DOI: http://dx.doi.org/10.18203/2349-2902.isj20193313

Impact of additional abdominal approach to transanal one stage endorectal pull-through in treatment of Hirschsprung’s disease

Ho Huu Thien, Cao Xuan Thanh, Nguyen Thanh Xuan, Nguyen Huu Son

Abstract


Background: The transanal one-stage endorectal pull-through (TOSEPT) procedure sometimes requires assistance by an abdominal approach to complete the operation. This study aims to rectify this by evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with HD.

Methods: A retrospective study was conducted at surgical paediatric department of Hue central hospital. All consecutive medical records of patients operated on for HD in our department between June 2010 and June 2018 were retrieved and analysed.

Results: 66/446 (14.79%) patients with HD who required TOSEPT with an additional abdominal approach to complete the operation for inclusion in this retrospective study. Length of the resected colon: 13.30±3.45 cm (open group) and 19.70±4.50 cm (laparoscopic group). Average operative time: 156±12 minutes (open group) and 170±14 minutes (laparoscopic group). No deaths or intra-operative complications were recorded in this study. No postoperative complication occured in the laparoscopic group. Grade II complication based on Dindo-Clavien classification occurred in 14 (21.21%) of the open group and one (1.51%) grade III complication. The length of hospital stay was shorter in the laparoscopic group at 5±1.5 days compared to 7±2.5 days for the open group. All of the complications were grade I or II, mainly enterocolitis at 3-month follow-up.

Conclusions: Additional abdominal approach impacts on post-operative results of TOSEPT procedure for HD but not on outcome of disease. Laparoscopic surgery as the additional abdominal approach should be used to reduce the complications.

 


Keywords


Hirschsprung’s disease, Transanal one-stage endorectal pull-through, Additional abdominal approach

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References


Georgeson KE, Cohen RD, Hebra A, Jona JZ, Powell DM, Rothenberg SS, et al. Primary laparoscopic-assisted endorectal colon pull-through for Hirschsprung's disease: a new gold standard. Ann Surg. 1999;229(5):678-82.

Yamataka A, Miyano G, Takeda M. Minimally Invasive Neonatal Surgery: Hirschsprung Disease. Clin Perinatol. 2017;44(4):851-864.

Guerra J, Wayne C, Musambe T, Nasr A. Laparoscopic-assisted transanal pull-through (LATP) versus complete transanal pull-through (CTP) in the surgical management of Hirschsprung's disease. J Pediatr Surg. 2016;51(5):770-4.

Miyano G, Takeda M, Koga H, Okawada M, Nakazawa-Tanaka N, Ishii J, et al. Hirschsprung's disease in the laparoscopic transanal pull-through era: implications of age at surgery and technical aspects. Pediatr Surg Int. 2018;34(2):183-8.

Thanh Liem N, Duc Hau B, Anh Quynh T. To compare early outcomes of primary laparoscopic-assisted endorectal colon pull through and transanal for Hirschprung disease. Ho Chi Minh city Med J. 2011;15(3):33-36.

Thomson D, Allin B, Long AM, Bradnock T, Walker G, Knight M. Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis. BMJ Open. 2015;5(3):e006063.

Uy Linh TN, Ngoc Linh PT, Kinh Bang N, Trung Hieu D. Transanal endorectal pull through in infants less than three months of age with Hirschsprung’ disease. Ho Chi Minh city Medical J. 2005;9(1):1-4.

Lu C, Hou G, Liu C, Geng Q, Xu X, Zhang J, et al. Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates: A multicenter study. J Pediatr Surg. 2017;52(7):1102-7.

Smith GHH, Cass D. Infantile Hirschsprung's disease — is a barium enema useful? Pediatric Surgery Int. 1991;6(318-321.

Tannuri AC, Tannuri U, Romao RL. Transanal endorectal pull-through in children with Hirschsprung's disease--technical refinements and comparison of results with the Duhamel procedure. J Pediatr Surg. 2009;44(4):767-72.

Teeraratkul S. Transanal one-stage endorectal pull-through for Hirschsprung's disease in infants and children. J Pediatr Surg. 2003;38(2):184-7.

Vu PA, Thien HH, Hiep PN. Transanal one-stage endorectal pull-through for Hirschsprung disease: experiences with 51 newborn patients. Pediatr Surg Int. 2010;26(6):589-92.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.

Rosenfield NS, Ablow RC, Markowitz RI, DiPietro M, Seashore JH, Touloukian RJ, et al. Hirschsprung disease: accuracy of the barium enema examination. Radiology. 1984;150(2):393-400.

Rita KM. Laparoscopic management of Hirschprung’disease. World J Laparoscopic Surg. 2017;10(3):91-94.

Langer JC, Durrant AC, de la Torre L, Teitelbaum DH, Minkes RK, Caty MG, et al. One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Ann Surg. 2003;238(4):569-83.