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<p><b>OBJECTIVE</b>To summarize the complications after endorectal pull-through radical operation, Soave procedure, for Hirschsprung disease.</p><p><b>METHODS</b>Clinical data of 286 cases with Hirschsprung disease who received Soave procedure and were proved by postoperative pathology in our hospital from February 2003 to February 2010 were analyzed retrospectively. All the patients were diagnosed with barium enema and anorectal manometry. Among them, 233 cases(81.5%) were identified during neonatal period. All the patients underwent cleansing enema and anus dilation immediately after definite diagnosis. Radical operation with Soave endorectal pull-through procedure, including simple transanal endorectal pull-through in 251 cases(87.8%), transabdominal approach in 17 cases (5.9%), laparoscopy-assisted endorectal pull-through in 18 cases (6.3%). The operations were performed in 54 cases (18.9%) within 3 months of age, in 183 cases (64.1%) between 3 and 6 months, in 38 cases(13.3%) between 6 months and one year, in 10 cases (3.5%) older than 1 year. The rectosigmoid was resected in 259 cases. Subtotal colectomy was performed in 25 cases, and total colectomy in 2 cases. Postoperative regular anal dilation lasted for 6 months. A total of 286 cases (male:250, female:36) were followed up for 2 to 5 years.</p><p><b>RESULTS</b>There was wound infection in 1 case, ileus in 1 cases, anastomotic stricture in 1 case, which was cured by continuous anal dilation. Two cases had constipation and received re-operation because of refractory to conservative therapy for 6 months. Perianal erosion was found in 63 cases(22.0%) and was healed within 3 months, except 2 children undergoing total colectomy. During follow-up, enterocolitis occurred in 11 cases(3.8%), including healing in 8 cases with conservative therapy, death in 1 case, and recurrent attacks in 2 cases. Soiling occurred in 45 cases(15.7%), among them, 5 cases presented in kindergarten and primary school. Morbidities of perianal erosion, enterocolitis and soiling were higher in infants undergoing operation within 3 months as compared to those more than 3 months [90.7%(49/63) vs. 6.0%(14/63), P=0.000; 9.3%(5/54) vs. 2.6%(6/232), P=0.022; 25.9%(14/54) vs. 13.4%(31/232), P=0.022]. Morbidity of perianal erosion enterocolitis was higher in infants undergoing subtotal or total colectomy as compared to those partial colon resection[51.9%(14/27) vs. 18.9%(49/259), P=0.000; 18.5%(5/27) vs. 2.3%(6/259), P=0.000].</p><p><b>CONCLUSIONS</b>Primary transanal endorental pull-through procedure can be performed in most children with Hirschsprung disease. Postoperative short-term complications are mainly perianal erosion and long-term ones are enterocolitis and soiling. Early diagnosis, colon irrigation, avoiding premature operation and anal dilation can decrease the morbidities of enterocolitis and soiling.</p>
Subject(s)
Female , Humans , Infant , Male , Anastomosis, Surgical , Colectomy , Colon, Sigmoid , Constipation , Enema , Hirschsprung Disease , Laparoscopy , Perineum , Postoperative Complications , Postoperative Period , Rectum , Retrospective StudiesABSTRACT
Objective To explore the feasibility of tw o- port laparoscopy in the treatment of congenital hypertrophic pyloric stenosis. Methods A total of 21 infants with confirmatively diagnosed con genital hypertrophic pyloric stenosis were given a two-port laparoscopic pylorom yotomy. The procedure was performed using two trocars: a 5 mm trocar at the lowe r border of the umbilical ring was placed for the insertion of camera, and a 3 m m trocar was introduced below the costal margin at the midclavicular line to pas s the hook electrode and curved forceps. Results No conversion s to open surgery were required. The operation time was 23~65 min (mean, 31.3 mi n). The patients were discharged from hospital at 4~6 postoperative days. No com plications occurred. Follow-up for 2~7 months (mean, 3.2 months) showed a norma l development in all the 21 patients. Conclusions Two-port lap aroscopic treameat for congenital hypertrophic pyloric stenosis in infants is ef fective.
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Objective To investigate the value of lapa ro scopic surgery in the diagnosis and treatment of bile duct diseases in newborns and infants. Methods Clinical records of 9 newborns or infants with bile duct diseases diagnosed and treated under laparoscope from January 20 03 to August 2004 in this hospital were reviewed retrospectively. Resul ts Laparoscopic exploration in the 9 cases found 2 cases of congenital choledochal cyst, 5 cases of biliary atresia, 1 case of cholestasis, and 1 case of congenital bile duct hypoplasia. Cholangiography was successfully performed i n 8 cases. Two patients with choledochal cyst received an excision of the cyst a nd Roux-en-Y hepatico-jejunostomy. Among the 5 patients with biliary atresia, he patic porto-enterostomy was performed via open approach in 3 patients and via la paroscopic approach in 1, and surgery was refused in 1 patient. Open hepatic por to-enterostomy was also used in the patient with bile duct hypoplasia. The patie nt with cholestasis underwent a biliary tract irrigation. Conclusions Laparoscopy is simple and reliable in the diagnosis of bile duct disease s in newborns and infants. For the treatment of bile duct diseases, laparoscopic techniques have advantages of minimal invasion, good cosmetic results, less blo od loss, quick recovery, and reliable clinical effects.
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Objective To explore the causes and treatment of the complications after laparoscopic surgery in neonate and infants.Methods From January 2003 to June 2007,totally 287 neonates and infants received laparoscopic surgeries in our hospital, 10 of them developed postoperative complications.Results The complications included 7 cases of gastric mucosa rupture during pyloric resection,1 case of delayed rupture of the pylorus,1 case of intestinal malrotation complicated with duodenal stenosis,and 1 case of incisional hernia.The former 9 cases were cured by open surgery,and the last one recovered spontaneously in 4 months. Conclusions Mucosarupture caused by pyloric resection is the most common complication after laparoscopic surgery in neonates and infants,open surgery should be performed in such a situation.Delayed rupture of the bowel after laparoscopic surgery can be potentially fatal,and should be treated as soon as possible.Intestinal malrotation may lead to a high rate of malformation,which can be avoided by early diagnosis and treatment.
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Freud initiated the new realm of personality psychology research.From the topographical view to the structural view,both of his theories on personality structures emphasized the coordination and balance between every levels of the structure.Taking Freud's personality structure theory as the cutting-in point,this article expatiates on the relationship between id,ego,superego and harmonious personality,and puts forward several suggestions on the development of harmonious education and the construction of harmonious personality.