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An evaluation of the modified endorectal procedure for Hirschsprung's disease
Insights
The modified endorectal pull-through procedure shows excellent functional results for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease is a congenital disorder characterized by the absence of ganglion cells in the distal bowel.
- The endorectal pull-through procedure is a surgical option for treating Hirschsprung's disease.
- Associated anomalies and varying degrees of colonic involvement present surgical challenges.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a modified endorectal pull-through procedure in patients with Hirschsprung's disease.
- To assess the functional results and complication rates associated with the procedure.
- To explore the expanded indications for this technique in other colorectal conditions.
Main Methods:
- A retrospective review of 28 patients with Hirschsprung's disease who underwent a modified endorectal pull-through procedure.
- Analysis of patient demographics, extent of aganglionosis, associated anomalies, operative complications, and functional outcomes.
- Follow-up assessment of continence and toilet training status.
Main Results:
- No operative or late mortality was observed in the series.
- Two major complications (anastomotic leak, incorrect pathological diagnosis) and five minor complications occurred.
- Excellent functional results were reported, with complete toilet training in older children and continence in younger patients.
Conclusions:
- The modified endorectal pull-through procedure is a safe and effective surgical option for Hirschsprung's disease, yielding excellent functional outcomes.
- The procedure's success has led to its application in total colectomy for ulcerative colitis and familial polyposis.
- Further research may explore long-term functional outcomes and refine indications for this technique.
Abstract:
During the past 4 yr, 60 patients with Hirschsprung's disease have been treated at our institution. Twenty-eight patients within this group have undergone a modified endorectal pull-through procedure. There are 18 males and 10 females in the series. There are 5 children with total colonic involvement, 3 patients with aganglionosis to the mid-transverse colon, and one child with Hirschsprung's disease extending to the distal jejunum. The associated anomalies have consisted of four cases of Down's syndrome, one of whom also has transposition of the great vessels. There has been no operative-related mortality or late mortality in our series. Two major complications (anastomotic leak following a colostomy closure and incorrect pathological diagnosis of aganglionic level) and five minor complications have occurred. The average follow-up period is 31.3 mo. The functional results postoperatively have been excellent. The 18 patients over the age of 3 yr are completely toilet-trained. The remaining patients are too young to be toilet-trained, but are continent in the sense that they do not soil between bowel movements. Because of the satisfying functional results in this series, we have now expanded our indications for this procedure to patients requiring total colectomy for ulcerative colitis and familial polyposis. During the past 2 yr, 8 patients with ulcerative colitis have undergone the endorectal pull-through together with a total colectomy.