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[Long term evaluation of transanal surgery with automatic suture in Hirschsprung's disease]
D Crehuet Gramatyka1, C Gutiérrez San Román1, R Fonseca Martín1
1Hospital Universitario y Politécnico La Fe. Valencia.
Insights
Transanal pull-through surgery for Hirschsprung disease (HD) using circular automatic suture is safe and effective. This minimally invasive approach shows low complication rates and positive long-term outcomes for pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Hirschsprung disease (HD) is a congenital condition affecting the large intestine.
- Surgical intervention is necessary to remove the affected aganglionic segment.
- Transanal pull-through techniques aim for minimally invasive treatment of HD.
Purpose of the Study:
- To evaluate the safety and efficacy of transanal pull-through surgery with circular automatic suture for Hirschsprung disease.
- To assess the operative and postoperative complication rates.
- To determine the long-term functional outcomes in patients treated with this technique.
Main Methods:
- Retrospective descriptive study of 21 patients diagnosed with Hirschsprung disease.
- Transanal De la Torre surgery performed with intraoperative biopsy confirmation of ganglionic cells.
- Circular automatic suture utilized for all pull-through procedures.
Main Results:
- No intraoperative complications observed in 21 patients.
- Low postoperative complication rate: 5% rectosigmoideal abscess, 5% umbilical trochar eventration, 5% stenosis, 5% sleeve compression.
- Excellent long-term outcomes with only 5% encopresis and 5% chronic constipation requiring management.
Conclusions:
- Transanal pull-through with circular automatic suture is a safe and effective surgical option for Hirschsprung disease.
- The technique demonstrates a low incidence of operative and postoperative complications.
- Good prospective functional results support its use in managing pediatric Hirschsprung disease.
Objective:
Retrospective and descriptive study of patients with diagnosis of Hirschsprung disease (HD) in whom transanal pull-through was performed in our center.
Material And Methods:
All patients with diagnosis of HD in whom transanal surgery was performed between 2006 and 2018 in our center were selected. In all cases laparoscopic biopsy was performed in the previous dilated area. Once intraoperatory biopsy revealed the presence of ganglionic cells, transanal De la Torre surgery was performed, until reaching the localization of the biopsied area. Circular automatic suture was performed in all cases.
Results:
Surgery was performed in 21 patients (16 boys and 5 girls) with a median age of 12 months (5-62). No patient had enterocolitis. The median resection length was 14.5 cm (3-45) and no intraoperative complications happened. One patient (5%) developed a rectosigmoideal abscess, which was solved with antibiotic. One case (5%) needed another surgery due to umbilical trochar eventration. No patient had enterocolitis after the surgery. One patient (5%) had stenosis, solved by its section and other case (5%) had sleeve compression which was solved by laparoscopic section. After a median follow up of 97 months (12-159), one child (5%) developed encopresis, which is treated with periodic anal irrigations and other patient (5%) has chronic constipation, which require periodic enemas. The rest of the patients have no symptomatology.
Conclusion:
In conclusion, in our series of cases, transanal pull-through with circular automatic suture was a safe and useful technique. It has a low rate of operative and postoperative complications and provides good prospective results.
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