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The Right Colon Patch Pull-through for Total Colonic Aganglionosis: A Systematic Review
Anna Cv Harris1, Noemi Jester2, Oliver Gee1
1Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
Journal of Pediatric Surgery
|February 6, 2025
Summary
The right colon patch (RCP) pull-through for total colonic aganglionosis (TCA) shows outcomes comparable to other techniques, though variability exists. Further research via a national registry is recommended for better understanding.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Total colonic aganglionosis (TCA) is a rare Hirschsprung Disease variant with multiple surgical approaches.
- Limited high-quality evidence exists to guide the selection of optimal surgical techniques for TCA.
- The right colon patch (RCP) pull-through offers potential physiological advantages but is infrequently documented.
Approach:
- A systematic review adhering to PRISMA guidelines was performed.
- EMBASE and PubMed databases were searched for studies reporting outcomes of the RCP pull-through technique.
- Included studies focused on mortality, continence, stool frequency, and complications, excluding duplicated patient data.
Key Points:
- Fifteen studies involving 95 patients undergoing RCP pull-through were analyzed.
- Enterocolitis or difficulty emptying affected 43% of patients; 33% experienced incontinence initially, improving to 78% stooling ≤3 times daily by follow-up.
- Mortality was exclusively reported in patients from low-income healthcare settings.
Conclusions:
- Outcomes associated with the RCP pull-through for TCA are comparable to those of alternative procedures.
- Significant variability in surgical techniques (patch length, pull-through type) and small patient numbers hinder definitive conclusions on RCP superiority.
- Establishing a national registry for TCA is crucial for enhancing the understanding of surgical outcomes given the condition's rarity and procedural diversity.
