Transanal endorectal stepwise gradient muscular cuff cutting pull‑through method: Technique refinements and comparison with laparoscopy‑assisted procedures

Abstract

In all existing radical resection procedures available for Hirschprung's disease (HD), the muscular cuff has been retained. In recent years, our study group has modified the procedure using a stepwise gradient muscular cuff cutting pull-through method for the treatment of HD. The objective of the present study was to assess patient prognosis following the use of the transanal endorectal pull-through (TEPT) method or the laparoscopy-assisted pull-through (LPT) method and to provide evidence to assist in clinical decisions. The medical records of 172 patients (age, ≥3 years) who underwent TEPT or LPT for HD between September 2003 and August 2014 at the Pediatric Surgery Department of The Affiliated Hospital of Zunyi Medical College (Zunyi, China) were reviewed (TEPT, n=94; LPT, n=78). Preoperative, intraoperative and post-operative data for the subjects involved were recorded. Each patient's family was interviewed using a uniform 12-item post-pull-through long-term outcome questionnaire, which was scored in order to compare the short and long-term treatment outcomes of patients in each group. Patients in the LPT group had significantly prolonged operating times, reduced intraoperative blood loss and perioperative transfusion rates and shorter anal dissection times. Furthermore, the oral feeding time and length of hospital stay were similar between groups. There were no significant differences in early complications between the groups. No significant differences in late complications, including anastomotic stricture and enterocolitis were observed; however, the soiling and constipation rates were significantly higher in the TEPT group compared with the LPT group. The stool pattern score was not significantly different between groups, while the frequency of bowel movements in the LPT group was significantly higher compared with the TEPT group from 9-24 months post-surgery. The stepwise gradient muscular cuff cutting pull-through method demonstrated a good safety profile and efficacy with regard to the long-term outcomes of patients with HD. These results support the clinical application of LPT as a promising surgical approach for children with HD.

Comparison Outcome of Patients with Rectal Tube and Without Rectal Tube Post Swenson Like Pull-Through Transanal Procedure at RSUP Prof Dr. I G.N.G. Ngoerah

“…Endorectal transanal pull-through (TERPT) has become one of the most common surgical procedures for HD in recent decades [27,28]. Research Zhang et al (2020) found that 65.3% of patients who underwent action were at the infant age of 1 month-4 years [21].…”

“…Rectal tube insertion in this procedure is done for 3-5 days, and the absence of signs of abdominal distension is observed. [21,22]. The risk of enterocolitis and anastomosis fistula complications is minimal in the transanal Swensonlike pull-through procedure because this procedure does not leave the muscular cuff.…”

Laparoscopic Complete Excision of the Posterior Muscular Cuff: Technique Refinements and Comparison With Stepwise Gradient Muscular Cuff Cutting for Hirschsprung Disease

“…In our center, we have carried out the stepwise gradient cutting muscular cuff procedure since 2003 and shortened the muscular cuff to avoid the long aganglionic muscular cuff problem ( 8 ). We found that the shortened muscular cuff procedures could decrease the incidence of enterocolitis and obstruction symptoms.…”

“…Due to our increased experience to Soave–Georgeson operation, we have modified the Soave–Georgeson procedure that developed laparoscopic stepwise gradient cutting muscular cuff procedure and shortened the muscular cuff to ~1–2 cm in neonates and infants or 3–4 cm in children. Good results using the laparoscopic stepwise gradient cutting muscular cuff (LSGC) procedure ( Figure 1 ) have been reported by Zheng et al ( 8 ).…”

“…The LSGC procedure was outlined by Zheng et al ( 8 ) in a previous description. In brief, the aganglionic colon dissection by laparoscopy procedures was the same as the LCEPC procedure.…”