Comparative evaluation of the use of minimally invasive interventions for hirshprung disease in children

Abstract

Introduction. The modern stage of medical science is marked by the search for and improvement of methods for the treatment of malformations and surgical diseases of the colon in childhood. Variants of surgical interventions for Hirschsprung's disease have undergone an obvious evolution. The development of medical technologies has led to the widespread introduction of minimally invasive endoscopic surgical interventions, often performed without the formation of stomas in various parts of the intestinal tube. The accumulated experience of clinics, the obtained long-term results of treatment are subject to reflection and the development of common approaches in choosing an operative strategy for correcting this malformation. The purpose of this study was to conduct a comparative analysis of various minimally invasive approaches in the treatment of Hirschsprung's disease used in the Ivano-Matreninskaya City Children's Clinical Hospital in Irkutsk.Material and method. We used a retrospective analysis of 96 records of an inpatient with a histologically verified diagnosis of congenital colon agangliosis. The exclusion group consisted of cases of total colon agangliosis.Results. In 86.7% of cases, the disease was presented as a short aganglionic segment localized in the rectosigmoid junction, which was an indication for transanal endorectal reduction in 100% (10) and laparoscopically assisted intervention in 80% (16) of cases. An extended aganglionic segment was an indication for video-assisted reduction in 20% of cases. The mean operation time was 118 min in the LAEPT group versus 140 min in the TAEPT group. Intraoperative complications and lethality were not observed. 83.33% were examined in follow-up, the follow-up period was over 2 years. Persistent constipation requiring the use of laxatives, cleansing enemas, course physiotherapy was noted in 3.3% of the LAEPT group and 6.7% of the TAEPT group. The incidence of Hirschsprung-associated colitis in the late postoperative period in the LAEPT and TAEPT groups was 3.3% (1) and 10% (3), respectively.Conclusion. Minimally invasive methods of surgical treatment of Hirschsprung's disease have excellent results, both cosmetically and functionally, and can claim to be the “gold standard” for the correction of this defect. Both methods have their obvious advantages and disadvantages, dictating a personalized approach to the choice of technological method in each specific case.