Email this article 
Features of postoperative course in children with Hirschsprung disease after endorectal interventions
- Authors: Kesaeva T.V.1,2, Karavaeva S.A.2,3, Kotin A.N.2, Kagan A.V.1,2
-
Affiliations:
- Children’s City Multidisciplinary Clinical Specialized Center of High Medical Technologies
- Pavlov First Saint Petersburg State Medical University
- Federal State Budgetary Educational Institution of Higher Education «North-Western State Medical University Named after I.I. Mechnikov
- Issue: Vol 26, No 1 (2022)
- Pages: 5-9
- Section: ORIGINAL STUDY
- URL: https://jps-nmp.ru/jour/article/view/432
- DOI: https://doi.org/10.55308/1560-9510-2022-26-1-5-9
- ID: 432
Cite item
Open Access
Access granted
Subscription or Fee Access
Abstract
Introduction. Minimally invasive procedures used in the treatment of children with Hirschsprung’s disease (HD) have reduced the rate of complications and allowed to perform these surgeries at any age. In literature, one can find much information on surgical treatment, complications, long-term results. However, features of postoperative period and mechanisms of colon function restorations after different pull-through procedures are not well described.
Material and methods. From 2008 to 2019, 77 patients with different forms of HD were operated in Children’s Clinical Specialized Center of High Medical Technologies in St-Petersburg. Patients were aged from 14 days till 3 years. They were divided into 3 groups according to the applied endorectal technique- Soave, «Soavson», Swenson. The following parameters were analyzed: age, sex, stoma, surgery duration, length of hospitalization, features of postoperative period, complications.
Results. An early postoperative period was similar in all groups. Two children after Soave procedure (9%) had wound infection; two children had anastomotic stricture (1 – Soave, 1 - «Soavson») which was treated with regular dilatations. Enterocolitis was diagnosed in 19 patients (25%). 20 patients (26%) had no self-defecation for 14 days – 6 months after the surgery. Most of the patients had HD of the rectosigmoid form. These disorders developed more often in patients after Soave and «Soavson» procedures, less often- after Svenson one.
Discussion. An issue of choosing an optimal technique for rectal dissection is still a debatable one. There has been no any significant difference revealed between the three variants of endorectal dissection during an early postoperative period.
Conclusion. A transanal endorectal pull-through procedure in children with HD is a preferable option of choice. It gives good functional outcomes. Features of the postoperative period are caused by the adaptation of new intestine to new defecation conditions.
About the authors
T. V. Kesaeva
Children’s City Multidisciplinary Clinical Specialized Center of High Medical Technologies; Pavlov First Saint Petersburg State Medical University
Author for correspondence.
Email: tomo4ka13@mail.ru
ORCID iD: 0000-0003-4116-5832
Tamara V. Kesaeva, pediatric surgeon
St-Petersburg, 198205
St-Petersburg, 197022
Russian FederationS. A. Karavaeva
Pavlov First Saint Petersburg State Medical University; Federal State Budgetary Educational Institution of Higher Education «North-Western State Medical University Named after I.I. Mechnikov
Email: fake@neicon.ru
ORCID iD: 0000-0001-5884-9128
St-Petersburg, 197022
St-Petersburg, 197022
Russian FederationA. N. Kotin
Pavlov First Saint Petersburg State Medical University
Email: fake@neicon.ru
ORCID iD: 0000-0003-1207-7171
St-Petersburg, 197022
Russian FederationA. V. Kagan
Children’s City Multidisciplinary Clinical Specialized Center of High Medical Technologies; Pavlov First Saint Petersburg State Medical University
Email: fake@neicon.ru
ORCID iD: 0000-0002-8657-4886
St-Petersburg, 198205
St-Petersburg, 197022
Russian FederationReferences
- Ионов А.Л., Гогина А.А., Сулавко Я.П. Повторные операции после хирургического лечения болезни Гиршпрунга у детей. Детская хирургия. 2017; 21(1): 42–6.
- Поддубный И.В., Морозов Д.А. Лапароскопические операции при аганглиозе толстой кишки у детей. Клиническая и экспериментальная хирургия. Петровский журнал. 2014; 3: 84–9.
- Поддубный И.В., Исаев А.А., Алиева Э.И. Лапароскопические операции при болезни Гиршпрунга у детей. Материалы Международный хирургический конгресс «Новые технологии в хирургии». Ростов на Дону. 2005; 57.
- Georgeson K.E., Cohen R.D., Hebra A., Jona J.Z., Powell D.M., Rothenberg S.S., Tagge E.P., Primary Laparoscopic-Assisted Endorectal Colon Pull-Through for Hirschsprung’s Disease A New Gold Standard. Annals of Surgery. 1999; 229(5): 678–683.
- Langer J.C., Durrant A.C., De la Torre L., Teitelbaum D.H., Minkes R.K., Caty M.G., et al. One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Annals of Surgery. 2003; 238: 569–83.
- De la Torre L., Ortega A. Transanal versus open endorectal pullthrough for Hirschsprung’s disease. Journal of Pediatric Surgery. 2000; 35: 1630–2.
- Stensrud K.J., Emblema R., Bjørnland K. Anal endosonography and bowel function in patients undergoing different types of endorectal pull-through procedures for Hirschsprung disease. Journal of Pediatric Surgery. 2015; 50: 1341–6.
- Stensrud K.J., Emblem R., Bjornland K. Functional outcome after operation for Hirschsprung disease — transanal vs transabdominal approach. Journal of Pediatric Surgery. 2010; 45(8): 1640–4.
- Levitt M.A., Dickie B., Pena A. The Hirschsprungs patient who is soiling after what was considered a “successful” pull-through. Seminars in Pediatric Surgery. 2012; 21(4): 344–53.
- Rouzrokh M., Khaleghnejad A.T., Mohejerzadeh L., et al: What is the most common complication after one-stage transanal pullthrough in infants with Hirschsprung’s disease? Pediatric Surgery International. 2010; 26: 967–70.
- Полухов РЮШ, Ближайшие и отдалённые результаты хирургического лечения болезни Гиршпрунга у детей. Казанский медицинский журнал. 2018; 99(2): 230–4.
- Rintala R.J., Lindahl H.G., Rasanen M. Do children with repaired low anorectal malformations have normal bowel function? Journal of Pediatric Surgery. 1997; 32: 823–6.
- Teitelbaum D.H., Cilley R.E., Sherman N.J., Bliss D., Uitvlugt N.D., Renaud E.J., et al. A decade of experience with the primary pullthrough for hirschsprung disease in the newborn period: a multicenter analysis of outcomes. Annals of Surgery. 2000; 232: 372–80.
- De La Torre L., Langer J.C., Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms. Seminars in Pediatric Surgery. 2010; 19(2): 96–106.
- Смирнов А.Н., Дронов А.Ф., Холостова В.В., Чундокова М.А., Залихин Д.В., Маннанов А.Г., Война С.В., Анисимова Е.А. Хирургическое лечение болезни Гиршпрунга у детей. 10 лет «на новых рельсах»: итоги. Детская хирургия. 2017; 21(6): 310–5.
- Говорухина О.А. Диагностика и лечение болезни Гиршпрунга у детей на современном этапе. Новости хирургии. 2017; 25(5): 510–7.
- Ishikawa N., Kubota A., Kawahara H., Hasegawa T., Okuyama H., Uehara S., et al. Transanal mucosectomy for endorectal pull-through in Hirschsprung’s disease: comparison of abdominal, extraanal and transanal approaches. Pediatric Surgery International. 2008; 24: 1127–9.
Supplementary files
