PAPS PapersLong-term outcome of bowel function for 110 consecutive cases of Hirschsprung's disease: Comparison of the abdominal approach with transanal approach more than 30 years in a single institution – is the transanal approach truly beneficial for bowel function?
Section snippets
Material and methods
We conducted a retrospective review of all patients who underwent definitive surgery at Kagoshima University. From 1984 to 2015, 110 patients with HD underwent mostly the SD approach or the TA approach, including laparoscopic-assisted approaches. The SD procedure is an open approach, one-step modified Soave procedure.
Background of patients
The extent of aganglionosis was as follows: short segment (ultra-short and recto-sigmoid): 87 (79.1%), long segment: 19 (17.4%), total colon aganglionosis with or without small intestine involvement: 3 (2.8%), and unknown: 1 (1.0%). Patients with total colon aganglionosis with or without small intestine involvement and unknown cases were excluded from the evaluation. Unknown cases underwent redo surgery after the Duhamel procedure at another hospital. We analyzed 106 patients of the short
Discussion
This study examined the long-term bowel function of 110 consecutive cases of HD more than 30 years in a single institution and compared the functional outcome with the operative procedure (SD vs. TA).
The major findings of this study were the following: (1) the TA procedure is minimally invasive and has fewer complications compared with SD (i.e., shorter postoperative hospital stay, decreased blood loss per body weight during operation and fewer early postoperative complications); (2) the ES
Conclusion
We analyzed 110 patients more than 30 years in a single institution. This is the first report of the long-term bowel function of 110 consecutive cases of HD more than 30 years in a single institution that compared the functional outcome with the operative procedure.
The ES of in patients undergoing each approach improved with age and was similar between groups. Both groups achieved satisfactory results at least 10 years after operation. The TA approach is simple and less invasive, thus pediatric
Conflict of interest
No competing financial interest exists.
Acknowledgments
We thank Mr. Brian Quinn for comments and help with the manuscript.
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Cited by (33)
Comparison of clinical outcomes after total transanal and laparoscopic assisted endorectal pull-through in patients with rectosigmoid Hirschsprung disease
2022, Journal of Pediatric SurgeryCitation Excerpt :Furthermore, TERPT is suggested to have shorter operative time and faster recovery as well as being less expensive than LERPT [3,4]. However, there are concerns that TERPT causes more anal sphincter damage because the exposure of the anal canal is longer and more forceful when the whole operation is performed through the anus [5–7]. The literature comparing bowel function after total transanal and transabdominal ERPT procedures is inconclusive [4,8-11].
Hirschsprung disease outcomes
2022, Seminars in Pediatric SurgeryLong-term growth outcomes in children with Hirschsprung disease after definitive surgery: A cross-sectional study
2020, Annals of Medicine and SurgeryFunctional outcome, quality of life, and ‘failures’ following pull-through surgery for hirschsprung's disease: A review of practice at a single-center
2020, Journal of Pediatric SurgeryCitation Excerpt :Contradicting this finding is a study [8] based on the same population which concludes that bowel function deteriorates with age and demonstrates persistence of constipation and soiling with age. While some studies have found that fecal incontinence [22] and constipation [27,35] do not change with age, other studies showed an improvement with age [3,7,27,36,37]. Our results suggest that as patients age their bowel function is neither improving nor deteriorating.
The long-term quality of life outcomes in adolescents with Hirschsprung disease
2018, Journal of Pediatric SurgeryCitation Excerpt :Studies using validated questionnaires have had similar results, with fecal incontinence rates above 30% [1,3,6]. There have been a few studies that have reported lower incidences of fecal incontinence; however, these studies utilized nonvalidated measures [15,16]. The results from the current study indicate no significant difference between the functional outcomes in children with HD compared to control populations.
Reply to letter to the Editor
2018, Journal of Pediatric Surgery