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[Application of partial internal sphincter myomectomy in patients with Hirschsprung disease undergoing transanal
Li-yong Wang1, Rui-ping Li, Hao-tang Ren
1Department of General Surgery, Dongguan People's Hospital, Guangdong Dongguan, China. 18925800766@189.cn
Insights
Partial internal sphincter myomectomy in transanal pull-through surgery for Hirschsprung disease (HD) reduces complications. This technique improves outcomes without negatively impacting patient continence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Hirschsprung disease (HD) is a congenital condition affecting the large intestine.
- The transanal one-stage pull-through operation is a common surgical approach for HD.
- Optimizing surgical techniques to minimize complications and preserve function is crucial.
Purpose of the Study:
- To evaluate the efficacy of partial internal sphincter myomectomy during the transanal one-stage pull-through operation for HD.
- To compare postoperative complications and continence outcomes between partial myomectomy and simple internal sphincter dissection.
Main Methods:
- A prospective study included 153 pediatric patients with HD undergoing transanal one-stage pull-through.
- Patients were divided into two groups: partial internal sphincter myomectomy (77 cases) and simple internal sphincter dissection (76 cases).
- Postoperative complications and continence (Kelly score) were assessed and compared between groups.
Main Results:
- The partial myomectomy group showed significantly lower rates of rectal muscularis infection, enterocolitis, anastomosis stenosis, and abdominal distension.
- Antibiotic administration duration was shorter in the partial myomectomy group.
- There was no statistically significant difference in postoperative continence between the two groups.
Conclusions:
- Partial internal sphincter myomectomy is a safe and effective adjunct to the transanal one-stage pull-through operation for Hirschsprung disease.
- This technique significantly reduces the incidence of key postoperative complications.
- The procedure does not compromise, and may even help preserve, long-term bowel function and continence.
Objective:
To investigate the effect of partial internal sphincter myomectomy on transanal one-stage pull-through operation for Hirschsprung disease (HD).
Methods:
A prospective group of 153 pediatric patients with HD in Guangdong Dongguan People's Hospital between 2003-2012 were enrolled, who underwent transanal one-stage pull-through operation. Children were divided into partial resection group (77 cases) undergoing partial internal sphincter myomectomy and simple incision group (76 cases) undergoing simply internal sphincter dissection, respectively. Differences of postoperative complications and continence between two groups were compared.
Results:
Postoperative complications such as rectal muscularis infection [1.3% (1/77) vs. 11.8% (9/76), P<0.05], enterocolitis [2.6% (2/77) vs. 13.2% (10/76), P<0.05], anastomosis stenosis[3.9% (3/77) vs. 22.4% (17/76), P<0.01] and abdominal distension [10.4% (8/77) vs. 25.0% (19/76), P<0.05] were lower in partial resection group as compared to simple incision group. The time of antibiotics administration was also lower in partial resection group [(3.9±1.1) d vs. (4.6±1.1) d, P<0.01]. Difference in the continence between the two groups was not statistically significant (kelly score, 5.1±0.5 vs. 5.2±0.6, P>0.05).
Conclusions:
Compared with simply internal sphincter dissection in operation, partial internal sphincter myomectomy with transanal one-stage pull-through operation for HD can reduce the postoperative complications and does not increase the damage of the continence.
