• Early and long-term results after Soave-Boley operation as the surgical treatment of colon agangliosis in children
en To content Full text of article

Early and long-term results after Soave-Boley operation as the surgical treatment of colon agangliosis in children

Paediatric surgery.Ukraine.2020.4(69):37-42; doi 10.15574/PS.2020.69.37
Prytula V. P.1, Krivchenya D. Yu.1, Silchenko M. I.2, Kurtash O. O.3, Hussaini S. F.1, Rudenko Ye. O.1
1Bogomolets National Medical University, Kyiv, Ukraine
2National Children’s Specialized Hospital «OKHMATDYT», Kyiv, Ukraine
3Ivano-Frankivsk National Medical University, Ukraine

For citation: Prytula VP, Krivchenya DYu, Silchenko MI, Kurtash OO et al. (2020). Early and long-term results after Soave-Boley operation as the surgical treatment of colon agangliosis in children. Paediatric Surgery.Ukraine. 4(69):37-42; doi 10.15574/PS.2020.69.37
Article received: Aug 07, 2020. Accepted for publication: Dec 07, 2020.

Introduction. Сolon agangliosis (CA) belongs to a group of severe congenital malformations of the colon that can only be treated by surgical approach. The Soave-Boley technique is one of the most physiological and technically acceptable among pediatric surgeons from from all over the world.
Aim – evaluate the early and long-term results of surgical treatment of CA in children by Soave-Boley method.
Materials and methods. We analysed surgical treatment of 774 children with various forms of CA aged from birth to 18 years for the period from 1980 to 2020, using the Soave-Boley method by the formation of the primary colo-anal anastomosis by manual (suture) and mechanical (stapler) method.
Results. All patients survived. Early postoperative surgical complications were seen in 19 (2.45%) of 774 children operated by Soave-Boley method: in 15 – after the formation of the primary colo-anal anastomosis by manual (sutures) method and 4 – after the imposition of a colo-anal anastomosis by mechanical (stapler) method. Long-term postoperative complications were noted in 15 (1.94%) of 774 children operated by Soave-Boley method: 14 – with a manual (suture) and 1 – with a mechanical (stapler) colo-anal anastomosis. Re-operation was successfully performed in 30 (3.87%) patients with reconstructing colo-anal anastomosis manually with Soave-Boley method after initial correction of CA in other clinics by other methods. Periodic episodes of soiling were seen in the remote period in 47 (6.07%) of 774 operated children which was treated conservatively. The success of the Soave-Boley technique is confirmed by a much lower number of early (2.45%) and long-term (1.94%) postoperative surgical complications, compared with those after the use of other methods of open surgical correction – 17.52% and 16.35%, respectively.
Conclusions. Soave-Boley operation with colo-anal anastomosis by manual (suture) and mechanical (stapler) methods in comparison with other methods is the most effective method of radical correction of CA as open surgical approach in children of different age groups as single staged or double staged interventions. According to the technical capabilities and results of the early and long period, the Soave-Boley technique with colo-anal anastomosis by manual (ligature) method is the operation of choice for both primary and re-surgical correction of CA compared to any other methods.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution.
No conflict of interest was declared by the authors.
Key words: agangliosis, colon, children, surgical treatment, results.

REFERENCES

1. Avansino JR, Levitt MA. (2017). Hirschsprung disease. In Fundamentals of pediatric surgery. 2. Mattei P et al. (eds.). Springer International Publishing. Cham: 513-524. https://doi.org/10.1007/978-3-319-27443-0_62

2. Bischoff A, Frischer J, Knod JL et al. (2017). Damaged anal canal as a cause of fecal incontinence after surgical repair for Hirschsprung disease – a preventable and under-reported complication. J Pediatr Surg. 52(4): 549-553. https://doi.org/10.1016/j.jpedsurg.2016.08.027; PMid:27624566

3. Ekenze SO, Ngaikedi C, Obasi AA. (2016). Problems and Outcome of Hirschsprung's Disease Presenting after 1 Year of Age in a Developing Country. World Journal of Surgery. 35(1): 22-26. https://doi.org/10.1007/s00268-010-0828-2; PMid:20976451

4. Fernandez IM, Sanchez MJM, Martinez CI et al. (2014). Quality of life and long-term results in Hirschsprung's disease. in Spanish. Cir Pediatr. 27(03): 117-124.

