Comparative evaluation of the use of minimally invasive interventions for hirshprung disease in children



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Introduction. The modern stage of medical science is marked by the search for and improvement of methods for the treatment of malformations and surgical diseases of the colon in childhood. Variants of surgical interventions for Hirschsprung's disease have undergone an obvious evolution. The development of medical technologies has led to the widespread introduction of minimally invasive endoscopic surgical interventions, often performed without the formation of stomas in various parts of the intestinal tube. The accumulated experience of clinics, the obtained long-term results of treatment are subject to reflection and the development of common approaches in choosing an operative strategy for correcting this malformation. The purpose of this study was to conduct a comparative analysis of various minimally invasive approaches in the treatment of Hirschsprung's disease used in the Ivano-Matreninskaya City Children's Clinical Hospital in Irkutsk.

Material and method. We used a retrospective analysis of 96 records of an inpatient with a histologically verified diagnosis of congenital colon agangliosis. The exclusion group consisted of cases of total colon agangliosis.

Results. In 86.7% of cases, the disease was presented as a short aganglionic segment localized in the rectosigmoid junction, which was an indication for transanal endorectal reduction in 100% (10) and laparoscopically assisted intervention in 80% (16) of cases. An extended aganglionic segment was an indication for video-assisted reduction in 20% of cases. The mean operation time was 118 min in the LAEPT group versus 140 min in the TAEPT group. Intraoperative complications and lethality were not observed. 83.33% were examined in follow-up, the follow-up period was over 2 years. Persistent constipation requiring the use of laxatives, cleansing enemas, course physiotherapy was noted in 3.3% of the LAEPT group and 6.7% of the TAEPT group. The incidence of Hirschsprung-associated colitis in the late postoperative period in the LAEPT and TAEPT groups was 3.3% (1) and 10% (3), respectively.

Conclusion. Minimally invasive methods of surgical treatment of Hirschsprung's disease have excellent results, both cosmetically and functionally, and can claim to be the “gold standard” for the correction of this defect. Both methods have their obvious advantages and disadvantages, dictating a personalized approach to the choice of technological method in each specific case.

作者简介

N. Stepanova

Irkutsk State Medical University; Municipal Children's Clinical Hospital

编辑信件的主要联系方式.
Email: dm.stepanova@mail.ru
ORCID iD: 0000-0001-5821-7059

Natalya M. Stepanova - associate professor of the department of pediatric surgery of the Irkutsk State Medical University; head of the Center for anomalies in the development of the anorectal region and colorectal surgery in children of the Irkutsk Municipal Pediatric Clinical Hospital.

664003, Irkutsk; 664009, Irkutsk.

俄罗斯联邦

V. Novozhilov

Irkutsk State Medical University; Irkutsk State Medical Academy of Postgraduate Education; Municipal Children's Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-9309-6691

Vladimir A. Novozhilov.

664003, Irkutsk; 664049, Irkutsk; 664009, Irkutsk.

俄罗斯联邦

D. Zvonkov

Municipal Children's Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-5541-7335

Denis A. Zvonkov.

664009, Irkutsk.

俄罗斯联邦

A. Marchuk

Irkutsk State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0001-9767-0454

Andrei A. Marchuk.

664003, Irkutsk.

俄罗斯联邦

A. Rasputin

Municipal Children's Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-5690-790X

Andrei A. Rasputin.

664009, Irkutsk.

俄罗斯联邦

T. Hanhasova

Irkutsk State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-5415-2718

Tamara D. Hanhasova.

664003, Irkutsk.

俄罗斯联邦

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