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Primary transanal Swenson pull-through operation for Hirschsprung's disease
Paiboon Sookpotarom1, Paisarn Vejchapipat
1Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand. Sookpotarom@yahoo.com
Insights
The transanal Swenson pull-through operation (TSPT) is a safe and effective new surgical technique for treating Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Congenital Disorders
Background:
- Hirschsprung's disease (HD) is a congenital condition affecting the large intestine.
- Surgical intervention is the primary treatment for HD.
- The transanal Swenson pull-through operation (TSPT) is a novel technique for HD management.
Purpose of the Study:
- To describe the authors' experience with the transanal Swenson pull-through operation (TSPT).
- To evaluate the safety and short-term outcomes of TSPT in children with Hirschsprung's disease.
Main Methods:
- Retrospective review of 27 children with HD who underwent primary TSPT.
- Surgical technique involves rectosigmoidectomy and coloanal anastomosis.
- Data collected on operative time, hospital stay, complications, and fecal continence.
Main Results:
- The average operative time was 153.5 minutes.
- Average hospital stay was 9.1 days, with no blood transfusions required.
- Complications included anastomotic stricture (6), enterocolitis (3), and urethral injury (1). Fecal continence was achieved in 70.8% at 1 year and 77.8% at 2 years.
Conclusions:
- Primary TSPT is a viable and safe alternative surgical technique for pediatric Hirschsprung's disease.
- The TSPT procedure is technically straightforward with acceptable short-term results.
- Long-term follow-up is essential to fully ascertain the benefits of TSPT.
Objective:
The authors describe an experience with a newly developed technique for the treatment of Hirschsprung's disease (HD)-transanal Swenson pull-through operation (TSPT).
Methods:
The records of 27 children (15 males and 12 females) with HD proven on the basis of rectal biopsy or barium enema who underwent primary TSPT between November 2003 and April 2008 were retrospectively reviewed. Rectosigmoidectomy begins at the level just above dentate line in neonates and approximately 1-cm above dentate line in older children. The full-thickness dissection is performed upward around the rectum. The colon is transected above transition zone and anastomosed to the anus. All patients had postoperative pathologic proof. Data are expressed as mean and SD.
Results:
Mean age at operation was 29.4 +/- 48.2 months (range, 1-155 months). The operative time averaged 153.5 +/- 85.9 min (range, 65-400 min). There was a statistically significant difference between those younger than 1 month (107.1 +/- 14.8 months) and those greater than 1 month (190.7 +/- 101.1 months). None did receive blood transfusion. Average length of hospital stay was 9.1 +/- 4.1 days (range, 4-21 days). Peri- and postoperative complications included anastomotic stricture (n = 6), enterocolitis (n = 3), and urethral injury (n = 1). Fecal continence (stooling frequency rate of 1-2 times per day) was noted in 70.8% (17/24) and 77.8% (14/18) at 1- and 2-year follow-up, respectively. There was no mortality in the series.
Conclusions:
Primary TSPT would be an alternative, safe technique in children with HD. The technique is not difficult, and associated with acceptable short-term outcomes. A long-term follow-up will be necessary to assess the real benefit of the technique.
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