Minimally Invasive Techniques for Hirschsprung Disease

Iacusso, Chiara; Leonelli, Lorenzo; Valfrè, Laura; Conforti, Andrea; Fusaro, Fabio; Iacobelli, Barbara Daniela; Bozza, Patrizia; Morini, Francesco; Mattioli, Girolamo; Bagolan, Pietro

doi:10.1089/lap.2019.0165

Cited by 14 publications

(4 citation statements)

References 14 publications

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“…2 Surgical site infection after conversion from TERPT to laparotomy. 3 Antibiotics and rectal irrigations were given because of obstructive symptoms to prevent Hirschsprung associated enterocolitis (HAEC). 4 Bowel irrigations were done under general anesthesia.…”

Section: Pre-and Perioperative Stomasmentioning

confidence: 99%

“…Median operative time for TERPT was 158 (84-318) min and 176 (95-318) min for LERPT ( p = 0.34). Hospital stay was median six days after both TERPT (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and LERPT (3-32) ( p = 0.50). Two intended TERPT procedures were converted to laparotomy or laparoscopy, because of multiple adhesions and difficult colonic mobilization.…”

Section: Surgical Details and Postoperative Complicationsmentioning

confidence: 99%

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Comparison of clinical outcomes after total transanal and laparoscopic assisted endorectal pull-through in patients with rectosigmoid Hirschsprung disease

Karlsen

Hoel

Fosby

et al. 2022

Journal of Pediatric Surgery

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Background: Total transanal (TERPT) and laparoscopic endorectal pull-through (LERPT) are the most common procedures to treat rectosigmoid Hirschsprung's disease (HD). Since few studies have compared the two methods, we aimed to assess clinical outcomes after TERPT and LERPT in this cross-sectional study. Methods and Patients: All patients with rectosigmoid HD operated with TERPT and LERPT between 2001 and 2018 were eligible. Peri-operative data were registered from patients' records, and bowel function was assessed according to the Krickenbeck classification. Results: 91/97 (94%) patients were included; 46 operated with TERPT and 45 with LERPT. Bowel function was assessed in 80 patients at median seven (4-17) years. There was no difference in functional outcome between the procedures. Unplanned procedures under general anesthesia were frequent; 28% after TERPT and 49% after LERPT ( p = 0.04). 11% of TERPT and 29% of LERPT patients got botulinum toxin injections ( p = 0.03). In the TERPT group, patients operated in the neonatal period had poorer outcome (78%) than those operated later (24%) ( p = 0.005). No difference in operative time, length of hospital stay, and rate of early and late complications was found between the procedures. Conclusion: There was no difference in long-term bowel function in patients with rectosigmoid HD operated with TERPT or LERPT. More LERPT patients had an unplanned procedure under general anesthesia, mostly due to obstructive symptoms.

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Section: Pre-and Perioperative Stomasmentioning

confidence: 99%

Section: Surgical Details and Postoperative Complicationsmentioning

confidence: 99%

Comparison of clinical outcomes after total transanal and laparoscopic assisted endorectal pull-through in patients with rectosigmoid Hirschsprung disease

Karlsen

Hoel

Fosby

et al. 2022

Journal of Pediatric Surgery

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“…Preoperative considerations preoperative resuscitation, correction of any electrolytes abnormalities and rectal irrigation with warm saline every six hours to relieve any obstruction [20]. Colostomy may be needed to decompress severely dilated colon [21].…”

Section: Preoperative Considerationsmentioning

confidence: 99%

Hirschsprung’s Disease: A Review of Its Management Options

Ragab

Almetaher

Eisa

et al. 2022

JAMMR

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Objectives: This article evaluates current data in literature on the definition, outcomes, and current management strategies for patients with Hirschsprung's disease (HD). Methods: Different questions about the definition, management, and outcomes of patients with Hirschsprung's disease (HD) had been created. English-language articles published until 2022 had been gathered by searching Scopus, PubMed, Google Scholar and Web of Science. Results: 61 manuscripts had been included in this review article. The Three well known operations which had been and still available for management of HD are: Soave, Swenson, and Duhamel operations. Transanal endorectal pull-through and laparoscopically assisted Swenson pull-through procedures for Hirschsprung’s disease offer a minimally invasive alternatives to traditional open abdominal operations. Conclusion: The outcomes of laparoscopic assisted trans-anal or complete transanal are slightly superior to other procedures.

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“…The Soave procedure is one of the main procedures for the treatment of HD. The outcomes of numerous reports indicate that impaired bowel function is common after surgical treatment, such as fecal incontinence and constipation (1), although surgical techniques have continuously improved in recent years (2)(3)(4). Fecal incontinence is the inability to control the passage of fecal contents through the anus and has enormous consequences on a patient's psychological, emotional, and social life (5,6).…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

Yuan

Yang

et al. 2021

Front. Pediatr.

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Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it.Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP).Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant (P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions (P < 0.05).Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.

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Minimally Invasive Techniques for Hirschsprung Disease

Cited by 14 publications

References 14 publications

Comparison of clinical outcomes after total transanal and laparoscopic assisted endorectal pull-through in patients with rectosigmoid Hirschsprung disease

Comparison of clinical outcomes after total transanal and laparoscopic assisted endorectal pull-through in patients with rectosigmoid Hirschsprung disease

Hirschsprung’s Disease: A Review of Its Management Options

The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

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