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Comparative analysis of hybrid transumbilical and anal laparoscopic pull-through versus totally transanal
Guizhen Huang1, Chi Sun2, Chaosheng He1
1Department of Pediatric Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China.
Objective:
To compare the efficacy of hybrid transumbilical and anal laparoscopic pull-through (HTALP) and totally transanal laparoscopic assisted pull-through (TTLAP) for the treatment of common type Hirschsprung's Disease (HD).
Methods:
A retrospective investigation was performed on the clinical data of children with common type Hirschsprung's disease who underwent either HTALP or TTLAP between 2010 and 2020. A comparative analysis was conducted between the two groups in terms of general patient information, operative time, postoperative defecation recovery interval, bowel control, and postoperative anorectal manometry.
Results:
A total of 74 cases were included in this study, comprising 53 cases of HTALP and 21 cases of TTLAP. The operative time for HTALP was 99.1 ± 18.7 min, while for TTLAP it was 137.6 ± 35.9 min, showing a statistically significant difference between the two groups (P < 0.001). The blood loss for HTALP was 16.7 ± 12.98 ml, compared to 25.20 ± 9.98 ml for TTLAP, demonstrating a statistically significant difference (P = 0.009). The postoperative bowel recovery interval for HTALP was 1.5 ± 0.35 days, whereas for TTLAP it was 3.3 ± 0.50 days, indicating a statistically significant difference between the two groups (P < 0.001). The postoperative hospital stay for HTALP was 5.3 ± 1.1 days, whereas for TTLAP it was 7.5 ± 0.8 days, showing a statistically significant difference between the two groups (P < 0.001). At 1 month and 3 months postoperatively, the resting anal pressure was significantly lower in the HTALP group compared to TTALP. At 3 months postoperatively, the length of the anal high-pressure zone in the HTALP group was significantly lower than that in the TTLAP group.
Conclusion:
The HTALP procedure for the radical surgery of HD has favorable surgical outcomes and a relatively low rate of perioperative complications. It is safe and reliable, and can further shorten the operative time and reduce intraoperative blood loss. It causes less damage to the anal sphincter muscles, thereby promoting rapid recovery.
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