Critical Analysis of the Operative Treatment of Hirschsprung's Disease

Fortuna, Randall S.; Weber, Thomas; Tracy, Thomas F.; Silen, Mark L.; Cradock, Thomas V.

doi:10.1001/archsurg.1996.01430170066013

Cited by 97 publications

(48 citation statements)

References 14 publications

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“…Elhalaby et al [6] reported that patients with lower colo-anal anastomosis at or distal to the dentate line had higher frequency of soiling than those with more proximally located anastomosis, although the soiling was transient. From our experience of open PT [12] and other reports [23,24], staining/soiling tends to improve with age although it takes a long time (6-15 years). In contrast, if postoperative constipation or enterocolitis develops, it is usually a significant problem often requiring hospitalization or surgical intervention [4,18,19].…”

Section: Discussionsupporting

confidence: 63%

Prospective analysis of primary modified Georgeson’s laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease: short- to mid-term results

et al. 2005

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The aim of this study was to analyze the short- to mid-term outcome of primary modified Georgeson's laparoscopy-assisted endorectal pull-through (PMGLEPT) for Hirschsprung's disease (HD). HD patients treated by PMGLEPT were evaluated prospectively by a single surgeon using a standard structured questionnaire to assess complications, incidence of enterocolitis, and evaluate continence (CE). CE involved scoring five parameters (frequency of motions, severity of staining/soiling, severity of perianal erosions, anal shape, and requirement for medications) on a 3-point scale (0, 1, and 2 for each parameter). Thus, scores for CE were: 10 = normal, 8-9 = good, 6-7 = fair, and 0-5 = poor. Our modifications include transanal rectal dissection starting below or on the dentate line, near total excision of the posterior rectal cuff, and intraoperative acetylcholinesterase staining to accurately identify normal colon. Patients with total colon aganglionosis or trisomy-21 were excluded, leaving 33 cases of PMGLEPT performed between 1997 and 2004. Mean operative age was 11.0 months. Follow-up ranged from 8 months to 7 years (mean 4.0 years). There were no intraoperative complications. Post-PMGLEP, bowel obstruction occurred in 1 subject who required middle colic division for pull-through (PT), and enterocolitis occurred in 3 (9.1%) of 33 patients. In 20 subjects aged over 3 years with a follow-up period of more than 12 months, final CE was normal in 5, good in 10, fair in 4, and poor in 1, despite staining/soiling being present in 12 (60%) of 20 subjects. None of the 33 had constipation. Our results suggest that PMGLEPT is safe with acceptable outcome in the short- to mid-term. However, careful long-term follow-up is mandatory as there appears to be a relatively high incidence of staining/soiling on short- to mid-term follow-up.

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Section: Discussionsupporting

confidence: 63%

Prospective analysis of primary modified Georgeson’s laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease: short- to mid-term results

et al. 2005

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“…Previously published questionnaires for assessing the outcomes for HD were felt to provide insufficient detail for the purposes of this study [7,13,15,[19][20][21]. They lacked purpose-design and/or definitional clarity for specific complications (such as soiling and constipation) and failed to address the different target groups involved (such as severity groups).…”

Section: Technical Informationmentioning

confidence: 99%

An example of psychological adjustment in chronic illness: Hirschsprung’s disease

et al. 2006

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The aim of this study was to investigate the outcomes after definitive surgical correction for children with Hirschsprung's disease (HD) and the psychosocial impact of HD on the child and family. The total sample comprised 72 children with HD along with their families. The development of a condition-specific questionnaire measured the functional and psychosocial outcomes for children with HD with parental perception of their child's condition. Psychiatric measures were also examined to assess psychiatric morbidity. The greatest functional problem after definitive surgery for HD was faecal soiling (76%). The principle findings of the study were that (1) HD did not have a significant impact on the child's rate of psychiatric morbidity and levels of hopefulness in comparison to the normal population, (2) surgical and psychosocial functioning improved with increasing age and, (3) families remain troubled about their future with HD and dealing with psychosocial difficulties related to the condition (such as distress because of faecal soiling). Specifically, faecal soiling was found to be physically, emotionally and psychosocially distressing complication. Bowel functioning and psychosocial distress improves with increasing age and parental and medical professional support. Despite the significant impairment of faecal continence, we found that children/young adults with HD have minimal psychiatric morbidity, yet experience condition-specific psychosocial problems (e.g. embarrassment and distress/discomfort). HD does not increase the rate of clinical psychiatric morbidity in children and families with HD, but does determine the context of their daily distress and concern.

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“…Anastomotic stricture is a recognised complication of this procedure [1][2][3][4][5]. There are multiple causes for these strictures, circular anastomosis being one of them.…”

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confidence: 99%

Oblique anastomosis in Soave endoanal pullthrough for Hirschsprung’s disease: a way of reducing strictures?

et al. 2007

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The Soave endorectal pullthrough is a commonly performed procedure for the definitive management of children with Hirschsprung's disease (HD). Anastomotic stricture is a recognised complication of this procedure. There are multiple causes for these strictures, circular anastomosis being one of them. There are techniques described which alter the shape of the anastomosis of the pulled through bowel to decrease the incidence of strictures. These are oblique and heart-shaped anastomoses. We describe a new technique of oblique anastomosis where the pulled through bowel is anastomosed posteriorly 0.5 cm from the dentate line, and anteriorly 1.5 cm above this point. This oblique anastomosis is designed to lower the stricture rate. If a stricture does occur, an anastomosis near the anocutaneous junction on the posterior aspect also faciltates Y-V anoplasty. We present our experience using this technique. Seventeen consecutive children underwent the procedure at our institution between 2003 and 2006. Only one child developed an anastomotic stricture requiring anal dilatation.

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Critical Analysis of the Operative Treatment of Hirschsprung's Disease

Cited by 97 publications

References 14 publications

Prospective analysis of primary modified Georgeson’s laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease: short- to mid-term results

Prospective analysis of primary modified Georgeson’s laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease: short- to mid-term results

An example of psychological adjustment in chronic illness: Hirschsprung’s disease

Oblique anastomosis in Soave endoanal pullthrough for Hirschsprung’s disease: a way of reducing strictures?

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