Minimally Invasive Techniques for Hirschsprung Disease

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Surgical treatment for Hirschsprung disease (HD) has advanced with minimally invasive techniques.
• Comparing outcomes of different minimally invasive approaches is crucial for optimizing patient care.

Purpose of the Study:

• To compare the outcomes of total transanal endorectal pull-through (TEPT) and laparoscopic-assisted transanal pull-through (LA-TAPT) for Hirschsprung disease.
• To evaluate patient demographics, postoperative complications, and hospital stay between the two surgical methods.

Main Methods:

• Retrospective analysis of patients with Hirschsprung disease undergoing TEPT or LA-TAPT between 2011 and 2016 in two Italian hospitals.
• Exclusion criteria included redo procedures, total colonic aganglionosis, and missing follow-up data.
• Comparison of patient age, weight, associated malformations, hospital stay, and early postoperative complications (within 30 days).

Main Results:

• TEPT patients were younger and lighter at surgery, with a higher incidence of congenital heart disease.
• The TEPT group experienced a longer postoperative hospital stay and a significantly higher prevalence of perianal dermatitis.
• Both groups showed similar rates of postoperative enterocolitis, redo surgery, anastomotic stenosis, and other infective complications.

Conclusions:

• Both TEPT and LA-TAPT offer surgical advantages for Hirschsprung disease.
• TEPT avoids pneumoperitoneum and transperitoneal access, but is associated with longer hospital stays and increased perianal dermatitis, likely due to younger age at operation and associated comorbidities.