Laparoscopy-assisted suction colonic biopsy and intraoperative rapid acetylcholinesterase staining during transanal pull-through for Hirschsprung's disease

Yamataka, Atsuyuki; Yoshida, Ryuji; Kobayashi, Hiroyuki; Tsukamoto, Kanako; Lane, Geoffrey J.; Segawa, Osamu; Kameoka, Shingo; Miyano, Takeshi

doi:10.1053/jpsu.2002.36684

Cited by 19 publications

(14 citation statements)

References 7 publications

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“…Biopsy-proven HD patients treated by PMGLEPT were prospectively followed up by a single surgeon (AY) who created a standard structured questionnaire about complications, incidence of enterocolitis, and evaluation of continence (CE) based on his vast knowledge and personal experience of HD surgery and histopathology [1,12,13]. Data obtained were evaluated by the same surgeon.…”

Section: Methodsmentioning

confidence: 99%

“…PMGLEPT was performed in all subjects under the direct supervision of a single surgeon (AY). Details of PMGLEPT are described elsewhere [1], but transanal rectal dissection was performed in the plane of the rectal muscle layer cranially for the first 15 mm from the dentate line in order to release internal anal sphincter achalasia, then continued in the plane between the rectal mucosa and muscles ( Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…We use primary modified Georgeson's laparoscopy-assisted endorectal pull-through (PMGLEPT) as the procedure of choice for the treatment of Hirschsprung's disease (HD) [1]. Our modifications include transanal rectal dissection starting from the dentate line (which is an irregular line at the base of the anal valves [2]) or 5 mm below the dentate line, near total excision of the posterior rectal cuff (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Our modifications include transanal rectal dissection starting from the dentate line (which is an irregular line at the base of the anal valves [2]) or 5 mm below the dentate line, near total excision of the posterior rectal cuff (Fig. 1), and intraoperative acetylcholinesterase staining to accurately identify normal colon [1,3]. There are many papers in the literature about the outcome of pull-through (PT) surgery for HD performed either as an open (laparotomy), transanal, or laparoscopy-assisted transanal procedure [4][5][6][7][8][9][10][11], but most are retrospective reviews and this prompted us to perform a prospective analysis of short-to mid-term outcome of PMGLEPT for HD using a structured questionnaire focusing on continence, anal shape, and medication usage.…”

Section: Introductionmentioning

confidence: 99%

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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: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Although biopsy with laparoscopic assistance or a small umbilical incision can differentiate between short-segment aganglionosis, longsegment aganglionosis and total colon aganglionosis, this procedure is not necessarily easy and negates the advantages associated with transanal surgery without laparotomy. Yamataka et al [12] reported suction colonic biopsy with laparoscopic assistance as a technique to determine the location of pull-through, but this technique is limited to short-segment aganglionosis and is technically complex.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of endoscopic marking for determining the location of transanal endorectal pull-through in the treatment of Hirschsprung’s disease

et al. 2005

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In the treatment of Hirschsprung's disease, transanal endorectal pull-through (TEPT) is being performed without laparoscopic assistance or laparotomy for short-segment aganglionosis. Preoperative ascertainment of the extent of aganglionosis is required, as this affects the planning for TEPT. The present study investigated the usefulness of preoperative endoscopic marking as an intraoperative marker of the location of pull-through. Since 1998, we have performed TEPT using a prolapsing technique for the treatment of Hirschsprung's disease. Subjects comprised 17 patients with short-segment aganglionosis and 2 patients with long-segment aganglionosis in whom endoscopic marking was performed preoperatively. Median age at time of surgery was 2.7 months. The relationship between pathologic findings at the marked area and location of actual pull-through was investigated. For endoscopic marking, each patient was sedated using intravenous ketamine hydrochloride. The junction between normal bowel with peristalsis and aganglionic bowel without peristalsis ("shorebreak" finding) was marked by either tattooing or clipping. Normal ganglion cells were seen in the marked area of 14 patients, and pull-through was performed at the marked area in each of these patients. In three patients, ganglion cells existed in the marked area, but the number of ganglion cells was considered insufficient. Additional frozen sections were thus prepared to ascertain the area with normal ganglion cells, showing that normal ganglion cells were seen 1, 3 or 5 cm proximal to the marked area. In one patient, no ganglion cells were seen in the marked area, but were present 5 cm proximal to the marked area. In the remaining one patient, normal ganglion cells were seen 7 cm distal to the marked area. Pathologic findings revealed ganglion cells at the shorebreak finding in 17 of the 19 patients (89.5%), suggesting that this junction basically matches the distribution of ganglion cells. Endoscopic marking of the junction is very useful for determining the tip of pull-through.

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Hirschsprung's Disease and Allied Disorders

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Laparoscopy-assisted suction colonic biopsy and intraoperative rapid acetylcholinesterase staining during transanal pull-through for Hirschsprung's disease

Cited by 19 publications

References 7 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

Usefulness of endoscopic marking for determining the location of transanal endorectal pull-through in the treatment of Hirschsprung’s disease

Duhamel’s Procedure

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