Efficacy evaluation of laparoscopic-assisted Soave radical operation in the treatment of children with congenital megacolon / 上海交通大学学报（医学版）

Objective • To evaluate the clinical efficacy of laparoscopic-assisted Soave radical operation in the treatment of children with congenital megacolon. Methods • The clinical datum of 148 pediatric patients with congenital megacolon who had underwent laparoscopic-assisted Soave radical operation in Hainan General Hospital from Mar. 2012 to Sept. 2015 were collected. Operation time, blood volume lost during the operation, complication incidence during the hospitalization and follow-up period were analyzed, retrospectively. Results • All 148 patients were finished the surgery successfully. Operation time was (121.66±22.98) min, blood volume lost during the operation was (4.86±0.66) mL. During the hospitalization, the incidence of complications was 8.10%. There were no short-term complications observed on abdominal bleeding and anastomotic leakage. The patients were followed up for 24 months, there was one patient with anastomotic stoma stenosis at the 6 months after the operation, who recovered after the treatment of anal dilation. All the pediatric patients’ stool were mushy within 3 months after the operation, and they recovered to normal at the 6-12 months. The excellent rate of defecation function was 97.97%. There were no symptoms of bloated abdomen and astriction for all the patients during the follow-up period. Conclusion • Laparoscopic-assisted Soave radical operation is effective and safe for the treatment of children with congenital megacolon, with few complications, quick recovery, good short-term and long-term clinical effect.

Comparative analysis of the modified laparoscopic swenson and laparoscopic soave procedure for children with short-segment hirschsprung disease / 实用医学杂志

Objective To compare the characteristics,complications and outcomes of the modified lapa-roscopic Swenson(MLSw)and laparoscopic Soave(LS)procedures for children with short-segment Hirschsprung disease(HD). Methods Seventy-seven pediatric patients with HD who underwent surgery from March 2007 to December 2016 were enrolled in this retrospective study. Twenty-six patients were treated with LS and 51 cases un-derwent MLSw. The preoperative,operative and postoperative data was collected,with follow-up periods ranging from 12 to 48 months. The perioperative/operative characteristics,postoperative complications,and outcomes were compared between the two groups. Results On average,the patients in the LS group had a longer operating time than that in the MLSw group(P < 0.05). Blood loss was significantly less in the MLSw group than that in the LS group(P < 0.05). There was no significant difference in feeding time between the two groups(P > 0.05). The MLSw group was discharged after a shorter hospitalization time than that in the LS group(P < 0.05). The MLSw group had lower incidences of postoperative complications than those in the LS group in the early postoperative period,with no significant difference in the rate of complications during the late postoperative period was found between the two groups. Conclusions Both LS and MLSw are suitable for treatment of children with short-segment HD. However,the MLSw operation is much simpler,with less operating time,less intraoperative blood loss,shorter hospitalization time and better bowel control in the early postoperative period. We favor this approach because it allows complete removal of the entire original aganglionic bowel,without leaving behind a cuff.

Short-term efficacy and influencing factor analysis of modified transanal Soave surgery on hirschsprung′s disease infants in initial radial resection / 实用医学杂志

Objective To observe the short-term clinical efficacy of modified transanal Soave surgery on infants with hirschsprung′s disease (HD) in initial radial resection, and to analyze the influencing factors. Methods 132 HD infants were selected. After initial radial resection with modified transanal , Soave surgery was conducted under general or sacral anesthesia. Postoperative antibiotics were routinely given. Results 19-56 cm intestinal canal samples were excised, with average length of (35.07 ± 3.15) cm. The average surgical duration and intra-operative hemorrhagic volume were (120.48 ± 18.34) min and verage was (45.74 ± 8.14) mL. All infants′ gastrointestinal function was recovered in 24 h postoperatively. The total excellent and effective rate of anal function in 6 months was 90.90% postoperatively. Cox modal multivariate analysis suggested that anastomotic orifice stenosis and enteritis were the two factors that greatly influenced the excellent and effective rate of anal function 6 months after the surgery (P < 0.05). Conclusion The modified transanal Soave surgery has small trauma and low complication rate on HD infants in initial radial resection , and the postoperative enteritis and anastomotic orifice stenosis are independent influencing factors for the short-term efficacy.

Clinical analysis on laparoscopic improved Soave operation for treating neonatal congenital megacolon / 重庆医学

Objective To study the clinical effect of laparoscopy-assisted improved Soave operation for treating neonatal congeni-tal megacolon .Methods 68 cases of neonatal congenital megacolon treated in our hospital from March 2010 to July 2013 were di-vided into 2 groups .The treatment group(34 cases) was performed the laparoscopy-assisted improved Soave operation after the sys-tematic examinations ,while the control group(34 cases) was given the conventional operation therapy .The postoperative curative effects were observed and compared between the two groups .Results The effects of intraoperative bleeding amount ,operative time and the pain score in the treatment group were superior to those in the control group with statistical difference between the two group(P<0 .05);the postoperative hospital stay ,postoperative intestinal peristalsis recovery time and fasting time in the treatment group were superior to those in the control group with statistical difference between the two group (P<0 .05) .Conclusion Laparo-scope-assisted improved Soave operation has better effect for treating neonatal congenital megacolon and should be widely used in clinic .

