RESUMO
Objective To introduce the laparoscope_assisted modified Swenson transanal pull_through pro_cedure and analyze its clinical outcome for Hirschsprungˊs allied disease(HAD). Methods Thirty_six patients with HAD underwent this new procedure at the Pirst Affiliated Hospital of Harbin Medical University during October 2009 to March 2016. During laparoscope exam,biopsies were taken from rectum,sigmoid and descending colon for rapid frozen pathological biopsy slices. Then the affected colons were dissected to the left hemicolon. Subsequently,a sponge forcep was inserted into anus and the colon was pulled through the right below the peritoneal reflection. In order to prevent re_traction and mark the resection line,sutures were performed circumferentially both at the proximal and distal bowel wall. Between the circles,a full_thickness,circumferential incision of rectum was made. The proximal bowel was mobi_lized out through the anus to the laparoscope part. The distal end was dissected anteriorly 2. 5_3. 0 cm above the den_tate line. The posterior rectal wall was split medium longitudinally and dissected to 0_0. 5 cm above the dentate line, so as to make a full _thickness ＂V＂ _shaped anastomosis. Results Dostoperative anal function scores:33 cases (91. 7%)were excellent,3 cases(8. 3%)were good,and no grades were scored. Compared with preoperative,the anal canal rest pressure[(12. 93 ± 3. 17)kDa,(11. 19 ± 6. 50)kDa vs.(22. 03 ± 6. 23)kDa],length of anal canal high pressure area[(25. 46 ± 5. 56)mm,(21. 61 ± 5. 10)mm vs.(35. 26 ± 5. 05)mm],and rectal resting pressure [(0. 79 ± 0. 29)kDa,(0. 64 ± 0. 23)kDa vs.(1. 22 ± 1. 02)kDa]decreased significantly after 6 month∕1 year follow_up,and the differences were significant(all P〈0. 05). The length of anal canal high pressure area was different be_tween 6 months and 1 year follow_up(P〈0. 05). However,the static pressure of the anal canal and the rectum did not differ significantly(all P〉0. 05). All the patients were diagnosed as HAD on the basis of intraoperative frozen lice ex_amination and postoperative pathologic examination. Thirty_six patients were followed up,and the reported complica_tions included soiling in 1 case(2. 8%),enterocolitis in 2 cases(5. 6%),without complications. During mean follow_up time(3. 3 years),none of the patients relapsed. Conclusions Laparoscope_assisted modified Swenson procedure for HAD is a minimally invasive approach with satisfactory results.
RESUMO
PURPOSE: The single stage transanal pull-through (SSPT) for Hirschsprung’s disease is becoming the most popular procedure. This single center study compared the result of single stage operation with two-stage operation for Hirschsprung’s disease in neonates. METHODS: We retrospectively reviewed medical records of all patients who were diagnosed as Hirschsprung’s disease and underwent SSPT or two-stage operation operation in Asan Medical Center between January 2003 and July 2014. RESULTS: There were 17 SSPT and 28 two-stage operation. The mean age of SSPT group was 14.2±7.1 days, and the mean age of two-stage operation group was 15.4±8.6 days for stomy formation, and 188.6±36.3 days for Duhamel operation. The operation time of SSPT was shorter than Duhamel operation (145.0±37.0 minutes vs. 193.0±36.0 minutes, p<0.001). The mean follow-up period of SSPT and two-stage operation was 35.5±34.9 months (range, 2-132 months) and 56.6±35.5 months (range, 1-121 months), respectively. Defecation problem rate such as fecal soiling or fecal impaction showed no significant difference between the two groups (p=0.719). Two SSPT patients required botulinum toxin injection due to rectal stenosis. Three patients of SSPT group underwent re-do endorectal pull-through due to remnant aganglionic or hypoganglionic bowel. CONCLUSION: The SSPT showed shorter hospital days. However, few patients experienced rectal stenosis, but were manageable with botulinum toxin injection. The SSPT requires experienced-pathologist, as well as surgeon, because intra-operation pathology reading is critical for appropriate SSPT. SSPT is a feasible and reasonable option to treat Hirschsprung’s disease.