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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Comparative Analysis of Surgical Outcomes Following Duhamel, Soave, and Transanal Endorectal Pull-through Techniques
Iqbal Pahlevi Adeputra Nasution1, Muhammad Al Anas1
1Clinic Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara.
Background:
Hirschsprung's disease (HD) is a congenital condition marked by the absence of ganglion cells in the distal bowel, leading to chronic functional obstruction. Surgical management involves resection of the aganglionic segment and reconstruction using ganglionated bowel. Among the commonly performed procedures - Duhamel, Soave, and transanal endorectal pull-through (TAEP) - complications such as obstruction, enterocolitis, and stricture can lead to reoperation. Objective: This study aims to compare postoperative complications requiring reoperation following Duhamel, Soave, and TAEP procedures in patients with HD treated at Pirngadi General Hospital between 2014 and 2022.
Methods:
A retrospective review was conducted of 58 pediatric patients diagnosed with HD who underwent definitive pull-through procedures. Clinical data were extracted from electronic medical records, focusing on demographics, surgical technique, complications, and need for reintervention. Patients requiring a second surgery due to severe constipation or obstruction were further evaluated. Results: Of the 58 patients (64% male, 36% female), 30 underwent Duhamel (51.8%), 16 Soave (27.5%), and 12 TAEP (20.6%). Eight patients (13.7%) required reoperation: 2 (25%) from the Duhamel group, 5 (62.5%) from Soave, and 1 (12.5%) from TAEP. The mean age at initial surgery was 10.25 ± 7.59 months. Stricture (75%) and enterocolitis (37.5%) were the most frequent complications. Management included dilatation, septum resection, colostomy, and revision pull-through procedures.
Conclusion:
The Soave procedure was associated with a higher rate of reoperation. Tailored surgical selection and close postoperative monitoring are essential to improve long-term outcomes in HD.
