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Primary transanal rectosigmoidectomy for Hirschsprung's disease: Preliminary results in the initial 33 cases
1Department of Pediatric Surgery, The Second Hospital of Xi'an Jiaotong University, Xi'an, P.R. China.
Insights
This study introduces a new transanal rectosigmoidectomy for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Hirschsprung's disease (HD) is a congenital condition characterized by the absence of ganglion cells in the distal bowel.
- Current surgical treatments for HD aim to remove the affected aganglionic segment and restore bowel continuity.
- Minimally invasive techniques are increasingly explored to improve outcomes in pediatric surgical patients.
Purpose of the Study:
- To describe a novel primary transanal rectosigmoidectomy technique for Hirschsprung's disease.
- To present the preliminary surgical outcomes of this new procedure in neonates and infants.
Main Methods:
- A cohort of 34 patients with biopsy-proven rectosigmoid HD underwent the transanal rectosigmoidectomy.
- The procedure involved rectal mucosectomy, resection of the rectal muscular sleeve, partial internal sphincterotomy, and oblique anastomosis.
- Patient data including operative time, bowel resection length, and postoperative complications were collected.
Main Results:
- The mean operative time was 160 minutes, with an average bowel resection of 29.5 cm.
- Postoperative enterocolitis (EC) occurred in 6.06% of patients, with successful management via rectal irrigation/dilation or myectomy.
- During a 6- to 18-month follow-up, 84% of patients experienced 1 to 6 daily bowel movements.
Conclusions:
- Primary transanal rectosigmoidectomy is a viable surgical approach for Hirschsprung's disease.
- The technique demonstrates promising early results in neonates and infants.
- Long-term follow-up is necessary to fully assess functional bowel outcomes.
Purpose:
The authors describe their newly developed technique-primary transanal rectosigmoidectomy for Hirschsprung's disease (HD) and its preliminary results in neonates and infants.
Methods:
Thirty-four consecutive patients (26 boys) with biopsy-proven rectosigmoid HD, aged 18 days to 4 years, underwent this new procedure. Rectal mucosectomy started 1 to 1.5 cm posteriorly and 2 to 3 cm anteriorly proximal to the dentate line. The rectal muscular sleeve below the peritoneal reflection was resected to the level of the striated muscle complex, leaving a shorter muscular cuff, into which a partial internal sphincterotomy was made posteriorly. An oblique anastomosis was constructed between the pull-through ganglionic colon and the anus canal.
Results:
The mean time for the operation was 160 minutes, and the average length of bowel resected was 29.5 cm (range, 12.5 to 41 cm). Two children (6.06%, 2 of 33) had 2 to 5 episodes of postoperative enterocolitis (EC). One was cured by rectal irrigation and dilation, and the another by Lynn's myectomy. Eighty-four percent of patients had 1 to 6 bowel movements per day during a 6- to 18-month follow-up period.
Conclusions:
Primary transanal rectosigmoidectomy for HD is logical and associated with excellent early results. A long-term follow-up is required to determine bowel functions. J Pediatr Surg 36:1816-1819.
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