A 15-Year Experience with the One-Stage Surgery for Treatment of Hirschsprung’s Disease in Newborns, Infants, and Young Children

Abstract

The treatment of Hirschsprung's disease has changed over the past several years. Significant modifications occurred after the implementation of surgery without laparotomy, using transanal access. The type of this surgery depends on the condition and the age of a child. The aim of the study was to summarize our 15-year experience with one-stage surgery for the treatment of Hirschsprung's disease in the wider context of current clinical practice and to identify transanal endorectal pull-through-related factors influencing the surgery and hospitalization. The retrospective analysis of newborns, infants, and young children was performed between 2000 and 2014. Four girls and 29 boys were operated on. The parameters describing the surgery and the hospitalization were analyzed. The number of patients treated using transanal endorectal pull-through technique was 30, and Duhamel-Martin, 3. There were significant correlations (p<0.05) between necessity of blood transfusion, length of resected intestine, operative time, the number of intraoperative histopathological assessments, and length of hospitalization. The time of one-step surgery is extended because of waiting for repeated intraoperative histopathological assessment of the level of resection. More extended bowel resection is connected with longer length of hospitalization and, more often, necessity of blood transfusion.

Neutrophil Lymphocytes Ratio (NLR) of One-Step and Multi-Step Procedure for Hirschsprung Disease Patients At Arifin Achmad General Hospital

“…13,14 NLR which is a ratio that represents the best expression of the close functional relationship between the two basic immunocompetent leukocyte populations (neutrophils for innate and lymphocytes for adaptive) is one of the reliable parameters to see the state of immune response in the body. 15,16,17 In this study, we compare two procedure of surgery in HD patient with pull-through procedure as one step, which in this case is likened to a less invasive surgical procedure, and pull-through plus colonostomy as multistep procedure as the conventional one. The value of NLR that we get, is not significant different statistically from the two procedures nor the postoperative increase of each procedure in this study, makes NLR can not be a parameter yet to predict the value of inflammatory state that occurs in this case.…”

Case Report: Rare Form of Hirschprung’s Disease

“…The treatment of choice for HD is surgical, such as Swenson, Soave, and Duhamel procedures. The goals are to resect the affected segment of the colon, bring the normal ganglionic bowel down close to the anus, and preserve internal anal sphincter function [10]. The traditional operation was an abdominoperineal pull-through in two or three stages, in which patients initially underwent a diverting colostomy with definitive repair performed later.…”

Are there any factors influencing the course of multistage treatment in Hirschsprung’s disease?

“…The use of Duhamel-Martin surgery in small children is limited by the size of disposable linear and circular staplers. The best option would be use of a laparoscopic stapler, but this was not the practice in our centre [ 6 ].…”