Factors affected by surgical technique when treating total colonic aganglionosis: laparoscopy-assisted versus open surgery
Tóm tắt
We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome. Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent). Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05). Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.
Tài liệu tham khảo
Dykes EH, Guiney EJ (1989) Total colonic aganglionosis. J Pediatr Gastroenterol Nutr 8(1):129–132
Ikeda K, Goto S (1984) Diagnosis and treatment of Hirschsprung’s disease in Japan. An analysis of 1628 patients. Ann Surg 199(4):400–405
Polley TZ, Coran AG, Wesley JR (1985) A ten-year experience with ninety-two cases of Hirschsprung’s disease. Including sixty-seven consecutive endorectal pull-through procedure. Ann Surg 202(3):349–355
Miyano G, Yanai T, Okazaki T, Kobayashi H, Lane GJ, Yamataka A (2007) Laparoscopy-assisted stoma closure. J Laparoendosc Adv Surg Tech A 17(3):395–398
Levy M, Reynolds M (1992) Morbidity associated with total colon Hirschsprung’s disease. J Pediatr Surg 27(3):364–366
Jasonni V, Martucciello G (1998) Total colonic aganglionosis. Semin Pediatr Surg 7(3):174–180
Menezes M, Pini Prato A, Jasonni V, Puri P (2008) Long-term clinical outcome in patients with total colonic aganglionosis: 31-year review. J Pediatr Surg 43(9):1696–1699
Swenson O, Bill AJ (1948) Resection of rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing megacolon: an experimental study. Surgery 23:212–220
Duhamel B (1957) Technique chirugical infantile. Masson et Eie, Paris
Soave F (1964) Hirschsprung’s disease: a new surgical technique. Arch Dis Child 39:116
Muensterer OJ, Chong A, Hansen EN, Georgeson KE (2010) Single-incision laparoscopic endorectal pull-through (SILEP) for Hirschsprung’s disease. J Gastrointest Surg 14(12):1950–1954
Grantcharou TP, Rosenberg J (2001) Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 167(4):260–267
Pfannenstiel JH (1900) Uber die vortheile des suprasymphysaren fascienguerschnitt fur die gynaaekologischen koeliotomien. Samml Klin Vortr Gynaekol (Leipzig) 97:1735
Travassos DV, Bax NM, Van der Zee DC (2007) Duhamel procedure: a comparative retrospective study between an open and a laparoscopic technique. Surg Endosc 21(12):2163–2165
Smith BM, Steiner RB, Lobe TE (1994) Laparoscopic Duhamel pull-through procedure for Hirschsprung’s disease in childhood. J Laparoendosc Surg 4(4):273–276
Sauer CJ, Langer JC, Wales PW (2005) The versatility of the umbilical incision in the management of Hirschsprung’s disease. J Pediatr Surg 40(2):385–389
Marquez TT, Acton RD, Hess DJ, Duval S, Saltzman DA (2009) Comprehensive review of procedures for total colonic aganglionosis. J Pediatr Surg 44(1):257–265