5. Garrett KM, Levitt MA, Pena A, Kraus SJ. (2012). Contrast enema findings in patients presenting with poor functional outcome after primary repair for Hirschsprung disease. Pediatr Radiol. 42(9): 1099-1106. https://doi.org/10.1007/s00247-012-2394-2; PMid:22526281

6. Ghirardo V, Betalli P, Mognato G, Gamba P. (2007). Laparotomic versus laparoscopic Duhamel pull-through for Hirschsprung disease in infants and children. J Laparoendosc Adv Surg Tech. 17: 119-123. https://doi.org/10.1089/lap.2006.0510; PMid:17362188

7. Hotta R, Cheng LS, Graham HK et al. (2016). Isogenic enteric neural progenitor cells can replace missing neurons and glia in mice with Hirschsprung disease. Neurogastroenterol Motil. 28: 498-512. https://doi.org/10.1111/nmo.12744; PMid:26685978 PMCid:PMC4808355

8. Khazdouz M, Sezavar M, Imani B, Akhavan H, Babapour A, Khademi G. (2015). Clinical outcome and bowel function after surgical treatment in Hirschsprung's disease. African Journal of Paediatric Surgery. 12(2): 143-147. https://doi.org/10.4103/0189-6725.160403; PMid:26168755 PMCid:PMC4955413

9. Khoury-Hanold W, Yordy B, Kong P, Kong Y, Ge W, Szigeti-Buck K et al. (2016). Viral spread to enteric neurons links genital HSV-1 infection to toxic megacolon and lethality. Cell Host Microbe. 19(6): 788-799. https://doi.org/10.1016/j.chom.2016.05.008; PMid:27281569 PMCid:PMC4902295

10. Kryvchenia DIu, Prytula VP, Silchenko MI, Danshyn TI, Sitkovska SM, Matiiash OIa. (2008). Rezultaty likuvannia ditei z khvoroboiu Hirshprunha. Prohnozy ta shliakhy pokrashchennia. Khirurhiia dytiachoho viku. 4: 51-54.

11. Levitt MA, Dickie B, Pena A. (2012). The Hirschsprungs patient who is soiling after what was a considered a «successful» pullthrough. Semin Pediatr Surg. 21: 344-353. https://doi.org/10.1053/j.sempedsurg.2012.07.009; PMid:22985840

12. Pena A, Elicevik M, Levitt MA. (2007). Reoperations in Hirschsprung disease. J Pediatr Surg. 42(6): 1008-1013. https://doi.org/10.1016/j.jpedsurg.2007.01.035; PMid:17560211

13. Prytula VP, Silchenko MI, Kurtash OO, Hussaini SF. (2019). Long-term results of miniinvasive methods of treatment of Hirshprung's disease in children. Paediatric surgery. Ukraine. 1: 37-42. https://doi.org/10.15574/PS.2019.62.37

14. Swenson O. (2004). Hirschsprung's disease – a complicated therapeutic problem: Some thoughts and solutions based on data and personal experience over 56 years. J Pediatr Surg. 39(10): 1449-1453. https://doi.org/10.1016/j.jpedsurg.2004.06.005; PMid:15486884

15. Taguchi T, Obata S, Ieiri S. (2017). Current status of Hirschsprung's disease: based on a nationwide survey of Japan. Pediatr Surg Int. 33(4): 497-504. https://doi.org/10.1007/s00383-016-4054-3; PMid:28058486

16. Taguchi T, Matsufuji H, Ieiri S. (2019). Hirschsprung's Disease and the Allied Disorders. Status Quo and Future Prospects of Treatment. Springer Nature Singapore. Pte Ltd.: 137-141. https://doi.org/10.1007/978-981-13-3606-5

17. Urushihara N, Fukumoto K, Fukuzawa H, Sugiyama A, Mitsunaga M, Watanabe K et al. (2012). Outcome of laparoscopic modified Duhamel procedure with Z-shaped anastomosis for Hirschsprung's disease. Surg Endosc. 26: 1325-1331. https://doi.org/10.1007/s00464-011-2031-4; PMid:22044983

18. Urushihara N, Fukumoto K, Fukuzawa H, Sugiyama A, Watanabe K, Mitsunaga M et al. (2011). Long-term outcome of modified Duhamel procedure with Z-shaped anastomosis for Hirschsprung's disease (in Japanese with English abstract). J Jpn Soc Pediatr Surg. 47: 1004-1009.