[Transumbilical laparoscopic pull-through for children with hypoganglionosis].

OBJECTIVE: To investigate the surgical outcomes after on transumbilical laparoscopic pull-through procedure for pediatric hypoganglionosis(HYP). METHODS: Twelve children with HYP had received transumbilical laparoscopic pull-through procedure from June 2009 to June 2010. Specially designed curved and elongated laparoscopic instruments were used during the procedures. All the patients were followed up over 10 months. Data were collected and analyzed. The diagnosis of hypoganglionsis was pathologically confirmed. RESULTS: No conversions to laparotomy or traditional laparoscopic surgery were required and there were no damages to the abdominal blood vessels, intestine, ductus deferens, or ureters. The average duration of operation was 140 min. The mean intraoperative blood loss was 45 ml. The mean length of specimen was 40 cm. Postoperatively there were no complications such as anastomotic leak, anastomotic stricture, constipation, seepage, or fecal in continence. The average hospital stay after surgery was 9 days. During 10 to 22 months of follow-up(median 16 months), no postoperative recurrence was noticed. No obvious scar was seen 1 months after surgery. CONCLUSION: It is safe and effective for children with hypoganglionosis to undergo transumbilical laparoscopic pull-through procedure.

[Reoperation for postoperative constipation recurrences of Hirschsprung disease].

OBJECTIVE: To summarize the causes and treatment experiences of postoperative constipation recurrences of Hirschsprung disease. METHODS: Clinical data of 37 cases receiving operation again for postoperative constipation recurrences of Hirschsprung disease were collected. The recurrent causes, reoperation procedures and therapeutic efficacy were analyzed. RESULTS: Among 37 cases, the recurrent causes included insufficient resection of the intestine in 14 cases, co-existent intestinal neural hypogenesis in 6, gate syndrome in 5, and others in 12 cases. There was no postoperative death. Thirty-one cases (83.8%) were followed-up from 6 months to 11 years. The defecation frequency was 1-2 times per day in 15 cases, one times per two days in 7, one times per three days in 6 cases. Two cases could defecate with the help of laxative purgatives. Nobody had incontinence. CONCLUSION: The main cause of postoperative constipation recurrences of Hirschsprung disease is insufficient resection of the intestine,and reoperation can get better results.

Heart-shaped anastomosis for Hirschsprung's disease: Operative technique and long-term follow-up.

AIM: To study the long-term therapeutic effect of "heart-shaped" anastomosis for Hirschsprung's disease. METHODS: From January 1986 to October 1997, we performed one-stage "heart-shaped" anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fifty-two patients were followed up patients (follow-up rate 79%). The operative outcome and postoperative complications were retrospectively analyzed. RESULTS: Early complications included urine retention in 2 patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases, including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient. CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our "heart-shaped anastomosis" procedure. "Heart-shaped" anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.