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Endorectal pull-through for Hirschsprung's disease: 17-year review of results in Ukraine
D Y Krivchenya1, M I Silchenko, V P Soroka
1Department of Pediatric Surgery, National Medical University, Kiev, Kiev 02087, Erevanskaya 8A/83, P.O. Box 721, Ukraine.
Insights
For Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease (HD) treatment involves surgical procedures where surgeon preference often dictates technique.
- Optimal patient outcomes require careful consideration of complications and mortality associated with different surgical approaches.
Purpose of the Study:
- To compare the outcomes of endorectal pull-through procedures for Hirschsprung's disease using hand-sutured anastomosis (HSA) versus stapled anastomosis (SA).
- To evaluate early and long-term complication rates and overall patient satisfaction between HSA and SA techniques.
Main Methods:
- A retrospective review of 275 children undergoing endorectal pull-through for HD.
- Procedures involved Soave-Boley dissection with either a hand-sutured (210 patients) or stapled (65 patients) primary perineal colorectal anastomosis.
- Follow-up duration ranged from 1 month to 15 years.
Main Results:
- Early postoperative complications occurred in 13 HSA patients and 5 SA patients.
- Long-term follow-up showed comparable complication rates: 20.5% for HSA and 13.8% for SA.
- The overall complication rate was 2.91%, consistent with published literature.
Conclusions:
- Both hand-sutured and stapled anastomoses are effective for Hirschsprung's disease treatment.
- Stapled anastomosis offers surgical convenience through a simpler and shorter procedure.
- Long-term outcomes demonstrate the safety and efficacy of both techniques in managing Hirschsprung's disease.
Abstract:
Several surgical procedures are available for the treatment of Hirschsprung's disease (HD) the choice often depends on the surgeon's preference. The procedure that is most convenient for the surgeon is not necessarily the optimal one for the patient, however, and complications and mortality need to be considered. We reviewed our series of 275 children operated upon for HD by endorectal pull-through after Soave-Boley dissection of the seromuscular cuff followed by a hand-sutured (HSA) (210) or stapled (SA) (65) primary perineal colorectal anastomosis. Early postoperative complications were documented in 13 children with a HSA and 5 with a SA Follow-up was from 6 months to 15 years for HSA patients with and from 1 month to 3 years after SA. Results were good or satisfactory; there were no unsatisfactory results. On long-term follow-up the complication rate after SA (13.8%) was comparable to that after HSA (20.5%). The overall complication rate on long-term follow-up was 2.91%, which is comparable to results published in the literature. The SA is particularly convenient for surgeon, as it allows a simpler and shorter operation than with the traditional HSA.