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Modified soave pull-through for Hirschsprung's disease: intraoperative internal sphincterotomy
1Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Journal of Pediatric Surgery
|December 11, 1999
Summary
The modified Soave pull-through (MSPT) procedure for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Anorectal achalasia (AA) can persist after Hirschsprung's disease (HD) pull-through (PT).
- Persistent AA may lead to postoperative enterocolitis (POE) and constipation.
- A modified Soave PT (MSPT) was developed to address AA.
Purpose of the Study:
- To evaluate the safety and efficacy of the modified Soave PT (MSPT) procedure.
- To assess the impact of MSPT on anorectal achalasia, postoperative enterocolitis, and constipation in HD patients.
Main Methods:
- Retrospective review of 43 patients with HD treated with MSPT over 16 years.
- MSPT involves posterior rectal cuff excision and intraoperative internal sphincterotomy.
- Analysis of preoperative and postoperative bowel function, including enterocolitis and constipation.
Main Results:
- 14% of patients had preoperative enterocolitis; only 5% experienced POE post-MSPT.
- 78% of patients older than 4 years had normal bowel function.
- 8% experienced constipation requiring intervention, and some had transient soiling.
Conclusions:
- The modified Soave PT (MSPT) is a safe procedure for HD.
- MSPT may reduce the incidence of postoperative enterocolitis and constipation.
- MSPT appears effective in managing HD with associated anorectal achalasia.