Perioperative nursing of patients with Hirschsprung's disease after laparoscopic-assisted improved Soave operation / 现代临床护理

Objective To summarize the experience of perioperatively nursing patients with Hirschsprung’s disease after laparoscopic-assisted improved Soave operation to improve nursing experience.Method Psychological nursing to both patients and their families,well-planned preoperative preparation,postoperative nutritional support and perineal nursing were done.Result Sixty-six patients got recovered and discharged except one who quitted treatment.Conclusion Careful nursing before and after operation is critical for the prevention of complications and successful manipulation of aparoscopic-assisted improved Soave operation.

Una rara presentación de la enfermedad de hirschsprung en el adulto / A rare presentation of adult hirschsprung disease

Objetivo: Presentación de un caso clínico de una patología bastante infrecuente, como es el síndrome de Waardenburg tipo IV, en un paciente intervenido en el servicio de Cirugía 2 del Hospital Domingo Luciani. IVSS, Caracas. Métodos: Paciente masculino de 32 años, quien consultó por presentar dolor y distensión abdominal. Al examen físico se evidenció desnutrición, retardo en el crecimiento, hipoacusia y distopia cantorum. Diagnóstico clínico: síndrome de Waardenburg, tipo IV. Resultados: Se practicó una laparotomía exploradora, evidenciándose gran dilatación pancolónica. Biopsias rectales compatibles con enfermedad de Hirschsprung. Un procedimiento de Soave fue realizado, con una ileostomía en asa. Actualmente en espera del cierre de la ileostomía Conclusión: El síndrome de Waardenburg es una rara enfermedad autosómica dominante de presentación clínica y genética heterogénea, de penetración variable. El tipo IV está asociado a enfermedad de Hisrchsprung(AU)

Objective: Presentation of a clinical case of a quite uncommon pathology, the Waardenburg's syndrome type IV, in a patient treated at Surgery 2 service of the Hospital Domingo Luciani. IVSS, Caracas. Methods: A 32 year old male patient, consulted for presenting pain and abdominal distention. Physical examination showed malnutrition, failure to thrive, hearing loss and dystopia cantorum. Clinical diagnosis: Syndrome Waardenburg type IV. Results: It was performed a laparotomy, showing a great pancolonic dilatation. Rectal biopsies compatible with Hirschsprung disease. A Soave procedure was done with a loop ileostomy. Currently waiting for ileostomy closure. Conclusion: Waardenburg syndrome is a rare autosomal dominant disease with heterogeneous clinical and genetic presentation of variable penetration. Type IV is associated with Hisrchsprung disease(AU)

Comparison of Transanal One-stage Soave Procedure to Modified Duhamel Procedure in Hirschsprung's Disease

PURPOSE: Transanal one-stage Soave (TOS) procedure is the most recently reported procedure for Hirschsprung's disease. This study was performed to compare the surgical outcomes of TOS with those of modified Duhamel procedure. METHODS: The study populations were 17 consecutive patients who underwent TOS procedure between March, 2003 and February, 2008 (TOS group) and 19 consecutive patients who underwent modified Duhamel procedure between March, 1996 and February, 2001 (Duhamel group) by one pediatric surgeon. Age, gender, length of aganglionic segment, operating time, complications, duration of postoperative hospital stay, and functional results were retrospectively analyzed and compared between the two groups. RESULTS: There was no difference in age, gender, and length of the aganglionic segment between the two groups. The operating time (195 versus 255 minutes, P<0.05) and the duration of postoperative hospital stay (7 versus 9 days, P<0.05) were significantly shorter in the TOS group. Postoperative complications occurred in 10 of 17 in the TOS group (4 perianal excoriation, 3 anastomotic stenosis, and 3 postoperative enterocolitis) and 10 of 19 in Duhamel group (2 wound infection, 1 perianal excoriation, 1 anastomotic leakage, 1 rectal bleeding, 2 intestinal obstruction, and 3 postoperative enterocolitis). Two cases in the Duhamel group required operation to treat postoperative complication, one for anastomotic leakage and one for intestinal obstruction. There was no significant difference in the functional results between both groups. CONCLUSION: TOS shows similar functional results and postoperative complications but has the advantage of a significantly shorter operating time and postoperative hospital stay compared with modified Duhamel procedure.