Articles
4 July 2024
Vol. 46 No. 1 (2024)
Are the complications after laparo-assisted endo-rectal pull-through for Hirschsprung disease related to the change of the anal tone?
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
1581
Views
301
Downloads
6
HTML
Authors
The main advantage of the laparo-assisted transanal endorectal pull-through technique (LA - TERPT) for Hirschsprung Disease (HD) is the respect to the rectal-anal anatomy. Postoperative complications have been observed recently. The present study aims to determine how often these postoperative complications occur in these patients. From January 2009 to December 2018, a retrospective analysis was conducted on 36 children (25 males) with HD who underwent LA-TERPT. Data were collected on the age of diagnosis and surgery, sex, the presence of other pathologies, and cases of enterocolitis. In all cases, anorectal manometry (ARM) was performed to evaluate the anal tone. The median age at diagnosis was 2 months and the mean age at surgery was 5 months. Nine related pathologies were identified: five cases of Down syndrome, one case of hypertrophic stenosis of the pylorus, atresia of the esophagus, polydactyly, and anorectal malformation. A patient with total colonic aganglionosis was identified through laparoscopic serummuscular biopsies. Enterocolitis was diagnosed in 7 cases before and 6 after surgery. At follow-up, the complications recorded were: 5 cases of constipation (treated with fecal softeners), one case of anal stenosis (patient with anorectal malformation), 16 cases of soiling (treated with enemas) and 1 child with fecal incontinence (treated with a transanal irrigation system). The ARM was performed in all 36 cases and showed normal anal tone, except for one case with anal hypotonia. LA-TERPT is an important surgical technique for HD. According to the literature, soiling is the most main complication after HD surgery, probably due to “pseudo-incontinence” with normal anal sphincter tone.
Altmetrics
Downloads
Download data is not yet available.
Citations
Wetherill C, Sutcliffe J. Hirschsprung disease and anorectal malformation. Early Hum Dev 2014;90:927-322. DOI: https://doi.org/10.1016/j.earlhumdev.2014.09.016
Zheng Z, Zhang F, Jin Z et Al. Transanal endorectal stepwise gradient muscular cuff cutting pull-through method: technique refinements and comparison with laparoscopy-assisted procedures. Exp Ther Med 2018;16:2144–51. DOI: https://doi.org/10.3892/etm.2018.6414
Haricharan RN, Georgeson KE. Hirschsprung disease. Semin Pediatr Surg 2008;17:266–75. DOI: https://doi.org/10.1053/j.sempedsurg.2008.07.005
Singh SJ, Croaker GD, Manglick P et Al. Hirschsprung’s disease: the Australian Paediatric Surveillance Unit’s experience. Pediatr Surg Int 2003;19:247–50. DOI: https://doi.org/10.1007/s00383-002-0842-z
Klein MD, Coran AG, Wesley JR, Drongowski RA. Hirschsprung’s disease in the newborn. J Pediatr Surg 1984;19:370–4. DOI: https://doi.org/10.1016/S0022-3468(84)80255-9
Polley TZ Jr, Coran AG, Wesley JR. A ten-year experience with ninety-two cases of Hirschsprung’s disease: including sixtyseven consecutive endorectal pull-through procedures. Ann Surg 1985;202:349–55. DOI: https://doi.org/10.1097/00000658-198509000-00012
Muise ED, Cowles RA. Rectal biopsy for Hirschsprung's disease: a review of techniques, pathology, and complications. World J Pediatr 2016;12:135-41. DOI: https://doi.org/10.1007/s12519-015-0068-5
Moore SW, Johnson G. Acetylcholinesterase in Hirschsprung’s disease. Pediatr Surg Int 2005;21:255–63. DOI: https://doi.org/10.1007/s00383-005-1383-z
Georgeson KE, Robertson DJ. Laparoscopic-assisted approaches for the definitive surgery for Hirschsprung's disease. Semin Pediatr Surg 2004;13:256-62. DOI: https://doi.org/10.1053/j.sempedsurg.2004.10.013
Scholfield DW, Ram AD. Laparoscopic duhamel procedure for Hirschsprung's disease: systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 2016;26:53-61. DOI: https://doi.org/10.1089/lap.2015.0121
Georgeson KE, Fuenfer MM, Hardin WD. Primary laparoscopic pull-through for Hirschsprung’s disease in infants and children. J Pediatr Surg 1995;30:1017–21. DOI: https://doi.org/10.1016/0022-3468(95)90333-X
Cantone N, Catania VD, Zulli A et Al. Comparison between two minimally invasive techniques for Hirschsprung disease: transanal endorectal pull-through (TERPT) versus laparoscopic-TERPT. Pediatr Surg Int 2023;39:198. DOI: https://doi.org/10.1007/s00383-023-05473-3
Dai Y, Deng Y, Lin Y, et Al. Long-term outcomes and quality of life of patients with Hirschsprung disease: a systematic review and meta-analysis. BMC Gastroenterol 2020;20:67. DOI: https://doi.org/10.1186/s12876-020-01208-z
