- Long-term results of miniinvasive methods of treatment of Hirshprung’s disease in children
Long-term results of miniinvasive methods of treatment of Hirshprung’s disease in children
PAEDIATRIC SURGERY.UKRAINE.2019.1(62):37-42; DOI 10.15574/PS.2019.62.37
Prytula V. P., Silchenko M. I., Kurtash O. O., Hussaini S. F.
Bogomolets National Medical University, Kyiv, Ukraine
National Children’s Specialized Hospital «OKHMATDYT», Kyiv, Ukraine
Ivano-Frankivsk National Medical University, Ukraine
The mini-invasive methods of treating Hirshprung’s disease (HD), namely, the Transanal Endorectal Pull-Through (TEPT) of the colon with or without laparoscopic assistance, have been widely used in pediatric surgery. Many clinics in their studies have noted the positive features of the mini invasive approach to HD treatment compared to classical methods, but long-term results after such operations in children are quite debatable.
Aim to study: the remote results of mini-invasive methods of treating HD in children.
Materials and methods. We analyzed the experience of using mini invasive method of surgical correction of HD in 187 children from 1 month to 8 years. Among them, 122 patients were operated using the TEPT method and 65 children by the method of laparoscopically-assisted TEPT. All children were operated in single step, without conversion, there were no intra-operative complications. In the early postoperative period, 2 (3.74%) out of 187 children had colo-anal anastomosis failure.
Results and discussion. In 4 children aged 1 to 12 months after TEPT, during the first 2-4 months after the operation, moderate stenosis of colo-anal anastomosis was seen, which was corrected without any complications. After TEPT, out of 122 in 6 (4.92%) patients, constipation was noted, in 11 (9.01%) – partial incontinence of feces and in 15 (12.29%) – enterocolitis (EC). Out of 65 children after laparoscopically-assisted TEPT in 3 (4.62%) patients, constipation was noted, in 9 (13.85%) – partial incontinence of feces and in 6 (9.23%) – EC. All children with postoperative bowel problems have been successfully treated conservatively. There was no need for repeated surgical interventions in these patients.
Conclusions. The nature of complications in the long-term post operative period after the correction of HD depends on the age of the patient at the time of operation, following carefully all the technical features of the method, taking into consideration the anatomical features of the disease, the presence and type of accompanying pathology. In 28.88% of children with HD, which were operated by mini-invasive methods, persistent intestinal problems continue in the long term post operative period. The earlier the correction of HD, the better the functional results in the long term post operative period. The children aged under 1 year are optimal for correction of HD with mini-invasive technique. In time detected and adequately corrected complication in the long term postoperative period promotes faster normalization of functional results and improving quality of life of patient’s.
Key words: Hirschsprung’s disease, children, mini-invasive methods of treatment, results.
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Article received: Nov 01, 2018. Accepted for publication: Feb 13, 2019.