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Laparoscopic-assisted pull-through for Hirschsprung's disease, a prospective repeated evaluation of functional
Anna Löf Granström1, Britt Husberg, Agneta Nordenskjöld
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Unit of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Insights
Laparoscopic-assisted pull-through surgery for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Hirschsprung's disease (HSCR) is a congenital disorder characterized by the absence of ganglion cells in the distal bowel.
- Laparoscopic-assisted endorectal pull-through (LAP) is a surgical technique used to treat HSCR.
- Long-term functional outcomes following LAP for HSCR require ongoing evaluation.
Purpose of the Study:
- To assess the long-term functional outcomes of laparoscopic-assisted endorectal pull-through (LAP) in patients with Hirschsprung's disease (HSCR).
- To evaluate changes in functional outcomes over time after LAP surgery for HSCR.
Main Methods:
- A cohort of 35 children with histologically confirmed HSCR who underwent LAP between 1998 and 2009 was studied.
- Prospective functional outcome assessments were conducted in 2009 and 2012 using semi-structured interviews.
- Twenty-seven patients completed both interviews, with data compared between the two time points.
Main Results:
- A statistically significant reduction in constipation was observed between the two assessment periods (p=0.023).
- Soiling episodes remained frequent, reported by 16 patients with loose stools and 15 with solid stools in the second interview.
- The use of laxatives or irrigations decreased but remained necessary for eight patients.
Conclusions:
- Laparoscopic-assisted pull-through surgery for Hirschsprung's disease demonstrates a significant long-term improvement in reducing constipation.
- However, a notable risk of incontinence persists post-LAP surgery, with limited short-term improvement observed.
- Continued monitoring of functional outcomes, particularly continence, is crucial for patients undergoing LAP for HSCR.
Aim Of The Study:
To evaluate the functional outcome of laparoscopic-assisted endorectal pull-through (LAP) for Hirschsprung's disease (HSCR) over time.
Methods:
Thirty-five children with HSCR underwent laparoscopic-assisted pull-through at our institution between 1998 and 2009. The diagnosis was histologically confirmed in all cases. Clinical data was extracted from the case records. A prospective assessment of the functional outcome was performed in 2009 and 2012. Exclusion criteria were a follow-up of less than 6 months after treatment (1 case) and total colonic aganglionosis (1 case). An independent examiner, not involved in the clinical care of the patients, performed interviews using a semi-structured questionnaire. Four patients could not be traced for the first interview. Two cases were lost for the second interview. Altogether twenty-seven patients completed the study. Data from the two interviews were compared. The regional ethical review board approved the study.
Main Results:
The median patient age was 4 years old (range 2-16) at the time of the first interview and 7 years old (range 5-19) at the time of the second interview . There were 23 males and 4 females in the study group. The median age at laparoscopic-assisted pull-through was 104 days old (range 29 days-8 years). In the first interview 11 patients reported constipation, 18 patients reported soiling more frequently than once per week when they had loose stools and 16 patients when they had solid stools. Laxatives or irrigations were used by 13 of the patients. In the second interview 4 patients reported constipation, 16 patients reported soiling when they had loose stools and 15 patients reported soiling when they had solid stools. Eight patients used laxatives or irrigations. The decrease in constipation was statistically significant (p=0,023).
Conclusions:
Our study shows a statistically significant reduction of constipation over time. There is a high risk of incontinence after laparoscopic-assisted pull-through, with few signs of short-term improvement.
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