Tomuschat C, Zimmer J, Puri P. Laparoscopic-assisted pull-through operation for Hirschsprung's disease: a systematic review and meta-analysis. Pediatr Surg Int 2016;32:751-7. DOI: https://doi.org/10.1007/s00383-016-3910-5
Soh HJ, Nataraja RM, Pacilli M. Prevention and management of recurrent postoperative Hirschsprung's disease obstructive symptoms and enterocolitis: Systematic review and meta-analysis. J Pediatr Surg 2018;53:2423-9. DOI: https://doi.org/10.1016/j.jpedsurg.2018.08.024
Noviello C, Cobellis G, Papparella A, et Al. Role of anorectal manometry in children with severe constipation. Colorectal Dis 2009;11:480-4. DOI: https://doi.org/10.1111/j.1463-1318.2008.01654.x
Loening-Baucke V. Encopresis and soiling. Pediatr Clin North Am 1996;43:279-98. DOI: https://doi.org/10.1016/S0031-3955(05)70406-5
Lin Z, Lin Y, Bai J, et al. Outcomes of preoperative anal dilatation for Hirschsprung disease. J Pediatr Surg 2021;56:483-6. DOI: https://doi.org/10.1016/j.jpedsurg.2020.05.008
Menezes M, Corbally M, Puri P. Long-term results of bowel function after treatment for Hirschsprung's disease: a 29-year review. Pediatr Surg Int 2006;22:987-90. DOI: https://doi.org/10.1007/s00383-006-1783-8
Rintala RJ, Pakarinen MP. Long-term outcomes of Hirschsprung's disease. Semin Pediatr Surg 2012;21:336-43. DOI: https://doi.org/10.1053/j.sempedsurg.2012.07.008
Townley OG, Lindley RM, Cohen MC, Murthi GV. Functional outcome, quality of life, and 'failures' following pull-through surgery for Hirschsprung's disease: A review of practice at a single-center. J Pediatr Surg 2020;55:273-7. DOI: https://doi.org/10.1016/j.jpedsurg.2019.10.042
Mao YZ Tang ST, Li S. Duhamel operation vs. transanal endorectal pull-through procedure for Hirschsprung disease: A systematic review and meta-analysis. J Pediatr Surg 2018;53:1710-5. DOI: https://doi.org/10.1016/j.jpedsurg.2017.10.047
El-Sawaf MI, Drongowski RA, Chamberlain JN, et al. Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through? A comparison of the 2 approaches for Hirschsprung disease. J Pediatr Surg 2007;42:41–7. DOI: https://doi.org/10.1016/j.jpedsurg.2006.09.007
Seo S, Miyake H, Hock A et Al. Duhamel and transanal endorectal pull-throughs for hirschsprung' disease: a systematic review and meta-analysis. Eur J Pediatr Surg 2018;28:81-8 DOI: https://doi.org/10.1055/s-0037-1607061
Tannuri AC, Tannuri U, Romao RL. Transanal endorectal pull-through in children with Hirshsprung disease: Refinements and comparison of results with the Duhamel procedure. J Pediatr Surg 2009;44:767–2 DOI: https://doi.org/10.1016/j.jpedsurg.2008.08.002
Thakkar HS, Bassett C, Hsu A, et al. Functional outcomes in Hirschsprung disease: A single institution's 12-year experience. J Pediatr Surg 2017;52:277-80. DOI: https://doi.org/10.1016/j.jpedsurg.2016.11.023
Felt B, Wise CG, Olson A, et al. Guideline for the management of pediatric idiopathic constipation and soiling. Arch Pediatr Adolesc Med 1999;153:380–5. DOI: https://doi.org/10.1001/archpedi.153.4.380
Di Lorenzo C, Solzi GF, Flores AF, et al. Colonic motility after surgery for Hirschsprung's disease. Am J Gastroenterol 2000;95:1759-64. DOI: https://doi.org/10.1111/j.1572-0241.2000.02183.x
Langer JC, Rollins MD, Levitt M, et al. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int 2017;33:523–6. DOI: https://doi.org/10.1007/s00383-017-4066-7
Levitt MA, Dickie B, Peña A. The Hirschsprungs patient who is soiling after what was considered a "successful" pull-through. Semin Pediatr Surg 2012;21:344-53. DOI: https://doi.org/10.1053/j.sempedsurg.2012.07.009
Saadai P, Trappey AF, Goldstein AM, et al. Guidelines for the management of postoperative soiling in children with Hirschsprung disease. Pediatr Surg Int 2019;35:829-34. DOI: https://doi.org/10.1007/s00383-019-04497-y
Huang WK, Li XL, Zhang J, Zhang SC. Prevalence, risk factors, and prognosis of postoperative complications after surgery for Hirschsprung disease. J Gastrointest Surg 2018;22:335-43. DOI: https://doi.org/10.1007/s11605-017-3596-6
Gosemann JH, Friedmacher F, Ure B, Lacher M. Open versus transanal pull-through for Hirschsprung disease: a systematic review of long-term outcome. Eur J Pediatr Surg 2013;23:94-102. DOI: https://doi.org/10.1055/s-0033-1343085
How to Cite
Are the complications after laparo-assisted endo-rectal pull-through for Hirschsprung disease related to the change of the anal tone?. (2024). La Pediatria Medica E Chirurgica, 46(1). https://doi.org/10.4081/pmc.2024.333
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
