000000001695; PMid:28169931
Prytula VP, Levytskyi AF, Silchenko MI, Hussaini SF, Godik OS, Kurtash OO, Kuzyk AS. (2016). Laparoscopic-assisted transanal endorectal pull-through of colon for treatment of Hirschsprung’s disease in children. Standardy Medyczne – Problemy Chirurgii Dziciecej. 6 (1):109.
Rajindrajith S, Devanarayana NM, Benninga MA. (2013). Review article: faecal incontinence in children: epidemiology, pathophysiology, clinical evaluation and management. Aliment Pharmacol Ther. 37 (01):37–48. https://doi.org/10.1111/apt.12103; PMid:23106105
Rintala RJ, Pakarinen MP. (2012). Long-term outcomes of Hirschsprung’s disease. Semin. Pediatr. Surg. 21 (04): 336–343. https://doi.org/10.1053/j.sempedsurg.2012.07.008; PMid:22985839
Sheng Q, Lv Zh, Xiao X. (2012). Re-operation for Hirschsprung’s disease: experience in 24 patients from China. Pediatr Surg Int. 28:501–506. https://doi.org/10.1007/s00383-012-3062-1; PMid:22358253
Stensrud KJ, Emblem R, Bjornland K. (2012). Late diagnosis of Hirschsprung disease – patient characteristics and results. J Pediatr Surg. 47 (10):1874–1879. https://doi.org/10.1016/j.jpedsurg.2012.04.022; PMid:23084200
Tabbers MM, Di Lorenzo C, Berger MY et al. (2014). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 58 (02):258–274. https://doi.org/10.1097/MPG.0000000000000266; PMid:24345831
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
Zakaria OM, El Labban GM, Shams ME. (2012). Fecal incontinence after single-stage Soave’s pull-through: abdominal versus transanal endorectal pull-through. Ann Pediatr Surg. 8:5–8. https://doi.org/10.1097/01.XPS.0000407759.30719.57
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